Abstract
Previous research highlighted associations between students’ motivation for medical studies and their learning approaches on the one hand and empathy on the other. Internal motivational factors for studying medicine (e.g., care for patients, save lives) coupled with a deep approach to learning have been positively related to empathy in contrast to external motivational factors (e.g., future earning potential, prestige) and surface learning. However, assessments of these assumptions among medical school candidates are scarce. This study examined the relationship between different motivational factors and empathy among students enrolled in a selection year in medicine by testing the mediating role of learning approaches. A sample of 572 candidates for medical studies answered a self-reported questionnaire half way through their selection year. Measures included internal and external motivational factors for studying medicine, deep and surface learning approaches and empathy. Path-analysis tested the mediation effects of deep and surface approaches to learning on the relationship of internal and external motivational factors with empathy. The deep learning approach partially mediated the significant positive association between internal motivational factors and empathy, while the surface learning approach fully mediated the significant negative association between external motivational factors and empathy. These results suggest that learning approaches could be a pathway by which internal and external motives for studying medicine are related to empathy among medical school candidates. Pedagogical strategies and educational environments accounting for individual differences in motivation and learning may contribute to training students to become professional and caring doctors in the future.
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Abbiati, M., Baroffio, A., & Gerbase, M. W. (2016). Personal profile of medical students selected through a knowledge-based exam only: Are we missing suitable students? Medical Education Online, 21(1), 29705.
Adams, K., Hean, S., Sturgis, P., & Clark, J. M. (2006). Investigating the factors influencing professional identity of first-year health and social care students. Learning in Health and Social Care, 5(2), 55–68.
Ahn, D., Park, G., Baek, K. J., & Chung, S. I. (2007). Academic motivation, academic stress, and perceptions of academic performance in medical students. Korean Journal of Medical Education, 19(1), 59–71.
Ahrweiler, F., Neumann, M., Goldblatt, H., Hahn, E. G., & Scheffer, C. (2014). Determinants of physician empathy during medical education: Hypothetical conclusions from an exploratory qualitative survey of practicing physicians. BMC Medical Education, 14(1), 122.
Alcorta-Garza, A., Gonzalez-Guerrero, J., Tavitas-Herrera, S., Rodríguez-Lara, F., & Hojat, M. (2005). Validity and reliability of the Jefferson Scale of Physician Empathy in Mexican medial students. Salud Mental, 28(5), 57–63.
Baeten, M., Kyndt, E., Struyven, K., & Dochy, F. (2010). Using student-centred learning environments to stimulate deep approaches to learning: Factors encouraging or discouraging their effectiveness. Educational Research Review, 5(3), 243–260.
Biggs, J. B. (1987). Student approaches to learning and studying. Research monograph. Washington: ERIC.
Biggs, J., Kember, D., & Leung, Y. (2001). The revised two-factor study process questionnaire: R-SPQ-2F. British Journal of Educational Psychology, 71(1), 133–149.
Boker, J. R., Shapiro, J., & Morrison, E. H. (2004). Teaching empathy to first year medical students: Evaluation of an elective literature and medicine course. Education for Health, 17(1), 73–84.
Burge, S. M. (2003). Undergraduate medical curricula: Are students being trained to meet future service needs? Clinical Medicine, 3(3), 243–246.
Charon, R. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA, 286(15), 1897–1902.
Chen, D., Lew, R., Hershman, W., & Orlander, J. (2007). A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine, 22(10), 1434–1438.
Chin, C., & Brown, D. E. (2000). Learning in science: A comparison of deep and surface approaches. Journal of Research in Science Teaching, 37(2), 109–138.
Cohen, M. J., Kay, A., Youakim, J. M., & Balaicuis, J. M. (2009). Identity transformation in medical students. The American Journal of Psychoanalysis, 69(1), 43–52.
Crossley, M. L., & Mubarik, A. (2002). A comparative investigation of dental and medical student’s motivation towards career choice. British Dental Journal, 193(8), 471–473.
