Research has demonstrated erosion of empathy in students during medical education. Particularly, U.S. studies have demonstrated empathy declines during clinical training in the third and fourth year of traditional medical programs. Yet, studies conducted outside the U.S. have not confirmed this trend. Timing and extent of patient interactions have been identified as empathy-protective factors. The need to examine empathy within different learning contexts has been noted, as has the need for longitudinal and time-series research designs to analyze trajectories. Between fall 2010 and spring 2019, we assessed empathy longitudinally among six student cohorts (N = 493) at a U.S. medical school, where patient interaction occurs early and throughout an integrated curriculum. Empathy levels of students in each cohort were assessed at five time points utilizing the Jefferson Scale of Physician Empathy-Student version. We hypothesized empathy levels will not degrade by program end, and trajectories will not show patterns of decline in Years Three and Four. Analysis of Variance (ANOVA) and Linear Mixed Model (LMM) analyses were used to analyze differences at baseline and changes in empathy trajectories. ANOVA analyses revealed statistically significant differences at baseline by class cohort (F(5, 487) = [23.28], p < 0.001). LMM analyses indicated empathy was either significantly higher or not different at the end of the program (F(19, 1676) = [13.97], p < 0.001). Empathy trajectories varied among cohorts; yet, none resulted in an overall empathy decline by the end of the program. Findings demonstrate empathy in U.S. medical students can be unchanged or higher by the end of medical education. Outcomes are consistent with reports of non-declining medical student empathy outside the U.S. and support the notion of context-specificity. Results further support recent research, suggesting decreases in empathy during training can stabilize or increase by program end. These findings have important implications for future empathy research context and design considerations, as well as program planning.

中文翻译：

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综合课程和学生同理心：纵向多队列分析。

研究表明，医学教育期间学生的同理心受到侵蚀。特别是，美国的研究表明，在传统医疗项目的第三年和第四年的临床培训期间，同理心会下降。然而，在美国境外进行的研究尚未证实这一趋势。患者互动的时间和程度已被确定为同理心保护因素。人们注意到需要在不同的学习环境中检查同理心，也需要纵向和时间序列研究设计来分析轨迹。2010 年秋季至 2019 年春季，我们对美国一所医学院的六个学生群体 (N = 493) 进行了纵向评估，其中患者互动发生在早期并贯穿整个综合课程。使用杰斐逊医师同理心量表-学生版在五个时间点评估每个队列中学生的同理心水平。我们假设同理心水平不会在项目结束时下降，并且轨迹不会显示出第三年和第四年下降的模式。方差分析（ANOVA）和线性混合模型（LMM）分析用于分析基线差异和共情轨迹的变化。方差分析显示各班级队列的基线存在统计学显着差异 (F(5, 487) = [23.28], p < 0.001）。LMM 分析表明，在项目结束时，同理心要么显着更高，要么没有差异 (F(19, 1676) = [13.97], p < 0.001）。不同群体的同理心轨迹各不相同；然而，在项目结束时，没有一个结果导致同理心总体下降。研究结果表明，在医学教育结束时，美国医学生的同理心可能保持不变或更高。结果与美国以外医学生同理心未下降的报告一致，并支持具体情况的概念。结果进一步支持了最近的研究，表明训练期间同理心的减少可以在项目结束时稳定或增加。这些发现对未来的同理心研究背景和设计考虑以及项目规划具有重要意义。