title: Empathy among undergraduate medical students: A multi-centre cross-sectional comparison of students beginning and approaching the end of their course.
abstract: BACKGROUND
  Although a core element in patient care the trajectory of empathy during undergraduate medical education remains unclear. Empathy is generally regarded as comprising an affective capacity: the ability to be sensitive to and concerned for, another and a cognitive capacity: the ability to understand and appreciate the other person's perspective. The authors investigated whether final year undergraduate students recorded lower levels of empathy than their first year counterparts, and whether male and female students differed in this respect.
  
  
  METHODS
  Between September 2013 and June 2014 an online questionnaire survey was administered to 15 UK, and 2 international medical schools. Participating schools provided both 5-6 year standard courses and 4 year accelerated graduate entry courses. The survey incorporated the Jefferson Scale of Empathy-Student Version (JSE-S) and Davis's Interpersonal Reactivity Index (IRI), both widely used to measure medical student empathy. Participation was voluntary. Chi squared tests were used to test for differences in biographical characteristics of student groups. Multiple linear regression analyses, in which predictor variables were year of course (first/final); sex; type of course and broad socio-economic group were used to compare empathy scores.
  
  
  RESULTS
  Five medical schools (4 in the UK, 1 in New Zealand) achieved average response rates of 55 % (n = 652) among students starting their course and 48 % (n = 487) among final year students. These schools formed the High Response Rate Group. The remaining 12 medical schools recorded lower response rates of 24.0 % and 15.2 % among first and final year students respectively. These schools formed the Lower Response Rate Group. For both male and female students in both groups of schools no significant differences in any empathy scores were found between students starting and approaching the end of their course. Gender was found to significantly predict empathy scores, with females scoring higher than males.
  
  
  CONCLUSIONS
  Participant male and female medical students approaching the end of their undergraduate education, did not record lower levels of empathy, compared to those at the beginning of their course. Questions remain concerning the trajectory of empathy after qualification and how best to support it through the pressures of starting out in medical practice.
authors.affiliation: Primary Care Unit, Department of Public Health, Primary Care University of Cambridge, IPH, Robinson Way, Cambridge, CB2 0SR, UK. taq1000@medschl.cam.ac.uk.
authors.forename: Thelma A
authors.initials: TA
authors.lastname: Quince
authors.affiliation: Institute of Medical Education, Medical School, Cardiff University 2nd floor, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4XN, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Kinnersley
authors.affiliation: Department of Medical and Social Care Education, University of Leicester, University Road, Leicester, LE1 7RH, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hales
authors.affiliation: College of Medicine, University of Swansea, Swansea, Wales, SA2 8PP, UK.
authors.forename: Ana
authors.initials: A
authors.lastname: da Silva
authors.affiliation: Department of Primary Health Care and General Practice, University of Otago, Wellington, 23a Mein Street, PO Box 7343, Wellington, New Zealand.
authors.forename: Helen
authors.initials: H
authors.lastname: Moriarty
authors.affiliation: Primary Care Unit, Department of Public Health, Primary Care University of Cambridge, IPH, Robinson Way, Cambridge, CB2 0SR, UK.
authors.forename: Pia
authors.initials: P
authors.lastname: Thiemann
authors.affiliation: Primary Care Unit, Department of Public Health, Primary Care University of Cambridge, IPH, Robinson Way, Cambridge, CB2 0SR, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hyde
authors.affiliation: Primary Care Unit, Department of Public Health, Primary Care University of Cambridge, IPH, Robinson Way, Cambridge, CB2 0SR, UK.
authors.forename: James
authors.initials: J
authors.lastname: Brimicombe
authors.affiliation: School of Clinical Medicine, University of Cambridge, Box 111 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Wood
authors.affiliation: Primary Care Unit, Department of Public Health, Primary Care University of Cambridge, IPH, Robinson Way, Cambridge, CB2 0SR, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Barclay
authors.affiliation: Primary Care Unit, Department of Public Health, Primary Care University of Cambridge, IPH, Robinson Way, Cambridge, CB2 0SR, UK.
authors.forename: John
authors.initials: J
authors.lastname: Benson
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004501:Education, Medical / Q000706:statistics & numerical data; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand; D012577:Schools, Medical / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Empathy; Interpersonal Reactivity Index; Jefferson Scale of Empathy-Student Version; Medical students; New Zealand; UK; Undergraduate