Cruess, R. L., Cruess, S. R., & Steinert, Y. (2016). Teaching medical professionalism: Supporting the development of a professional identity. Cambridge: Cambridge University Press.
Dart, B. C., Burnett, P. C., Purdie, N., Boulton-Lewis, G., Campbell, J., & Smith, D. (2000). Students’ conceptions of learning, the classroom environment, and approaches to learning. The Journal of Educational Research, 93(4), 262–270.
Delva, M. D., Kirby, J. R., Knapper, C. K., & Birtwhistle, R. (2002). Postal survey of approaches to learning among Ontario physicians: Implications for continuing medical education. BMJ, 325(7374), 1218.
DiLalla, L. F., Hull, S. K., & Dorsey, J. K. (2004). Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teaching and Learning in Medicine, 16(2), 165–170.
Edwards, J. R., & Lambert, L. S. (2007). Methods for integrating moderation and mediation: A general analytical framework using moderated path analysis. Psychological Methods, 12(1), 1–22.
Feeley, A.-M., & Biggerstaff, D. L. (2015). Exam success at undergraduate and graduate-entry medical schools: Is learning style or learning approach more important? A critical review exploring links between academic success, learning styles, and learning approaches among school-leaver entry (“traditional”) and graduate-entry (“nontraditional”) medical students. Teaching and Learning in Medicine, 27(3), 237–244.
Ferguson, E., James, D., & Madeley, L. (2002). Factors associated with success in medical school: Systematic review of the literature. BMJ, 324(7343), 952–957.
Field, A. (2009). Discovering statistics using SPSS. Thousand Oaks: Sage publications.
Firouznia, S., Yousefi, A., & Ghassemi, G. (2009). The relationship between academic motivation and academic achievement in medical students of Isfahan University of Medical Sciences. Iranian Journal of Medical Education, 9(1), 79–84.
Goel, S., Angeli, F., Dhirar, N., Singla, N., & Ruwaard, D. (2018). What motivates medical students to select medical studies: A systematic literature review. BMC Medical Education, 18(1), 16.
Gonçalves-Pereira, M., Loureiro, J., Trancas, B., Papoila, A., & Caldas-de-Almeida, J. M. (2013). Empathy as related to motivations for medicine in a sample of first-year medical students. Psychological Reports, 112(1), 73–88.
Griffin, B. (2018). Selecting medical students: Considering qualities other than academic ability. Medical Education, 52(1), 9–11.
Grosseman, S., Hojat, M., Duke, P. M., Mennin, S., Rosenzweig, S., & Novack, D. (2014). Empathy, self-reflection, and curriculum choice. Interdisciplinary Journal of Problem-Based Learning, 8(2), 35–41.
Hall, M., Ramsay, A., & Raven, J. (2004). Changing the learning environment to promote deep learning approaches in first-year accounting students. Accounting Education, 13(4), 489–505.
Helmich, E., & Dornan, T. (2012). Do you really want to be a doctor? The highs and lows of identity development. Medical Education, 46(2), 132–134.
Hojat, M. (2018). Change in empathy in medical school. Medical Education, 52(4), 456–457.
Hojat, M., Gonnella, J. S., Mangione, S., Nasca, T. J., Veloski, J. J., Erdmann, J. B., et al. (2002). Empathy in medical students as related to academic performance, clinical competence and gender. Medical Education, 36(6), 522–527.
Hojat, M., Mangione, S., Nasca, T. J., Cohen, M. J., Gonnella, J. S., Erdmann, J. B., et al. (2001). The Jefferson scale of Physician Empathy: Development and preliminary psychometric data. Educational and Psychological Measurement, 61(2), 349–365.
Hojat, M., Zuckerman, M., Magee, M., Mangione, S., Nasca, T., Vergare, M., et al. (2005). Empathy in medical students as related to specialty interest, personality, and perceptions of mother and father. Personality and Individual Differences, 39(7), 1205–1215.
