How Can Medical Schools Graduate Students Who Are Empathic?

By Michael Blumenfield, MD | June 7, 2010

Empathy is the ability to put yourself in someone else’s shoes and understand what they are feeling. This is something that psychiatrists try to do in our everyday work. Those of us who have worked in medical schools have struggled with the question of whether or not we can teach this to young men and women who are learning to be doctors or whether it is something that they either have or do not have. Certainly I have seen medical students who seemed to be decidedly lacking in this quality, just as I have seen students to whom it came very naturally and some who were far more empathic than I was as a student or even after years of experience.

Choose Empathic Students in the Admission Process

I have gone through many phases in trying to figure out how medical schools can graduate doctors who have this empathic quality. My first thought was to try and influence the selection process so students who seemed to have this natural quality would be chosen. I had the opportunity to join the admissions committee of the medical school where I taught and participated in the interviewing and selection of prospective students.

Actually, there were a few psychiatrists already on the committee along with other medical specialists and basic scientists who would be training the students in their preliminary non-clinical years. It was relatively easy to determine which students had this quality in abundance and which students did not. I could see the tears in a student’s eyes as he or she told me about experiences which he had known someone who had been ill or disadvantaged and how this had motivated him to want to be a doctor. I remember the caring response of one student to me as I was suffering with allergies with my eyes running on a particular day that I was interviewing her. On the other hand I could detect the intellectual response of students who ticked off their many volunteer activities or told of their dedication to finding the cure of cancer because it would then increase life expectancy. However, when it came down to the votes on the committee, a student being the most empathic would never trump the one with potential to become a world famous doctor.

Trying to Teach Empathy in the Classroom

I had opportunity to see if it were possible to teach students to be empathic. It was traditional in our medical school for psychiatrists to teach students interviewing technique both in formal lectures and at the bedside. In preparation for a formal lecture I made a video tape (we were not yet using DVDs) in which I had some senior students act as doctor and patient in a hospital room in various scenarios. In one of them the “doctor” asked the “patient” if anyone in her family had a cancer. The patient began to cry and said her daughter died of cancer. I then showed three possible responses. In the first one the doctor just continued with the interview and kept asking questions. In the second scenario, the doctor got up and excused himself and said he would come back later when the patient was feeling better. In the third case the doctor offered the patient a tissue and said that he was sorry. Obviously the third vignette was meant to be the correct one, and most students seemed to get it. However, a group of Asian students approached me after the lecture and told me that they did not agree with the choice of the best vignette. In their particular culture it was a sign of respect to let a patient be alone in that particular situation. Excusing one self and walking out of the room was the correct response as far as they were concerned. So I began to realize that this was not an easy task.

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by Louise B | October 29, 2010 6:01 PM EDT

Back in the 1970's I applied to go to College to become a Registered Nurse. Part of the entry test was to do psychological tests to make sure I had the "right stuff" to become a nurse. This included a healthy level of empathy.

I gather, based on what I'm reading here, the doctors don't have to go through this test. That is too bad. Why?

Because a healthy, and reasonable amount of empathy will foster an immense improvement in both physical and mental health.

by Colleen McCaffery | October 29, 2010 12:57 PM EDT

I think to ensure empathetic doctors medical schools should primarily choose students with social phobias because I understand we have empathy in spades...

by Gary Thomas | October 29, 2010 12:19 PM EDT

I don't think that you can teach empathy. Children develop empathy and attachment in early childhood with possibly some genetic predisposition. If you want to screen for empathy, then we need to understand the right interview techniques that work. Medical students who are sauvy will quickly find out that their empathy is being assessed and they will start to behave in a way that seems like they have empathy.

by The Editors | October 26, 2010 3:57 PM EDT

Posted on behalf of:
Lauretta Young MD
Chief Emeritus Kaiser Mental Health Portland Oregon
OHSU Division of Management Professor currently

I applaud the thoughtfulness of various methods used to increase empathy in the medical profession.

However, I wonder about an underlying issue which is the unnecessary brutality of medical training itself which may erase any pre-existing tendencies to be empathetic we select for in the admissions process.

We all still read in the JAMA editorials wondering if limiting residents to an 80 hour work week can be "afforded" and if there is really sufficient evidence about error reduction to allow this. Despite the innumerable studies in NASA and airlines about the effects of sleep deprivation on learning and other higher cognitive skills we still are debating this. What is worse is that most of the effects of sleep deprivation are on what makes us most human--our energy, our enthusiasm, our passion, our positivity, our creativity and our self care and connections to our families, our spirituality, and our communities. Can one really honestly think that having young people work 80 plus hours a week is good for them, good for their health, good for their relationships or good for empathy?

Besides sleep deprivation we all are still acutely aware of less than desirable teaching practices. There is overall an acute lack of consideration of students' needs not just at the school with which I am most familiar but in speaking to MDs who have graduated around the country it appears to be widespread.

So what can we as individuals do--we can certainly volunteer our time at our medical schools, we can lobby the deans and we can participate in community wide efforts to treat younger physicians with more respect and consideration.

by David Saltman | July 06, 2010 7:59 PM EDT

Although the teaching interventions described are most appropriate, they do one thing: they teach people to behave in empathic ways.They do not create empathic people. Unfortunately, my experience in teaching and training leads me to believe that we are ineffective in teaching adults to be empathic people. Once they reach adolescence they either have the capacity to be empathic or, they don't. However, we can be quite effective in assisting people, both professionals and our patients, to behave in empathic ways which has a positive impact on their relationships and our ability to help change to occur. David B. Saltman, LCSW, Faculty Stempel College of Public Health and Social Work, Florida International University

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How Can Medical Schools Graduate Students Who Are Empathic?

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