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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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BackgroundEmpathy and Perceived Stress among College Students
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“A result similar to this was found in a study done by Chen et al., 2007 who found that empathy scores of the students decreased at the end of the third year.”
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Srivastava, A. K., Tiwari, K., Vyas, S., Semwal, J., & Kandpal, S. D. (2017) · Indian Journal of Community Health · doi:10.47203/ijch.2017.v29i03.008 · Cited by 7
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“(10) have revealed that empathy scores of students in the preclinical years are higher than in the clinical years.”
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“Additionally, healthcare medicalization and system-level drivers contribute to empathy erosion and burnout during clinical training [3–5].”
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“Along the same lines, medical students preferring clinical care– oriented specialties have higher empathy scores than students preferring technology-oriented specialties.(37) Greater verbal ability and general fund of knowledge increase physicians’ ability to establish productive patient-physician relationships.”
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“Various factors have been hypothesised to contribute to this, including: a lack of positive senior role models,(3) experiencing being put down by senior colleagues,(4,5) an overemphasis on the technological aspects of care in medical education,(6) and the challenge of sustaining empathy as students face emotionally ch…”
BackgroundHospice Patient Care Goals and Medical Students’ Perceptions: Evidence of a Generation Gap?
Levy, K., Grant, P. C., Kerr, C. W., Byrwa, D. J., & Depner, R. M. (2020) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909120934737 · Cited by 4
“While some research has found nonsignificant or positive change throughout medical school,(51,52) other studies found a decrease in empathy throughout medical school and residency, particularly during the third year.(53,54) The aim of this study is to compare medical student perception of EOL care goals to those of ho…”
ResultLim, E. K. H., Loh, G. J. T., Ong, R. Y., Tan, R. R., Yan, C. C. K., Huang, K. S., Chan, M. Y. C., & Yeung, M. T. L. (2021) · Proceedings of Singapore Healthcare · doi:10.1177/20101058211048581 · Cited by 7
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“Some studies show that women are more empathic among medical students than men [12–16].”
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The Level of Empathy Among Medical Students at the University of Tabuk, Saudi Arabia
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Empathic education in design: Strategies for healthcare practitioners?
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Empathic profile of nursing freshmen
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“Moreover, a better understanding of the patients not only improves healthcare services, but also makes patients feel valued (Chen et al., 2007).”
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Multiple cross-sectional assessments of empathy in medical undergraduate students
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Profiling medical specialties and informing aspiring physicians: a data-driven approach
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“…of various personality dimensions such as “friendly, intimate and helpful” or “nar-cissistic pride”, and has since been used as a framework for other studies investigating how medical students are drawn to certain specialties (Chen et al., 2007; Lepièce et al., 2016 ; Pedersen et al., 2011 ).”
EMPATHIC EDUCATION IN DESIGN: STRATEGIES FOR HEALTHCARE PRACTITIONERS?
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Communication skills and the problem with fake patients
Gillett, G. (2017) · BMJ · doi:10.1136/sbmj.j974 · Cited by 3
Empathy and Components of Empathy in Obstetrics Students
Alburqueque, C. M. A., Yace-Martínez, J., Díaz-Narváez, V. P., Calzadilla‐Núñez, A., Utsman, R., & Reyes‐Reyes, A. (2020) · Redalyc (Universidad Autónoma del Estado de México) · Cited by 3
Steinmair, D., Zervos, K., Wong, G., & Löffler‐Stastka, H. (2022) · World Journal of Psychiatry · doi:10.5498/wjp.v12.i2.333 · Cited by 3
Teamwork in medical education: are medical students team workers?
Boone, A., Roelants, M., Hoppenbrouwers, K., Vandermeulen, C., Bois, M. D., & Godderis, L. (2022) · Safety and Health at Work · doi:10.1016/j.shaw.2021.12.1075 · Cited by 3
Hall, M., Hanna, L., Hanna, A. J., & McDevitt, C. (2015) · Research Portal (Queen's University Belfast) · Cited by 3
Service Learning for Medical Students: Program Development and Students' Reflections.
Yang, S.-H., Shih, C., Liu, C.-H., Peng, H.-T., & Chan, W. P. (2014) · Taipei Medical University Repository · Cited by 3
Direct-Care Staff Perceptions of Patient Engagement and Treatment Planning in Detox
Sharp, A., Brown, B., Shreve, T., Moore, K. A., Carlson, M., & Braughton, D. (2021) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-021-09757-1 · Cited by 4
Chamorro-Plata, D., & Fajardo-Orduña, G. R. (2022) · Ética & cine/Ética & cine · doi:10.31056/2250.5415.v12.n1.37382 · Cited by 3
Changes in Students’ Empathy During Their Training
Jeffrey, D. I. (2019) · Springer eBooks · doi:10.1007/978-3-030-11211-0_8 · Cited by 3
Lombard, M., Poropat, A. E., Alldridge, L. C., & Rogers, G. D. (2018) · MedEdPublish · doi:10.15694/mep.2018.0000282.1 · Cited by 2
Anecdote or Reality: Are People From the South and/or Rural Areas of the USA More Empathetic?
