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Clarifying changes in student empathy throughout medical school: a scoping review

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Abstract

Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students’ empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students’ empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students’ empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.

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References

  • Arksey, H., & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. doi:10.1080/1364557032000119616.

    Article  Google Scholar 

  • Austin, E. J., Evans, P., Magnus, B., & O’Hanlon, K. (2007). A preliminary study of empathy, emotional intelligence and examination performance in MBChB students. Medical Education, 41(7), 684–689. doi:10.1111/j.1365-2923.2007.02795.x.

    Article  Google Scholar 

  • Bratek, A., Bulska, W., Bonk, M., Seweryn, M., & Krysta, K. (2015). Empathy among physicians, medical students and candidates. Psychiatria Danubina, 27(Suppl 1), S48–S52.

    Google Scholar 

  • Chen, D., Lew, R., Hershman, W., & Orlander, J. (2007). A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine, 22(10), 1434–1438. doi:10.1007/s11606-007-0298-x.

    Article  Google Scholar 

  • Chen, D. C. R., Kirshenbaum, D. S., Yan, J., Kirshenbaum, E., & Aseltine, R. H. (2012). Characterizing changes in student empathy throughout medical school. Medical Teacher, 34(4), 305–311. doi:10.3109/0142159X.2012.644600.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Erlbaum.

  • Colliver, J. A., Conlee, M. J., Verhulst, S. J., & Dorsey, J. K. (2010). Reports of the decline of empathy during medical education are greatly exaggerated: A reexamination of the research. Academic Medicine, 85(4), 588–593.

    Article  Google Scholar 

  • Costa, P., Alves, R., Neto, I., Marvão, P., Portela, M., & Costa, M. J. (2014). Associations between medical student empathy and personality: A multi-institutional study. PLoS One, 9(3), e89254. doi:10.1371/journal.pone.0089254.

    Article  Google Scholar 

  • Costa, P., Magalhães, E., & Costa, M. J. (2013). A latent growth model suggests that empathy of medical students does not decline over time. Advances in Health Sciences Education, 18(3), 509–522. doi:10.1007/s10459-012-9390-z.

    Article  Google Scholar 

  • Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44(1), 113–126. doi:10.1037/0022-3514.44.1.113.

    Article  Google Scholar 

  • Duarte, M. I., Branco, M. C., Raposo, M. L., & Rodrigues, P. J. (2015). Empathy in medical students as related to gender, year of medical school and specialty interest. South East Asian Journal of Medical Education, 9(1), 51.

    Google Scholar 

  • Esquerda, M., Yuguero, O., Viñas, J., & Pifarré, J. (2016). La empatía médica, ¿nace o se hace? Evolución de la empatía en estudiantes de medicina. Atención Primaria, 48(1), 8–14. doi:10.1016/j.aprim.2014.12.012.

    Article  Google Scholar 

  • Handford, C., Lemon, J., Grimm, M. C., & Vollmer-Conna, U. (2013). Empathy as a function of clinical exposure-reading emotion in the eyes. PLoS One, 8(6), e65159. doi:10.1371/journal.pone.0065159.

    Article  Google Scholar 

  • Hegazi, I., & Wilson, I. (2013). Maintaining empathy in medical school: It is possible. Medical Teacher, 35(12), 1002–1008. doi:10.3109/0142159X.2013.802296.

    Article  Google Scholar 

  • Hojat, M., Gonnella, J. S., Mangione, S., Nasca, T. J., Veloski, J. J., Erdmann, J. B., et al. (2002). Empathy in medical students as related to academic performance, clinical competence and gender. Medical Education, 36(6), 522–527. doi:10.1046/j.1365-2923.2002.01234.x.

    Article  Google Scholar 

  • Hojat, M., Mangione, S., Nasca, T. J., Rattner, S., Erdmann, J. B., Gonnella, J. S., et al. (2004). An empirical study of decline in empathy in medical school. Medical Education, 38(9), 934–941. doi:10.1111/j.1365-2929.2004.01911.x.

    Article  Google Scholar 

  • Hojat, M., Vergare, M. J., Maxwell, K., Brainard, G., Herrine, S. K., Isenberg, G. A., et al. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine, 84(9), 1182–1191.

