Why might medical student empathy change throughout medical school? Protocol for a systematic review and thematic synthesis of qualitative studies

Abstract

IntroductionSeveral studies suggest that medical student empathy declines throughout medical school. However, no studies have systematically investigated why. The objective of our proposed review is to conduct a systematic review and thematic synthesis of qualitative studies investigating the reasons empathy may change throughout medical school.Methods and analysisThis systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We have searched MEDLINE, Scopus, CINAHL, ERIC and APA PsycINFO for relevant studies. We will also search reference lists of included studies and contact experts to identify additional studies. We will include any qualitative study investigating the reasons why empathy changes throughout medical school. We will use the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. We will use thematic analysis to synthesise our results. For all included studies, we will summarise the main characteristics including the number of participants, medical school year, country and gender. In our discussion, we will summarise the limitations of the evidence (including the risk of bias and inconsistency), and provide a general interpretation of the results and important implications.Ethics and disseminationThis study will not require ethical approval since no original data will be collected. The results of this review will be published through peer-reviewed publications and conference presentations. Additionally, this review will inform changes to the enhanced empathy curriculum at the Leicester Medical School.

Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies

“…This study has been reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-2020) statement [ 15 ]. A protocol for the review has been published [ 16 ].…”

Beyond empathy training for practitioners: Cultivating empathic healthcare systems and leadership

“…Evolving beyond era 2 will be promoted by making empathy an explicit lived value of healthcare organisations. The fact that empathy often declines throughout medical school 36 and among newly qualified doctors 53 suggests that empathy must be more highly valued. A reason for the decline is that technical skill and the biomedical model of disease are promoted over and above broader factors promoted by the biopsychosocial model of disease 36 .…”

Towards an empathic hidden curriculum in medical school: A roadmap

“…76,77 However, "tick box" empathy training is ineffective and can backfire by giving students the wrong impression that empathy is superficial. 17 Because medical students focus on what will be assessed, 78 encouraging students to be empathic, must involve assessing empathy. 79,80 In the United Kingdom, Objective Structured Clinical Examinations are used to assess communication skills; they also can and are being used to assess empathy.…”

“…Especially where medicine is an undergraduate degree, medical students are younger, healthier, and from more privileged backgrounds than many of the patients they treat 59 . This lack of experience can present a barrier to empathic care 17 . A systematic review of 12 studies (including five randomised trials) reports an empathy enhancing effect of asking students to simulate or play the role of patients 21 .…”

“…59 This lack of experience can present a barrier to empathic care. 17 A systematic review of 12 studies (including five randomised trials) reports an empathy enhancing effect of asking students to simulate or play the role of patients. 21 Some of these studies found that empathy of the students who had played the role of patients was enhanced.…”