Skip to main content
SpringerLink
Log in

Having Heart: Affective and Cognitive Empathy Scores vs. Residency Specialty Match at an Osteopathic Medical School

  • Original Research
  • Published:
Medical Science Educator Aims and scope Submit manuscript

Abstract

Background

Past studies examining the cognitive empathy of medical school graduates grouped the various residency selections vs. parsing them out. This study examines both affective and cognitive empathy scores of osteopathic medical school graduates entering eleven different residency specialties.

Methods

Participants from the Campbell University Jerry M. Wallace School of Osteopathic Medicine (CUSOM) classes of 2017–2019 completed the Balanced Emotional Empathy Scale (BEES; measuring affective empathy) and the Jefferson Scale of Empathy, Student version (JSE-S; measuring cognitive empathy). Empathy scores were compared to residency choice upon graduation. The specialty choices were broken into two groups: Core specialties (i.e., people-oriented) that include Family Medicine, Internal Medicine, Obstetrics and Gynecology (OB/Gyn), Pediatrics, and Psychiatry. The remaining specialties are considered Non-Core specialties (i.e., technical/procedure-oriented) and included Anesthesiology, Diagnostic Radiology, Emergency Medicine, General Surgery, Neurology, and Orthopedics. Results are compared to data from the nationwide Project in Osteopathic Medical Education and Empathy (POMEE).

Results

Women graduates tended to have larger BEES and JSE-S scores than men. Affective empathy scores were the largest for students selecting Core specialties. Four of these Core specialties were in the top four positions out of the eleven specialties selected by eight or more graduates. None of the eleven specialties was ranked higher than the 50th percentile compared to BEES score norms. Cognitive empathy scores were also the largest for students selecting Core specialties. All five of the Core specialties were in the top six positions out of the eleven specialties. None of the eleven specialties ranked greater than the 39th percentile when compared to OMS-III and OMS-IV POMEE data. Only women entering Psychiatry had a JSE-S score that was greater than the 50th percentile.

Conclusions

Osteopathic graduates selecting the five Core specialties have BEES and JSE-S scores that are, usually, larger than students entering Non-Core specialties. For either survey instrument, both Pediatrics and Family Medicine were first and second out of a possible 11 positions, respectively. Most CUSOM graduates had JSE-S scores lower than their peers in other osteopathic medical schools that participated in the POMEE study. When the CUSOM data are compared to allopathic data, there is no clear evidence that osteopathic students have substantially higher affective or cognitive empathy scores than their allopathic peers. Therefore, it appears that medical students who select osteopathy for its tenant of a more holistic approach to patient care are no more empathetic than students studying allopathic medicine. Several suggestions are made on how to potentially increase student empathy during undergraduate medical education.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chaitoff A, Sun B, Windover A, Bokar D, Featherall J, Rothberg MB, Misra-Hebert AD. Associations between physician empathy, physician characteristics, and standardized measures of patient experience. Acad Med. 2017;92(10):1464–71. https://doi.org/10.1097/ACM.0000000000001671.

    Article  Google Scholar 

  2. Del Canale S, Louis DZ, Maio V, Wang X, Rossie G, Hojat M, Gonnella JS. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma. Italy Acad Med. 2012;87(9):1243–9. https://doi.org/10.1097/ACM.0b013e3182628fbf.

    Article  Google Scholar 

  3. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians’ empathy and clinical outcomes in diabetic patients. Acad Med. 2011;86:359–64. https://doi.org/10.1097/ACM.0b013e3182086fe1.

    Article  Google Scholar 

  4. Stewart MA. Effective physician-patient communication and health outcomes: a review. Canadian Med Assoc J. 1996;152:1423–33.

    Google Scholar 

  5. Rakel D, Barrett B, Zhang Z, Hoeft T, Chewning B, Marchand L, Scheder J. Perception of empathy in the therapeutic encounter: effects on the common cold. Patient Educ Couns. 2011;84(3):390–7. https://doi.org/10.1016/j.pec.2011.01.009.

