Undergraduate medical students’ empathy: Current perspectives

Advances in Medical Education and Practice

Volumn 7, Issue , 2016, Pages 443-455

  Quince, Thelma ^a   Thiemann, Pia ^a   Benson, John ^a   Hyde, Sarah ^a  

^a UNIVERSITY OF CAMBRIDGE   (United Kingdom)

Author keywords

Davis s Interpersonal Reactivity Index; Jefferson Scale of Empathy Student Version; Undergraduate medical students empathy

Indexed keywords

EID: 85020592332     PISSN: None     EISSN: 11797258     Source Type: Journal    
DOI: 10.2147/AMEP.S76800     Document Type: Review

References (122)

1. Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary. http://webarchive.nationalarchives.gov. uk/20150407084003/http://www.midstaffspublicinquiry.com/report. Accessed March 10, 2015.
2. Thom DH. Physician behaviors that predict patient trust. J Fam Pract. 2001;50(4):323–328.
3. Krupat E, Bell RA, Kravitz RL, Thom D, Azari R. When physicians and patients think alike: patient-centred beliefs and their impact on satisfaction and trust. J Fam Pract. 2001;50(12):1057–1062.
4. Reiss HT, Clark MS, Pereira Gray DJ, et al. Measuring the responsiveness in the therapeutic relationship: a patient perspective. Basic Appl Soc Psychol. 2008;30(4):339–348.
5. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27(3): 237–251.
6. Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63(606): e76–e84.
7. Zachariae R, Pedersen CG, Jensen AB, et al. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br J Cancer. 2003;88(5):658–665.
8. Bandura A. Self-efficacy – The Exercise of Control. New York: Freeman and Company; 1997.
9. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331–342.
10. Del Canale S, Louis DZ, Maio V, et al. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med. 2012;87(9):1243–1249.
11. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359–364.
12. Rakel D, Barrett B, Zhang Z, et al. Perception of empathy in the therapeutic encounter: effects on the common cold. Patient Educ Couns. 2011;85(3):390–397.
13. Neumann M, Wirtz M, Bollschweiler E, et al. Determinants and patient-reported long-term outcomes of physician empathy in oncol-ogy: a structural equation modelling approach. Patient Educ Couns. 2007;69(1–3):63–75.
14. Price S, Mercer SW, MacPherson H. Practitioner empathy, patient enablement and health outcomes: a prospective study of acupuncture patients. Patient Educ Couns. 2006;63(1–2):239–245.
15. Gleichgerrcht E, Decety J. The relationship between different facets of empathy, pain perception and compassion fatigue among physicians. Front Behav Neurosci. 2014;8:243.
16. Larson EB, Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA. 2005;293(9):1100–1106.
17. Coulehan JL, Platt FW, Egener B, et al. “Let me see if I have this right… ”: words that help build empathy. Ann Intern Med. 2001;135(3):221–227.
18. Beckman HB, Frankel RM. Training practitioners to communicate effectively in cancer care: it is the relationship that counts. Patient Educ Couns. 2003;50(1):85–89.
19. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000;284(8):1021–1027.
20. Skinner C, Spurgeon P. Valuing empathy and emotional intelligence in health leadership: a study of empathy, leadership behavior and outcome effectiveness. Health Serv Manage Res. 2005;18(1):1–12.
21. Neumann M, Bensing J, Mercer S, et al. Analysing the “nature” and “specific effectiveness” of clinical empathy: a theoretical overview and contribution towards a theory based research agenda. Patient Educ Couns. 2009;74(3):339–346.
22. Pedersen R. Empirical research on empathy in medicine-a critical review. Patient Educ Couns. 2009;76(3):307–322.
23. Hemmerdinger J, Stoddart SD, Lilford RJ. A systematic review of tests of empathy in medicine. BMC Med Educ. 2007;7:24.
24. Baron-Cohen S. Zero Degrees of Empathy. London, UK: Penguin; 2011.
25. Posick C, Rocque M, Rafter N. More than a feeling: integrating empathy into the study of lawmaking, lawbreaking, and reactions to lawbreaking. Int J Offender Ther Comp Criminol. 2014;58(1):5–26.
