Battling the 'Devil in the Third Year': The Fight to Foster Empathy in Medical Trainees

Ryan Syrek, MA


July 29, 2019

Quantifying Individual Caring Capacity

Various tools have been developed to help assess empathy in patient care. Among the most well recognized is the Jefferson Scale of Empathy. That measurement has a key role in the nationwide Project in Osteopathic Medical Education and Empathy. As Mark Speicher, PhD, senior vice president for medical education and research at the American Association of Colleges of Osteopathic Medicine (AACOM) explains, the project includes more than 6000 students across 41 osteopathic institutions. That's approximately 85% of all incoming osteopathic medical students in the United States. The intent is to establish a national norm for empathy scoring in medical students and to "see how empathy changes, not only over time but between students."

Results of the first phase have been published and include national norm tables for empathy scores among first-year students at the beginning of the academic year, using the Jefferson Scale of Empathy. "The national norm tables are important because, when you have an individual student's empathy score, it doesn't mean anything by itself. With a norms table, you can say, 'Hey, your score is in the best 10% of students with empathy.'" This information may not only provide a more tangible way to measure an individual's relative empathy, it can also ideally identify when and where interventions are necessary.

As Speicher describes, "We did find that empathy declined slightly between year 2 and year 3." Although the project seems to have identified the same "devil in the third year" as Hojat and colleagues noted a decade ago, Speicher says the findings do not identify a specific cause. "That's why we are proposing to do a second phase of the study, where we follow a class of students from their entrance into medical school through their graduation from medical school."

Although Speicher says the study was a significant undertaking for AACOM, they recognize how important these data can be. "I think that everyone who works with medical students would be troubled by the fact that medical school does something to our future physicians that makes their empathy decline."

As AACOM and others work to provide a concrete quantification for empathy measurement, others are unsure that such a quality can truly be objectively measured. "I just feel like quantitative measures fall short," explains Chisolm. "I'm much more interested in understanding through someone's language and reflections whether or not they grow in empathy."


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