Searching for the erosion of empathy in medical undergraduate students: a longitudinal study

Abstract

ObjectiveTo analyse the trajectory of empathy throughout the degree programme of medicine in a Spanish school of medicine.DesignLongitudinal, prospective 5-year study, between October 2014 and June 2019.SettingStudents from a Spanish university of medicine.ParticipantsTwo voluntary cohorts of undergraduate medical students from two different school years were invited to participate (n=135 (cohort 1, C1) and 106 (cohort 2, C2) per school year). Finally, a total number of 174 students (102 (C1, 71.6% women) and 72 (C2, 70.8% women) students, respectively) were monitored for 5 years. Each cohort was divided in two subcohorts of paired and unpaired students that were analysed to check possible social desirability bias.Primary outcome measureThe Jefferson Scale of Empathy (JSE).ResultsThe cohort of 102 students (C1) monitored between their first and fifth years of study (71.6% women) showed an improvement among paired women of 2.15 points in total JSE score (p=0.01) and 2.39 points in cognitive empathy (p=0.01); in the unpaired female cohort the increase was of 2.32 points (cognitive empathy) (p=0.02). The cohort of 72 students (C2) monitored between their second and sixth years of study (70.8% women) displayed a cognitive empathy increase of 2.32 points (p=0.04) in the paired group of women. There were no significant differences between paired and unpaired results for either cohort. Empathy scores among men did not decrease.ConclusionsThe empathy of medical students at our school did not decline along grade years. In fact, it improved slightly, particularly cognitive empathy, among women. This paper contributes to enlarge data from Europe, where longitudinal studies are scarce. It supports the idea that there may be global geo-sociocultural differences; however, more studies comparing different school settings are needed.

Medical empathy in medical students in Madrid: A proposal for empathy level cut-off points for Spain

“…The sample size of the study is much larger than that in previous research [ 28 , 29 , 31 ] analyzing empathy in this field. All of Madrid’s medical schools, both public and private, participated in the study.…”

“…If we compare the cut-off points established by Hojat et al in 2,637 medical students at Sidney Kimmel Medical College with those proposed in this study, we find that, except at the lower limit of empathy in men, other points that define empathy as high and low are higher in our study. We believe that this is a reflection of the higher average levels of global empathy found in Spanish medical students [ 30 , 31 ], compared with those in US students [ 39 , 46 ]. The empathy scores of medical students in this study showed moderate negative asymmetry (-0.95 in men and -0.94 in women).…”

“…Other possible explanations for these differences could be the different designs (longitudinal or cross-sectional) or instruments used to measure empathy. A cohort study [ 31 ] conducted at one of the universities participating in this study centered on 102 medical students over a five-year period, showed that empathy did not decline during this time. In fact, it improved slightly in women, especially in terms of cognitive empathy.…”

“…In a recent systematic review, Ferreira-Valente et al [ 39 ] report a significant deterioration in the level of empathy among medical students when analyzing different longitudinal studies, whereas cross-sectional studies did not corroborate this trend. Other longitudinal studies carried out in this setting observe that empathy does not deteriorate over time [ 31 ].…”

“…Currently, it is the most widely used tool to measure empathy in medical education [ 2 ]. In Spain, various studies have shown the validity and reliability of the JSE [ 28 – 31 ].…”