26. Halpern J. From idealized clinical empathy to empathetic communication in medical care. Med Health Care Philos. 2014;17(2):301–311.
27. Mercer SW, Reynolds WJ. Empathy and the quality of care. Br J Gen Pract. 2002:52 (Suppl):S9–S13.
28. Lamm C, Batson CD, Decety J. The neural substrate of human empathy: effects of perspective taking and cognitive appraisal. J Cogn Neurosci. 2007;19(1):42–58.
29. Wang Q, Zhang Z, Dong F, et al. Anterior insula GABA levels corre-late with emotional aspects of empathy: a proton magnetic resonance spectroscopy study. PLoS One. 2014;9(11):e113845.
30. van Langen MAM, Wissink IB, van Vugt ES, Van der Stouwe T, Stams GJJM. The relation between empathy and offending: a meta-analysis. Aggress Violent Behav. 2014;19(2):179–189.
31. van Noorden TH, Haselager GJ, Cillessen AH, Bukowski WM. Empathy and involvement in bullying in children and adolescents: a systematic review. J Youth Adolesc. 2014;44(3):637–657.
32. Barth J, Lannen P. Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis. Ann Oncol. 2011;22(5):1030–1040.
33. Jackson PL, Meltzoff AN, Decety J. How do we perceive the pain of others? A window into the neural processes involved in empathy. Neuroimage. 2005;24(3):771–779.
34. Benson J, Quince T, Hibble A, Fanshawe T, Emery J. The impact on patients of expanded, general practice based, student teaching: obser-vational and qualitative study. BMJ. 2005;331(7508):89.
35. Silvester J, Patterson F, Koczwara A, Ferguson E. “Trust me ….” Psychological and behavioral predictors of perceived physician empathy. J Appl Psychol. 2007;92(2):519–527.
36. O’Connor K, King R, Malone KM, Guerandel A. Clinical examiners, simulated patients and student self-assessed empathy in medical students during a psychiatry Objective Structured Clinical Examination. Acad Psychiatry. 2014;38(4):451–457.
37. Berg K, Blatt B, Lopreiato J, et al. Standardised patients’ assessment of medical student empathy: ethnicity and gender in a multi-institutional study. Acad Med. 2015;90(1):105–111.
38. Berg K, Majden JF, Berg D, Veloski J, Hojat M. Medical students self-reported empathy and simulated patients’assessment of student empathy: an analysis by gender and ethnicity. Acad Med. 2011;86(8):984–988.
39. Schweller M, Costa FO, Antônio MA, Amaral EM, De Carvalho-Filho MA. The impact of simulated medical consultations on empathy levels of students at one medical school. Acad Med. 2014;89(4):632–637.
40. Johnston JL, Lundy G, McCullough M, Gormley GJ. The view from over there: reframing the OSCE through the experience of standardised patient rates. Med Educ. 2013;47(9):899–909.
41. Ogle J, Bushnell JA, Caputi A. Empathy is related to clinical competence in medical care. Med Educ. 2013;47(8):824–831.
42. Lee J, Zaki J, Harvey PO, Ochsner K, Green MF. Schizophrenia patients are impaired in empathetic accuracy. Psychol Med. 2011;41(11):2297–2304.
43. Hojat M. Empathy in Patient Care: Antecedents, Development, Mea-surement, and Outcomes. Philadelphia: Springer; 2007 (Chapter 7).
44. Fields SK, Mahan P, Tillman P, Harris J, Maxwell K, Hojat M. Measuring empathy in healthcare profession students using the Jefferson Scale of Physician Empathy: healthcare provider – student version. J Interprof Care. 2011;25(4):287–293.
45. Ward J, Schaal M, Sullivan J, et al. Reliability and validity of the Jefferson Scales of Physician Empathy in undergraduate nursing students. J Nurs Meas. 2009;17(1):73–88.
46. Shashikumar R, Chaudhary R, Ryali VS, et al. Cross sectional assessment of empathy among undergraduates from a medical college. Med J Armed Forces India. 2014;70(2):179–185.
47. Shariat SV, Habibi M. Empathy in Iranian medical students: measurement model of the Jefferson Scale of Empathy. Med Teach. 2013; 35(1):e913–e918.
48. Park KH, Roh H, Sun DH, Hojat M. Empathy in Korean medical students: findings from a nationwide survey. Med Teach. 2015;37(10): 943–948.
49. Davis MH. A multidimensional approach to individual differences in empathy. JSAS Catalog Selected Documents Psychol. 1980;10:85.
