The Role of Empathy in Medical Students' Choice of Specialty Harold H. Harsch, M.D. The role of empathy in medical students' postgraduate training interest was studied. The level of empathy, as measured by the Hogan Empathy Scale, was not found to be a
discriminating {actor in career seleetion. Students interested in psyehilltry had empathy levels similar to other groups of students. Although empathy has been suggested as a possible discriminating varillble among medical sehool candidates, individuals with high and low empathy scores were found to be interested in every field of praetiee. Further studies are needed before measurement of empathy is used in the seleetion process for medical school admission.
T
he effect of various factors on medical students' future specialty choice has been studied, including demographics, personality, faculty role modeling, financial considerations, and various attitudes (1,2). Empathy has not been directly evaluated, but it is commonly believed that the various medical specialties attract individuals with different interpersonal skills and levels of empathy, as reflected in the stereotypes of surgeons and psychiatrists. Empathy can be briefly defined as an ability to understand and feel what another person is experiencing. More broadly, it can be viewed as social sensitivity or an ability to view situations in a moral perspective (3). Empathy has long been feIt to be a desirable trait for health professionals that could facilitate doctor-patient relationships. The Hogan Empathy Scale (HES), an instrument mainly derived from the California PsychoDr. Harsch is associate professor in thedepartment of psychiatry at the Medical College of Wisconsin and medical director of the medical-psychiatry unit at Milwaukee County Medical Complex, Box 175, 8700 W. Wisconsin Avenue, Milwaukee, Wl53226. The author thanks A. J. Anderson for help in statistical analysis. Copyright e 1989 Academic PsychÜltry.
I
logical Inventory, has been used to examine levels of empathy in medical students and other professions (3). The scale has been correlated with peer-, patient-, and self-rated empathy and was found to measure a quality of interpersonal effectiveness (4). Prior studies of medical students have reported a lack of correlation between empathyand academic performance (4) and Medical College Admission Test Scores (5,6), as weIl as a possible decline in empathy during medical school education (7). To evaluate empathy as a variable in the selection of postgraduate medical training among medical students, the short 38-item version of the HES (Hogan R, personal communication, 1985) and a career choice questionnaire were administered to the members of one junior class. Questions about interest in psychiatry, often viewed as a more interpersonal specialty, were included. METHODS
The HES and the career survey were given to 185 junior students at the end of their psychiatrie clerkship. Two 100point Likerttype scales were used to measure interest in l
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psychiatrie knowledge and in a psychiatrie career. Demographie data were obtained, as was information about the respondents' specialty interest, if any, when they entered medica1 school and at the time of the survey. Specialty choice was coded into 10 groups: anesthesiology; medicine, induding family practice; physical medicine and rehabilitation; obstetrics and gynecology; psychiatry; surgical specialties; nonpatient contact areas (i.e., pathology, radiology, nudear medicine, and public health); pediatries; emergency medicine; and other, which induded students who were undecided. Empathy scores for the first nine specialty-choice groups were compared using analysis of variance for both career interest at entry into medical school and at the time of the survey. The relationships between empathyand other factors were analyzed using the Pearson product-moment correlation coefficient (range -1.0 to +1.0). The criterion for statistical significance was a p of ~.05.
RESULTS A total of 129 questionnaires were retumed, for a response rate of 70%. Individual empathy scores ranged from a high of 35 to a low of 15 (mean±SD, 24.2±4). Empathy scores were not significantly different between specialty groups either at entry into medical school or in the junior year. Mean empathy levels were lowest, however, in students interested in non-patient contact specialties (22.1) and highest in students interested in surgery and its subspecialties (25.5). Students interested in psychiatry had a mean score of 24.3. Age did not vary significantly between specia1ty groups and was not correlated with empathy scores (r=.03). There was little correlation between empathy and interest in psychiatry (r=.I7).
DISCUSSION Although empathy was not found to be a discriminating factor in medical students'
choice of career specialty, the findings are interesting nevertheless. It may be too simplistic to believe that one personality attribute would be enough to determine one's future field of practice. Measured empathy, however, has been suggested as a discriminating variable for medical school admission (5,7,8). In our sampie, students with high and low empathy scores were found to be interested in every specialty field. There was a tendency, although a nonsignificant one, for individuals with lower empathy scores to choose areas of practice that did not offer patient contact. It would be of interest to follow this sampie and retest empathy at the end of specialty training to see if this measure changes or has any correlation with patients' perceptions of the effectiveness of the students after they begin their practices. Does postgraduate training in the various specialties vary to the extent that residents in some specialties become uniformly higher in interpersonal effectiveness than others? There is some evidence that self-exploratory group experiences, as apart of a psychiatrie rotation, enhance empathy (10). If empathy is found to be related to the quality of future physicians, such experiences could be implemented in most medical schools. Recently the notion of "entitlement" was discussed as a phenomenon affecting relationships between students and their teachers and possibly physicians and their patients (9). Global trends in society may be more important in future physician-patient relationships than measured empathy. As there are still no data linking empathy in medica1 school students to future effectiveness as physicians, it would seem premature to use measurement of empathy as a criterion for medica1 school admission. References 1. Paiva REA, Vu NV, Verhulst 5J: The effect of clinica1 experiences in medica1 school on specialty choke decisions. J Med Educ 1982; 57:666-674
2. Matteson MT, Smith SV: Selection of medical specialties:preferencesversuschoices.JMedEducl977; 52:548-554 3. Hogan R: Development of an empathy scale. J Consult Clin Psycholl969; 33:306-316 4. Homblow AR, Kidson MA, Jones KV: Measuring medical students' empathy: a validation study. J Med Educ 1977; 11:7-12 5. Kupfer OJ, Drew FL, Curtis EI
discriminating {actor in career seleetion. Students interested in psyehilltry had empathy levels similar to other groups of students. Although empathy has been suggested as a possible discriminating varillble among medical sehool candidates, individuals with high and low empathy scores were found to be interested in every field of praetiee. Further studies are needed before measurement of empathy is used in the seleetion process for medical school admission.
