Bruce W. Newton, PhD, professor and chair of anatomy at Campbell University’s Jerry M. Wallace School of Osteopathic Medicine (CUSOM), recently became the first osteopathic medical educator to receive the International Association of Medical Science Educators (IAMSE)’s Master Teacher Award for his research on empathy in medical students.
Dr. Newton’s research began in 2008 when he co-published “Is There a Hardening of the Heart During Medical School?” detailing a scientific study through which he found an answer to this question: yes.
Dr. Newton began his research on empathy in medical students as a professor at the University of Arkansas, measuring empathy in MD students. This is where the first longitudinal measurement of student empathy was conceived. The study posed two questions: 1) does student vicarious empathy decrease during medical school, and 2) does greater patient contact help to maintain vicarious empathy?
To measure vicarious empathy, medical students were given the Balanced Emotional Empathy Scale (BEES) at the start of each school year for three consecutive years. The first measurement occurred before students began medical school and the final test at the start of their fourth year, which was also the end of their first year of clinical rotations.
The results found a significant decline after the first year of medical school and a second sharp decline after the third year when students were first introduced to patient care. While non-core (less maintained patient contact) and core (more maintained patient contact) specialty physicians differed in initial levels of vicarious empathy, both experienced significant drops in empathy by the conclusion of the study.
A New Approach
Dr. Newton is currently repeating the study at CUSOM. Dr. Newton told us that this time around, the study has a few changes, however. He is expanding the four-year study to a seven-year study, and will also be measuring cognitive empathy in addition to vicarious empathy thanks to a new survey instrument.
Although he has not completed his DO student research, Dr. Newton says he sees a key difference in the data between the MD and DO students he has worked with. While he is early in his study at CUSOM, when asked whether there are any key differences in the results of his previous and current studies, he said, “I do not see as sharp a drop after finishing the first year of medical school. Other than that, the other data are too sparse to make any early conclusions. My hope is that the drop I saw after finishing the third year does not happen here. The data will tell the story.”
The implication of this study is that it will provide the timeframe and causes of the loss of empathy that occurs in medical students. The stress of adjusting to medical school, and later clinical rotations, can be addressed by teachers and administrators. Dr. Newton has already adapted his teaching style because of his work on empathy.
“I have reduced the content in my lectures, now being more aware that you have many other classes you have to study for as well. I try to be more encouraging in the gross laboratory to help boost student moral. I emphasize, as much as possible, that as physicians-in-training you need to have good communication skills. Finally, I try to get a feel for how empathetic a medical school applicant is when I an interviewing them.”
Emphasis on Empathy in OME
Dr. Newton further explains that:
The osteopathic medical profession is a “people-oriented” one. You have to learn how to communicate with patients and establish that empathic bond of trust. Even if your affective empathy response, which is the first empathic response to reach your central nervous system, is one of dismay, you need to use cognitive empathy to emote to the patient in a clam and “feeling” fashion. In brief, affective empathy is what you feel, and cognitive empathy is what you say (and/or how you act) after you have thought about your affective response. Cognitive empathy can be enhanced through training. So even if you are not very “empathetic,” you can still put on an empathic front and form that bond of trust with the patient. Conversely, it may be a good thing for physicians to learn how to blunt their affective empathic response. If you let those affective, gut-feelings, “get to you,” then you are more prone to make errors and to suffer from burnout.