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A Cross-sectional Measurement of Medical Student Empathy
Open accessAbstract
Background Empathy is important in the physician-patient relationship. Prior studies have suggested that physician empathy may decline with clinical training. Objective To measure and examine student empathy across medical school years. Design and participants A cross-sectional study of students at Boston University School of Medicine in 2006. Incoming students plus each class near the end of the academic year were surveyed. Measurements The Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a validated 20-item self-administered questionnaire with a total score ranging from 20 to 140. JSPE-S scores were controlled for potential confounders such as gender, age, anticipated financial debt upon graduation, and future career interest. Results 658 students participated in the study (81.4% of the school population). The first-year medical student class had the highest empathy scores (118.5), whereas the fourth-year class had the lowest empathy scores (106.6). Measured empathy differed between second- and third-year classes (118.2 vs 112.7, P < .001), corresponding to the first year of clinical training. Empathy appears to increase from the incoming to the first-year class (115.5 vs 118.5, P = .02). Students preferring people-oriented specialties had higher empathy scores than students preferring technology-oriented specialties (114.6 vs 111.4, P = .002). Female students were more likely than male students to choose people-oriented specialties (51.5 vs 26.9%, P < .001). Females had higher JSPE-S scores than males (116.5 vs 112.1, P < .001). Age and debt did not affect empathy scores. Conclusions Empathy scores of students in the preclinical years were higher than in the clinical years. Efforts are needed to determine whether differences in empathy scores among the classes are cohort effects or represent changes occurring in the course of medical education. Future research is needed to confirm whether clinical training impacts empathy negatively, and, if so, whether interventions can be designed to mitigate this impact.
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“Such studies of medical student empathy are limited in several important ways: they measure only the student's self-assessment of empathy; the comparisons involve students from single osteopathic and allopathic institutions that are not generalizable to the broader populations of osteopathic and allopathic medical students; and they do not provide measures of empathy that reflect actual patient En”
From Empathy in Medicine Osteopathic and Allopathic Physician Interpersonal Manner, Empathy, and Communication Style and Clinical Status of Their Patients: A Pain Registry–Based Study (2019) · cites this paper as [5]
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“Alternatively, another study of selfreported empathy found a significant difference in favor of osteopathic medical students, 4 but only among thirdyear students in comparison with an externally acquired control group.5”
From Empathy in Medicine Osteopathic and Allopathic Physician Interpersonal Manner, Empathy, and Communication Style and Clinical Status of Their Patients: A Pain Registry–Based Study (2019) · cites this paper as [5]
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“Comparative studies of empathy have focused on osteopathic and allopathic medical students.”
From Empathy in Medicine Osteopathic and Allopathic Physician Interpersonal Manner, Empathy, and Communication Style and Clinical Status of Their Patients: A Pain Registry–Based Study (2019) · cites this paper as [5]
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Items 101–200 of 547
Stansfield, R. B., Schwartz, A., O’Brien, C. L., Dekhtyar, M., Dunham, L. N., & Quirk, M. E. (2015) · Advances in Health Sciences Education · doi:10.1007/s10459-015-9605-1 · Cited by 52
“Previous studies have viewed empathy as a single construct and generally use the JSE total score to define the variable (Chen et al. 2007; Colliver et al. 2010; Del Canale et al. 2012; Hegazi and Wilson 2013; Hojat and LaNoue 2014; Hojat et al. 2001, 2002a, b, c, 2005, 2011, 2013; Neumann et al. 2011).”
MethodInfluentialZazulak, J., Halgren, C., Tan, M., & Grierson, L. (2015) · Medical Humanities · doi:10.1136/medhum-2014-010584 · Cited by 51
Preusche, I., & Wagner‐Menghin, M. M. (2012) · Advances in Health Sciences Education · doi:10.1007/s10459-012-9393-9 · Cited by 50
Empathy in Medical Students Is Moderated by Openness to Spirituality
Damiano, R. F., DiLalla, L. F., Lucchetti, G., & Dorsey, J. K. (2016) · Teaching and Learning in Medicine · doi:10.1080/10401334.2016.1241714 · Cited by 50
Findyartini, A., Greviana, N., Putera, A. M., Sutanto, R. L., Saki, V. Y., & Felaza, E. (2021) · BMC Medical Education · doi:10.1186/s12909-021-02547-5 · Cited by 49
“Studies on empathy among undergraduate medical students suggest a similar pattern due to the challenges faced during this transition time [39, 40].”