Johnson, M. K., Rowatt, W. C., Barnard-Brak, L. M., Patock-Peckham, J. A., LaBouff, J. P., & Carlisle, R. D. (2011). A mediational analysis of the role of right-wing authoritarianism and religious fundamentalism in the religiosity–prejudice link. Personality and Individual Differences, 50(6), 851–856.
Kesternich, I., Schumacher, H., Winter, J., Fischer, M. R., & Holzer, M. (2017). Student characteristics, professional preferences, and admission to medical school. GMS Journal for Medical Education, 34(1), 1–16.
Kline, R. B. (2015). Principles and practice of structural equation modeling. London: Guilford publications.
Kusurkar, R. A., Croiset, G., Galindo-Garré, F., & Ten Cate, O. (2013). Motivational profiles of medical students: Association with study effort, academic performance and exhaustion. BMC Medical Education, 13(1), 87.
Kusurkar, R. A., Ten Cate, T. J., Van Asperen, M., & Croiset, G. (2011). Motivation as an independent and a dependent variable in medical education: A review of the literature. Medical Teacher, 33(5), e242–e262.
Lefevre, J. H., Roupret, M., Kerneis, S., & Karila, L. (2010). Career choices of medical students: A national survey of 1780 students. Medical Education, 44(6), 603–612.
Lyndon, M. P., Henning, M. A., Alyami, H., Krishna, S., Zeng, I., Yu, T.-C., et al. (2017). Burnout, quality of life, motivation, and academic achievement among medical students: A person-oriented approach. Perspectives on Medical Education, 6(2), 108–114.
Madjar, N., Kushnir, T., & Bachner, Y. G. (2015). Communication skills training in medical students: Do motivational orientations predict changes over time in psychosocial attributes? Advances in Health Sciences Education, 20(1), 45–57.
Marton, F. (1983). Beyond individual differences. Educational Psychology, 3(3–4), 289–303.
Marton, F., & Säljö, R. (1976). On qualitative differences in learning: I—outcome and process. British Journal of Educational Psychology, 46(1), 4–11.
Mattick, K., Dennis, I., & Bligh, J. (2004). Approaches to learning and studying in medical students: Validation of a revised inventory and its relation to student characteristics and performance. Medical Education, 38(5), 535–543.
McLean, M. (2001). Can we relate conceptions of learning to student academic achievement? Teaching in Higher Education, 6(3), 399–413.
McManus, I., Livingston, G., & Katona, C. (2006). The attractions of medicine: The generic motivations of medical school applicants in relation to demography, personality and achievement. BMC Medical Education, 6(1), 11.
Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., et al. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine, 86(8), 996–1009.
Niemi, P. (1997). Medical students’ professional identity: Self-reflection during the preclinical years. Medical Education, 31(6), 408–415.
Pelaccia, T., & Viau, R. (2017). Motivation in medical education. Medical Teacher, 39(2), 136–140.
Platt, J. R. (1964). Strong inference. Science, 146(3642), 347–353.
Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, 36(4), 717–731.
Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42(1), 185–227.
Preusche, I., & Wagner-Menghin, M. (2013). Rising to the challenge: Cross-cultural adaptation and psychometric evaluation of the adapted German version of the Jefferson Scale of Physician Empathy for Students (JSPE-S). Advances in Health Sciences Education, 18(4), 573–587.
Reid, W., Duvall, E., & Evans, P. (2005). Can we influence medical students’ approaches to learning? Medical Teacher, 27(5), 401–407.
Roh, M.-S., Hahm, B.-J., Lee, D. H., & Suh, D. H. (2010). Evaluation of empathy among Korean medical students: A cross-sectional study using the Korean Version of the Jefferson Scale of Physician Empathy. Teaching and Learning in Medicine, 22(3), 167–171.
Rosenthal, S., Howard, B., Schlussel, Y. R., Herrigel, D., Smolarz, B. G., Gable, B., et al. (2011). Humanism at heart: Preserving empathy in third-year medical students. Academic Medicine, 86(3), 350–358.
