Student ResearchCross sectional assessment of empathy among undergraduates from a medical college
Introduction
The word empathy is derived from Greek word ‘empatheia’ meaning affection or passion with a quality of suffering.1 Empathy is essentially a cognitive phenomenon but it also involves affective sensitivity to patients' need and a behavioral ability to convey and communicate the same to him/her.2 William Osler had very aptly summed up empathy when he said “ it is as important to know what kind of a man (sic) has the disease as to know what kind of a disease has the man”.3 Hozat had found in a study that medical graduates with higher empathy did better in clinical competence than on academic competence.4 Empathy among physicians is known to vary depending on their personality,5 choice of specialty.6
While some western studies among medical students found significant fall in empathy levels when they progressed from non-clinical to clinical training years,7, 8, 9, 10 others like from Iran, Korea and Japan did not find any significant change in empathy; on the contrary the Japanese study reported increased empathy when students moved to clinical rotation.11, 12, 13 These differences probably could be due to differences in curriculum content and timings of clinical rotations.7 The curriculum in India differs from western countries in that clinical rotation starts from second year itself and from Korea and Japan in that there is no humanities content in the curriculum.12, 13 Studies have shown that medical students who plan to pursue people oriented specializations such as internal medicine, family medicine, psychiatry and pediatrics showed higher empathetic scores and across all years of study in medical school than those who choose to pursue technology oriented specialties such as radiology, surgery and anesthesiology8, 14. These changes were reported more among male students and those selecting noncore subject such as other than internal medicine, family medicine, obstetrics and gynecology and psychiatry.7 Paula Neures et al had reported decline in empathy not only among medical student but also in dentistry, pharmacy, nursing, and veterinary medicine students.15
Studies have suggested that female are more receptive to emotions than male, have evolved with more caring attitude towards offspring as compared to male which contributes to better understanding and being more empathetic.4, 16 Hojat et al had found that female students scored significantly higher on empathy than male students among medical students (p < 0.01).4, 17 Newton et al had in study found female students to have same empathy as male students but had significant decline across medical years of education only in those who chose noncore (non-people oriented subjects) for specialization (2.25-fold decrease).7 However a study from Iran did not find any significant difference at all though female students did score more than male students.11
Female students were found to have more empathy than male students across various years of medical education.8, 4, 13, 7 However a Japanese study found no decline in empathy scoring as students progressed from non-clinical to clinical training.12 In view of such varying empathy findings from different countries, we need to understand empathy among medical students in Indian context. Do our female students have more empathy than male students? Does choice of specialty correlate with levels of empathy? Do they differ in any way from those of US and Japan? There has been no study among Indian medical students as yet.
This study was undertaken to measure empathy among medical students of various years with an objective to compare the empathy scores among the medical students of various semesters, to compare the empathy scores among male and female medical students and to compare the empathy scores among students who opted for technology oriented specialization with those who opted for people oriented specialization or were either undecided/chose other subjects.
Section snippets
Material and method
The study was conducted in a premier medical college on a single day. Prior sanction of the ethical committee and academic authorities was obtained. The students were briefly explained the nature of study, their consent was taken. They were assured of keeping the contents confidential. All forms were coded to avoid identification of the student by the authors. The coding was done by a person not associated with the study. The course of medical education is divided into nine semesters of six
Results
A total of 488 students out of 650 enrolled in the college (75%) had participated in the assessment. Among them were 108 were female and 380 were male students. While the actual proportion of female students to male students in the college was 24:76, the sample proportion was 28:72. There were no invalid scales. The first semester students had completed just a month in college, while the third semester students had completed just about a month of their initial clinical rotations and the ninth
Discussion
A total of 488 students completed the form, which is much higher than the study from Japan13 and Iran,11 almost similar to that from Portugal20 but lesser than that from US.8 There were no non-responders as all those present on the day of assessment completed the questionnaire (Table 1). This is in contrast to the poor response rate of third year students (77.2%) in the study by Chen et al8 in which incidentally a decrease in empathy scores was also found whereas in this study significant
Conclusion
The decline in empathy levels with years in medical college is probably not just restricted to western colleges. Significant decline is seen much later than in western studies. Female students are more empathetic than male students. The relation of mean empathy scores and choice of specialty is inconclusive and at variance from other studies.
A longitudinal follow up study including a larger sample from more number of colleges would help find if decline in empathy with years in medical college
Conflicts of interest
All authors have none to declare.
Acknowledgment
Mohammadreza Hojat, PhD, Director of Jefferson Longitudinal Study of Medical Education, Research Professor, Psychiatry and Human Behavior, Jefferson Medical College.
References (24)
The empathy cycle: refinement of a nuclear concept
J Couns Psychol
(1981)- et al.
Empathy training to improve physician–patient communication skills
Acad Med
(1995) With Other Addresses to Medical Students, Nurses, and Practitioners of Medicine
(1932)- et al.
Empathy in medical students as related to academic performance, clinical competence and gender
Med Educ
(2002) Care of the patient
JAMA
(1984)- et al.
Empathy in medical education and patient care (Letter)
Acad Med
(2001) - et al.
Is there hardening of the heart during medical school?
Acad Med
(2008) - et al.
A cross-sectional measurement of medical student empathy
J Gen Intern Med
(2007) - et al.
An empirical study of decline in empathy in medical school
Med Educ
(2004 Sep) - et al.
Comparing a self-administered measure of empathy with observed behavior among medical students
J Gen Intern Med
(2009)
Empathy in Iranian medical students: a preliminary psychometric analysis and differences by gender and year of medical school
Medcae Teach
Evaluation of empathy among Korean medical students: a cross- sectional study using the Korean version of the Jefferson scale of physician empathy
Teach Learn Med
Cited by (43)
The relationship between medical students’ empathy and burnout levels by gender and study years
2022, Patient Education and CounselingCitation Excerpt :Despite of the increased education in physician empathy during medical school and residency, there have been concerns over the decline of students’ empathy levels during their training. In several cross-sectional [12–18] and longitudinal studies [19–22] that used the Jefferson Scale of Physician Empathy-Student Version (JSPE-S) tool, medical students’ empathy scores decreased with rising seniority. Other studies using the Interpersonal Reactivity Index (IRI) empathy measuring instrument also reported medical students’ empathy declining during clinical practice, specifically in the ‘empathic concern’ and ‘personal distress dimensions’ [23].
Are parental rearing patterns and learning burnout correlated with empathy amongst undergraduate nursing students?
2018, International Journal of Nursing SciencesCitation Excerpt :In the clinical context, new educational concept has emerged and requires nurse empathy as the first lesson imbibed by nursing students [9,10]. However, studies undertaken early in this century suggested the empathy decline during undergraduate medical education [11–13], whereas other studies reported either no change or an increase in empathy [14–16]. A systematic review by Quince et al., in 2016 [17] concluded that although the trajectory of empathy in undergraduate medical education continues to be debated, the factors that may influence the development of empathy should be realised.
Enhancing Empathy in Medical Students by Focused Learner Centered Activities
2023, Journal of the College of Physicians and Surgeons Pakistan
Available online 12 April 2014