Much has been written in the academic literature about the growing disparity between the kind of physicians graduating from medical schools today and what sort of doctor the public seeks. Consequently, the lay press and those within the medical community frequently report numerous breakdowns within the patient-physician relationship. Patients report that physicians do not listen to them, treat them like individuals, or acknowledge their suffering (Neufeld 1998; Levine 2004). Indeed, greater empathy has been shown to be an essential feature of an ideal patient-physician relationship and has become the focus of numerous academic initiatives at the undergraduate and graduate medical levels (Spiro, McCrea, Peschel, et al 1993). Still, the problem persists. Perhaps these initiatives are ineffective because they focus on the physician far too downstream of the educational process. Earlier interventions may be more appropriate. Therefore, it might be prudent to consider premedical students with increased empathy as optimal candidates for matriculation to medical school as those best suited to practice better medicine.
In response, medical educators have given additional attention to the humanities, literature, and the liberal arts to re-inculcate the art of medicine and the humanistic physician in an era dominated by technical expertise and managed care. For example, narrative medicine encompasses the comprehension of human suffering through the understanding and appreciation of the particular context of patients stories with empathy, trust, and respect (Talan 2003). Whether one can teach students to be more empathic through a formal curriculum remains highly controversial and deserves continued investigation, though some studies suggest it unlikely or at least difficult (Maguire and Booth 1996; Farnill and Todisco 1997; Winefield and Chur-Hansen 2000). Nonetheless, any added empathy to a baseline must first be built upon the pre-existing intrinsic characteristic of the individual. These attributes have been cited as the summation of life experience and internalization of social and cultural understanding.
Several medical educators have postulated an undergraduate education in the liberal arts and the humanities, in contrast to the traditional sciences, may contribute to increased empathy. It therefore behooves medical educators to examine the relationship between empathy as a personal virtue and the educational backgrounds of the applicants to medical school. This study attempts to analyze whether there indeed exists a correlation between empathy and significant commitment to an undergraduate curriculum in the humanities via undergraduate degree major in pre-medical students.
In this pilot phase one cross-sectional cohort study of 127 first-year medical students, two instruments designed to assess empathy were distributed along with a demographic survey tool at the start of the school year. Empathy scores were compared to several variables for statistical significance: undergraduate major, gender, years between college and medical school matriculation, participation in a combined undergraduate and medical school program, presence of advanced degrees, and college minor. Each score on the two empathy scales were analyzed independently.
The results of this study failed to show a statistically significant difference between undergraduate science and nonscience majors. Females demonstrated increased empathy compared to their male counter parts on the DIRI and Jefferson instruments respectively (74.9 vs. 64.7 p<.005; 116.8 vs. 110.3 p<.005). In addition, students in the Siena College combined degree program reported significantly more empathy than students from the Union College degree program on both instruments respectively (75.8 vs. 64.0 p=.005; 121.0 vs. 107.4 p=.005).
Despite the results of this small initial study suggesting no difference between undergraduate major, there remains reason to believe a curriculum geared towards service and humanism is associated with increased empathy, as the Siena cohort suggests. Furthermore, the study confirmed that females demonstrate increased empathy as compared to males.