Medical students show gains in empathy are short-lived after training

An exercise on the challenges of aging helps students feel more compassion for patients, but researchers say repetition is needed for lasting results.

By Carolyne Krupa — Posted March 14, 2012

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The actor wore goggles smeared with petroleum jelly to simulate poor vision and earplugs to replicate hearing loss.

He portrayed an elderly patient being admitted to a long-term, assisted-care facility and fired questions at another actor playing the facility's assistant manager.

The two had trouble communicating. While the patient wanted to know about the center's schedule, food service and what to do in an emergency, the assistant manager wanted to focus on rules.

It was a brief, 10-minute performance, but it had a strong impact on the 370 first-year medical and pharmacy students who saw it. The students showed increased signs of empathy after watching and discussing the skit, but the results were not sustained, said a study in the Feb. 10 American Journal of Pharmaceutical Education (link).

Still, the results are encouraging, said Mohammadreza Hojat, PhD, study co-author and research professor of psychiatry and human behavior at Thomas Jefferson University Jefferson Medical College in Philadelphia.

"In another study, we found there was a decline in empathy in medical students as they progress through medical school, and that decline is particularly noticeable the third year of medical school," he said. "That was a warning signal. We decided to do something about it. We don't want our students and residents to lose their empathy."

The latest study suggests that educational exercises can improve empathy, but they need to be an ongoing and integral part of students' education to have a lasting effect, Hojat said.

The link of outcomes and empathy

Previous research has shown a positive relationship between physician empathy and patient outcomes. In a March 2011 Academic Medicine study, Hojat and his colleagues found that physicians with high empathy had patients with significantly greater control over their diabetes than patients of physicians with low empathy (link).

The studies used the Jefferson Scale of Empathy, which Hojat and his colleagues developed to assess how empathetic physicians are to patients. The test is now used throughout the world, Hojat said.

For the latest study, the test was administered to students at the Chicago College of Pharmacy and the Chicago College of Osteopathic Medicine at Midwestern University. Groups of 20 to 40 students at a time participated in a 40-minute workshop that included the skit. They all took the test before and after the workshop. The pharmacy students took the test again seven days later, and medical students repeated it 26 days after the workshop.

Students' scores on their last test returned to the pretest levels, showing that the increase in empathy experienced immediately after the workshop did not last. "That gain that we noticed was lost," Hojat said.

Unpublished research since has shown that additional activities in the weeks after the workshop help maintain the initial positive results.

"If you want to sustain empathy, you need to reinforce it," Hojat said. "It is not a one-session endeavor. It should be repeatedly reinforced."

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