Letters to the Editor
To the Editor:
As one of the authors of “Is there hardening of the heart during medical school?”1 I want to respond to the recent article by Colliver et al2 concerning their interpretation of our empathy study. First, there is a misinterpretation of our data. Colliver and colleagues show that our medical school year 1 (M1) data point reflects changes in freshman year empathy. Our M1 data point is defined as the score on the Balanced Emotional Empathy Scale (BEES)—which we clearly stated measures vicarious versus cognitive empathy—obtained during medical school orientation. Therefore, this is a baseline data point that should be labeled as “pre-MS” (premedical school) in the authors' table. Therefore, our M2–M4 data points should also be shifted left so that they correspond to the MS1–MS3 columns, respectively, in the authors' table.
Colliver et al state we had no response rate. We indicated we reported data only on students who completed the BEES for all four time points. Therefore, the response rate is 419/535 (78%) for every time point and represents a statistically sound sample size. The authors' expectation of a 100% response rate is unobtainable, since students are considered a vulnerable population by IRBs and can't be compelled to participate. We also clearly stated that our nonresponders were not statistically different in any regard from the responders. Therefore, our data were not biased by the nonresponders, as suggested by Colliver et al.
The authors also criticize the lack of validity of self-report inventories. All well-known, validated personality scales (e.g., the BEES) use self-reporting. In addition, the different-sized Likert scales used by the reviewed studies makes suspect the transformation the authors employed to “equalize” data comparisons; well-accepted effect size measures should have been used for comparisons. Ultimately, the issue is not whether the clear drop in vicarious/innate empathy in our longitudinal study is trivial but, rather, how to help ameliorate the loss.
Colliver and colleagues suggest that “etiquette and good manners” are more important traits to patients than empathy. An empirical, reasonable assumption is that those students who better maintain their empathy are those most likely to express etiquette and good manners, and vice versa. Finally, we argue that good physician role models are also empathetic, and if the revealed empathy declines are “trivial,” then there should be an abundance of physician role models who exhibit patience, etiquette, and a good bedside manner.
Bruce W. Newton, PhD
Professor of neurobiology and developmental sciences and educational development, and associate dean for undergraduate medical education, University of Arkansas for Medical Sciences, Little Rock, AR; firstname.lastname@example.org.
1 Newton BW, Barber L, Clardy J, Cleveland E, O'Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83:244–249.
2. Colliver JA, Conlee MJ, Verhulst SJ, Dorsey JK. Reports on the declines of empathy during medical education are greatly exaggerated: A reexamination of the research. Acad Med. 2010;85:588–593.