50. Davis MH. Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol. 1983;44(1): 113–126.
51. Lehmann A, Bahcesular K, Brockmann EM, et al. Subjective experience of emotions and emotional empathy in paranoid schizophrenia. Psychiatry Res. 2014;220(3):825–833.
52. Narme P, Mouras H, Roussel M, Duru C, Krystowiak P, Godefroy O. Emotional and cognitive social processes are impaired in Parkinson’s disease and are related to behavioral disorders. Neuropsychology. 2013;27(2):182–192.
53. Schaffer M, Clark S, Jeglic EL. The role of empathy and parent-ing style in the development of antisocial behaviors. Crime Delinq. 2009;55(4):586–599.
54. Eberly-Lewis MB, Coetzee TM. Dimensionality in adolescent prosocial tendencies: individual differences in serving others versus serving the self. Pers Individ Dif. 2015;82:1–6.
55. Parton F, Day A. Empathy, intimacy, loneliness and locus of control in child sex offenders: a comparison between familial and non-familial child sexual offenders. J Child Sex Abus. 2002;11(2):41–57.
56. Konrath SH, O’Brien EH, Hsing C. Changes in dispositional empathy in American college students over time: a meta-analysis. Pers Soc Psychol Rev. 2011;15(2):180–198.
57. Costa P, Carvalho-Filho M, Schweller M. et al. Measuring medical students’ empathy: exploring the underlying constructs of and associa-tions between, two widely used self-report instruments in five countries. Acad Med. In press 2016.
58. Hojat M, Gonnella JS. Eleven years of data on the Jefferson Scale of Empathy-Medical Student Version JSE-S: proxy norm data and tentative cut-off scores. Med Princ Pract. 2015;24(4):344–350.
59. Bock EM, Hosser D. Empathy as a predictor of recidivism among young adult offenders. Psychol Crime Law. 2014;20(2):101–115.
60. Haidet P, Daines JE, Paterniti DA, et al. Medical student attitudes towards the doctor-patient relationship. Med Educ. 2002;36(6): 568–574.
61. Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38(9):934–941.
62. Woloschuk P, Harasym PH, Temple W. Attitude change during medical school: a cohort study. Med Educ. 2004;38(5):522–534.
63. Austin EJ, Evans P, Magnus B, O’Hanlon K. A preliminary study of empathy, emotional intelligence and examination performance in MBChB students. Med Educ. 2007;41(7):684–689.
64. Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med. 2007;22(10):1434–1438.
65. Youssef FF, Nunes P, Sa B, Williams S. An exploration of changes in cognitive and emotional empathy among medical students in the Carib-bean. Int J Med Educ. 2014;5:185–192.
66. Magalhães E, Salgueira AP, Costa P, Costa MJ. Empathy in senior year and first year medical students: a cross-sectional study. BMC Med Educ. 2011;11:52.
67. Roh MS, Hahm BJ, Lee DH, et al. 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. 2010;22(3):167–171.
68. Kakaoka HU, Koide N, Ochi K, Hojat M, Gonnella JS. Measurement of empathy among Japanese medical students: psychometrics and score differences by gender and level of medical education. Acad Med. 2009;84(9):1192–1197.
69. Lee BK, Bahn GH, Lee WH, Park JH, Yoon TY, Baek SB. The relationship between empathy medical education system, grades and personality in medical college and medical school. Korean J Med Educ. 2009;21(2):117–124.
70. Rahimi-Madiseh M, Tavakol M, Dennick R, Nasiri J. Empathy in Iranian medical students: a preliminary psychometric analysis and differences by gender and year of medical school. Med Teach. 2010;32(11):e471–e478.
71. Mostafa A, Hogue R, Mostafa M, Rang MM, Mostafa F. Empathy in undergraduate medical students of Bangladesh: psychometrics analysis and differences by gender, academic year and speciality preferences. ISRN Psychiatry. 2014;2014:375–439.
72. Toto RL, Man L, Blatt B, Simmens SJ, Greenberg L. Do empathy, perspective-taking, sense of power and personality differ across undergraduate education and are they inter-related? Adv Health Sci Educ Theory Pract. 2015;20(1):23–31.
