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The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School

Hojat, Mohammadreza PhD; Vergare, Michael J. MD; Maxwell, Kaye; Brainard, George PhD; Herrine, Steven K. MD; Isenberg, Gerald A. MD; Veloski, Jon MS; Gonnella, Joseph S. MD

doi: 10.1097/ACM.0b013e3181b17e55
Empathy

Purpose: This longitudinal study was designed to examine changes in medical students’ empathy during medical school and to determine when the most significant changes occur.

Method: Four hundred fifty-six students who entered Jefferson Medical College in 2002 (n = 227) and 2004 (n = 229) completed the Jefferson Scale of Physician Empathy at five different times: at entry into medical school on orientation day and subsequently at the end of each academic year. Statistical analyses were performed for the entire cohort, as well as for the “matched” cohort (participants who identified themselves at all five test administrations) and the “unmatched” cohort (participants who did not identify themselves in all five test administrations).

Results: Statistical analyses showed that empathy scores did not change significantly during the first two years of medical school. However, a significant decline in empathy scores was observed at the end of the third year which persisted until graduation. Findings were similar for the matched cohort (n = 121) and for the rest of the sample (unmatched cohort, n = 335). Patterns of decline in empathy scores were similar for men and women and across specialties.

Conclusions: It is concluded that a significant decline in empathy occurs during the third year of medical school. It is ironic that the erosion of empathy occurs during a time when the curriculum is shifting toward patient-care activities; this is when empathy is most essential. Implications for retaining and enhancing empathy are discussed.

Dr. Hojat is research professor of psychiatry and human behavior, Department of Psychiatry and Human Behavior, and director, Jefferson Longitudinal Study of Medical Education, Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pennsylvania.

Dr. Vergare is senior vice president for academic affairs and The Daniel Lieberman Professor and Chairman, Department of Psychiatry and Human Behavior, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.

Ms. Maxwell is manager of testing services, Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pennsylvania.

Dr. Brainard is professor of neurology and director, Light Research Program, Jefferson Medical College, Philadelphia, Pennsylvania.

Dr. Herrine is professor of medicine, Division of Gastroenterology and Hepatology, and assistant dean for academic affairs, Jefferson Medical College, Philadelphia, Pennsylvania.

Dr. Isenberg is associate professor of surgery and director of undergraduate education, Department of Surgery, Program Director for Colorectal Residency, Jefferson Medical College, Philadelphia, Pennsylvania.

Mr. Veloski is director, Medical Education Division, Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pennsylvania.

Dr. Gonnella is dean emeritus, Distinguished Professor of Medicine, and founder and director, Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pennsylvania.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Hojat, Jefferson Medical College, 1025 Walnut Street, Suite 119, Philadelphia, PA 19107-5083; telephone: (215) 955-9549, fax: (215) 923-6939, e-mail: (Mohammadreza.Hojat@Jefferson.edu).

Editor’s Note: Commentaries on this article appear on pages 1174 and 1177.

© 2009 Association of American Medical Colleges