Rethinking empathy decline: results from an OSCE.
BACKGROUND
The phenomenon of empathy decline among medical students during training is widely accepted, with evidence based largely on studies using self-administered instruments. Recently, researchers have called into question this phenomenon, in light of new findings that suggest a discrepancy between self-administered empathy scores and observed empathic behaviours: for example, during objective structured clinical examinations (OSCEs). Our objective was to compare observed empathy among medical students in different clerkship years using an OSCE.


METHODS
Participants were medical students in their first or second year of clinical clerkships, enrolled in a required family medicine clerkship at Stanford University. Participants completed an OSCE that was directly observed by trained faculty staff, who used the Measure of Patient-Centered Communication (MPCC) instrument to measure empathic behaviours. Statistics were used to determine correlations between observed empathy and the students' year of clerkship, gender, and specialty preference.


RESULTS
A total of 129 medical students, evenly divided by gender and clerkship year, participated. There was a possible trend towards higher MPCC scores among students in their second clerkship year compared with students in their first year (p = 0.09), which became more significant when adjusted for outlier effects (p = 0.05). There was no difference in performance by gender. Students interested in a 'people-oriented' specialty scored higher in 'handling the patient's frustration' compared with those who are interested in a 'technology-oriented' specialty.


CONCLUSIONS
In our study, observed empathic behaviours were not lower in the second compared with the first year of clerkship training. More research is warranted to investigate the apparent discrepancy between self-administered empathy scores and observed empathic behaviours. New findings suggest a discrepancy between self-administered empathy scores and observed empathic behaviours.
San Jose-O'Connor Hospital Family Medicine Residency Program, San Jose, California, USA.
Valerie Chan
VC
Teng
Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.
Cathina
C
Nguyen
Standardized Patient Program, Center for Immersive and Simulation-based Learning, Stanford University School of Medicine, Stanford, California, USA.
Karen Thomson
KT
Hall
Division of Primary Care, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Tracy
T
Rydel
Division of Primary Care, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Amelia
A
Sattler
Division of Primary Care, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Erika
E
Schillinger
Division of Primary Care, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Eva
E
Weinlander
Division of Primary Care, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Steven
S
Lin
D002982:Clinical Clerkship / Q000706:statistics & numerical data; D004521:Educational Measurement; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D011581:Psychological Tests; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data