Royston, P. (2001). Flexible parametric alternatives to the Cox model, and more. Stata Journal, 1(1), 1–28.
Samra, R., Cox, T., Gordon, A. L., Conroy, S. P., Lucassen, M. F., & Griffiths, A. (2017). Factors related to medical students’ and doctors’ attitudes towards older patients: A systematic review. Age and Ageing, 46(6), 911–919.
Shariat, S. V., Eshtad, E., & Ansari, S. (2010). Empathy and its correlates in Iranian physicians: A preliminary psychometric study of the Jefferson Scale of Physician Empathy. Medical Teacher, 32(10), e417–e421.
Smith, K. E., Norman, G. J., & Decety, J. (2017). The complexity of empathy during medical school training: evidence for positive changes. Medical Education, 51(11), 1146–1159.
Sobral, D. T. (2004). What kind of motivation drives medical students’ learning quests? Medical Education, 38(9), 950–957.
Socha, A., & Sigler, E. A. (2014). Exploring and “reconciling” the factor structure for the Revised Two-factor Study Process Questionnaire. Learning and Individual Differences, 31, 43–50.
Soo, J., Brett-MacLean, P., Cave, M.-T., & Oswald, A. (2016). At the precipice: A prospective exploration of medical students’ expectations of the pre-clerkship to clerkship transition. Advances in Health Sciences Education: Theory and Practice, 21(1), 141–162.
Stepien, K. A., & Baernstein, A. (2006). Educating for empathy. Journal of General Internal Medicine, 21(5), 524–530.
Tavakol, S., Dennick, R., & Tavakol, M. (2012). Medical students’ understanding of empathy: A phenomenological study. Medical Education, 46(3), 306–316.
Thompson, B. M., Teal, C. R., Rogers, J. C., Paterniti, D. A., & Haidet, P. (2010). Ideals, activities, dissonance, and processing: A conceptual model to guide educators’ efforts to stimulate student reflection. Academic Medicine, 85(5), 902–908.
Vaglum, P., Wiers-Fenssen, F., & Ekeberg, Ø. (1999). Motivation for medical school: The relationship to gender and specialty preferences in a nationwide sample. Medical Education, 33(4), 236–242.
Wasityastuti, W., Susani, Y. P., Prabandari, Y. S., & Rahayu, G. R. (2017). Correlation between academic motivation and professional identity in medical students in the Faculty of Medicine of the Universitas Gadjah Mada Indonesia. Educación Médica, 19(1), 23–29.
Williams, G. C., & Deci, E. L. (1996). Internalization of biopsychosocial values by medical students: A test of self-determination theory. Journal of Personality and Social Psychology, 70(4), 767–779.
Winseman, J., Malik, A., Morison, J., & Balkoski, V. (2009). Students’ views on factors affecting empathy in medical education. Academic Psychiatry, 33(6), 484–491.
Zeegers, P. (2001). Approaches to learning in science: A longitudinal study. British Journal of Educational Psychology, 71(1), 115–132.
Zenasni, F., Boujut, E., du Vaure, B., Catu-Pinault, A., Tavani, J., Rigal, L., et al. (2012). Development of a French-language version of the Jefferson Scale of Physician Empathy and association with practice characteristics and burnout in a sample of general practitioners. International Journal of Person Centered Medicine, 2(4), 759–766.
Zhang, L.-F. (2000). University students’ learning approaches in three cultures: An investigation of Biggs’s 3P model. The Journal of Psychology, 134(1), 37–55.
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Piumatti, G., Abbiati, M., Baroffio, A. et al. Associations between motivational factors for studying medicine, learning approaches and empathy among medical school candidates. Adv in Health Sci Educ 24, 287–300 (2019). https://doi.org/10.1007/s10459-018-9866-6
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DOI: https://doi.org/10.1007/s10459-018-9866-6