Journal of General Internal Medicine最新文献

{"title":"Medical School Curriculum Evaluation to Improve Health Equity Education.","authors":"Max Jordan Nguemeni Tiako, Ram Sundaresh, Marcella Nunez-Smith, Douglas Shenson, Beverley Sheares","doi":"10.1007/s11606-024-09347-9","DOIUrl":"10.1007/s11606-024-09347-9","url":null,"abstract":"<p><p>Following the birth of Black Lives Matter, USA medical students advocated for greater commitment to health equity from their schools. In response to such concerns, in 2015, the Yale School of Medicine formed a committee for diversity, inclusion, and social justice and a committee on lesbian, gay, bisexual, transgender, queer, questioning, and intersex affairs. Based on their efforts, our Educational Policy and Curriculum Committee commissioned a student-faculty-led task force to survey the curriculum and make recommendations toward the creation of a health equity curriculum. We conducted a national review of reforms in medical schools' health equity curricula and reviewed health equity content throughout ours. We then interviewed course directors to assess their perception of the state of health equity education and conducted student focus groups to assess their awareness of structural competency and the efficacy of the existing curriculum. We identified three themes that needed high-quality coverage. The first theme was a critical understanding of difference along various axes of oppression including but not limited to race, class, gender, sexuality, disability, and culture. The second theme was a focus on the impact of difference on the physician-patient relationship, and the third theme was the impact of social structures on health and healthcare. We designed best practices for incorporating health equity into the curriculum, and a plan for a health equity thread spanning all its core components. We identified that classroom teaching is not sufficient, and recommended a required experiential learning practicum responsive to community needs. Lastly, we made recommendations regarding faculty and housestaff health equity education given the critical role they play in undergraduate medical education.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2687-2691"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Basket Message Volume in Primary Care: A Cross-sectional Analysis by Gender and Specialty.","authors":"Katherine J Gold, Chidimma J Udegbunam, Eve H Shikanov, Chloe Miwa, Luke J DeRoos, Amy Cohn, Emmett Springer","doi":"10.1007/s11606-025-09377-x","DOIUrl":"10.1007/s11606-025-09377-x","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2805-2806"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rise of the Hospital Chief Equity Officer-A National Survey of Early Experiences and Attributes.","authors":"Joel S Weissman, Rachel R Adler, Saba Ilkhani, Aswita Tan-McGrory, Alysa Pomer, Joy Lewis, Catherine DesRoches, Andrea Liebig, Elaine Singh, Saathvika Diviti, Tanujit Dey, Joseph Betancourt","doi":"10.1007/s11606-025-09453-2","DOIUrl":"10.1007/s11606-025-09453-2","url":null,"abstract":"<p><strong>Background: </strong>Many hospitals have created the position of equity officer (EQO) in efforts to reduce disparities and address social determinants of health.</p><p><strong>Objective: </strong>To describe EQOs' experiences and needs, and the environment in which they operate.</p><p><strong>Design and participants: </strong>A national, cross-sectional survey of EQOs in US community hospitals in 2023. Hospitals determined not to have an EQO were excluded, leaving an estimated 1228 eligible EQOs.</p><p><strong>Main measures: </strong>Characteristics of the respondents and their positions, perceptions of preparedness, critical attributes for success, and obstacles.</p><p><strong>Key results: </strong>We obtained 363 survey responses (response rate 29.6%). About one-third of respondents had been in their position for less than 1 year (35.8%), and 46.1% reported directly to the CEO. Only 8.3% had their entire full-time equivalent effort dedicated to equity work. Respondents scored positively on about half of the criteria considered important for a robust equity environment. Only 14.4% reported their hospital had an adequate, dedicated equity budget. Persons of color were significantly more likely to work in places where equity was included in the strategic plan, but also faced more environment-related obstacles. Overall, many EQOs felt less than well prepared to fulfill certain key functions of their position, such as developing community health programs (47.2%) or changing the culture of their hospital (46.9%). More than 90% of respondents identified good community relations (93.7%) and access to their hospital or health system's equity data (92.2%) as critically or very important attributes of their position. The most common obstacle to achieving their equity goals was lack of sufficient equity staff (81.5%). Differences by hospital type also were noted.</p><p><strong>Conclusions: </strong>The position of EQO is relatively new and the majority in these positions commit only a small amount of their effort to health equity issues. EQOs will need appropriate and adequate resources going forward to achieve their goals.