    Article  Google Scholar 

  • Kataoka, H. U., Koide, N., Ochi, K., Hojat, M., & Gonnella, J. S. (2009). Measurement of empathy among Japanese medical students: Psychometrics and score differences by gender and level of medical education. Academic Medicine, 84(9), 1192–1197.

    Article  Google Scholar 

  • Kliszcz, J., Hebanowski, M., & Rembowski, J. (1998). Emotional and cognitive empathy in medical schools. Academic Medicine, 73, 541.

    Article  Google Scholar 

  • Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1), 69. doi:10.1186/1748-5908-5-69.

    Article  Google Scholar 

  • Lim, B. T., Moriarty, H., Huthwaite, M., Gray, L., Pullon, S., & Gallagher, P. (2013). How well do medical students rate and communicate clinical empathy? Medical Teacher, 35(2), e946–e951. doi:10.3109/0142159X.2012.715783.

    Article  Google Scholar 

  • Loureiro, J., Gonçalves-Pereira, M., Trancas, B., Caldas-de-Almeida, J. M., & Castro-Caldas, A. (2011). Empathy in the doctor-patient relationship as viewed by first-year medical students: Data on validity and sensibility to change of the Jefferson measure in Portugal. Acta Médica Portuguesa, 24, 431–442.

    Google Scholar 

  • Magalhães, E., Salgueira, A. P., Costa, P., & Costa, M. J. (2011). Empathy in senior year and first year medical students: A cross-sectional study. BMC Medical Education, 11(1), 52.

    Article  Google Scholar 

  • Mays, N., Roberts, E., & Popay, J. (2001). Synthesising research evidence. In N. Fulop, P. Allen, A. Clarke, & N. Black (Eds.), Studying the organisation and delivery of health services: research methods (pp. 188–220.). London, UK: Routledge.

  • Montilva, M., García, M., Torres, A., Puertas, M., & Zapata, E. (2015). Empatía según la escala de Jefferson en estudiantes de Medicina y Enfermería en Venezuela. Investigación en Educación Médica, 4(16), 223–228. doi:10.1016/j.riem.2015.04.006.

    Article  Google Scholar 

  • Newton, B. W., Barber, L., Clardy, J., Cleveland, E., & OʼSullivan, P. (2008). Is there hardening of the heart during medical school? Academic Medicine, 83(3), 244–249. doi:10.1097/ACM.0b013e3181637837.

    Article  Google Scholar 

  • Nunes, P., Williams, S., Sa, B., & Stevenson, K. (2011). A study of empathy decline in students from five health disciplines during their first year of training. International Journal of Medical Education, 2, 12–17. doi:10.5116/ijme.4d47.ddb0.

    Article  Google Scholar 

  • Pedersen, R. (2009). Empirical research on empathy in medicine—A critical review. Patient Education and Counseling, 76(3), 307–322. doi:10.1016/j.pec.2009.06.012.

    Article  Google Scholar 

  • Pham, M. T., Rajić, A., Greig, J. D., Sargeant, J. M., Papadopoulos, A., & McEwen, S. A. (2014). A scoping review of scoping reviews: Advancing the approach and enhancing the consistency. Research Synthesis Methods, 5(4), 371–385. doi:10.1002/jrsm.1123.

    Article  Google Scholar 

  • Quince, T. A., Parker, R. A., Wood, D. F., & Benson, J. A. (2011). Stability of empathy among undergraduate medical students: A longitudinal study at one UK medical school. BMC Medical Education, 11(1), 90.

    Article  Google Scholar 

  • Roff, S. (2015). Reconsidering the “decline” of medical student empathy as reported in studies using the Jefferson Scale of Physician Empathy-Student version (JSPE-S). Medical Teacher,. doi:10.3109/0142159X.2015.1009022.

    Google Scholar 

  • Roh, M.-S., Hahm, B.-J., Lee, D. H., & Suh, D. H. (2010). Evaluation of empathy among Korean medical students: A cross-sectional study using the Korean version of the Jefferson scale of physician empathy. Teaching and Learning in Medicine, 22(3), 167–171. doi:10.1080/10401334.2010.488191.

    Article  Google Scholar 

  • Schwellnus, H., & Carnahan, H. (2014). Peer-coaching with health care professionals: What is the current status of the literature and what are the key components necessary in peer-coaching? A scoping review. Medical Teacher, 36(1), 38–46. doi:10.3109/0142159X.2013.836269.

