In Reply to Schattner and to Ozair et al.

Abstract

Thanks to the authors of both letters for their comments and their kind words about our study. Schattner suggests it would be important to shift the emphasis from empathy research to indicators of burnout (e.g., emotional exhaustion, depersonalization) because of high rates of burnout in physicians-in-training and in practice, as well as wider implications. We believe that empirical research on burnout in medical students is as important as empathy research because they both have implications for medical education and patient care. In addition, in our previous research with MD-degree medical students,1 we found a significant inverse association between scores of the Jefferson Scale of Empathy (JSE) and those of the Maslach Burnout Inventory, suggesting that higher empathic orientation in medical students predicts lower burnout. Thus, because of the significant relationship between empathy and burnout, it would be more desirable to study both topics together. Ozair and colleagues correctly suggest that rigorous longitudinal, multi-institutional, and international research is required to address the issue of erosion of empathy in medical students. We agree that longitudinal study is more desirable than cross sectional to examine changes over time.2 The first longitudinal study of decline in empathy in medical students from matriculation to graduation2 was undertaken by our team. Currently, we are involved in a 5-year nationwide longitudinal study of DO-degree medical students that should provide the most definitive answers to the questions of changes in empathy and burnout and explore reasons for such changes, as reported by students’ own experiences/observations in each year of medical school. Preliminary data collected in the first year of this large-scale project (unpublished) show a significantly negative correlation between JSE scores and a measure of burnout, but significantly positive correlations between JSE scores and validated measures of orientation toward interprofessional collaboration and lifelong learning. Interestingly, a recent longitudinal study of U.S. MD-degree medical students3 reports a decline in empathy scores when the JSE was used, but an increase in empathy scores in the same sample when the Questionnaire of Cognitive and Affective Empathy was used. The controversial findings were attributed to the sensitivity and specificity of the JSE in measuring changes in empathy in medical students.4