73. Bratek A, Bulska W, Bonk M, Seweryn M, Krysta K. Empathy among physicians, medical students and candidates. Psychiatr Danub. 2015;27 (Suppl 1):S48–S52.
74. Paro HB, Silveira PS, Perotta B, et al. Empathy among medical stu-dents: is there a relation with quality of life and burnout? PLoS One. 2014;9(4):e94133.
75. Tavakol S, Dennick R, Tavakol M. Empathy in UK medical students: differences by gender, medical year and specialty interest. Educ Prim Care. 2011;22(5):297–303.
76. Neumann M, Edlehäuser F, Tauschel D, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996–1009.
77. Roff S. Reconsidering the “decline” of medical student empathy as reported in studies using the Jefferson Scale of Physician Empathy-Student version (JSPE-S). Med Teach. 2015:37(8): 783–786.
78. Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83(3):244–249.
79. Williams B, Sadasivan S, Kadirvelu A. Malaysian medical students self-report empathy: a cross-sectional comparative study. Med J Malaysia. 2015;70(2):76–80.
80. Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182–1191.
81. Khademalhosseini M, Khademalhosseini Z, Mahmoodian F. Comparison of empathy among medical students in both basic sciences and clinical levels. J Adv Med Educ Prof. 2014;2(2):88–91.
82. Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach. 2012;34(4):305–311.
83. Quince TA, Parker RA, Wood DF, Benson JA. Stability of empathy among undergraduate medical students: a longitudinal study at one UK medical school. BMC Med Educ. 2011;11:90.
84. Colliver JA, Conlee MJ, Verhulst SJ, Dorsey JK. Reports of the decline of empathy during medical education are greatly exaggerated: a re-examination of the research. Acad Med. 2010;85(4):588–593.
85. Quince TA, Kinnersley P, Hales J, et al. Empathy among undergraduate medical students: A multi-centre cross-sectional comparison of students beginning and approaching the end of their course. BMC Med Educ. 2016;16(1):92.
86. Ze O, Thomas P, Suchan B. Cognitive and affective empathy in younger and older individuals. Aging Ment Health. 2014;18(7):929–935.
87. Myyry L, Juujärvi S, Pesso K. Empathy, perspective taking and personal values as predictors of moral schemas. J Moral Educ. 2010;39(2):213–233.
88. Coulter ID, Wilkes M, Der-Martirosian C. Altruism revisited: a comparison of medical, law and business students’ altruistic attitudes. Med Educ. 2007;41(4):341–345.
89. Blair RJ. Responding to the emotions of others: dissociating forms of empathy through the study of typical and psychiatric populations. Conscious Cogn. 2005;14(4):698–718.
90. van Langen MAM, Wissink IB, van Vugt ES, Van der Stouwe T, Stams GJJM. The relationship between empathy and offending: a meta analy-sis. Aggress Violent Behav. 2014;19(2):179–189.
91. Wilbertz, G, Brakemeier EL, Zobel I, Härter M, Schramm E. Exploring the preoperational features in chronic depression. J Affect Disord. 2010;124(3):262–269.
92. Cusi AM, MacQueen GM, Spreng RN, McKinnon MC. Altered empathetic responding in major depressive disorder: relation to symptom severity, illness burden and psychosocial outcome. Psychiatry Res. 2011;188(2):231–236.
93. Cusi A, MacQueen GM, McKinnon MC. Altered self-report empathetic responding in patients with bi-polar disorder. Psychiatry Res. 2010;178(2):354–358.
94. Hope V, Henderson M. Medical student depression, anxiety and distress outside North America: a systematic review. Med Educ. 2014;48(10):963–979.
95. Dyrbye LN, Thomas MR, Shanafelt TD. A systematic review of depres-sion, anxiety and other indicators of psychological distress among US and Canadian medical students. Acad Med. 2006;81(4): 354–373.
96. Bellini LM, Shea JA. Mood change and empathy decline per-sist during three years of internal medical training. Acad Med. 2005;80(2):164–167.
97. Quince TA, Wood DF, Parker RA, Benson J. Prevalence and persistence of depression among undergraduate medical students: a longitudinal study at one UK medical school. BMJ Open. 2012;2(4):e001519.
