Skip to main content

Advertisement

Log in

Changes in Humanism During Medical School: a Synthesis of the Evidence

Medical Science Educator Aims and scope Submit manuscript

Abstract

Background

The importance of humanism in medical education and practice has been well established with relevance to patient satisfaction, adherence to recommended treatment plans, medical-legal risk, and potential for physician burnout. This review focused on longitudinal studies of medical students to answer two research questions: (1) Do components of humanism change over time in medical students? (2) Do components of humanism respond to intervention?

Methods

We conducted a systematic review of the literature for English language articles published between 2000 and 2014. We searched using the word “humanism” and terms that represent constructs of humanism combined with “undergraduate medical education.” Articles including humanism at more than one point in time were included. Data extracted included the following: construct of humanism measured, measurement tool, timing of measurements, type of intervention included (deliberate programming vs. standard curriculum), and direction of change of the construct being assessed. Descriptive and non-parametric statistics were used.

Results

Forty-eight studies from 22 journals were reviewed. The direction of change was associated with study duration (Spearman’s rho = −.573, p = .000), indicating that studies with longer duration were more likely to report negative change. Study duration also differed across design categories (F = 17.447, p = .000). Empathy was assessed in 37 (77%), humanism in 16 (33%), and altruism in 1 study.

Discussion

Recommendations for practice include intentional, ongoing educational experiences to address humanism in medical students. Recommendations for future investigations include additional exploration of the role of context and perspective in understanding changes in humanism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Stepien KA, Baernstein A. Educating for empathy. J Gen Intern Med. 2006;21:524–30.

    Article  Google Scholar 

  2. Cohen LG, Sherif YA. Twelve tips on teaching and learning humanism in medical education. Med Teach. 2014;36:680–4.

    Article  Google Scholar 

  3. Arnold P. Gold Foundation. What is humanism in health care?// http://humanism-in-medicine.org/about-us/faqs/. Accessed 2/27/2017.

  4. Hojat M, Mangione S, Nasca TJ, Rattner S, Erdmann JB, Gonnella JS, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38:934–41.

  5. Colliver JA, Conlee MJ, Verhust SJ, Dorsey JK. Reports of the decline of empathy during medical education are greatly exaggerated: a reexamination of the research. Acad Med. 2010;85:588–395.

    Article  Google Scholar 

  6. Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: an updated, systematic review. Acad Med. 2013;88:1171–7.

    Article  Google Scholar 

  7. Kelm Z, Womer J, Walter JK, Feudtner C. Interventions to cultivate physician empathy: a systematic review. BMC Med Educ. 2014;14:219–29.

    Article  Google Scholar 

  8. Buck E, Holden M, Szauter K. A methodological review of the assessment of humanism in medical students. Acad Med. 2015;90:S14–23.

    Article  Google Scholar 

  9. Cook DA, Reed DA. Appraising the quality of medical education research methods: the Medical Education Research Study Quality Instrument and the Newcastle-Ottawa Scale-Education. Acad Med. 2015;90(8):1067–76.

    Article  Google Scholar 

  10. Michalec B. An assessment of medical school stressors on preclinical students’ levels of clinical empathy. Curr Psychol. 2010;29(3):210–21.

    Article  Google Scholar 

  11. Newton BW, Barber L, Clardy J, Cleveland E, O'Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83(3):244–9.

    Article  Google Scholar 

  12. Stratton Terry D, Saunders Justin A, Elam Carol L. Changes in medical students’ emotional intelligence: an exploratory study. Teach Learn Med. 2008;20(3):279–84.

    Article  Google Scholar 

  13. Çiğdem D, Hacer H, Serdar G, Ayfer G, Mehmet E. Teaching empathy in medical education. Turk Psikiyatri Dergisi. 2005;16(2)

  14. Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182–91.

  15. Varkey P, Chutka DS, Lesnick TG. The aging game: improving medical students’ attitudes toward caring for the elderly. J Am Med Dir Assoc. 2006;7(4):224–9.

    Article  Google Scholar 

  16. Costa P, Magalhães E, Costa MJ. A latent growth model suggests that empathy of medical students does not decline over time. Adv Health Sci Educ Theory Pract. 2013;18(3):509–22.

    Article  Google Scholar 

  17. Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach. 2012;34(4):305–11.

    Article  Google Scholar 

  18. Bond AR1, Mason HF, Lemaster CM, Shaw SE, Mullin CS, Holick EA, et al. Embodied health: the effects of a mind-body course for medical students. Med Educ Online. 2013;18:1–8.