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2523-2536"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Availability of Women's Health Clinics, Primary Care Providers, and Women Veterans' Ratings of Care Experiences.","authors":"Danielle E Rose, Melissa M Farmer, Sabine M Oishi, Bevanne A Bean-Mayberry, Ismelda Canelo, Donna L Washington, Elizabeth M Yano","doi":"10.1007/s11606-025-09451-4","DOIUrl":"10.1007/s11606-025-09451-4","url":null,"abstract":"<p><strong>Background/objective: </strong>VA strives to improve women Veterans' access to comprehensive care. We assessed if availability of specialized clinic arrangements for women or specialized providers (women's health primary care providers) was associated with women Veterans' ratings of primary care experiences.</p><p><strong>Design: </strong>Cross sectional.</p><p><strong>Participants: </strong>We linked patient-level survey data (Survey of Healthcare Experiences of Patients, FY 2017, n=4264) with primary care clinic-level data (Clinical Practice Organizational Survey, primary care module, 2017-2018, n=126) from clinics with ≥300 women Veterans.</p><p><strong>Main measures: </strong>Our dependent variables were derived from top ratings for items rating access, care coordination, comprehensiveness (behavioral health assessed), provider communication, and primary care provider. Our variables of interest were the availability of specialized clinic arrangements such as women's health clinics and specialized providers such as women's health primary care providers.</p><p><strong>Statistical analyses: </strong>We conducted multi-level, multivariate logistic regression predicting women Veterans' optimal ratings of care, controlling for patient-, clinic-, and area-level characteristics.</p><p><strong>Key results: </strong>Women Veterans receiving care at general primary care clinics with no women's health primary care providers had a lower likelihood of rating provider communication as optimal (Adjusted Odds Ratio .60, 95%CI .45-.78) or rating the primary care provider as 9 or 10/10 (Adjusted Odds Ratio .61, 95%CI .42-.86). Women Veterans receiving care at VA sites with a gynecology clinic had a higher likelihood of rating access as optimal (Adjusted Odds Ratio 1.40, 95%CI 1.01-1.94).</p><p><strong>Conclusions: </strong>Our study found that availability of women's health primary care providers in general primary care and availability of gynecology clinics were associated with higher likelihood of women Veterans rating care experiences as optimal. Almost all VA sites have women's health primary care providers available, increasing availability at every site remains an important goal. Relatively few VA community-based outpatient clinics offer gynecology clinics, offering opportunities for improved care experiences among women Veterans.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2593-2601"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research on Patients with Non-English Language Preference: More of the Same.","authors":"Kathy Sliwinski, Lenny López, Lisa C Diamond","doi":"10.1007/s11606-025-09522-6","DOIUrl":"10.1007/s11606-025-09522-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2499-2501"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Management of Sleep Disturbances in Post-9/11 Men and Women Veterans: A 20-year Prospective Cohort Study.","authors":"Allison E Gaffey, Sally G Haskell, Matthew M Burg, Henry K Yaggi, Kristin M Mattocks, Lori A Bastian, Melissa Skanderson, Eric C DeRycke, Eric D A Hermes, Cynthia A Brandt","doi":"10.1007/s11606-025-09534-2","DOIUrl":"10.1007/s11606-025-09534-2","url":null,"abstract":"<p><strong>Introduction: </strong>Sleep disorders and chronic conditions that are comorbid with disordered sleep represent a high burden to the U.S. population, and Veterans have a particularly high risk for disordered sleep. Sleep disorders also present differently by sex and there is a rapidly growing proportion of women Veterans. Among the most recent Veteran cohort (i.e., discharged post-9/11), the extent of sleep disorders and how those conditions are managed is unknown. The objectives were to characterize the frequency of sleep assessment, diagnosis, and treatment among post-9/11 Veterans served by the Veterans Health Administration (VA), the timing of sleep management, and to determine if there were sex-based disparities in all sleep care.</p><p><strong>Methods: </strong>This prospective cohort study included all post-9/11 Veterans who enrolled in VA care, and completed ≥ 1 outpatient encounter, 10/1/2001-9/30/2021. Diagnostic and procedural codes, health factors, and dates were used to extract variables for assessment (e.g., behavioral, polysomnography), diagnoses (i.e., insomnia, sleep-related breathing [SRBD], comorbid insomnia and SRBD [COMISA], sleep-related movement [SRMD], or Other disorders), treatment of insomnia or SRBD, and time to sleep assessment, diagnosis, and treatment. Logistic regressions assessed likelihood of sleep care by sex.</p><p><strong>Results: </strong>The final sample included 1,113,633 patients (12% women, 61% White). Overall, 39% had sleep disorders - 27% with SRBD, 18% with insomnia, 8% with COMISA, 2% with SRMD, and 6% with Other. Men were more likely to have any diagnosis, especially SRBD. Women were assessed up to one year later than men and had greater odds of insomnia or SRMD. Women also had greater odds of insomnia treatment and those with SRBD were 31% less likely to receive treatment than men.