    Article  Google Scholar 

  6. Levinson W, Roter D, Mullooly JP, Dull VT, Frankel R. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553–9. https://doi.org/10.1001/jama.277.7.553.

    Article  Google Scholar 

  7. Colliver JA, Willis MS, Robbs RS, Cohen DS, Swartz MH. Assessment of empathy in a standardized-patient examination. Teach Learn Med. 1998;10:8–11. https://doi.org/10.1207/S15328015TLM1001_2.

    Article  Google Scholar 

  8. LaNoue MD, Roter DL. Exploring patient-centeredness: the relationship between self-reported empathy and patient-centered communication in medical trainees. Patient Educ Couns. 2018;101(6):1143–6. https://doi.org/10.1016/j.pec.2018.01.016.

    Article  Google Scholar 

  9. Mehrabian A, Young AL, Sato S. Emotional empathy and associated individual differences. Curr Psychol Res Rev. 1988;8:221–40.

    Article  Google Scholar 

  10. Mehrabian A. Manual for the Balanced Emotional Empathy Scale (BEES). 1996 (Note: As of 2014, the BEES is no longer available for distribution by Dr. Mehrabian).

  11. Newton, BW. Walking a fine line: is it possible to remain an empathic physician and have a hardened heart?. In: The neural underpinnings of vicarious empathy, Peter Enticott, ed., Front Hum Neurosci. 2013;11(7):233. https://doi.org/10.3389/fnhum.2013.00233.

  12. Davis MH. A multidimensional approach to individual differences in empathy. JSAJ Catalog of Selected Docs Psychol. 1980;10(4):85.

    Google Scholar 

  13. Hogan R. Development of an empathy scale. J Consult Clin Psychol. 1969;33(3):307–16. https://doi.org/10.1037/h0027580.

    Article  Google Scholar 

  14. Hojat M, Mangione S, Nasca TJ, Cohen MJ, Gonnella JS, Erdmann JB, et al. The Jefferson Scale of Physician Empathy: development and preliminary psychometric data. Educ Psychol Measure. 2001;61(2):349–65. https://doi.org/10.1177/00131640121971158.

    Article  Google Scholar 

  15. 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(9):1563–9. https://doi.org/10.1176/appi.ajp.159.9.1563.

    Article  Google Scholar 

  16. Foreback J, Kusz H, Lepisto BL, Pawlaczyk B. Empathy in internal medicine residents at community-based hospitals: a cross-sectional study. J Med Educ Curric Devl. 2018;5:1–4. https://doi.org/10.1177/2382120518771352.

    Article  Google Scholar 

  17. Stratta EC, Riding DM, Baker P. Ethical erosion in newly qualified doctors: perceptions of empathy decline. Int J Med Educ. 2016;7:286–92. https://doi.org/10.5116/ijme.57b8.48e4.

    Article  Google Scholar 

  18. Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996–1009. https://doi.org/10.1097/ACM.0b013e318221e615.

    Article  Google Scholar 

  19. 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(4):370–3. https://doi.org/10.1080/01421590220145725.

    Article  Google Scholar 

  20. Hojat M, Mangione S, Nasca TJ, Gonnella JS. Empathy scores in medical school and ratings of empathic behavior in residency training 3 years later. J Soc Psychol. 2005;145(6):663–72. https://doi.org/10.3200/SOCP.145.6.663-672.

    Article  Google Scholar 

  21. Newton BW, Clardy J, Barber L, Cleveland E. Who has heart? Vicarious empathy vs. residency match. Med Sci Educ. 2014;24(1):45–50. https://doi.org/10.1007/s40670-014-0021-6.

    Article  Google Scholar 

  22. Calabrese LH, Bianco JA, Mann D, Massello D, Hojat M. Correlates and changes in empathy and attitudes toward interprofessional collaboration in osteopathic medical students. J Am Osteopath Assoc. 2013;113(2):898–907. https://doi.org/10.7556/jaoa.2013.068.

