Table 1 Results
Title | Author, year published | Country | Study objective | Study design | Sample size (response rate) | Scales1 | Results | Comments on study quality |
|---|---|---|---|---|---|---|---|---|
A latent growth model suggests that empathy of medical students does not decline over time [32] | Costa et al. 2013 [32] | Portugal | Investigate empathy throughout medical school | Longitudinal | 77 | JSPE-S NEO-Five-Factor Inventory | - Non-significant positive evolution in empathy scores across three time points in Portuguese undergraduate medical students that cover the preclinical/clinical transmission - A significant decline in empathy was found in females in the transition period from pre-clinical to the clinical phase of education | - Single-institution survey - Small sample size |
A Quantitative Study of Empathy in Pakistani Medical Students: A Multicentered Approach [33] | Tariq et al. 2017 [33] | Pakistan | Investigate empathy among medical students in the context of patient care | Cross-sectional | 1453 | JSPE-S | - A statistically significant difference in JSPE scores for the 5 medical year groups - No significant difference in the JSPE scores for males and females - No significant difference in the JSPE scores across specialty preference | - Multi-center survey - Response rate unspecified |
An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean [34] | Youssef et al. 2014 [34] | Trinidad &Tobago | Investigate the empathy profile across all five years of training in a medical school | Cross-sectional | 667 (67%) | JSPE-STEQ RMET | - Highest scores were observed when students enter medical school and the lowest scores among third-year students - Female mean scores were significantly higher than male - No significant effects of ethnicity or specialisation | - Single-institution survey - Highest response rate at year one |
Characterizing changes in student empathy throughout medical school [35] | Chen et al. 2012 [35] | USA | Investigate long-term trajectories of empathy among medical students | Longitudinal | 1162 (81%) | JSPE-S | - Empathy levels increased from the beginning of medical school until the end of preclinical years, followed by a decline in the third year of medical school that persisted throughout graduation - Females showed significantly higher empathy levels than males | - Single-institution survey - Varying response rate (54–99%) |
Clinical empathy in medical students in India measured using the Jefferson Scale of Empathy–Student Version [36] | Chatterjee et al. 2017 | India | Investigate clinical empathy and the various associated factors in medical students spanning 4 years of undergraduate study | Cross-sectional | 418 (69.7%) | JSPE-S | - Mean empathy scores fell from the first to the third semester, then more or less plateaued, and then rose again in the seventh semester - Females having significantly higher empathy scores than males | - Single-institution survey |
Comparative cross-sectional study of empathy among first year and final year medical students in Jimma University, Ethiopia: Steady state of the heart and opening of the eyes [37] | Dehning, S. et al. 2012 | Ethiopia | Investigate whether empathy increases with medical training and identify the socio-demographic background of medical students influencing their empathy levels | Cross-sectional | 237 | BEES RMET | - No significant difference in emotional empathy between first-year and final year medical students - Higher cognitive empathy among final year students as compared to first-year students - Males scored lower mean cognitive and emotional empathy scores than females | - Single-institution survey - No response rate - Instruments not validated |
Comparing a Self-Administered Measure of Empathy with Observed Behaviour Among Medical Students [38] | Chen et al. 2010 | USA | Investigate the relationship between self-administered, JSPE-S, and observed empathy | Longitudinal | 2nd year: 163 (97.6%) 3rd year: 159 (98.1%) | JSPE-SOSCE-evaluation | - Second-year students had higher JSPE-scores compared to third-year students, but the average observed empathy score for second-year students was lower than the observed empathy scores for third-year students - A trend towards a decline in measured empathy with increased clinical training with a self-administered instrument, but an improvement in observed empathy among those clinically experienced (i.e. third-year-students) | - Single-institution survey - A small number of OSCE participants |