98. Brazeau CM, Shanafelt T, Durning SJ, et al. Distress among matricu-lating medical students relative to the general population. Acad Med. 2014;89(11):1520–1525.
99. Dahlin M, Nilsson C, Stotzer E, Runeson B. Mental distress, alcohol use and help-seeking among medical and business students: a cross-sectional comparative study. BMC Med Educ. 2011;11:92.
100. Bassols AM, Okabayashi LS, Silva AB, et al. First and last year medical students: is there a differences in the prevalence and intensity of anxiety and depressive symptoms? Rev Bras Psiquiats. 2014;36(3):233–240.
101. Chibnall JT, Tait RC, Jovel A. Accountability and empathy effects on medical students’ clinical judgments in a disability determination context for low back pain. J Pain. 2014;15(9):915–924.
102. Littlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J, Dornan T. Early practical experience and the social responsiveness of clinical education: systematic review. BMJ. 2005;331(7513): 387–391.
103. Krupat E, Pelletier S, Alexander EK, Hirsh D, Ogur B, Schwartzstein R. Can changes in the principal clinical year prevent the erosion of stu-dents’ patient-centred beliefs? Acad Med. 2009;84(5):582–586.
104. Schweller M, de Jorge B, Santos TM, Grangeia TdeAG, de Carvalho-Filho, MA. Do it again! Medical students achieve higher empathy levels when exposed a simulated training with standardised patients more than once. Poster presented at: AMEE Conference; 2015; Glasgow.
105. Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73(4):403–407.
106. West CP, Shanafelt TD. The influence of personal and environmental factors on professionalism in medical education. BMC Med Educ. 2007;7:29.
107. Caldicott CV, Faber-Langendoen K. Deception, discrimination and fear of reprisal: lessons in ethics from third year medical students. Acad Med. 2005;80(9):866–873.
108. Burgess A, Goulston K, Oates K. Role modelling of clinical tutors a focus group study among medical students. BMC Med Educ. 2015;15:17.
109. Karnieli-Miller O, Vu TR, Frankel RM, et al. Which experiences in the hidden curriculum teach medical students about professionalism? Acad Med. 2011;86(3):369–377.
110. Brown J. How clinical communication has become a core part of medical education in the UK. Med Educ. 2008;42(3):271–278.
111. Stepien KA, Baernstein A. Educating for empathy. J Gen Intern Med. 2006;21(5):524–530.
112. Brown J. Transferring clinical communication skills from the classroom to the clinical environment: perceptions of a group of medical students in the United Kingdom. Acad Med. 2010;85(6):1052–1059.
113. Blatt B, Le Lacheur SF, Galinsky AD, Simmens SJ, Greenberg L. Does perspective taking increase patient satisfaction in medical encounters? Acad Med. 2010;85(9):1445–1452.
114. Fernández-Olano C, Montoya-Fernández J, Salinas-Sánchez AS. Impact of clinical interview training on empathy level of medical students and medical residents. Med Teach. 2008;30(3):322–324.
115. DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79(4):351–356.
116. Lim BT, Moriarty H, Huthwaite M. “Being in role”: a teaching innovation to enhance empathetic communication skills in medical students. Med Teach. 2011;33(12):e663–e669.
117. Mullen K, Nicolson M, Cotton P. Improving medical students’ attitudes towards the chronic sick. BMC Med Educ. 2010;10:84.
118. Batt-Rawden S, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: an updated systematic review. Acad Med. 2013;88(8):1171–1177.
119. de Silva D. No. 18. Measuring Patient Experience. London, UK: The Health Foundation; 2013.
120. Hegazi I, Wilson I. Maintaining empathy in medical school: it is pos-sible. Med Teach. 2013;35(12):1002–1008.
121. Choi D, Nishimura T, Motoi M, EgashiraY, Matsumoto R, Watanuki S. Effect of empathy trait on attention to various facial expressions: evidence from N170 and late positive potential (LPP). J Physiol Anthropol. 2014;33(1):18.
122. Christopher G, McMurran M. Alexithymia, empathic concern, goal management, and social problem solving in adult male prisoners. Psychol Crime Law. 2009;15(8):697–709.