Ask the Authors: Dr. Mohammadreza Hojat Speaks on the Erosion of Empathy Exhibited by Medical Students

Last week, DocWire News covered a study which suggests that medical students lose empathy as they progress through medical school.

We spoke with lead researcher Mohammadreza Hojat, PhD, who detailed what prompted him to undertake this study. “As a psychologist by academic training, I became interested in exploring the effects of human relationships in health and illness,” said Dr. Hojat, of the Sidney Kimmel Medical College at Thomas Jefferson University.

“This interest shifted to a more specific area of patient-doctor relationship when I started a career in medical education research about 40 years ago. The questions of why some health professionals are more capable than others to form empathic relationship with patients, what are the factors that contribute to the development of empathy, and what are the outcomes of empathic engagement in patient care prompted me to search for answers.”

The study comprised 10,751 medical students (3,616 first-year, 2,764 second-year, 2,413 third-year, and 1,958 fourth-year students) enrolled in 41 campuses of DO-granting medical schools in the US while comparing preexisting data from students of MD-granting medical schools. All participants were asked to complete a web-based survey at the end of the 2017-2018 academic year.

Findings ‘Raise a Red Flag’

The results showed a decline in empathy scores between medical students in the pre-clinical years (first-and-second year students) and medical students in the clinical years (third-and-fourth year students). Furthermore, the researchers observed that the pattern of empathy decline was similar among DO students, but the magnitude was less pronounced.

The findings of the study “raise a red flag for medical education leaders,” said Dr. Hojat. “Among implications of the findings is a call for the development and implementation of targeted educational programs in medical schools to enhance and sustain empathy in physicians-in-training.”

Dr. Hojat noted that the study did have a limitation – its design. As a “cross-sectional” study, the baseline empathy at the start of medical school may be different for students in different years, “thus variation in empathy in different years could be attributed to the baseline differences, and not necessarily to changes during medical school.”

He feels that a more “desirable” study design would be a longitudinal study, “in which a cohort of students is followed up (for four years) during medical school and changes in their empathy scores are compared as the cohort progresses through medical school.”

Next Steps

Moving forward, to attenuate this limitation, Dr. Hojat is currently undertaking a five-year longitudinal study of a national cohort of osteopathic medical students from the 2019-2020 entering class. He plans “to follow (the students) from matriculation to graduation to examine yearly changes in empathy, reasons for such changes, and to explore approaches to enhance and sustain their empathy.”

This Project in Osteopathic Medical Education and Empathy (POMEE), according to Dr. Hojat, is sponsored by the American Association of Colleges of Osteopathic Medicine (AACOM), the American Osteopathic Association (AOA), and the Cleveland Clinic in collaboration with the Sidney Kimmel Medical College at Thomas Jefferson University.

Dr. Hojat added that: “In addition to examining empathy, we plan to study changes in orientation toward holistic, integrative, and patient-centered care, attitudes toward interprofessional collaboration, lifelong learning, and burnout experiences as the cohort progresses through medical school.”