  19. Hirsh D, Gaufberg E, Ogur B, Cohen P, Krupat E, Cox M, et al. Educational outcomes of the Harvard medical school-Cambridge integrated clerkship: a way forward for medical education. Acad Med. 2012;87:643–50.

  20. Lim BT, Moriarty H, Huthwaite M, Gray L, Pullon S, Gallagher P. How well do medical students rate and communicate clinical empathy? Med Teach. 2013;35(2):e946–51.

    Article  Google Scholar 

  21. Dyrbye LN, Eacker AM, Harper W, Power DV, Massie FS Jr, Satele D, et al. Distress and empathy do not drive changes in specialty preference among US medical students. Med Teach. 2012;34(2):e116–22.

  22. Borges NJ, Kirkham K, Deardorff AS, Moore JA. Development of emotional intelligence in a team-based learning internal medicine clerkship. Med Teach. 2012;34(10):802–6.

    Article  Google Scholar 

  23. 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(2):90–4.

    Article  Google Scholar 

  24. Shapiro J, Morrison EH, Boker J. Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Educ Health. 2004;17(1):73–84.

    Article  Google Scholar 

  25. Hojat M, Axelrod D, Spandorfer J, Mangione S. Enhancing and sustaining empathy in medical students. Med Teach. 2013;35(12):996–1001.

    Article  Google Scholar 

  26. Doherty EM, Cronin PA, Offiah G. Emotional intelligence assessment in a graduate entry medical school curriculum. BMC Med Educ. 2013;13:38.

    Article  Google Scholar 

  27. Nunes P, Williams S, Sa B, Stevenson K. A study of empathy decline in students from five health disciplines during their first year of training. Int J Medl Educ. 2011;2:12–7.

    Article  Google Scholar 

  28. Quince TA, Parker RA, Wood DF, Benson JA. Stability of empathy among undergraduate medical students: a longitudinal study at one UK medical school. BMC Med Educ. 2011;11:90.

    Article  Google Scholar 

  29. Fernandez-Olano C, Montoya-Fernandez J, Salinas-Sanchez AS. Impact of clinical interview training on the empathy level of medical students and medical residents. Med Teach. 2008;30(3):322–4.

    Article  Google Scholar 

  30. Rosenthal S, Howard B, Schlussel YR, Herrigel D, Smolarz BG, Gable B, et al. Humanism at heart: preserving empathy in third-year medical students. Acad Med. 2011;86(3):350–8.

  31. Van Winkle LJ, Fjortoft N, Hojat M. Impact of a workshop about aging on the empathy scores of pharmacy and medical students. Am J Pharm Educ. 2012;76(1):9.

    Article  Google Scholar 

  32. Austin E, Evans P, Goldwater R, Potter V. A preliminary study of emotional intelligence, empathy and exam performance in first year medical students. Pers Individ Dif. 2012;39(8):1395–405.

    Article  Google Scholar 

  33. Hong M, Lee WH, Park JH, Yoon TY, Moon DS, Lee SM, et al. Changes in empathy in medical college and medical school students: 1-year follow up study. BMC Med Educ. 2012;12:122.

  34. Lim BT, Moriarty H, Huthwaite M. Being-in-role: a teaching innovation to enhance empathic communication skills in medical students. Med Teach. 2011;33(12):e663–9.

    Article  Google Scholar 

  35. Hojat M, Mangione S, Nasca TJ, Ratner S, Erdmann JB, Gonnella JS, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38:934–41.

  36. Ozcan CT, Oflaz F, Bakir B. The effect of a structured empathy course on the students of a medical and a nursing school. Int Nurs Rev. 2012;59:532–8.

    Article  Google Scholar 

  37. De Valck C, Bensing J, Bruynooghe R. Medical students’ attitudes toward breaking bad news: an empirical test of the World Health Organization model. Psychooncology. 2001;10(5):398–409.

    Article  Google Scholar 

  38. Tsimtsiou Z, Kerasidou O, Efstathiou N, Paharitou S, Hatzimouratidis K, Hatzighristou D. Medical students’ attitudes toward patient-centered care: a longitudinal survey. Med Educ. 2007;41(2):146–53.

    Article  Google Scholar 

  39. Maudsley G, Williams EMI, Taylor DCM. Junior medical students’ notions of a ‘good doctor’ and related expectations: a mixed methods study. Med Educ. 2007;41(5):476–86.

