Journal of General Internal Medicine

, Volume 22, Issue 10, pp 1434–1438 | Cite as

A Cross-sectional Measurement of Medical Student Empathy

  • Daniel ChenEmail author
  • Robert Lew
  • Warren Hershman
  • Jay Orlander
Original Article



Empathy is important in the physician–patient relationship. Prior studies have suggested that physician empathy may decline with clinical training.


To measure and examine student empathy across medical school years.

Design and Participants

A cross-sectional study of students at Boston University School of Medicine in 2006. Incoming students plus each class near the end of the academic year were surveyed.


The Jefferson Scale of Physician Empathy–Student Version (JSPE-S), a validated 20-item self-administered questionnaire with a total score ranging from 20 to 140. JSPE-S scores were controlled for potential confounders such as gender, age, anticipated financial debt upon graduation, and future career interest.


658 students participated in the study (81.4% of the school population). The first-year medical student class had the highest empathy scores (118.5), whereas the fourth-year class had the lowest empathy scores (106.6). Measured empathy differed between second- and third-year classes (118.2 vs 112.7, P < .001), corresponding to the first year of clinical training. Empathy appears to increase from the incoming to the first-year class (115.5 vs 118.5, P = .02). Students preferring people-oriented specialties had higher empathy scores than students preferring technology-oriented specialties (114.6 vs 111.4, P = .002). Female students were more likely than male students to choose people-oriented specialties (51.5 vs 26.9%, P < .001). Females had higher JSPE-S scores than males (116.5 vs 112.1, P < .001). Age and debt did not affect empathy scores.


Empathy scores of students in the preclinical years were higher than in the clinical years. Efforts are needed to determine whether differences in empathy scores among the classes are cohort effects or represent changes occurring in the course of medical education. Future research is needed to confirm whether clinical training impacts empathy negatively, and, if so, whether interventions can be designed to mitigate this impact.


empathy medical student education physician attitudes 



Permission to use the JSPE-S was obtained from the Jefferson Medical College Center for Research in Medical Education and Health Care. We thank Phyllis Carr, MD, BUSM, for her role in reviewing the manuscript.

Funding sources

None of the authors received any funding support for the study.

Conflict of interest statement

None disclosed.


