Dangerous decline in empathy found in US medical schools

US medical school students lose empathy with others as they progress through their training, raising major long-term concerns for the quality of patient care, an unprecedented nationwide comparative study has found.

The study, covering more than 16,000 students at 41 US medical schools, showed that the drop in empathy was especially pronounced as students reached the point where they actually began interacting with patients.

The findings are a clear warning that medical schools must do a much better job of teaching empathy and screening out applicants who show a low likelihood of developing it, said the study’s lead author, Mohammadreza Hojat of Thomas Jefferson University in Philadelphia.

“It’s better to admit the students who have a kind of potential for empathic engagement, as opposed to those who have less potential,” said Professor Hojat, a research professor of psychiatry and human behaviour. “You can teach them, but it’s like you are just teaching a deaf student – they cannot hear it.”

Nearly 20 years ago, Professor Hojat led the development of the Jefferson Scale of Empathy, a 20-question survey that is now used in 85 countries and 57 languages for assessing the “orientation toward empathic engagement” of medical doctors and students.

The JSE is typically used by institutions to track the changes in empathy among their own students or to compare themselves with other institutions. It weighs factors such as a person’s interest in reading non-medical literature as proxies for measuring the capacity to understand human pain and suffering.

In the study published on 25 July in The Journal of the American Osteopathic Association, Professor Hojat and his team compiled 16,149 test results from the 41 osteopathic medical schools to create their first broad table for nationwide comparisons.

Key findings, the team reported, included numerical confirmation of more anecdotal indications that students regress on measures of human empathy as their medical coursework prioritises scientific and technical skills.

That decline is sharpest in the third year of study, when students begin the clinical phase of their medical education, Professor Hojat said.

US medical schools, however, are simply failing to pay enough attention to that problem, he said. That is despite years of studies showing that physicians with high levels of empathy achieve higher patient satisfaction and better medical outcomes, he said.

Empathy towards patients – shown in behaviours such as speaking to them with sympathy and concern – can be taught and enhanced in medical schools, but few if any schools make sufficiently serious attempts, Professor Hojat said.

“I would like this to be part of formal medical education, meaning that all medical schools, in addition to having courses, for example, in physiology or anatomy, have classes in empathic relationships or clinical empathy,” he said “As far as I know, there is no such school.”

The scale of the problem requires medical schools to simply reject applicants who show too little potential for improvement in empathetic treatment, Professor Hojat said. “The intention is to graduate physicians who can take care of patients, not to graduate physicians who can pass examinations,” he said.

US medical schools are aware of the problem and already have taken important steps to include such considerations in their admissions processes, said John Prescott, chief academic officer at the Association of American Medical Colleges.

The AAMC changed the Medical College Admission Test in 2015 to evaluate future doctors on their knowledge of cultural and social differences, and on factors that influence communication and behaviour, Dr Prescott said. The association plans to continue studying ways of making more improvements in that area, he added.

The new nationwide comparison of JSE test results affirmed the long-standing social recognition that women generally fare better than men on measures of empathy, Professor Hojat said. The comparison also found significant race-based differences, which he said he would detail in future publications.

paul.basken@timeshighereducation.com