Comparison of empathy score among medical students in both basic and clinical levels [21] | Khademalhosseini et al. 2014 | Iran | Investigate and compare the empathy scores of medical students between basic sciences and clinical levels | Cross-sectional | 260 | JSPE-S | - Empathy scores among medical students decreased by the increase in their educational years - Females had higher mean empathy students than males | - Single-institution survey - Response rate unspecified |
Comparison of Empathy Skills and Conflict Tendency in Preclinical and Clinical Phase Turkish Medical Students: a Cross-Sectional Study [23] | Atay et al. 2014 | Turkey | Investigate the differences and relations of empathy and conflict tendencies of medical students in preclinical and clinical phase | Cross-sectional | 186 (55%) | Empathic Skill Scale B Form Conflict Tendency Scale | - A significantly higher score of empathy skills in last year medical students as compared to first-year and fourth-year students - No significant differences in empathy skill scores among males and females | - Single-institution survey - Low response rate |
Cross sectional assessment of empathy among undergraduates from a medical college [39] | Shashikumar et al. 2014 | India | Investigate empathy among medical students of various years | Cross-sectional | 488 (75%) | JSPE-S | - Empathy declines during medical school, but only significant when comparing first-year and seventh-year - Significantly higher empathy score in females compared to males - No significant differences in empathy scores among different groups of specialty preferences | - Single-institution survey - A low number of responders in 7th semester |
Decline of empathy among medical students: Dehumanization or useful coping process? [40] | Triffaux et al. 2019 | Belgium | Investigate empathy decline among Belgian medical students across the different years of education and compare the level of empathy with commercial students | Cross-sectional | 1353 medical students and 249 commercial students | The Basic Empathy Scale | - A significant decline in empathy scores among medical students - Significantly higher empathy scores among females in comparison with males - Significant higher empathy scores on all aspects of empathy for medical students compared to commercial students | - Single-institution survey - Unspecified response-rate |
Empathic orientation among medical students from three universities in Barranquilla, Colombia and one university in the Dominican Republic [41] | Diaz Narvaez et al. 2014 | Colombia The Dominican Republic | Investigate and compare empathic orientation in medical students from four universities | Cross-sectional | Universidad del Norte: n = 345 (40.16%) Universidad San Martín, n = 283 (57.4%) Universidad Libre, n = 695 (61.56%). Universidad Central del Este, n = 515 (60.38%) | JSPE-S | - Empathy values reduced as courses advanced in all schools analysed - No differences between genders | - Multi-center survey - Lack of consistency between text and table presentation of results |
Empathy among undergraduate medical students: A multi-centre cross-sectional comparison of students beginning and approaching the end of their course [42] | Quince et al. 2016 | United Kingdom (UK) New Zealand (NZ) | Investigate empathy among students at the beginning and end of undergraduate medical training in multiple medical schools | Cross-sectional | 1139 UK: 1st/2nd year: 652 (54.9%) Final year: 487 (48.1) NZ 1st year: 721 (24%) Final year: 476 (15.2%) | JSPE-SIRI | - No significant differences in empathy scores between students starting and approaching the end of their course - Females had significantly higher empathy scores than males | - Multi-center survey - A low response rate in NZ final year |
Empathy differences by gender and specialty preference in medical students: a study in Brazil [43] | Santos et al. 2016 | Brazil | Investigate medical students’ empathy and to examine empathy differences by students’ socio-demographic characteristics, including gender, and specialty preference | Cross-sectional | 226 (70.6%) | JSPE-S | - Consistently high scores of empathy in medical students enrolled in all levels of training - Higher empathy scores in females and students who intend to pursue people-oriented specialties | - Single-institution survey |
Empathy in Chinese medical students: psychometric characteristics and differences by gender and year of medical education [44] | Wen et al. 2013 | China | Investigate the psychometric properties of the JSPE-S among a sample of Chinese medical students and investigate the primary levels of empathy of the medical students and analyse group differences | Cross-sectional | 753 (83.5%) | JSPE-S | - Statistically significant differences in empathy scores among medical students in different years of medical school. The first-year students had the lowest empathy scores and the fourth-year students had the highest empathy scores. - Significant higher empathy scores among females | - Single-institution survey - Applied mean data as a substitution for missing data |