  1. 1.
    Coulehan JL, Platt FW, Egener B, et al. “Let me see if I have this right...”: words that help build empathy. Ann Intern Med. 2001;135:221–7.PubMedGoogle Scholar
  2. 2.
    Hojat M, Mangione S, Nasca TJ, et al. The Jefferson Scale of Physician Empathy: development and preliminary psychometric data. Educ Psychol Meas. 2001;61:349–65.CrossRefGoogle Scholar
  3. 3.
    Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor–patient relationship and malpractice: lessons from plaintiff depositions. Arch Intern Med. 1994;154:1365–70.PubMedCrossRefGoogle Scholar
  4. 4.
    Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Bikker AP, Mercer SW, Reilly D. A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow Homoeopathic Hospital. J Altern Complement Med. 2005;11:591–600.PubMedCrossRefGoogle Scholar
  6. 6.
    Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27:237–51.PubMedCrossRefGoogle Scholar
  7. 7.
    MacPherson H, Mercer SW, Scullion T, Thomas KJ. Empathy, enablement, and outcome: an exploratory study on acupuncture patients’ perceptions. J Altern Complement Med. 2003;9:869–76.PubMedCrossRefGoogle Scholar
  8. 8.
    Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52(suppl):S9–12.PubMedGoogle Scholar
  9. 9.
    Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26:331–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Suchman AL, Roter D, Green M, Lipkin M. Physician satisfaction with primary care office visits. Collaborative Study Group of the American Academy on Physician and Patient. Med Care. 1993;31:1083–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Mangione S, Kane GC, Caruso JW, Gonnella JS, Nasca TJ, Hojat M. Assessment of empathy in different years of internal medicine training. Med Teach. 2002;24:370–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA 2002;287:3143–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Bellini LM, Shea JA. Mood change and empathy decline persist during three years of internal medicine training. Acad Med. 2005;80:164–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy and burnout among interns. Acad Med. 2006;81:82–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38:934–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Diseker RA, Michielutte R. An analysis of empathy in medical students before and following clinical experience. J Med Educ. 1981;56:1004–10.PubMedGoogle Scholar
  17. 17.
    Hojat M, Gonnella JS, Nasca TJ, Mangione S, Veloksi JJ, Magee M. The Jefferson Scale of Physician Empathy: further psychometric data and differences by gender and specialty at item level. Acad Med. 2002;77(suppl):S58–60.PubMedCrossRefGoogle Scholar
  18. 18.
    Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159:1563–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Hojat M, Gonnella JS, Mangione S, et al. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002;36:522–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Sherman JJ, Cramer A. Measurement of changes in empathy during dental school. J Dent Educ. 2005;69:338–45.PubMedGoogle Scholar
  21. 21.
    Davis MH. Measuring individual differences in empathy; evidence for a multidimensional approach. J Pers Soc Psychol. 1983;44:113–26.CrossRefGoogle Scholar
  22. 22.
    Newton BW, Savidge MA, Barber L, et al. Differences in medical students’ empathy. Acad Med. 2000;75:1215.PubMedCrossRefGoogle Scholar
  23. 23.
    Hojat M, Mangione S, Nasca TJ, Gonnella JS, Magee M. Empathy scores in medical school and ratings of empathic behavior in residency training 3 years later. J Soc Psychol. 2005;145:663–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkships? Acad Med. 2004;79:832–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Kay J. Traumatic deidealization and the future of medicine. JAMA. 1990;263:572–3.PubMedCrossRefGoogle Scholar
  26. 26.
    Kramer D, Ber R, Moore M. Increasing empathy among medical students. Med Educ. 1989;23:168–73.PubMedCrossRefGoogle Scholar
  27. 27.
    Marcus ER. Empathy, humanism, and the professionalization process of medical education. Acad Med. 1999;74:1211–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Anderson R, Schiedermayer D. The art of medicine through the humanities: an overview of a one-month humanities elective for fourth year students. Med Educ. 2003;37:560–2.PubMedCrossRefGoogle Scholar
  29. 29.
    Charon R. Narrative medicine: form, function, and ethics. Ann Intern Med. 2001;134:83–7.PubMedGoogle Scholar
  30. 30.
    Charon R. Narrative and medicine. N Engl J Med. 2004;350:862–4.PubMedCrossRefGoogle Scholar
  31. 31.
    DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79:351–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Hatem D, Ferrara E. Becoming a doctor: fostering humane caregivers through creative writing. Patient Educ Couns. 2001;45:13–22.PubMedCrossRefGoogle Scholar
  33. 33.
    Lichstein PR, Young G. “My most meaningful patient”: reflective learning on a general medicine service. J Gen Intern Med. 1996;11:406–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Shapiro J, Lie D. Using literature to help physician-learners understand and manage “difficult” patients. Acad Med. 2000;75:765–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Feighny KM, Monaco M, Arnold L. Empathy training to improve physician–patient communication skills. Acad Med. 1995;70:435–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Stepien KA, Baernstein A. Educating for empathy: a review. J Gen Intern Med. 2006;21:524–30.PubMedCrossRefGoogle Scholar
  37. 37.
    Winefield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ. 2000;34:90–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Branch W, Pels RJ, Lawrence RS, Arky R. Becoming a doctor. critical-incident reports from third-year medical students. N Engl J Med. 1993;329:1130–2.PubMedCrossRefGoogle Scholar
  39. 39.
    Bodenheimer T. Primary care—will it survive? N Engl J Med. 2006;355:861–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Joyce CM, McNeil JJ. Fewer medical graduates are choosing general practice: a comparison of four cohorts, 1980–1995. Med J Aust. 2006;185:102–4.PubMedGoogle Scholar
  41. 41.
    American College of Physicians: The impending collapse of primary care medicine and its implications for the state of the nation’s health care. Accessed September 19, 2006.

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Daniel Chen
    • 1
    Email author
  • Robert Lew
    • 2
    • 3
  • Warren Hershman
    • 1
  • Jay Orlander
    • 1
    • 4
  1. 1.Section of General Internal Medicine, Evans Department of MedicineBoston University School of MedicineBostonUSA
  2. 2.Department of BiostatisticsBoston University School of Public HealthBostonUSA
  3. 3.MAVERICVA Boston Healthcare SystemBostonUSA
  4. 4.Medical ServiceVA Boston Healthcare SystemBostonUSA

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