Nguyen, V. P., & Newton, B. W. (2019) · Medical Science Educator · doi:10.1007/s40670-019-00693-6 · Cited by 2
“The Water in Which We Swim:” A Unique, Post-Clerkship Multidisciplinary Course
Laird, J., Garabedian, L. F., Conrad, R. C., Schaffer, A. C., Witkowski, M. L., Mateo, C. M., Jones, D. S., Hundert, E. J., & Kasper, J. Y. (2024) · Journal of Medical Education and Curricular Development · doi:10.1177/23821205241232184 · Cited by 2
Ying, I., Stepita, R., Whyte, S., Seccareccia, D., Beaune, L., Karim, A., & Sirianni, G. (2024) · Medical Science Educator · doi:10.1007/s40670-024-02020-0 · Cited by 2
“Studies in medical education have shown an “erosion of empathy” as medical training progresses, especially from the third year of medical school onward [1–3].”
Emotional Empathy and Its Relationship with Perceived Stress
Salerno, N., & Urquijo, S. (2024) · IntechOpen eBooks · doi:10.5772/intechopen.1004214 · Cited by 3
An Empathy and Arts Curriculum During a Pediatrics Clerkship: Impact on Student Empathy and Behavior
Neeley, M., Acosta, L. M. Y., Davidson, M., & Dewey, C. M. (2024) · MedEdPORTAL · doi:10.15766/mep_2374-8265.11414 · Cited by 2
Habib, H., Niinuma, S. A., Alrefaie, K., Khalaf, H. A. A., Hani, M. J., Al-Rawi, Z. Y. M., Hussain, Z., Menezes, P., Roy, S. R., Mathew, B., et al. (2024) · BMC Medical Education · doi:10.1186/s12909-024-05921-1 · Cited by 3
The Empathy Quandary in Postgraduate Medical Training
Bhagat, P. R., Kinjal, Y. T., & Vijay, R. (2024) · International Journal of Applied and Basic Medical Research · doi:10.4103/ijabmr.ijabmr_288_24 · Cited by 2
Examining the empathy levels of medical students using CHAID analysis
SÖYLEMEZ, N. H. (2025) · BMC Medical Education · doi:10.1186/s12909-025-07296-3 · Cited by 3
“In addition, structured practices such as Balint group discussions, narrative workshops, and mindfulness-based training have been found to improve emotional awareness and strengthen empathic communication [19, 45].”
Karimi, F. Z., Abdollahi, M., & Zarifnejad, G. (2018) · Razavi International Journal of Medicine · doi:10.30483/rijm.2018.35 · Cited by 2
Fennern, E. B., & Sur, M. D. (2022) · Difficult decisions in surgery: an evidence-based approach · doi:10.1007/978-3-030-84625-1_10 · Cited by 2
Does a sense of gratitude protect against empathy loss in medical students? An exploratory study
Vogel, C. E., Kiessling, C., Fischer, M. R., & Graupe, T. (2022) · PubMed Central · doi:10.3205/zma001553 · Cited by 2
“dents seem to experience a significant decline in their empathy skills, especially when they enter the clinical phase [1], [22], [23], [24], [25], [26], [27].”
BackgroundReconsidering Empathy: An Interpersonal Approach and Participatory Arts in the Medical Humanities
Cao, E. L., Blinderman, C. D., & Cross, I. R. M. (2022) · Springer eBooks · doi:10.1007/978-3-031-19227-2_8 · Cited by 2
The Effect of a Storytelling Course on Medical Students' Empathy toward Patients
Yaghmaei, M., Monajemi, A., & Soltani-Arabshahi, K. (2014) · International journal of body, mind and culture · doi:10.22122/ijbmc.v1i2.12 · Cited by 2
Towards promoting and assessing clinical compassion
Burr, S. A., & Leung, Y. L. (2013) · British Journal of Hospital Medicine · doi:10.12968/hmed.2013.74.12.677 · Cited by 2
La empatía y los estudiantes de medicina en la Universidad de Azuay, Ecuador
Pontón, Y. D., Neira, V. A., Muñoz, J. A., Reyes, F. C. M., Vélez‐Calvo, X., & Díaz-Narváez, V. P. (2017) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 2
Attitudes towards patients by undergraduate health students
Boyle, M. J., Williams, B. A., Brown, G. T., McKenna, L., Molloy, E., & Lewis, B. (2010) · Cited by 2
A measurement of empathy among Moroccan medical students
Jaafari, M., Aalouane, R., Aarab, C., & Rammouz, I. (2018) · Nursing and Palliative Care · doi:10.15761/npc.1000188 · Cited by 2
GAMBARAN EMPATI PADA MAHASISWA FAKULTAS KEDOKTERAN UNIVERSITAS SAM RATULANGI ANGKATAN 2010
Warokka, M. C., Pasiak, T. F., & Wongkar, D. (2016) · Jurnal e-Biomedik · doi:10.35790/ebm.4.1.2016.11249 · Cited by 2
A closer look into empathy among medical students: The career eulogy as a lens
Crump, W. J., Fricker, R. S., & Ziegler, C. H. (2021) · Marshall Journal of Medicine · doi:10.33470/2379-9536.1317 · Cited by 2
“5 in an individual question really have any meaning, but these scales are still considered the most quantitative method for measuring empathy.(9-10) As part of ongoing assessment of our professional identity curriculum, we have begun to use an exercise that we term a career eulogy.”
MethodA Longitudinal Measure of Medical Student Empathy at a Regional Campus
Crump, W. J., Ziegler, C. H., & Fricker, R. S. (2021) · Journal of Regional Medical Campuses · doi:10.24926/jrmc.v4i1.3475 · Cited by 3
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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