title: Complex and novel determinants of empathy change in medical students.
abstract: OBJECTIVE
  Physician empathy is a core attribute in medical professionals, giving better patient outcomes. Medical school is an opportune time for building empathetic foundations. This study explores empathy change and focuses on contributory factors.
  
  
  METHODS
  We conducted a cross-sectional study involving 881 students (63%) from Years 1 to 5 in a Singaporean medical school using the Jefferson Scale of Physician Empathy-Student version (JSPE-S) and a questionnaire investigating the relationship between reported and novel personal-social empathy determinants.
  
  
  RESULTS
  Empathy declined significantly between preclinical and clinical years. Female and medical specialty interest respondents had higher scores than their counterparts. Despite strong internal consistency, factor analysis suggested that the JSPE model is not a perfect fit. Year 1 students had highest Perspective Taking scores and Year 2 students had highest Compassionate Care scores. High workload and inappropriate learning environments were the most relevant stressors. Time spent with family, arts, and community service correlated with higher empathy scores, whilst time spent with significant others and individual leisure correlated with lower scores. Thematic analysis revealed that the most common self-reported determinants were exposure to activity (community service) or socialisation, personal and family-related event as well as environment (high work-load).
  
  
  CONCLUSIONS
  While the empathy construct in multicultural Singapore is congruent with a Western model, important differences remain. A more subtle understanding of the heterogeneity of the medical student experience is important. A greater breadth of determinants of empathy, such as engagement in arts-related activities should be considered.
authors.affiliation: Dean's Office, Yong Loo Lin School of Medicine, National University of Singapore.
authors.forename: Gerald
authors.initials: G
authors.lastname: Sng
authors.affiliation: Dean's Office, Yong Loo Lin School of Medicine, National University of Singapore.
authors.forename: Joshua
authors.initials: J
authors.lastname: Tung
authors.affiliation: Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore.
authors.forename: Yeo Su
authors.initials: YS
authors.lastname: Ping
authors.affiliation: Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore.
authors.forename: Shuh Shing
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Ma Thin Mar
authors.initials: MT
authors.lastname: Win
authors.affiliation: Dean's Office, Yong Loo Lin School of Medicine, National University of Singapore.
authors.forename: Shing Chuan
authors.initials: SC
authors.lastname: Hooi
authors.affiliation: Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore.
authors.forename: Dujeepa D
authors.initials: DD
authors.lastname: Samarasekera
mesh_terms: D001154:Art; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate; D004645:Empathy; D005163:Factor Analysis, Statistical; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D010817:Physician-Patient Relations; D010820:Physicians; D057566:Self Report; D012737:Sex Factors; D012846:Singapore; D058992:Social Participation; D013337:Students, Medical; D016526:Workload
keywords: Empathy; Medical students; Personal-social empathy determinants
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