The Complexity of Empathy During Medical School Training: Evidence for Positive Changes

Context: Empathy is an essential aspect of clinical care, associated with improved patient satisfaction, increased adherence to treatment, and fewer malpractice complaints. Previous studies suggest that empathy declines during medical training. However, past research relied on a single narrowly operationalised, self-report measure of empathy. As empathy is a complex socio-emotional construct, it is critical to assess changes across its distinct components using multiple measures in order to better understand how it is influenced by medical training.

Methods: In a longitudinal study, medical students completed a series of self-report and behavioural measures twice per year during the first 3 years of their study (2012-2015). These included the previously used Jefferson Scale of Physician Empathy (JSPE), designed to assess empathy in the clinical context, the Questionnaire of Cognitive and Affective Empathy (QCAE), designed to assess overall empathy and its main components, and behavioural measures of sensitivity to others' pain and understanding of others' emotions, both of which are important aspects of empathy. The employment of multiple measures allowed for a more complete assessment of medical students' empathy and related processes.

Results: In reflection of findings in previous work, students' empathy assessed by the JSPE decreased over training. However, on the QCAE, aspects of students' empathy, specifically overall cognitive empathy and its subcomponent perspective taking, and the emotion contagion subcomponent of affective empathy improved, whereas the remaining subcomponents remained stable. During medical school, students also exhibited comparable growth in their understanding of others' emotions and increased sensitivity to others' pain.

Conclusions: Changes in empathy during medical school cannot be simply characterised as representing an overall decline. Indeed, aspects of empathy thought to be valuable in positive physician-patient interactions improve during training. Overall, this study points to the importance of assessing the distinct components of empathy using multiple forms of measurement in order to better understand the mechanisms involved in empathy changes in medical practice.