    Article  Google Scholar 

  40. Yedidia MJ, Gillespie CC, Kachur E, Schwartz MD, Ockene J, Chepaitis AE, et al. Effects of communications training on medical student performance. JAMA. 2003;290(9):1157–65.

  41. Austin EJ, Evans P, Magnus B, O'Hanlon K. A preliminary study of empathy, emotional intelligence and examination performance in MBChB students. Med Ed. 2007;41(7):684–9.

    Article  Google Scholar 

  42. Chen DCR, Pahilan ME, Orlander JD. Comparing a self-administered measure of empathy with observed behavior among medical students. J Gen Intern Med. 2009;25(3):200–2.

    Article  Google Scholar 

  43. Bombeke K, Van Roosbroeck S, De Winter B, Debaene L, Schol S, Van Hal G, et al. Medical students trained in communication skills show a decline in patient-centered attitudes: an observational study comparing two cohorts during clinical clerkships. Patient Educ Couns. 2011;84(3):310–8.

  44. Bunn W, Terpstra J. Cultivating empathy for the mentally ill using simulated auditory hallucinations. Acad Psychiatr. 2009;33(6):457–60.

    Article  Google Scholar 

  45. Airagnes G, Sm C, De Morlhon O, Galliot AM, Lemogne C, Jaury P. Appropriate training based on Balint groups can improve the empathic abilities of medical students: a preliminary study. J Psychosom Res. 2014;76(5):426–9.

    Article  Google Scholar 

  46. Joekes K, Noble LM, Kubacki AM, Potts HW, Lloyd M. Does the inclusion of ‘professional development’ teaching improve medical students’ communication skills? BMC Med Educ. 2011;11:41.

    Article  Google Scholar 

  47. Lee KH, Seow A, Luo N, Koh D. Attitudes towards the doctor-patient relationship: a prospective study in an Asian medical school. Med Educ. 2008;42(11):1092–9.

    Article  Google Scholar 

  48. Crow SM, O'Donoghue D, Vannatta JB, Thompson BM. Meeting the family: promoting humanism in gross anatomy. Teach Learn Med. 2012;24(1):49–54.

    Article  Google Scholar 

  49. Karaoglu N, Seker M. Looking for winds of change with a PBL scenario about communication and empathy. HealthMED. 2011;5(3):515–21.

    Google Scholar 

  50. Kommalage M. Using videos to introduce clinical material: effects on empathy. Med Educ. 2011;45(5):514–5.

    Article  Google Scholar 

  51. Krupat E, Pelletier S, Alexander EK, Hirsh D, Ogur B, Schwartzsteing R. Can changes in the principal clinical year prevent the erosion of students’ patient-centered beliefs? Acad Med. 2009;84(5):582–6.

    Article  Google Scholar 

  52. Brazeau CM, Schroeder R, Rovi S, Boyd L. Relationship between medical students service and empathy. Acad Med. 2010;85(10 Suppl):S33–6.

    Article  Google Scholar 

  53. Schweller M, Costa FO, Antônio M, Amaral EM, de Carvalho-Filho MA. The impact of simulated medical consultations on the empathy levels of students at one medical school. Acad Med. 2014;89(4):632–7.

    Article  Google Scholar 

  54. Matharu K, Shapiro JF, Hammer RR, Kravitz RL, Wilson MD, Fitzgerald FT. Reducing obesity prejudice in medical education. Educ Health. 2014;27(3):231–7.

    Article  Google Scholar 

  55. Potash JS, Chen JY, Lam CL, Chau VT. Art-making in a family medicine clerkship: how does it affect medical student empathy? BMC Med Educ. 2014;14:247.

    Article  Google Scholar 

  56. Kushner RF, Zeiss DM, Feinglass JM, Yelen M. An obesity educational intervention for medical students addressing weight bias and communication skills using standardized patients. BMC Med Educ. 2014;14(1):53.

    Article  Google Scholar 

  57. Shapiro SM. Evaluation of a communication skills program for first-year medical students at the University of Toronto. BMC Med Educ. 2009;9:11.

    Article  Google Scholar 

Download references

Acknowledgements

This project was made possible with a Mapping the Landscape, Journeying Together grant from the Arnold P. Gold Foundation Research Institute.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Era Buck.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buck, E., Holden, M. & Szauter, K. Changes in Humanism During Medical School: a Synthesis of the Evidence. Med.Sci.Educ. 27, 887–893 (2017). https://doi.org/10.1007/s40670-017-0438-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40670-017-0438-9

Keywords

Navigation