A Cross-sectional Measurement of Medical Student Empathy

Abstract

BACKGROUND: Empathy is important in the physicianpatient relationship. Prior studies have suggested that physician empathy may decline with clinical training.OBJECTIVE: To measure and examine student empathy across medical school years. DESIGN AND PARTICIPANTS:A cross-sectional stud of students at Boston University School of Medicine in 2006. Incoming students plus each class near the end of the academic year were surveyed. MEASUREMENTS:The Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a validated 20-item self-administered questionnaire with a total score ranging from 20 to 140. JSPE-S scores were controlled for potential confounders such as gender, age, anticipated financial debt upon graduation, and future career interest.RESULTS: 658 students participated in the study (81.4% of the school population). The first-year medical student class had the highest empathy scores (118.5), whereas the fourth-year class had the lowest empathy scores (106.6). Measured empathy differed between second-and third-year classes (118.2 vs 112.7, P< .001), corresponding to the first year of clinical training. Empathy appears to increase from the incoming to the first-year class (115.5 vs 118.5, P =.02). Students preferring people-oriented specialties had higher empathy scores than students preferring technology-oriented specialties (114.6 vs 111.4, P=.002). Female students were more likely than male students to choose peopleoriented specialties (51.5 vs 26.9%, P<.001). Females had higher JSPE-S scores than males (116.5 vs 112.1, P<.001). Age and debt did not affect empathy scores.CONCLUSIONS: Empathy scores of students in the preclinical years were higher than in the clinical years. Efforts are needed to determine whether differences in empathy scores among the classes are cohort effects or represent changes occurring in the course of medical education. Future research is needed to confirm whether clinical training impacts empathy negatively, and, if so, whether interventions can be designed to mitigate this impact.KEY WORDS: empathy; medical student education; physician attitudes.

Cross sectional assessment of empathy among undergraduates from a medical college

“…There is a need to further explore why most Asian students have almost similar scores but lower than the American studies. 8,20,21 The empathy scores at the entry point of medical school is much less than those found in US by Chen et al (115.5), Hojat et al (114.5) but similar to that from Iran (110.3). 8,11,14 The curriculum in this college is different in many respects from medical schools in US, Japan and Iran.…”

“…8 There were no non-responders as all those present on the day of assessment completed the questionnaire (Table 1). This is in contrast to the poor response rate of third year students (77.2%) in the study by Chen et al 8 in which incidentally a decrease in empathy scores was also found whereas in this study significant decline was evident only in seventh semester. From this study we confirmed our first hypothesis that empathy declines during medical education but it reaches significant level only in seventh semester.…”

“…8,14 It is during this semester that students have examination for preventive and social medicine, otorhinolaryngology (non-people oriented subjects) and ophthalmology (people oriented) therefore probably are more inclined towards these subjects, which may be an explanation for the change. Katoaka et al have in their study argued that different entrance methods in medical schools and different cultures across various countries may account for variation in empathy.…”

“…11 Female students were found to have more empathy than male students across various years of medical education. 4,7,8,13 However a Japanese study found no decline in empathy scoring as students progressed from non-clinical to clinical training. 12 In view of such varying empathy findings from different countries, we need to understand empathy among medical students in Indian context.…”

“…7 The curriculum in India differs from western countries in that clinical rotation starts from second year itself and from Korea and Japan in that there is no humanities content in the curriculum. 12,13 Studies have shown that medical students who plan to pursue people oriented specializations such as internal medicine, family medicine, psychiatry and pediatrics showed higher empathetic scores and across all years of study in medical school than those who choose to pursue technology oriented specialties such as radiology, surgery and anesthesiology 8,14 . These changes were reported more among male students and those selecting noncore subject such as other than internal medicine, family medicine, obstetrics and gynecology and psychiatry.…”