T
he effect of various factors on medical students' future specialty choice has been studied, including demographics, personality, faculty role modeling, financial considerations, and various attitudes (1,2). Empathy has not been directly evaluated, but it is commonly believed that the various medical specialties attract individuals with different interpersonal skills and levels of empathy, as reflected in the stereotypes of surgeons and psychiatrists. Empathy can be briefly defined as an ability to understand and feel what another person is experiencing. More broadly, it can be viewed as social sensitivity or an ability to view situations in a moral perspective (3). Empathy has long been feIt to be a desirable trait for health professionals that could facilitate doctor-patient relationships. The Hogan Empathy Scale (HES), an instrument mainly derived from the California PsychoDr. Harsch is associate professor in thedepartment of psychiatry at the Medical College of Wisconsin and medical director of the medical-psychiatry unit at Milwaukee County Medical Complex, Box 175, 8700 W. Wisconsin Avenue, Milwaukee, Wl53226. The author thanks A. J. Anderson for help in statistical analysis. Copyright e 1989 Academic PsychÜltry.
I
logical Inventory, has been used to examine levels of empathy in medical students and other professions (3). The scale has been correlated with peer-, patient-, and self-rated empathy and was found to measure a quality of interpersonal effectiveness (4). Prior studies of medical students have reported a lack of correlation between empathyand academic performance (4) and Medical College Admission Test Scores (5,6), as weIl as a possible decline in empathy during medical school education (7). To evaluate empathy as a variable in the selection of postgraduate medical training among medical students, the short 38-item version of the HES (Hogan R, personal communication, 1985) and a career choice questionnaire were administered to the members of one junior class. Questions about interest in psychiatry, often viewed as a more interpersonal specialty, were included. METHODS
The HES and the career survey were given to 185 junior students at the end of their psychiatrie clerkship. Two 100point Likerttype scales were used to measure interest in l
\ '
.',
\
f
"
•
'
"
psychiatrie knowledge and in a psychiatrie career. Demographie data were obtained, as was information about the respondents' specialty interest, if any, when they entered medica1 school and at the time of the survey. Specialty choice was coded into 10 groups: anesthesiology; medicine, induding family practice; physical medicine and rehabilitation; obstetrics and gynecology; psychiatry; surgical specialties; nonpatient contact areas (i.e., pathology, radiology, nudear medicine, and public health); pediatries; emergency medicine; and other, which induded students who were undecided. Empathy scores for the first nine specialty-choice groups were compared using analysis of variance for both career interest at entry into medical school and at the time of the survey. The relationships between empathyand other factors were analyzed using the Pearson product-moment correlation coefficient (range -1.0 to +1.0). The criterion for statistical significance was a p of ~.05.
RESULTS A total of 129 questionnaires were retumed, for a response rate of 70%. Individual empathy scores ranged from a high of 35 to a low of 15 (mean±SD, 24.2±4). Empathy scores were not significantly different between specialty groups either at entry into medical school or in the junior year. Mean empathy levels were lowest, however, in students interested in non-patient contact specialties (22.1) and highest in students interested in surgery and its subspecialties (25.5). Students interested in psychiatry had a mean score of 24.3. Age did not vary significantly between specia1ty groups and was not correlated with empathy scores (r=.03). There was little correlation between empathy and interest in psychiatry (r=.I7).
DISCUSSION Although empathy was not found to be a discriminating factor in medical students'
choice of career specialty, the findings are interesting nevertheless. It may be too simplistic to believe that one personality attribute would be enough to determine one's future field of practice. Measured empathy, however, has been suggested as a discriminating variable for medical school admission (5,7,8). In our sampie, students with high and low empathy scores were found to be interested in every specialty field. There was a tendency, although a nonsignificant one, for individuals with lower empathy scores to choose areas of practice that did not offer patient contact. It would be of interest to follow this sampie and retest empathy at the end of specialty training to see if this measure changes or has any correlation with patients' perceptions of the effectiveness of the students after they begin their practices. Does postgraduate training in the various specialties vary to the extent that residents in some specialties become uniformly higher in interpersonal effectiveness than others? There is some evidence that self-exploratory group experiences, as apart of a psychiatrie rotation, enhance empathy (10). If empathy is found to be related to the quality of future physicians, such experiences could be implemented in most medical schools. Recently the notion of "entitlement" was discussed as a phenomenon affecting relationships between students and their teachers and possibly physicians and their patients (9). Global trends in society may be more important in future physician-patient relationships than measured empathy. As there are still no data linking empathy in medica1 school students to future effectiveness as physicians, it would seem premature to use measurement of empathy as a criterion for medica1 school admission. References 1. Paiva REA, Vu NV, Verhulst 5J: The effect of clinica1 experiences in medica1 school on specialty choke decisions. J Med Educ 1982; 57:666-674
2. Matteson MT, Smith SV: Selection of medical specialties:preferencesversuschoices.JMedEducl977; 52:548-554 3. Hogan R: Development of an empathy scale. J Consult Clin Psycholl969; 33:306-316 4. Homblow AR, Kidson MA, Jones KV: Measuring medical students' empathy: a validation study. J Med Educ 1977; 11:7-12 5. Kupfer OJ, Drew FL, Curtis EI