    Article  Google Scholar 

  • Shariat, S. V., & Habibi, M. (2013). Empathy in Iranian medical students: Measurement model of the Jefferson scale of empathy. Medical Teacher, 35(1), e913–e918. doi:10.3109/0142159X.2012.714881.

    Article  Google Scholar 

  • Shashikumar, R., Chaudhary, R., Ryali, V. S. S. R., Bhat, P. S., Srivastava, K., Prakash, J., & Basannar, D. (2014). Cross sectional assessment of empathy among undergraduates from a medical college. Medical Journal Armed Forces India, 70(2), 179–185. doi:10.1016/j.mjafi.2014.02.005.

    Article  Google Scholar 

  • Silva, M. G., Arboleda Castillo, J., & Díaz Narváez, V. P. (2014). Orientación empática en estudiantes de Medicina en una universidad de República Dominicana. Educación Médica Superior, 28(1), 74–83.

    Google Scholar 

  • Stansfield, R. B., Schwartz, A., O’Brien, C. L., Dekhtyar, M., Dunham, L., & Quirk, M. (2015). Development of a metacognitive effort construct of empathy during clinical training: A longitudinal study of the factor structure of the Jefferson scale of empathy. Advances in Health Sciences Education,. doi:10.1007/s10459-015-9605-1.

    Google Scholar 

  • Thomazi, L., Moreira, F. G., & Marco, M. A. (2014). Avaliação da evolução da empatia em alunos do quarto ano da graduação em medicina da Unifesp em 2012. Revista Brasileira de Educação Médica, 38(1), 87–93.

    Article  Google Scholar 

  • Todres, M., Tsimtsiou, Z., Stephenson, A., & Jones, R. (2010). The emotional intelligence of medical students: An exploratory cross-sectional study. Medical Teacher, 32(1), e42–e48. doi:10.3109/01421590903199668.

    Article  Google Scholar 

  • Toto, R. L., Man, L., Blatt, B., Simmens, S. J., & Greenberg, L. (2015). Do empathy, perspective-taking, sense of power and personality differ across undergraduate education and are they inter-related? Advances in Health Sciences Education: Theory and Practice, 20(1), 23–31. doi:10.1007/s10459-014-9502-z.

    Article  Google Scholar 

  • Wen, D., Ma, X., Li, H., Liu, Z., Xian, B., & Liu, Y. (2013). Empathy in Chinese medical students: Psychometric characteristics and differences by gender and year of medical education. BMC Medical Education, 13(1), 130.

    Article  Google Scholar 

  • Youssef, F. F., Nunes, P., Sa, B., & Williams, S. (2014). An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean. International Journal of Medical Education, 5, 185–192. doi:10.5116/ijme.5412.e641.

    Article  Google Scholar 

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Acknowledgments

The authors thank Thelma Quince and Mohammadreza Hojat for critically reviewing the text.

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Authors and Affiliations

  1. Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, Gualtar, 4710-057, Braga, Portugal

    Alexandra Ferreira-Valente, Ana Salgueira, Patrício Costa & Manuel J. Costa

  2. 3B PT Government Associate Laboratory, Braga, Guimarães, Portugal

    Alexandra Ferreira-Valente, Ana Salgueira, Patrício Costa & Manuel J. Costa

  3. University Lusíada of Lisbon, Lisbon, Portugal

    Alexandra Ferreira-Valente

  4. USF Odisseia, Maia, Portugal

    Joana S. Monteiro

  5. Faculty of Medicine, Oporto University, Porto, Portugal

    Joana S. Monteiro

  6. USF Rainha D. Amélia, Porto, Portugal

    Rita M. Barbosa

  7. Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal

    Patrício Costa

Authors
  1. Alexandra Ferreira-Valente
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  2. Joana S. Monteiro
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  3. Rita M. Barbosa
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  4. Ana Salgueira
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  5. Patrício Costa
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  6. Manuel J. Costa
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Correspondence to Manuel J. Costa.

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Ferreira-Valente, A., Monteiro, J.S., Barbosa, R.M. et al. Clarifying changes in student empathy throughout medical school: a scoping review. Adv in Health Sci Educ 22, 1293–1313 (2017). https://doi.org/10.1007/s10459-016-9704-7

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  • DOI: https://doi.org/10.1007/s10459-016-9704-7

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