By Tracey Vause Earland, PhD, OTR/L, Associate Professor, Jefferson College of Rehabilitation Sciences, Jefferson Student Hotspotting Program, Lead; Megan Hershman, MS, Advanced Programs Coordinator, Jefferson Center for Interprofessional Practice and Education; Quadira McPherson, BS, Program Assistant, Jefferson Center for Interprofessional Practice and Education

In a new study from Thomas Jefferson University (Jefferson), researchers found that Student Hotspotting participants exhibited greater empathy for and self-efficacy in working with patients with complex health and social needs versus a group of students who did not participate in the program. Jefferson Student Hotspotting staff summarized the study for our blog, focusing on how programs like Student Hotspotting help prepare students to provide team-based, person-centered care for people with complex health and social needs. Learn more about our Student Hotspotting program here.

Background

The COVID-19 crisis has disproportionately impacted our most vulnerable communities, further exposing deeply rooted structural injustices, such as systemic racism, lack of access to healthcare and other manifestations of poverty. In order to address these disparities in healthcare, our future providers need to understand how the intersection of race, ethnicity, age and other socioeconomic status factors can lead to negative patient outcomes, multiple patient comorbidities, and otherwise perpetuate inequality.

In 2017, Jefferson was selected by the National Center for Complex Health and Social Needs as one of four national hubs to expand their Student Hotspotting program. In this annual program, interprofessional student teams receive training to help them best work with patients with complex health and social needs, and address the social determinants of health using a patient-centered approach.

During the 2017–2018 academic year, the Jefferson hub helped train 20 new hotspotting teams, including eight internal (Jefferson-based) and 12 external (regional) teams with a total of 134 students from 15 professions. With guidance from interprofessional advisors, these students enrolled patients who had received care from a Jefferson primary care practice and had been pre-identified as those with complex health and social needs by Jefferson Care Coordinators.

In April 2020, Thomas Jefferson University (Jefferson) published a study on their 2017-2018 endeavors in the Journal of Interprofessional Care, titled Self-efficacy and empathy development through interprofessional student hotspotting. “The 7-month pilot study explored whether students who participated in student hotspotting experienced an increase in their knowledge of, comfort working with, and empathy toward medically and socially complex patients.” 

Students were surveyed twice, with the same set of questions; in at the beginning of the program in the fall, and towards the end of the program in the spring. In this first cohort, 45 Jefferson students joined hotspotting teams; teams consisted of  five or six individuals from various health professions, including medicine, nursing, occupational therapy, pharmacy, physician assistant studies, public health and social work. A control group of 39 students, who did not participate in student hotspotting, were selected on a volunteer basis as a representative convenience sample to participate in the study.

The study specifically addressed empathy, as research increasingly shows how important this quality is for clinicians to form genuine patient connections, and ultimately improves patient outcomes. As another Jefferson study shows, when clinicians show empathy towards their patients, instances of medical error are reduced, and overall healthcare costs are lowered. 

Without specific programming and education related to empathy, it can decline as early as the first year for health professions students. Through “Essentials Workshops”, case conference calls, student presentations and other endeavors, Jefferson embeds programming related to empathy throughout its Hotspotting curriculum, in order to train future clinicians who are prepared to best advocate for patients with complex needs.

Findings

Preliminary results indicated that student participants exhibit greater self-efficacy and empathy than a control group of nonparticipating students, with the gap in the latter widening over time. To measure self-efficacy, students answered 10 knowledge questions and were surveyed on 17 items related to working with patients with complex health and social needs. Empathy toward working with these patients was also measured before and after the intervention using the Jefferson Scale of Empathy for Health Providers (JSE-HP). 

As the authors found, “Overall, analyses showed that interest, confidence, and efficacy were moderately, but significantly intercorrelated at pre and posttest. In addition, empathy was moderately, but significantly correlated with interest and confidence at both time points. Thus, efficacy and empathy seem to represent independent constructs.”

There was also a difference in the pre-post change in efficacy between the hotspotting group and the control group; “while the two groups illustrated similar efficacy scores to start… the gap between hotspotting and control students widened at posttest, with the hotspotting group reporting higher efficacy than the control group.” Participant-group members had increased empathy scores, while control group scores dropped; “despite attrition in both groups, pre-post survey findings show higher self-efficacy and empathy scores among participants than controls at posttest.”

Next steps

While further study is warranted given limitations in the sample size and from attrition, this pilot study suggested that student hotspotting may be an effective way to better prepare our healthcare workforce to provide patient-centered, team-based care to patients with complex health and social needs and to reduce healthcare expenditures. Institutions can use the findings to build curricular frameworks to guide program development and formal integration into required health professions curricula.

On Saturday September 26, Jefferson hosted its annual Kickoff event for Student Hotspotting with Compassionomics authors Dr. Stephen Trzeciak, MD, MPH and Dr. Anthony Mazzarelli, MD, JD, MBE, both of Cooper University Healthcare, as guest speakers. The authors discussed the importance of human connection in healthcare and how compassion can save lives. We look forward to exploring these themes during the 2020-21 year of Student Hotspotting.