Empathy is somewhat difficult to define, as there are different schools of thought.  Some researchers have described empathy as a cognitive attribute, Thus, it predominantly involves understanding another person’s concerns. Others have described empathy as an affective or emotional characteristic, which implies that it primarily involves feeling another person’s pain and suffering. And, there is a third group that views empathy as both

affective and cognitive.

Hojat et al (2009) defined empathy in the context of medical education and patient care as a "predominantly cognitive (as opposed to affective or emotional) attribute that involves an understanding (as opposed to feeling) of patients’ experiences, concerns, and perspectives combined

with a capacity to communicate this understanding. An intention to help by preventing and alleviating pain and suffering is an additional feature of

empathy in the context of patient care.

These authors in a longitudinal study of erosion of empathy in medical students found that empathy scores did not change significantly during the first two years of medical school. However, a significant decline in empathy scores was observed at the end of the third year, and it  persisted until graduation. The patterns of decline in empathy scores were similar for men and women and across specialties. They state that this erosion may be due to:

• Lack of role models.
• A high volume of materials to learn.
• Time pressure.
• Patient and environmental factors.
• Focus on the science of medicine and a benign neglect of the art of patient care.
• Partial sleep deprivation
• Emphasis of market-driven health care systems and evidence based medicine.

This decline in empathy was not observed in cross-sectional studies of medical students in Japan or Korea (both studies used the same instrument - the JSPE).

References:

1. Hojat M, Vergare,  MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA,Veloski J,Gonnella JS. The Devil is in the Third Year: A Longitudinal

Study of Erosion of Empathy in Medical School. Acad Med. 2009; 84:1182–1191.

DOI Number10.1097/ACM.0b013e3181b17e55

2. Wright SM, Kern DE, Kolodner K, Howard DM, Brancati FL. Attributes of excellent attending physician role models. N Engl J Med. 1998;339:1986 –1993.