Empathy in Chinese eight-year medical program students: differences by school year, educational stage, and future career preference [45] | Li et al. 2018 | China | Investigate the factor structure of a Chinese version of the JSPE-S with Chinese students, as well as to assess the differences in empathy scores | Cross-sectional | 442 (83%) | JSPE-S | - A statistically significant difference in the mean JSPE-S scores in different school years. There was a difference between fifth- and sixth-year students (109.1 vs. 101.2). The seventh-year students had significant differences in empathy scores when compared to the first-year students (99.5 vs.107.6) and seventh-year students differed from fifth-year students (99.5 vs. 109.1) - No significant differences in empathy scores among females and males - A statistically significant difference in empathy mean score according to future career preference. Students who preferred not to become doctors had lower empathy than those who did prefer to become doctors | - Single-institution survey - Participants among the top level of medical students in China |
Empathy in Iranian medical students: A comparison by age, gender, academic performance and specialty preferences [46] | Benabbas et al. 2016 | Iran | Investigate self-reported empathy and its alteration during medical school in Iranian medical students | Cross-sectional | 459 (91.8%) | JSPE-S | - The mean score of empathy among interns was significantly lower than both trainees and preclinical students - No statistically significant differences in empathy scores between genders - Empathy score was not related to specialty choice | - Single-institution survey |
Empathy in Iranian medical students: Measurement model of the Jefferson Scale of Empathy [47] | Shariat et al. 2013 | Iran | Investigate empathy in Iranian medical students, as well as to determine the measurement model and psychometric properties of JSE in Iranian students | Cross-sectional | 1187 (76.7%) | JSPE-S | - Significant decreasing linear trend in the score of empathy with increasing years of education - Females outscored male students in empathy - JSPE-S showed acceptable internal consistency and re-test reliability | - Multi-institution survey - Variable response rates at different universities |
Empathy in Korean medical students: Findings from a nationwide survey [48] | Park et al. 2015 | Korea | Investigate empathy scores of medical students throughout the country | Cross-sectional | 5521 (39%) | JSPE-S | - Lower empathy score in males, those in higher grades, and among undergraduate students | - Multi-center survey - Low response rate |
Empathy in senior year and first year medical students: a cross-sectional study [27] | Magalhães et al. 2011 | Portugal | Investigate the differences in empathy scores between first-year and senior students, between genders, and between specialty preferences | Cross-sectional | 476 (92%) | JSPE-S | - Sixth-year students had higher empathy scores than first-year medical students - Females had higher empathy scores than males - No significant difference in empathy scores among different speciality preferences | - Single-institution survey |
Empathy in UK medical students: differences by gender, medical year and specialty interest [49] | Tavakol et al. 2011 | United Kingdom | Investigate the relationship between undergraduate medical students’ empathy scores | Cross-sectional | 853 (68.2%) | JSPE-S | - There was no significant difference between the mean empathy scores across year groups - Females scored significantly higher empathy scores on the JSPE-S - Medical students choosing people-orientated specialties were more empathic than students choosing technology-orientated specialties | - Single-institution survey - Missing data were replaced with the mean of all values |
Empathy score among medical students in Mashhad, Iran: study of the Jefferson Scale of Physician [50] | Rezayat et al. 2018 | Iran | Investigate psychometric characteristics of the JSPE scale among medical students in Mashhad, Iran | Cross-sectional | 640 | JSPE-S | - Empathy score among medical students decreased when their educational years increased - Higher empathy scores in females than in male students - The overall rate of empathy in basic sciences period was more than in the clinical period - Empathy decreased with increasing age | - Single-Institution survey. - No response rate - Selection bias due to exclusion criteria |
