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

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.

The complexity of empathy during medical school training: evidence for positive changes

“…Worryingly, the steepest decreases are thought to occur between medical students’ second and third years as they begin their clinical training, a time when empathic communication is critical. However, it is not clear how reliable this decline is . Recent work failed to find changes in empathy during medical school or found declines in only some aspects of empathy and none in others .…”

“…However, it is not clear how reliable this decline is. 11 Recent work failed to find changes in empathy during medical school 12 or found declines in only some aspects of empathy and none in others. 13 There is some evidence for increases in behavioural aspects of empathy.…”

Is empathy change in medical school geo‐socioculturally influenced?

“…During the most recent phase of research, evidence on changes in empathy in medical students from countries other than those in North America emerged. Three recent reviews concluded that there was no generalisable trend in changes in empathy during medical undergraduate training. The ‘mixed’ results reported by these reviews did not identify any discernible pattern or trend in changes in empathy across different parts of the world.…”

Nurturing virtues of the medical profession: does it enhance medical students’ empathy?

“…A recent review showed a trend toward higher empathy levels in later years of the undergraduate course, 19 although another systematic review indicated that most studies on the subject found a decline in empathy, 20 with hidden curriculum being the most reported cause of this phenomenon 4 . This finding is in agreement with the students’ perception that the main causes for the decline in empathy are the lack of positive role models and time pressure 21 …”