Introduction
Empathy in doctor-patient relationships is a familiar topic for medical scholars, and a crucial goal for medical educators. Nonetheless, there are persistent disagreements in the research literature concerning how best to evaluate empathy among physicians, and whether empathy declines or increases across medical education. Some researchers have argued that the instruments used to study “empathy” may not be measuring anything meaningful to clinical practice or to patient satisfaction.
Methods
We performed a systematic review to learn how empathy is conceptualized in medical education research. How do researchers define the central construct of empathy, and what do they choose to measure? How well do definitions and operationalizations match?
Results
Among the 109 studies that met our search criteria, 20% failed to define the central construct of empathy at all, and only 13% had an operationalization that was well-matched to the definition provided. The majority of studies were characterized by internal inconsistencies and vagueness in both the conceptualization and operationalization of empathy, constraining the validity and usefulness of the research. The methods most commonly used to measure empathy relied heavily on self-report and cognition divorced from action, and may therefore have limited power to predict the presence or absence of empathy in clinical settings. Finally, the large majority of studies treated empathy itself as a black box, using global construct measurements that are unable to shed light on the underlying processes that produce empathic response.
Discussion
We suggest that future research should follow the lead of basic scientific research that conceptualizes empathy as relational—an engagement between a subject and an object—rather than a personal quality that may be modified wholesale through appropriate training.