Erosion of empathy during medical training by gender. A cross-sectional study [51] | Calzadilla-Núñez et al. 2017 | Colombia Ecuador | Investigate whether empathic erosion is a general phenomenon in the schools of medicine included in the study and its relation to gender | Cross-sectional | University 1: 278 (98%) University 2: 756 (77.86%) | JSPE-S | - There are no general patterns of how overall empathy and its components behave over school years - Males and females do not have the same empathic response | - Multi-center survey - Some educational years have small sample sizes - No assessment of statistical significance |
How well do medical students rate and communicate clinical empathy? [52] | Lim et al. 2013 | New Zealand | Investigate the teaching, learning and communication skills of clinical empathy in New Zealand medical students; in particular to determine if there is a similar decline during training in that country, and how well students, peers, and tutors recognise good skills and communication of empathy | Longitudinal | 72 | JSPE-S= BECCI | - Self-reported empathy declines during undergraduate medical training - No significant gender difference in self-reported empathy scores was observed | - Single-institution survey |
Level of Empathy among Medical Students in Kuwait University [53] | Hasan et al. 2013 | Kuwait | Investigate the level of empathy among medical students at various years of study and other factors | Cross-sectional | 264 (56%) | JSPE-SZKPQ-50-CCPSS-10 | - Increasing empathy level with the academic year, which peaked in the 4th-year, followed by a slight drop in subsequent years - A higher level of empathy among females - The desired specialty was not significantly associated with levels of empathy | - Single-institution survey - A non-validated Arabic version of empathy scales |
Maintaining empathy in medical school: It is possible [24] | Hegazi et al. 2013 | Australia | Investigate levels of empathy in University of Western Sydney (UWS) Medical School students across the different years of undergraduate medical education | Cross-sectional | 404 (69.78%) | JSPE-S | - No significant difference in empathy scores in relation to the year of the medical course - Gender difference in levels of empathy, favouring females | - Single-institution survey. |
Malaysian Medical Students’ self-reported Empathy: A cross-sectional Comparative Study [54] | Williams et al. 2015 | Malaysia | Investigate empathy levels between first-year and second-year medical students | Cross-sectional | 1st year: 122 (100%) 2nd year: 71 (70%) | JSPE-S | - Self-reported empathy levels declined significantly from first-year to second-year - No significant differences in empathy scores between genders | - Single-institution survey |
Rethinking empathy decline: results from an OSCE [28] | Teng et al. 2017 | USA | Investigate observed empathy among medical students in different clerkship years using an OSCE | Cross-sectional | 129 | MPCC | - Found a possible trend towards higher MPCC among students in their second clerkship year compared with students in their first-year (p = 0.09), which became more significant when adjusting for outliers (p = 0.05) - There was no difference in performance by gender. - Students who intended to pursue a “people-orientated” specialty score higher in handling the patient’s frustration | - Single-institution survey - Small sample size |
Stability of empathy among undergraduate medical students: A longitudinal study at one UK medical school [55] | Quince et al. 2011 | United Kingdom | Investigate the following questions: 1. Do men and women medical students differ in empathy? 2. Does empathy change amongst men and women over time? | Longitudinal | 1653 | IRI | - Compared to females, males recorded lower levels of affective empathy throughout their course and lower levels of cognitive empathy for part of their medical course - Male’s affective empathy declined slightly across the course overall, while female’s affective empathy showed no change. Neither male nor female showed any change in cognitive empathy during the course | - Single-institution survey |
The complexity of empathy during medical school training: Evidence for positive changes [56] | Smith et al. 2017 | USA | Investigate multiple facets of empathy | Longitudinal | 122 | JSPE-SQCAE | - JSPE-S empathy scores decreased throughout training - Students exhibited an increase in QCAE total score over time - Females exhibited higher levels of self-reported empathy | - Single-institution survey - Small sample-size |