Data from a recent longitudinal study published in Medical Education suggest that changes in empathy during medical school training are complex and need to be evaluated using multiple forms of measurement. Depending on the scale used, some elements of empathy declined during training, whereas aspects thought to be valuable in positive physician-patient interactions improved.

Empathy plays an important role in the physician-patient relationship and is associated with a number of beneficial outcomes, including increased patient compliance with treatment, decreased malpractice suits, and increased physician health, well-being, and overall career satisfaction. Patient perception of physician empathy is also associated with better patient outcomes.

Despite these benefits, research has revealed a decrease in empathy over the course of medical school training, particularly between students’ second and third years, when clinical training begins. However, more recent research has reported increases in empathy throughout the course of study.

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Most studies that reported negative changes in empathy used the Jefferson Scale of Physician Empathy (JSPE) as their only measure. The JSPE is meant to measure cognitive empathy specifically within the physician-patient interaction. Some suggest these self-reported measures are less reliable than empathy measured behaviorally, and that JSPE findings do not correlate with observer-reported empathy. The Questionnaire of Cognitive and Affective Empathy (QCAE) was developed to address weaknesses in current measurement tools and to assess different components of empathy.

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In the current study, students completed a series of self-report and behavioral measures, including the JSPE and the QCAE, twice per year during the first 3 years of their medical school training.

As assessed by the JSPE, students’ empathy declined over the course of their training. However, results from the QCAE showed improvement in certain aspects of students’ empathy, particularly in overall cognitive empathy and the “perspective taking” and “emotion contagion” subcomponents of affective empathy. Other subcomponents remained stable. Students also improved their understanding of others’ emotions and exhibited increased sensitivity to others’ pain.


Smith KE, Norman GJ, Decety J. The complexity of empathy during medical school training: evidence for positive changes. Medical Educ. 2017;51(11):1146-1159.