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Student Empathy Improves During Medical School

By Jennifer Thew RN  
   September 12, 2017

A new study challenges the wide-held belief that medical student empathy declines over the course of medical school.

His gallows humor and abrasive personality made Dr. Gregory House a television icon, but future physicians are not destined to follow in his jaded, albeit fictional, footsteps.

A new study by social neuroscientists at the University of Chicago, calls into question the common perception that empathy declines during medical training, particularly between the second and third years of medical school. The study was published in September in Medical Education.

While prior studies reporting a deterioration of empathy during medical training relied on one self-reported assessment of cognitive empathy, The University of Chicago study, considers both cognitive and affective empathy.

"Cognitive empathy is the ability to recognize and understand another person's experience, to communicate and confirm that understanding, and to act in an appropriate and helpful manner without necessarily sharing his or her emotions," says the university’s Jean Decety, the Irving B. Harris Distinguished Service Professor in Psychology and Psychiatry, and lead author of the new study. "Affective, or emotional, empathy is being attuned to someone else's emotions, feeling what he or she feels.”

Traditionally, cognitive empathy has been emphasized as most important in a clinical setting since it enables physicians to understand how patients feel without having an emotional attunement. Affective empathy has been believed to impede a physician's effectiveness in diagnosing and treating patients. Decety and colleagues say that both facets of empathy are important in patient-physician interactions, because physicians must be able to accurately perceive and respond to their patients' emotional states.

Empathy Increases During Medical School
Researchers followed 129 medical students during their first three years of medical school. At the beginning and end of each year, students completed a series of online surveys and behavioral tasks designed to objectively assess different components of empathy.

When researchers evaluated the respondents’ answers to the Jefferson Scale of Physician Empathy, a common self-assessment questionnaire thought to primarily evaluate the cognitive aspects of empathy, they did see a decline in scores of the course of training.

But when they administered the Questionnaire of Cognitive and Affective Empathy, an assessment to distinguish the two facets of empathy, students’ scores on the questionnaire improved over time and both affective empathy and cognitive empathy increased during medical training. They also showed greater sensitivity to facial expressions of pain and progress in their ability to quickly and accurately recognize others' emotional states.

"We found that changes in empathy during medical training are not necessarily negative—the narrative appears to be much more complicated than we initially thought and illustrates how problematic it is to rely on a single, subjective measure to evaluate a complex psychological construct," say the study’s authors.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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