BackgroundPreparing Tomorrow's Doctors to Care for Patients With Autism Spectrum Disorder
Havercamp, S. M., Ratliff-Schaub, K. L., Macho, P. N., Johnson, C. N., Bush, K. L., & Souders, H. T. (2016) · Intellectual and developmental disabilities · doi:10.1352/1934-9556-54.3.202 · Cited by 49
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Descenso de empatía en estudiantes de enfermería y análisis de posibles factores implicados
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Exploring the missing link - Empathy among dental students: An institutional cross-sectional survey
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The impact of empathy on medical students: an integrative review
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“Medical specialties were divided into peo-ple-oriented specialties that paid more attention to communication with patients and the technology-ori-ented specialties that relied more on medical technology [33].”
BackgroundMethodResultInfluentialAssociations of medical student empathy with clinical competence
Casas, R. S., Xuan, Z., Jackson, A. H., Stanfield, L., Harvey, N., & Chen, D. C. R. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.11.006 · Cited by 47
“All medical students enrolled at BUSM (N=1,162) between 2006 and 2010 were eligible to participate in empathy surveys through previously outlined methods [21, 23, 28].”
MethodResultSelf-citationThe Hidden Curriculum of Veterinary Education: Mediators and Moderators of Its Effects
Roder, C., & May, S. A. (2017) · Journal of Veterinary Medical Education · doi:10.3138/jvme.0416-082 · Cited by 48
Empathy among dental students: A systematic review of literature
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BackgroundResultMorley, C. P., Roseamelia, C., Smith, J., & Villarreal, A. (2013) · Medical Education Online · doi:10.3402/meo.v18i0.21194 · Cited by 44
“Finally, empathy in students has also been noted to drop over the course of training (1, 11, 26), although at least one study has indicated that empathy might spike in year two, before a precipitous drop during clinical years (27).”
BackgroundA Quantitative Study of Empathy in Pakistani Medical Students: A Multicentered Approach
Tariq, N., Rasheed, T., & Tavakol, M. (2017) · Journal of Primary Care & Community Health · doi:10.1177/2150131917716233 · Cited by 44
“better than those who are interested in technology-oriented specialties on the empathy scores.(20,21,24,44,45) However, some studies are not in agreement with our results on the empathy scores.”
ResultThe temporal decline of idealism in two cohorts of medical students at one institution
Mader, E. M., Roseamelia, C., & Morley, C. P. (2014) · BMC Medical Education · doi:10.1186/1472-6920-14-58 · Cited by 43
“However, a growing body of literature generally places a decrease in student idealism around the beginning of the third year of medical school [4-7].”
BackgroundEmpathy among physicians, medical students and candidates.
Bratek, A., Bulska, W., Bonk, M., Seweryn, M., & Krysta, K. (2015) · PubMed · Cited by 42
Williams, B. A., Boyle, M. J., & Fielder, C. (2014) · Nurse Education Today · doi:10.1016/j.nedt.2014.12.007 · Cited by 41
“, 2010a, 2010b); however, the altruism in these people has been shown to decline by the end of their medical education particularly during their third year of study when students undergo their first full year of clinical placements (Branch, 2001; Chen et al., 2007; Hojat et al., 2004; Newton et al., 2008; Singh, 2005).”
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Sonis, J. D., & White, B. A. (2020) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2020.04.008 · Cited by 41
The relationship between medical students’ empathy and burnout levels by gender and study years
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Is empathy an important attribute of midwives and other health professionals?: A review
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“Chen et al. (2007)65 Aim To measure and examine student empathy across medical school years.”
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“A decline in empathy paperand-pencil test scores was found in five cross-sectional (Newton et al. 2000; DiLalla et al. 2004; Sherman and Cramer 2005; Chen et al. 2007; Thomas et al. 2007), and in four longitudinal (Hojat et al. 2004, 2009; Newton et al. 2008; Stratton et al. 2008) studies of…”
BackgroundSchoenfeld-Tacher, R. M., Kogan, L. R., Meyer-Parsons, B., Royal, K. D., & Shaw, J. R. (2015) · Journal of Veterinary Medical Education · doi:10.3138/jvme.0115-007r · Cited by 42
Jeffrey, D. I. (2016) · Medical Teacher · doi:10.1080/0142159x.2016.1210110 · Cited by 41
“Quantitative research using self-reported questionnaires suggests that medical students’ empathy declines during their undergraduate training (Hojat et al. 2004; Chen et al. 2007; Pedersen 2009; Neumann et al. 2011).”
