Context Our understanding of clinical empathy could be enhanced through qualitative research—research currently underrepresented in the field. Physician associates within the UK undergo an intensive 2-year postgraduate medical education. As a
new group of health professionals, they represent a fresh pair of eyes through which to examine clinical empathy, its nature and
teaching.
Methods Working with a constructivist paradigm, utilising grounded theory methodology, researchers studied 19 purposively
sampled physician associate students in two UK medical schools. One-to-one semi-structured interviews were transcribed
verbatim. Data were analysed using a grounded theory approach.
Results The global themes were the pathways to empathy, empathy modifiers and empathic dissonance a novel term to describe
the discomfort students experience when pressurised into making empathic statements they don’t sincerely feel. Students
preferred using non-verbal over verbal expressions of empathy. A conceptual model is proposed. The more substantial empathic
pathway, affective empathy, involves input from the heart. An alternative empathy, more constrained, comes from the head:
cognitive empathy was considered a solution to time pressure and emotional burden. Formal teaching establishes empathic
dissonance, a problem which stems from over-reliance on the empathic statement as the means to deliver clinical empathy.
Conclusions This study furthers our understanding of the construct and teaching of empathy. It identifies empathic barriers,
especially time pressure. It proposes a novel concept—empathic dissonance—a concept that challenges medical educationalists
to reframe future empathy teaching.