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Purpose:Physician empathy is a core attribute in medical professionals, giving better patient outcomes. Medical school is an opportune time for building empathetic foundations. This study explores empathy change and focuses on contributory factors.Methods:We conducted a cross-sectional study involving 881 students (63%) from Years 1 to 5 in a Singaporean medical school using the Jefferson Scale of Physician Empathy-Student version (JSPE-S) and a questionnaire investigating the relationship between reported and novel personal-social empathy determinants.Results:Empathy declined significantly between preclinical and clinical years. Female and medical specialty interest respondents had higher scores than their counterparts. Despite strong internal consistency, factor analysis suggested that the JSPE model is not a perfect fit. Year 1 students had highest Perspective Taking scores and Year 2 students had highest Compassionate Care scores. High workload and inappropriate learning environments were the most relevant stressors. Time spent with family, arts, and community service correlated with higher empathy scores, whilst time spent with significant others and individual leisure correlated with lower scores. Thematic analysis revealed that the most common self-reported determinants were exposure to activity (community service) or socialisation, personal and family-related event as well as environment (high work-load).Conclusion:While the empathy construct in multicultural Singapore is congruent with a Western model, important differences remain. A more subtle understanding of the heterogeneity of the medical student experience is important. A greater breadth of determinants of empathy, such as engagement in arts-related activities should be considered.

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The field of Urology is no stranger to artificial intelligence (AI) and machine learning, with prior applications in urological cancer management [1,2]. Smart conversational agents ('chatbots') are one such example of AI technology and have been shown to be a convenient and powerful tool for providing patients with medical information [3], and addressing their concerns postoperatively [4,5].

HighlightsNovel technique for increasing working space in the common bile duct.May enable endoscopists to re-attempt mechanical lithotripsy after initial failed attempt.If successful, will decrease number of procedures patient has to undergo.Should be used only by advanced endoscopists.