MethodLee, B. K., Bahn, G. H., Lee, W. H., Park, J. H., Yoon, T., & Baek, S. B. (2009) · Korean journal of medical education · doi:10.3946/kjme.2009.21.2.117 · Cited by 39
“[11]의 연구를 토대로 사람 중심(people-oriented) 전 공과 기술 중심(technology-oriented) 전공으로 나누”
InfluentialYang, K., & Yang, J. (2013) · BMC Medical Education · doi:10.1186/1472-6920-13-142 · Cited by 39
“Female medical students were reported to have higher JSPE scores than male in a previous study [8].”
BackgroundResultDental professionalism and influencing factors: patients’ perception
Taibah, S. M. (2018) · Patient Preference and Adherence · doi:10.2147/ppa.s172788 · Cited by 39
“32,33 As these studies have been performed in countries that are culturally different than the present study, similar studies are required to evaluate the level of empathy change among dental students in the dental schools of Saudi Arabia.”
Piumatti, G., Abbiati, M., Baroffio, A., & Gerbase, M. W. (2020) · Advances in Health Sciences Education · doi:10.1007/s10459-020-09965-y · Cited by 39
Empathy levels in undergraduate paramedic students: A three-year longitudinal study
Williams, B. A., Boyle, M. J., & Howard, S. (2015) · Nurse Education in Practice · doi:10.1016/j.nepr.2015.09.002 · Cited by 38
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Empathy Gender in Dental Students in Latin America: An Exploratory and Cross-Sectional Study
Díaz-Narváez, V. P., Coronado, A. M. E., Bilbao, J., González, F., Padilla, M., Howard, M., Silva-Vetri, M. G., Bullen, M., Gutiérrez, F., de Villalba, T. V., et al. (2015) · Health · doi:10.4236/health.2015.711166 · Cited by 36
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Self-citationEmotional and Cognitive Empathy in First-Year Medical Students
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Impact of Resident Well-Being and Empathy on Assessments of Faculty Physicians
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A Methodological Review of the Assessment of Humanism in Medical Students
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Maintenance of empathy levels among first and final year medical students: a cross sectional study
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“The medical education course taken by the medical student, be it hands-on experience, role models, science and theory, [10] or clinical training can impact empathy negatively [11].”
BackgroundCOVID 19: A Cause for Pause in Undergraduate Medical Education and Catalyst for Innovation
Southworth, E., & Gleason, S. H. (2021) · HEC Forum · doi:10.1007/s10730-020-09433-5 · Cited by 33
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“The hypothesis might be that the training curriculum itself contributes to a decline in compassion after starting medical school [10, 11].”
BackgroundResultInfluentialConfronting the caring crisis in clinical practice
Ma, F., Li, J., Zhu, D., Bai, Y., & Song, J. (2013) · Medical Education · doi:10.1111/medu.12250 · Cited by 32
Reconsidering the ‘Decline’ of Dental Student Empathy within the Course in Latin America
Díaz-Narváez, V. P., Coronado, A. M. E., Bilbao, J., Martínez, F. D. G., Padilla, M., Calzadilla‐Núñez, A., Silva-Vetri, M. G., Arboleda, J., Bullen, M., Utsman, R., et al. (2017) · Acta Médica Portuguesa · doi:10.20344/amp.8681 · Cited by 31
Empathy, well-being and stressful experiences in the clinical learning environment
Roling, G., Lutz, G. K., Edelhäuser, F., Hofmann, M., Valk-Draad, M. P., Wack, C., Haramati, A., Tauschel, D., & Scheffer, C. (2020) · Patient Education and Counseling · doi:10.1016/j.pec.2020.04.025 · Cited by 32
The Jefferson Scale of Empathy
Hojat, M. (2016) · Springer eBooks · doi:10.1007/978-3-319-27625-0_7 · Cited by 30
Wahjudi, J. W., Findyartini, A., & Kaligis, F. (2019) · Korean journal of medical education · doi:10.3946/kjme.2019.132 · Cited by 30
“Nevertheless, it should be noted that similar results were found in previous studies [9-11,20,29].”
