Exploring medical students’ perceptions of empathy after cinemeducation based on Vygotsky’s theory – BMC Medical Education

In the present study, participants have explored their perceptions of empathy toward patients with Alzheimer’s after participating in an interactive educational program. The results of the qualitative content analysis of 216 codes from 38 reflection papers can be presented in four categories, including communication with a patient with Alzheimer’s, understanding the patient with Alzheimer’s as a whole, medical science development, and the student’s individual ideology.

Communication with a patient with Alzheimer’s

According to the participants, professional patient-physician communication was one of the components of empathy toward patients with Alzheimer’s. They believed that it could be very influential in the treatment of these patients and includes communication with patients with Alzheimer’s, communication with the families of these patients, and mental and psychological support of these patients.

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   Communication with the patient with Alzheimer’s.

Some participants supposed that a part of empathy toward patients with Alzheimer’s was to effectively communicate with the patient. As shared by P42, “I will try to treat patients with Alzheimer’s respectfully, because this disease is a shocking crisis. In order not to hurt their feelings, I deal with them more carefully.”

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   Communication with the family of the patient with Alzheimer’s.

Another finding regarding empathy toward patients with Alzheimer’s was related to the efficient communication with the families of these patients that developed productivity as described in some reflections. As noted by P6, “This disease is not well known and causes a lot of fear for the person and those around him, and we, as doctors, are responsible for the peace of their mind, making the family members aware of this disease, explaining the upcoming events, and showing enough patience in dealing with the patient’s family members who bear a lot of pressure.”

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   Mental and psychological support of the patient with Alzheimer’s.

Some of the participants believed that their willingness for the mental and psychological support of these patients increased. “Now I better understand the effects of this disease on various aspects of the personal, family, and social lives of these patients and I will try to provide the best support for these patients and improve their quality of life.” (P14) and “Sometimes it is necessary to have psychiatric treatment, we can request counseling and refer to the relevant experts.” (P2).

Understanding the patient with Alzheimer’s as a whole

One of the components of being a proper physician is providing holistic care involves treating a patient as a “whole” person instead of focusing on just the illness. Some students described their attitudes toward the patient with Alzheimer’s in terms of increasing awareness and understanding of their emotional, physical, and social conditions after participating in the interactive educational program.

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   Understanding the emotional conditions of the patient with Alzheimer’s

Living with Alzheimer’s disease affects a person’s feelings, thoughts, and responses and leads to a range of symptoms such as depression, aggression, anxiety, and agitation. In the treatment process, it is significant for the physician to know and respond to the patient’s emotional needs. As P26 described, “Any medical book can’t help us to understand their mental and emotional states, but watching this movie made me put myself into the patient’s shoes and understand his condition better”, this interactive educational program improves their awareness of the emotional conditions of the patient with Alzheimer’s.

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   Understanding the physical conditions of the patient with Alzheimer

As Alzheimer’s disease progresses to its last stages, brain changes begin to affect physical functions, such as swallowing, balance, and bowel and bladder control. Some participants believed that they gain a perspective on the physical conditions of the patient with Alzheimer’s. “Before this, I had never put myself in the patient’s place. I had not seen what difficult moments they were going through and what physical problems they were suffering from.” (P11).

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   Understanding the social conditions of the patient with Alzheimer

Before the disease, many patients with Alzheimer’s disease were useful and effective people in society, and probably they were in high social and occupational positions, but after the disease, they were not able to continue their social activities. Some students believed that participation in this program has helped them to better understand the social conditions of the patients, and they can imagine that every patient might be a doctor, a teacher, or… so they will treat him with more respect. “Many of them were important and useful people, and might provide a lot of services to society. Now, the current situation is very difficult for them and their families to bear.” (P6).

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   Changing the attitude toward the patient with Alzheimer’s

A physician’s positive attitude toward the patient with Alzheimer’s is an important factor in early diagnosis of the disease, timely intervention, and treatment. According to the participants’ perceptions of the patient with Alzheimer’s, strengthening attitudes to support these patients and provide better healthcare was emphasized. “Until now, I didn’t know how painful and difficult everything can be for these people. As doctors, most of the symptoms related to the diagnosis of a disease are valuable to us… but it is very important to pay attention to the fact that the disease is not just a series of ordinary symptoms and affects the present and future of the patient and those around him.” (P11).

Medical science development

According to the participants, watching the movie and participating in this program, have helped them in developing medical knowledge in the field of Alzheimer’s disease, increased their awareness and medical knowledge of better treatment of Alzheimer’s disease, and even motivated them to perform research on Alzheimer’s disease.

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   Helping the doctor perform better in the field of treatment and encouraging scientific research about Alzheimer’s disease.

Some students reported that by participating in this program, they will perform better in providing treatment to patients with Alzheimer’s. Some believed that they would prefer to conduct research in the field of new treatments and new ways to manage Alzheimer’s disease. “By watching this movie and knowing the symptoms better, I will get a more appropriate history from these patients. I try to advise my patients as much as possible about the ways to postpone each side effect. I want to do more research in this field.” (P32) and “By watching this movie, I learned how to deliver the news of this disease to the patients and their families.” (P15).

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   Desire to promote knowledge of Alzheimer’s disease.

Many students believed that with this educational experience, their knowledge of Alzheimer’s disease, its symptoms, and treatment has increased. “Watching this kind of movie helps to understand the conditions and sufferings of patients, it also helps to learn the early and late symptoms of the disease, and we can remember them better. It is also effective in diagnosis and treatment of the disease.” (P38).

The student’s individual ideology

It was found that the cognitive orientation of students, including philosophy, norms, values, emotions, and ethics, has a significant effect on their empathy toward patients with Alzheimer’s. This main category contains two sub-categories including the student’s attitude toward life and arousing the feeling of fear and discomfort.

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   Student’s attitude toward life.

Doctors have different attitudes and beliefs toward patients with Alzheimer’s, which affect their behavior in providing health services to these patients. Some students considered the impact of the instability of life, destiny, the unpredictability of the future, the value of life, and human identity on their empathy toward patients with Alzheimer’s. “It was a good experience. Full of thinking about the purpose of life… the identity of a person and her values” (P25) and “The impermanence and the power of change in life that turns this scene. What matters is that we live” (P17).

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   Arousing the feeling of fear and discomfort.

Some of the students believed that after watching this movie, they had feelings and worries such as the fear that they or their families will get Alzheimer’s disease, and they felt sadness for patients with Alzheimer’s. “The feeling of fear took over my whole being, first concerning my family, grandparents, then my parents, if this happens to them, how can I cope with it,? Is it possible that one day I will forget that a movie about Alzheimer’s causes this fear in me or not?!” (P22).