“…Unsuitable learning environments, cynicism/loss of idealism (Hojat et al, 2004;Newton et al, 2008), distress (Neumann et al, 2011), hidden curriculum (Eikeland et al, 2014), negative role-models, a high volume of materials to learn, time pressure, patient factors and overreliance on computer-based diagnostic and therapeutic technology can affect the students and cause a decline in empathy. However, in one longitudinal study (Quince et al, 2011), no significant change was observed, and in some cross-sectional studies greater levels of empathy were observed in medical students in their final year (Kataoka et al, 2009;Roh et al, 2010;Magalhães et al, 2011).…”