The integrated curriculum and student empathy: a longitudinal multi-cohort analysis

Abstract

Research has demonstrated erosion of empathy in students during medical education. Particularly, U.S. studies have demonstrated empathy declines during clinical training in the third and fourth year of traditional medical programs. Yet, studies conducted outside the U.S. have not confirmed this trend. Timing and extent of patient interactions have been identified as empathy-protective factors. The need to examine empathy within different learning contexts has been noted, as has the need for longitudinal and time-series research designs to analyze trajectories. Between fall 2010 and spring 2019, we assessed empathy longitudinally among six student cohorts (N = 493) at a U.S. medical school, where patient interaction occurs early and throughout an integrated curriculum. Empathy levels of students in each cohort were assessed at five time points utilizing the Jefferson Scale of Physician Empathy-Student version. We hypothesized empathy levels will not degrade by program end, and trajectories will not show patterns of decline in Years Three and Four. Analysis of Variance (ANOVA) and Linear Mixed Model (LMM) analyses were used to analyze differences at baseline and changes in empathy trajectories. ANOVA analyses revealed statistically significant differences at baseline by class cohort (F(5, 487) = [23.28], p < 0.001). LMM analyses indicated empathy was either significantly higher or not different at the end of the program (F(19, 1676) = [13.97], p < 0.001). Empathy trajectories varied among cohorts; yet, none resulted in an overall empathy decline by the end of the program. Findings demonstrate empathy in U.S. medical students can be unchanged or higher by the end of medical education. Outcomes are consistent with reports of non-declining medical student empathy outside the U.S. and support the notion of context-specificity. Results further support recent research, suggesting decreases in empathy during training can stabilize or increase by program end. These findings have important implications for future empathy research context and design considerations, as well as program planning.

Keywords: Clinical training; Curriculum; Empathy; Medical education; Medical students; Student-patient interaction.

Fig. 1

Interrelated Pre-Clerkship Courses

Fig. 2

Four-Year Integrated Curriculum Overview. Source: Paul L. Foster School of Medicine Academic Catalog 2018–19. For current PLFSOM curriculum overview see https://elpaso.ttuhsc.edu/som/catalog/ContentOverview.aspx. Notes ^aScientific Principles of Medicine (SPM) is organized around clinical presentations, which are assigned to a corresponding organ system unit. Presentations are delivered in the form of clinical schemes, designed to instruct students in the relevant basic science content and presentation-specific pathophysiological processes. ^bMedical Skills incorporates interactions with standardized patients and simulations to prepare students for patient interviews and examinations. Patients present clinical problems that are simultaneously addressed in SPM. ^cCollege Colloquium promotes critical reflection through faculty-led discussions on patient-centered and empathy-related topics. ^dSociety Community and the Individual (SCI) immerses students in clinical experiences and empathy-related topics. Sessions utilize standardized patients and upon course completion students interact with actual patients

Fig. 3

Empathy Scores at Five Time Points by Class Cohort. Note: The figure shows mean empathy (JSPE-S) scores of each class cohort at five time points across the medical education program. ^aThe JSPE-S was administered to students at the beginning of each academic program year (Times 1–4) and at time of graduation (Time 5). Time 4 data is not available for Class of 2015