    Article  Google Scholar 

  23. Magalhães E, Salgueria AP, Costa P, Costa MJ. Empathy in senior and first year medical students: a cross-sectional study. BMC Med Educ. 2011;11:52. https://doi.org/10.1186/1472-6920-11-52.

  24. Hojat M, Zuckerman M, Magee M, Mangione S, Nasca T, Vergare M, Gonnella JS. Empathy in medical students as related to specialty interest, personality, and perceptions of mother and father. Person Individ Diff. 2005;39(7):1205–15. https://doi.org/10.1016/j.paid.2005.04.007.

    Article  Google Scholar 

  25. Santos MA, Grosseman S, Morelli TC, Giuliano ICB, Erdmann TR. Empathy differences by gender and specialty preference in medical students: a study in Brazil. Int J Med Educ. 2016;7:149–53. https://doi.org/10.5116/ijme.572f.115f.

    Article  Google Scholar 

  26. Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Empathy in medicine national norms for the Jefferson Scale of Empathy: a nationwide project in osteopathic medical education and empathy (POMEE). J Am Osteopath Assoc. 2019;119(8):520–32. https://doi.org/10.7556/jaoa.2019.091.

    Article  Google Scholar 

  27. 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. https://doi.org/10.1097/ACM.0b013e3181637837.

    Article  Google Scholar 

  28. Hojat M, DeSantis J, Shannon SC, Speicher MR, Bragan L, Calabrese LH. Empathy as related to gender, age, race, ethnicity, academic background and career interest: a nationwide study of osteopathic medical students in the United States. Med Educ. 2020;54:571–81. https://doi.org/10.1111/medu.14138.

    Article  Google Scholar 

  29. Newton BW, Vaskalis Z. A cross-sectional study of affective and cognitive empathy of the osteopathic classes of 2017–2020. Med Sci Educ. 2017;27(suppl. 1):S22.

    Google Scholar 

  30. Christov-Moore L, Simpson EA, Coudé G, Grigaityte K, Iacoboni M, Ferrari PF. Empathy: gender effects in brain and behavior. Neurosci Biobehav Rev. 2014;46(4):604–27. https://doi.org/10.1016/j.neubiorev.2014.09.001.

    Article  Google Scholar 

  31. Decety J. The neurodevelopment of empathy in humans. Dev Neurosci. 2010;32(4):257–67. https://doi.org/10.1159/000317771.

    Article  Google Scholar 

  32. Singer T, Seymour B, O’Doherty J, Kaube H, Dolan RJ, Frith CD. Empathy for pain involves the affective but not sensory components of pain. Science. 2004;303:1157–62. https://doi.org/10.1126/science.1093535.

    Article  Google Scholar 

  33. Singer T, Lamm C. The social neuroscience of empathy. Ann NY Acad Sci. 2009;1156:81–96. https://doi.org/10.1111/j.1749-6632.2009.04418.x.

    Article  Google Scholar 

  34. Berkley KJ. Sex differences in pain. Behav Brain Sci. 1997;20(3):371–80. https://doi.org/10.1017/s0140525x97221485.

    Article  Google Scholar 

  35. Fillingim RB. Sex, gender, and pain: women and men are really different. Curr Rev Pain. 2000;4(1):24–30. https://doi.org/10.1007/s11916-000-0006-6.

    Article  Google Scholar 

  36. Chen C, Martinez RM, Chen Y. The developmental origins of the social brain: empathy, morality, and justice. Front Psychol. 2018;9:2584. https://doi.org/10.3389/fpsyg.2018.02584.

