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Original research
Searching for the erosion of empathy in medical undergraduate students: a longitudinal study
  1. José Manuel Blanco1,2,
  2. Fernando Caballero1,
  3. Santiago Álvarez1,
  4. Mercedes Plans2,
  5. Diana Monge1
  1. 1 School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
  2. 2 Valle de la Oliva Healthcare Centre, Madrid, Spain
  1. Correspondence to Dr Diana Monge; d.monge{at}


Objective To analyse the trajectory of empathy throughout the degree programme of medicine in a Spanish school of medicine.

Design Longitudinal, prospective 5-year study, between October 2014 and June 2019.

Setting Students from a Spanish university of medicine.

Participants Two voluntary cohorts of undergraduate medical students from two different school years were invited to participate (n=135 (cohort 1, C1) and 106 (cohort 2, C2) per school year). Finally, a total number of 174 students (102 (C1, 71.6% women) and 72 (C2, 70.8% women) students, respectively) were monitored for 5 years. Each cohort was divided in two subcohorts of paired and unpaired students that were analysed to check possible social desirability bias.

Primary outcome measure The Jefferson Scale of Empathy (JSE).

Results The cohort of 102 students (C1) monitored between their first and fifth years of study (71.6% women) showed an improvement among paired women of 2.15 points in total JSE score (p=0.01) and 2.39 points in cognitive empathy (p=0.01); in the unpaired female cohort the increase was of 2.32 points (cognitive empathy) (p=0.02). The cohort of 72 students (C2) monitored between their second and sixth years of study (70.8% women) displayed a cognitive empathy increase of 2.32 points (p=0.04) in the paired group of women. There were no significant differences between paired and unpaired results for either cohort. Empathy scores among men did not decrease.

Conclusions The empathy of medical students at our school did not decline along grade years. In fact, it improved slightly, particularly cognitive empathy, among women. This paper contributes to enlarge data from Europe, where longitudinal studies are scarce. It supports the idea that there may be global geo-sociocultural differences; however, more studies comparing different school settings are needed.

  • education & training (see medical education & training)
  • medical education & training
  • ethics (see medical ethics)

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  • Contributors All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JMB, DM and FC. FC and SA led the person-centred medical curriculum. MP made substantial contributions to interpretation of data. The first draft of the manuscript was written by JMB and DM, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Informed consent was obtained from all individual participants included in the study.

  • Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. All the questionnaires were anonymous, by use of codes, with the aim of adhering to international data protection laws, such as the current Spanish regulation (Organic Law 3/2018, of 5 December, regarding the Protection of Personal Data and guarantee of digital rights, BOE 294 of 6/12/2018). When students voluntarily accept it, some data had a numerical identification code to make possible analysis of paired student cohorts without compromising anonymity. The study received the approval of the Ethics Committee of the Francisco de Vitoria University (Number/ID: 09/2017). Participation was voluntary and independent of students’ academic results.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.