Nationwide Study on Medical Students’ Empathy, at a Time When Empathy Is Needed Most

We’re living in a time when empathy seems more important than ever, with the societal uncertainty prompted by COVID-19.

While not spurred on by patient/doctor relationships as seen through the pandemic’s lens, a nationwide study of empathy in medical students was recently published on the Medical Education journal’s website ahead of its inclusion in print.

The study was led by Dr. Mohammadreza Hojat, research professor in the department of psychiatry and human behavior and director of the Jefferson Longitu­dinal Study at the Asano-Gonnella Center for Research in Medical Education and Health Care.

This week, Dr. Hojat discussed the findings of the study undertaken by the Jefferson team, investigators at the American Association of Colleges and Osteopathic Medicine (AACOM), and the Cleveland Clinic . He noted that reports on empathy in patient care are so important to share “especially in this challenging era of coronavirus.”

What are the study highlights, and how was it conducted?

This is a nationwide, landmark study of 10,751 osteopathic medical students in the United States who completed the survey online in 2018, sponsored by AACOM and the American Osteopathic Association.

We found that women tend to score higher than men on a validated measure of empathy, the Jefferson Scale of Empathy (JSE), and that African-American and Hispanic/Latino/Spanish students were more likely than white and Asian students to score higher on the JSE.

Findings also showed those who planned to pursue people-oriented specialties—internal medicine, family medicine, pediatric and psychiatry—tended to obtain higher JSE scores than others who planned to pursue technology-/procedures-oriented specialties like anesthesiology, pathology, radiology, and surgery.

What do these findings mean in general for the education of physicians-in-training?

These findings allow medical educators to assess and enhance empathy in medical students, residents and practicing physicians.

For example, we have shown, and this study confirmed, that clinical empathy in the context of patient care can be measured by a psychometrically sound instrument (JSE), which can be used to assess professional development of physicians-in-training and in-practice. This instrument can also be employed as a complementary measure for admission decisions of applicants to medical school and residency training programs.

The findings can be used to identify those who may need additional help than others to enhance and sustain their empathic orientation toward patient care. Given limited resources for offering remedial or continuing medical education programs, it is imperative to identify those who can benefit more than others from improving their empathy. Additionally, findings have implications for career counseling and specialty selection.

With the world facing a pandemic, why is empathy in physicians, and in patients and their families toward their healthcare professionals, more important than ever?

Empathy is the backbone of the patient-physician relationship and the heart of the art of patient care. In our previous studies in the U.S. and in Italy, we have shown that physicians who scored higher than other physicians on the JSE rendered better care to their diabetic patients. Therefore, empathy has a significant role in improving patient care.

There is a popular belief that the best in people emerges during the worst time of misery. We are witnessing the heroic and altruistic care rendered by physicians and nurses, depicted frequently in public media, who risk their own lives to save patients in this unprecedented era of the coronavirus pandemic. Their stories will be remembered as lessons for generations of health professionals and will contribute to regaining the compassionate image of doctors and nurses.

Now that they can’t be in their clinicals, how should physicians-in-training and their educators approach learning and teaching the need for empathy from their virtual settings?

The importance of empathy in patient care can be taught by having students study art and literature, read relevant materials, such as conceptual and empirical research on clinical empathy. This does not necessarily require students to assemble in a class, lecture hall or clinic.

Watching relevant video clips of patient-physician/nurse encounters or selected movies or plays on empathic care could be assigned to be watched on electronic media.

However, none of these approaches can fully replace live observations of faculty/attending physician/role model interactions with patients, nor can they be a substitute for live experiences of interacting with patients. I think that the effects of virtual teaching in interpersonal engagement would be similar to that of taking virtual courses in surgery without performing one!