    Article  Google Scholar 

  37. Eisenberg N. Empathy-related responding and prosocial behavior. Novartis Found Symp. 2007;278:71–80. PMID 17214311.

  38. Eisenberg N, Morris, AS, McDaniel B, Spinrad TL. Moral cognitions and prosocial responding in adolescence. In Lerner RM, Steinberg L (Eds.). Handbook of adolescent psychology (pp. 229–265). 2009. New York, NY: John Wiley & Sons.

  39. Hojat M, DeSantis J, Shannon SC, Mortensen LH, Speicher MR, Bragan L, et al. The Jefferson Scale of Empathy: a nationwide study of measurement properties, underlying components, latent variable structure, and national norms in medical students. Adv Health Sci Educ Theory Pract. 2018;23(5):899–920. https://doi.org/10.1007/s10459-018-9839-9.

    Article  Google Scholar 

  40. Hojat M. Empathy in health professions education and patient care. 2016. New York, NY: Springer. ISBN: 978-3-319-27624-3.

  41. Thompson BM, Hearn GN, Collins MJ. Patient perceptions of health professional interpersonal skills. Australian Psychol. 1992;27(2):91–5. https://doi.org/10.1080/00050069208257586.

    Article  Google Scholar 

  42. Decety J, Yang CY, Cheng Y. Physicians down-regulate their pain empathy response: an event-related brain potential study. Neuroimage. 2010;50(4):1676–82. https://doi.org/10.1016/j.neuroimage.2010.01.025.

    Article  Google Scholar 

  43. Stefanello E. Your pain is not mine: a critique of clinical empathy. Bioethics. 2021;1–8. https://doi.org/10.1111/bioe.12980.

  44. Backović DV, Zivojinović JI, Maksimović J, Maksimović M. Gender differences in academic stress and burnout among medical students in final years of education. Psychiatr Danub. 2012;24(2):175–81. PMID: 22706416.

    Google Scholar 

  45. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–73. https://doi.org/10.1097/00001888-200604000-00009.

    Article  Google Scholar 

  46. Riess H, Kraft-Todd G. EMPATHY: a tool to enhance nonverbal communication between clinicians and their patients. Acad Med. 2014;89:1108–12. https://doi.org/10.1097/ACM.0000000000000287.

    Article  Google Scholar 

  47. Hojat M. Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm Spring. 2009;31(4):412–50. https://doi.org/10.2307/25790741.

    Article  Google Scholar 

  48. Harden RM. Twelve tips on teaching and learning how to break bad news. Med Teach. 1996;18(4):275–8. https://doi.org/10.3109/01421599609034177.

    Article  Google Scholar 

  49. Hojat M, DeSantis J, Cain RA, Speicher MR, Bragan L, Shannon SC, Calabrese LH. Attitudes toward osteopathic medicine scale: development and psychometrics. Int J Med Educ. 2021;12:222–32. https://doi.org/10.5116/ijme.615c2cf.

    Article  Google Scholar 

Download references

Acknowledgements

The author is grateful to those members of the CUSOM graduating classes of 2017–2019 who participated in the longitudinal empathy study. Various aspects of these data were presented in abstract form at the 2007, 2008, and 2015–2019 meetings of the International Association for Medical Science Educators (IAMSE).

Author information

Authors and Affiliations

  1. Department of Anatomy, Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC, 27546, USA

    Bruce W. Newton

Authors
  1. Bruce W. Newton
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The author designed the study, collected the data, and wrote the manuscript.

Corresponding author

Correspondence to Bruce W. Newton.

Ethics declarations

Ethics Approval

N/A. Informed consent was obtained from all participants in this study via Campbell University IRB #030.

Consent for Publication

N/A.

Conflict of Interest

The author has no conflicts of interest to declare that are relevant to the content of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Newton, B.W. Having Heart: Affective and Cognitive Empathy Scores vs. Residency Specialty Match at an Osteopathic Medical School. Med.Sci.Educ. 32, 423–436 (2022). https://doi.org/10.1007/s40670-022-01526-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40670-022-01526-9

Keywords

Search

Navigation