</p><p><strong>Conclusions: </strong>As managing sleep health is central to patient-centered care, concerted efforts are required to implement existing VA guidelines concerning sleep, bridging men and women Veteran's sleep needs with available resources.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2573-2582"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Assessment of Pelvic Floor Physical Therapy Experiences for Women Veterans in VHA Care.","authors":"Ashley C Mog, Jessica P Young, Jordan H Mamkhezri, Caroline Merkel, Kristen E Gray","doi":"10.1007/s11606-025-09645-w","DOIUrl":"10.1007/s11606-025-09645-w","url":null,"abstract":"<p><strong>Background: </strong>Nearly 25% of women experience pelvic floor disorders, for which pelvic floor physical therapy (PFPT) is a first-line treatment. Within the Veterans Health Administration (VHA), only one-third of health care systems offer PFPT on site. Alternatives include receiving care from providers in the community (\"Community Care\") or from VHA providers at a distant site via telehealth (\"Clinical Resource Hub\"). Little is known about Veterans' experiences with these two PFPT care pathways.</p><p><strong>Objective: </strong>To characterize women Veterans' experiences with PFPT, including factors affecting access to and receipt of care.</p><p><strong>Design: </strong>Using VHA data, we recruited and conducted semi-structured qualitative interviews with women Veterans who had received PFPT services within the last 6 months.</p><p><strong>Participants: </strong>We recruited N = 20 women Veterans from five VHA health care systems. Participants from four health care systems went through the Community Care pathway (N = 12), while participants from the fifth went through the Clinical Resource Hub (N = 8).</p><p><strong>Approach: </strong>We recorded and auto-transcribed semi-structured interviews. Using structured interview summaries, we completed a two-step analysis process, first using rapid, team-based matrix analysis, followed by thematic analysis. We identified key themes and domains into which we organized those themes.</p><p><strong>Key results: </strong>We identified themes in three domains: barriers getting care, experiences of care, and barriers extending care. Veterans described barriers to receiving care initially, including a lack of knowledge, stigma, providers dismissing concerns, and referral challenges. Participants were generally satisfied with their care and experienced quality of life improvements. Most desired some in-person care. Patients wanting more care after completing initially approved visits faced additional administrative barriers, leading to symptom recurrence.</p><p><strong>Conclusions: </strong>Findings about patient access barriers suggest provider training and education (including awareness of PFPT's clinical benefits, referral pathways, and trauma-informed care), patient education, hybrid care modalities, expansion of the PFPT provider workforce, and streamlining referrals may improve access to PFPT among Veterans.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2563-2572"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Management and Outcomes of Hip Fractures Among Low- and High-Income Patients in Six High-Income Countries.","authors":"Nicole Huang, Laura A Hatfield, Saeed Al-Azazi, Pieter Bakx, Amitava Banerjee, Nitzan Burrack, Yu-Chin Chen, Christina Fu, Carlos Godoy Junior, Renaud Heine, Dennis T Ko, Lisa M Lix, Victor Novack, Laura Pasea, Feng Qiu, Bheeshma Ravi, Therese A Stukel, Carin Uyl-de Groot, Peter Cram, Bruce E Landon","doi":"10.1007/s11606-024-09274-9","DOIUrl":"10.1007/s11606-024-09274-9","url":null,"abstract":"<p><strong>Background: </strong>There is a perception that income-based disparities are present in most countries but may differ in magnitude. However, there are few international comparisons that describe income-based disparities across countries and none that focus on hip fractures.</p><p><strong>Objective: </strong>To compare treatment patterns and outcomes of high- and low-income older adults hospitalized with hip fracture across six high-income countries.</p><p><strong>Design: </strong>Retrospective serial cross-sectional cohort study.</p><p><strong>Participants: </strong>Adults aged ≥ 66 years hospitalized with hip fracture from 2013 to 2019 in Canada, England, Israel, the Netherlands, Taiwan, and the USA using population-representative patient-level administrative data.</p><p><strong>Main measures: </strong>Older adults in the top and bottom income quintiles within countries were compared on 30-day and 1-year mortality, treatment approaches, hospital length of stay (LOS), 30-day readmission rates, time to surgery, and discharge disposition.