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Is There Hardening of the Heart During Medical School?

Newton, Bruce W. PhD; Barber, Laurie MD; Clardy, James MD; Cleveland, Elton MD; O'Sullivan, Patricia EdD

doi: 10.1097/ACM.0b013e3181637837
Physician–Patient Relationship

Purpose To determine whether vicarious empathy (i.e., to have a visceral empathic response, versus role-playing empathy) decreases, and whether students choosing specialties with greater patient contact maintain vicarious empathy better than do students choosing specialties with less patient contact.

Method The Balanced Emotional Empathy Scale was administered at the beginning of each academic year at the University of Arkansas for Medical Sciences for four classes, 2001–2004. Students also reported their gender and specialty choice. Specialty choice was classified as core (internal medicine, family medicine, obstetrics–gynecology, pediatrics, and psychiatry) or noncore (all other specialties).

Results Vicarious empathy significantly decreased during medical education (P < .001), especially after the first and third years. Students choosing core careers had higher empathy than did those choosing noncore careers. Men choosing core careers initially had empathy exceeding population norms, but their empathy fell to be comparable with that of norms by the end of their third year. The empathy of men choosing noncore careers was comparable with that of norms. Women choosing core careers had empathy scores comparable with those of norms, but the scores of women choosing noncore careers fell below those of the norms by their second year.

Conclusions The findings suggest that undergraduate medical education may be a major determinant differentially affecting the vicarious empathy of students on the basis of gender and/or specialty choice. The greatest impact occurred in men who chose noncore specialties. The significant decrease in vicarious empathy is of concern, because empathy is crucial for a successful physician–patient relationship.

Dr. Newton is associate professor of neurobiology and developmental sciences, and associate dean for undergraduate medical education, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Dr. Barber is professor of ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Dr. Clardy is professor of psychiatry, and associate dean for graduate medical education, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Dr. Cleveland is associate professor of family medicine and pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Dr. O'Sullivan is professor of medicine, and associate director of educational research, University of California at San Francisco, San Francisco, California.

Correspondence should be addressed to Dr. Newton, College of Medicine, Academic Affairs, #603, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205; telephone: (501) 686-7407; fax: (501) 686-8160; e-mail: (newtonbrucew@uams.edu).

© 2008 Association of American Medical Colleges