BackgroundResultEmpathy in Dentistry: How Attitudes and Interaction With Older Adults Make a Difference
Waldrop, D. P., Nochajski, T. H., Davis, E. L., Fabiano, J. A., & Goldberg, L. J. (2014) · Gerontology & Geriatrics Education · doi:10.1080/02701960.2014.993065 · Cited by 30
Empathy levels among first year Malaysian medical students: an observational study
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An assessment of undergraduate paramedic students' empathy levels
Williams, B. A., Boyle, M. J., Brightwell, R. F., Devenish, S., Hartley, P., McCall, M., McMullen, P., Munro, G., O'Meara, P. F., Webb, V., et al. (2012) · International Journal of Medical Education · doi:10.5116/ijme.4fba.9190 · Cited by 30
“Our findings found females produced higher mean scores than males on each medical condition and support the multitude of empathy studies on healthcare students, where females were identified as being more empathetic than their male counterparts.(7,9,10,16,18) There is debate amongst academics as to how to explain this…”
BackgroundAssessment of Korean Pharmacy Students’ Empathy Using the Jefferson Scale of Empathy
Jeon, S., & Cho, E. (2015) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe79567 · Cited by 29
Fernández, D., Latorre, E. M., Giménez‐Espert, M. D. C., & Prado‐Gascó, V. (2021) · Nurse Education Today · doi:10.1016/j.nedt.2021.104861 · Cited by 29
Measurement of Empathy Levels in Undergraduate Paramedic Students
Williams, B. A., Boyle, M. J., & Earl, T. L. (2013) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x1300006x · Cited by 29
“Among medical students, empathy levels and JSPE scores have been shown to be higher in preclinical years than during their clinical years.(1) Other research findings have demonstrated a consistent, but not significant, decline in JSPE scores among medical residents during post-graduate training.”
BackgroundMethodResultInfluentialSilva, J. T. N., & Júnior, A. T. (2021) · Revista Brasileira de Educação Médica · doi:10.1590/1981-5271v45.1-20200053.ing · Cited by 28
Rethinking empathy decline: results from an OSCE
Teng, V. C., Nguyen, C. T., Hall, K. T., Rydel, T. A., Sattler, A. L., Schillinger, E., Weinlander, E. E., & Lin, S. (2017) · The Clinical Teacher · doi:10.1111/tct.12608 · Cited by 28
Improving Empathy in Nursing Students: A Comparative Longitudinal Study of Two Curricula
Özcan, C. T., Öksüz, E., & Oflaz, F. (2018) · Journal of Korean Academy of Nursing · doi:10.4040/jkan.2018.48.5.497 · Cited by 28
“Studies conducted with medical students have suggested similar results [4,8,20-22].”
BackgroundResultOstović, M., Mikuš, T., Pavičić, Ž., Matković, K., & Mesić, Ž. (2017) · Veterinární Medicína · doi:10.17221/172/2016-vetmed · Cited by 27
“Chen et al. (2007) found that medical students preferring people-oriented specialties (e.g., family medicine, paediatrics, psychiatry) had higher empathy scores as compared with students preferring technology (instrument)-oriented specialties (e.g., radiology, surgery) characterised by less…”
ResultSearching for the erosion of empathy in medical undergraduate students: a longitudinal study
Blanco, J. M., Caballero, F., Montero, S. Á., Plans, M., & Martín, D. M. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-041810 · Cited by 27
Effect of Medical Education on Empathy in Osteopathic Medical Students
McTighe, A. J., DiTomasso, R. A., Felgoise, S. H., & Hojat, M. (2016) · Journal of Osteopathic Medicine · doi:10.7556/jaoa.2016.131 · Cited by 26
“The decline in empathic attitude found in this study is similar to results obtained by Hojat et al. (2002a,b) and Chen et al. (2007), but contrasts with findings by both Kimmelman et al. (2012) and Calabrese et al. (2013) in osteopathic samples (see Figure 4 for osteopathic comparisons and Figure 5…”
BackgroundResultInfluentialDuarte, M., Raposo, M. L. B., Rodrigues, P., & Branco, M. C. (2016) · Investigación en Educación Médica · doi:10.1016/j.riem.2016.04.007 · Cited by 26
“…presents a positive relationship with the ‘‘cognitive dimen-sion’’, ‘‘clinical outcomes’’ and ‘‘standing in patient shoes’’ and negative relationship with the others The results of post hoc Tukey, comparing the means between the different groups, give statistical support to the identified clusters”
ResultEmpathy in medical students of Córdoba, Argentina
Ulloque, M. J., Villalba, S., de Villalba, T. V., Fantini, A., Quinteros, S., & Díaz-Narváez, V. P. (2019) · Archivos Argentinos de Pediatria · doi:10.5546/aap.2019.eng.81 · Cited by 25
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Huang, Y., Ho, K. H. M., Christensen, M., Wong, D. W., Wang, S., Su, J. J., Zhao, I. Y., Kor, P. P. K., Liu, J. Y. W., Cheung, J. C., et al. (2023) · International Journal of Mental Health Nursing · doi:10.1111/inm.13240 · Cited by 25
Need to teach family medicine concepts even before establishing such practice in a country
Mudiyanse, R. M. (2014) · Asia Pacific Family Medicine · doi:10.1186/1447-056x-13-1 · Cited by 25
“Jefferson’s Scale of Empathy assesses empathy of students and doctors [30] and it has helped to recognize deterioration of empathy during clinical practice [30].”
