Is empathy change in medical school geo‐socioculturally influenced?

Abstract

Context There is convincing evidence that physician empathy leads to better patient care. As a result, there has been considerable research interest in investigating how empathy changes during undergraduate medical studies. Early (generally North American) studies raised concerns that medical training causes a decline in empathy. More recent studies (conducted around the world) have begun to suggest that either a slight increase or decrease in empathy occurs during undergraduate medical training, which has led some to argue that empathy changes indiscriminately (with no discernible pattern). This paper explores whether there is evidence to suggest that empathy changes indiscriminately or with a discernible geo‐sociocultural pattern during undergraduate medical training. Methods Literature that investigated change in empathy during undergraduate medical training was reviewed. Cross‐sectional and longitudinal studies were tabulated separately according to their respective geographical locations. The tabulated results were analysed to investigate whether empathy changed similarly or differently within different geographical locations. Results The studies reviewed indicate similar patterns of empathy change within approximate geo‐sociocultural clusters. Whereas US studies predominantly show small but significant decreases in empathy, Far Eastern studies mostly show small but significant increases in empathy as undergraduates progress through the medical course. Conclusions These results suggest that change in empathy during undergraduate medical education is not as indiscriminate (patternless) as once thought. Additionally, these results support the notion that empathy is a locally construed global construct.

Health Empathy Map: Creation of an Instrument for Empathy Development

“…Empathy is related to the emotional response arising from the apprehension or understanding of the emotional state of the other, being an important factor for establishing interpersonal relationships and, therefore, particularly relevant in the doctor-patient relationship 8,9 . Studies have suggested that medical students' empathy may change throughout the course, ranging from a small increase to a decrease in it 10,11,12 . Interestingly, it has been observed that this skill tends to decrease exactly when medical students start the clinical activity in the undergraduate years 13,14,15 .…”

Geo‐sociocultural influences on empathy

“…In sum, Ponnamperuma et al. 's characterisation of empathy as a ‘locally construed global construct’ opens up some intriguing new avenues of enquiry, but it will be a difficult characterisation with which to grapple . Current literature does indicate that multidimensional empathy varies across regions and cultures, although the evidence that cognitive empathy does so is less clear.…”

“…add a new perspective on this conundrum. They examine change in empathy during medical school by geographical region, concluding that it is not without a pattern, but follows ‘a discernible pattern or trend within similar geo‐sociocultural locations or regions’ . Broadly speaking, empathy appears to decline among medical students in the Western world and increase among medical students in the Eastern world.…”

“…Holistic cognitive processes, common in the East, are characterised by much greater attention to context and relationships than analytical cognitive processes, common in the West . Cognitive empathy, however, as measured by the Jefferson Scale of Physician Empathy (JSPE), has been studied in more than 70 countries with relatively small differences observed and no obviously discernible pattern at present . Given that a recent systematic review of medical literature found that 85% of articles described empathy as a cognitive ability, further exploration of cross‐cultural variation in cognitive empathy will be of particular interest to medical educators.…”

“…Therefore, aggregating results across studies that use different scales or subscales to measure empathy constitutes a significant methodological problem that impacts our ability to have confidence in Ponnamperuma et al. 's conclusions . Investigators can choose from an abundance of measurement tools.…”