</p><p><strong>Key results: </strong>Annual age- and sex-standardized incidence rates of hip fracture were higher for low- than for high-income populations in all countries except in the USA. In all countries, adjusted 1-year mortality was lower for high-income than low-income patients, with the largest difference in Israel (- 10.0 percentage points [95% confidence interval [CI], - 15.2 to - 4.8 percentage points]). Across countries, utilization of total hip arthroplasty was 0.1 (95% CI, 0.0-0.2 percentage points) to 6.9 percentage points (95% CI, 4.6-9.2 percentage points) higher among high- vs. low-income populations. With few exceptions, LOS, adjusted 30-day readmission rate, and time to surgery were shorter and lower for high-income patients.</p><p><strong>Conclusions: </strong>Income-based disparities in treatments and outcomes for older adults hospitalized for hip fractures differed in magnitude, but were present in all six high-income countries. Defying our expectations, the USA did not have consistently larger disparities than other countries suggesting that the impacts of poverty exist in vastly different healthcare systems and transcend geopolitical borders.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2602-2612"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Discrimination in the Healthcare Setting and Medical Mistrust: Findings from the Health Information National Trends Survey, 2022.","authors":"Matthew A Kaczynski, Gregorio Benitez, Fadi Shehadeh, Eleftherios Mylonakis, Mark A Fiala","doi":"10.1007/s11606-025-09369-x","DOIUrl":"10.1007/s11606-025-09369-x","url":null,"abstract":"<p><strong>Background: </strong>Perceived discrimination and medical mistrust are barriers to care that impact both individual and population health.</p><p><strong>Objective: </strong>This study aims to characterize the prevalence of perceived racial or ethnic discrimination in healthcare as well as mistrust in the medical system and explore their associations with race and ethnicity.</p><p><strong>Design: </strong>Cross-sectional study of nationally representative data from the Health Information National Trends Survey (fielded March-November 2022).</p><p><strong>Participants: </strong>Non-institutionalized US adults (n = 6252; weighted household response rate = 28.1%).</p><p><strong>Main measures: </strong>Outcomes were perceived racial or ethnic discrimination in healthcare and medical mistrust. The independent variable was race or ethnicity.</p><p><strong>Key results: </strong>An estimated 7.1% (95%CI, 6.0-8.2%) of the US adult population report experiencing racial or ethnic discrimination in healthcare. Perceived discrimination is most prevalent among individuals identifying as Black (18.8% [95%CI, 14.8-22.8%]), followed by Asian (15.1% [95%CI, 4.8-25.4%]) and Hispanic individuals (9.8% [95%CI, 7.4-12.2%]). Medical mistrust is reported by an estimated 62.3% (95%CI, 60.4-64.2%) of the US population, with the highest prevalence among Hispanic (68.9% [95%CI, 64.8-73.0%]) and Black individuals (67.8% [95%CI, 62.7-72.9]). In a multivariable Poisson regression, the prevalence of medical mistrust was significantly higher among Hispanic (adjusted prevalence ratio (aPR), 1.12 [95%CI, 1.04-1.21]) and Black (aPR, 1.10 [95%CI, 1.01-1.20]) respondents relative to White respondents, after adjusting for age, sex, and sexual orientation. Additionally, when adjusting for race and ethnicity, age, sex, and sexual orientation, medical mistrust was significantly more prevalent among those reporting perceived discrimination (aPR, 1.38 [95%CI, 1.30-1.47]).</p><p><strong>Conclusions: </strong>Perceived discrimination in healthcare and medical mistrust are prevalent at the national scale, with racial and ethnic groups of color bearing the brunt. System-wide efforts are needed to improve health equity for marginalized patient populations.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2491-2498"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empathy Decline During Medical Training: Insights from a Novelist.","authors":"Barry R Meisenberg","doi":"10.1007/s11606-025-09567-7","DOIUrl":"10.1007/s11606-025-09567-7","url":null,"abstract":"<p><p>Modern concerns that medical students and trainees suffer a loss of empathy during medical training have generated handwringing, research, and innovation. But a literary vignette from a well-known American author reveals adverse attitude changes during medical training have been noted for more than a hundred years. Loss of empathy and rise of cynicism among students has been a subject of academic scrutiny for many decades though the focus has shifted from deficiencies of the student to deficiencies of the care delivery system in which they learn. The causes of empathy loss were recognized in the vignette and are little changed: exhaustion due to the stress and burden of working with the acutely ill in high volume, a devaluing of patient suffering due to insecurity about one's own clinical competence, and working within health care systems that do not celebrate empathy or its sister virtue compassion, as useful or desirable skills on the road to clinical competence. But data is available that links empathetic relationships with many types of improved clinical outcomes. Evidence-based tools for relationship building are available for adaptation in the student/trainee situation. Educators should emphasize the link between empathy and improved clinical outcomes in designing empathy-sustaining curricula.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"2703-2705"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}