BackgroundAhmadpour, N., Shariati, A., & Moghadam, M. P. (2025) · BMC Medical Education · doi:10.1186/s12909-024-06593-7 · Cited by 24
“Generally, empathy means the ability to put oneself in others’ shoes to better understand the feelings and experiences of both parties in their interactions [3].”
Vallabh, K. (2011) · South African Journal of Bioethics and Law · doi:10.7196/sajbl.164 · Cited by 24
Miles, S. J. (2019) · BJPsych Bulletin · doi:10.1192/bjb.2019.49 · Cited by 24
Cecchetti, M., Last, J., Lynch, J., & Linehan, C. (2021) · Disability and health journal · doi:10.1016/j.dhjo.2021.101092 · Cited by 32
Predictors of Medical Students’ Compassion and Related Constructs: A Systematic Review
Wang, C. X. Y., Pavlova, A., Boggiss, A. L., O’Callaghan, A., & Consedine, N. S. (2022) · Teaching and Learning in Medicine · doi:10.1080/10401334.2022.2103816 · Cited by 24
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Yücel, H., & Acar, G. (2016) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.321.8745 · Cited by 24
Análise dos Níveis de Empatia de Estudantes de Medicina
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“beginnen, Kontakt mit Patienten zu haben [31], [32].”
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“Many studies in medical students have consistently found a gender difference in empathy, with those who identify as women consistently scoring higher on empathy scales than male identified students [7, 10, 11, 22, 23].”
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“The total JSEHPS score ranges from 20 to 140, with higher scores indicating a higher degree of empathy [39].”
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“In the United States, various longitudinal [24], and cross-sectional [25] studies have shown a significant decline in empathy among third-year medical students (equivalent to fifth-year medical students in Japan).”
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BackgroundEmpatía en estudiantes de enfermería de la Universidad Mayor, Sede Temuco, IX región, Chile
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“Establishing professional communication between physicians and nurses is inevitable, as nurses play a supplementary role in the care and treatment of patients, and also fulfill a function in other common areas of health care (1, 2).”
Background
Metadata
- Authors
- Chen, D., Lew, R., Hershman, W., & Orlander, J.
- Affiliations
- Boston University (US)
- Corresponding author
- Chen, Daniel
- Venue
- Journal of General Internal Medicine
- Published
- 2007-07-26
- Volume
- 22
- Issue
- 10
- Pages
- 1434-1438
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2305857
- OpenAlex
- W1974059841
- Cited by
- 547
- References
- 43
- Citations by year
- 2026: 12 · 2025: 21 · 2024: 32 · 2023: 32 · 2022: 35 · 2021: 46 · 2020: 48 · 2019: 35 · 2018: 35 · 2017: 35 · 2016: 41 · 2015: 39 · 2014: 35 · 2013: 30 · 2012: 29
- FWCI
- 5.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Social Sciences › Education › Innovations in Medical Education
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Keywords
- physician empathy, medical students, specialty choice, gender differences, physician-patient relationship
- MeSH terms
- Adult, Analysis of Variance, Attitude of Health Personnel, Cross-Sectional Studies, Education, Medical, Undergraduate, Empathy, Female, Humans, Male, Probability, Surveys and Questionnaires, Sex Factors, Students, Medical, Time Factors
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