How do medical students without formal training in empathy development understand empathy in the context of patient care?

Main Article Content

E Archer
N Chhabra
S Chhabra
S Chhabra



Empathy is a crucial component of clinical practice and professionalism. Quantitative studies have reported empathy erosion in medical students. However, studies investigating medical students' perspectives on their understanding and behavioral expressions of empathy with patients are limited.


This study aimed to explore medical students' perspectives on the nature, significance, and expressions of empathy during their undergraduate training.


The study used a qualitative phenomenological approach. Twenty-five medical students (out of a total of 45) were invited to participate. Semi-structured online interviews were conducted to elicit experiential details from participants. The recorded interviews were transcribed verbatim, and data were analyzed using Braun and Clarke's thematic analysis method.


Students described their beliefs and understanding about empathy and reflected on the process of empathizing with patients. Most students defined empathy as having four interrelated and overlapping dimensions: cognitive, affective, behavioral, and moral. In addition, they believed that empathizing with patients was a bidirectional relational process, necessitating empathic inclination, adequate time, a non-judgmental approach, and effective communication and listening skills.


Empathy is more than a personal attribute; it is a multi-faceted, dynamic, and bidirectional relational process. Adequate time, support, stress management strategies, formal training, and encouragement from experienced teachers are crucial elements to fostering genuine or deep empathy in medical students. In addition, students should be trained in developing emotional regulation and maintaining an appropriate balance between professional detachment and empathic connections.


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How do medical students without formal training in empathy development understand empathy in the context of patient care?. (2023). African Journal of Health Professions Education, 15(3), 2-7.
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How do medical students without formal training in empathy development understand empathy in the context of patient care?. (2023). African Journal of Health Professions Education, 15(3), 2-7.


Smith KE, Norman GJ, Decety J. The complexity of empathy during medical school training: Evidence for positive changes. Med Educ 2017;51(11):1146-1159.

Ahrweiler F, Neumann M, Goldblatt H, Hahn EG, Scheffer C. Determinants of physician empathy during medical education: Hypothetical conclusions from an exploratory qualitative survey of practicing physicians. BMC Med Educ 2014;14:122.

Elayyan M, Rankin J, Chaarani MW. Factors affecting empathetic patient care behaviour among medical doctors and nurses: An integrative literature review. East Mediterr Health J 2018;24(3):311-318. https://doi. org/10.26719/2018.24.3.311

Pohontsch NJ, Stark A, Ehrhardt M, Kötter T, Scherer M. Influences on students’ empathy in medical education: An exploratory interview study with medical students in their third and last year. BMC Med Educ 2018;8(1):231.

Huang L, Thai J, Zhong Y, Peng H, Koran J, Zhao XD. The positive association between empathy and self-esteem in Chinese medical students: A multi-institutional study. Front Psychol 2019;10:1921. fpsyg.2019.01921

Neubauer BE, Witkop CT, Varpio L. How phenomenology can help us learn from the experiences of others. Perspect Med Educ 2019;8(2):90-97.

Magalhães E, Salgueira, AP, Costa P, Costa MJ. Empathy in senior year and first-year medical students: A cross- sectional study. BMC Med Educ 2011;11:52.

Pedersen R. Empathy: A wolf in sheep’s clothing? Med Health Care Philos 2008;11:325-335. https://doi. org/10.1007/s11019-007-9104-0

Hemmerdinger JM, Stoddart SD, Lilford RJ. A systematic review of tests of empathy in medicine. BMC Med Educ 2007;7:24.

Gladstein GA. Understanding empathy: Integrating counseling, developmental, and social psychology perspectives. J Couns Psychol 1983;30(4):467-482.

Coulehan JL, Platt FW, Egener B, et al. ‘Let me see if I have this right ...’: Words that help build empathy. Ann Intern Med 2001;135(3):221-227.

Morse JM, Anderson G, Bottorff JL, et al. Exploring empathy: A conceptual fit for nursing practice? J Nurs Scholar 1992;24(4):273-280.

Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract 2002;52(Suppl.):S9-S12. https://doi. org/10.1007/0-387-33608-7

Jeffrey D. Exploring empathy with medical students: A qualitative longitudinal phenomenological study. PhD thesis. Edinburgh: University of Edinburgh, 2018.

Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med 2009;84(9):1182-1191.

Hamed OA, Alahwal AM, Basri AH, Bukhari BM. Personal, cultural, and academic factors affecting empathy score in third-year medical students. Int J Educ Res 2015;3(3):727-740.

Krishnasamy C, Ong SY, Loo ME, Thistlethwaite J. How does medical education affect empathy and compassion in medical students? A meta-ethnography: BEME Guide No. 57. Med Teach 2019;41(11):1220-1231. https://doi. org/10.1080/0142159X.2019.1630731

Spatoula V, Panagopoulou E, Montgomery A. Does empathy change during undergraduate medical education? A meta-analysis. Med Teach 2019;41(8):895-904.

Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Does empathy decline in the clinical phase of medical education? A nationwide, multi-institutional, cross-sectional study of students at DO-granting medical schools. Acad Med 2020;95(6):911-918.

Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci 2013;15(3):398-405.

Sundler AJ, Lindberg E, Nilsson C, Palmér L. Qualitative thematic analysis based on descriptive phenomenology. Nurs Open 2019;6(3):733-739.

Tavakol S, Dennick R, Tavakol M. Medical students’ understanding of empathy: A phenomenological study. Med Educ 2012;46(3):306-316.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77-101. https://doi. org/10.1191/1478088706qp063oa

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: A synthesis of recommendations. Acad Med 2014;89(9):1245-1251.

Ramani S, Mann K. Introducing medical educators to qualitative study design: Twelve tips from inception to completion. Med Teach 2016;38(5):456-463.

StalmeijerRE,McnaughtonN,vanMookWN.Usingfocusgroupsinmedicaleducationresearch.AMEEGuide No. 91. Med Teach 2014;36(11):923-939.

Neumann M, Scheffer C, Tauschel D, Lutz G, Wirtz M, Edelhäuser F. Physician empathy: Definition, outcome relevance and its measurement in patient care and medical education. GMS Z Med Ausbild 2012;29(1). https://

Hojat M, Mangione S, Nasca TJ, et al. The Jefferson scale of physician empathy: Development and preliminary psychometric data. Educ Psychol Meas 2001;61(2):349-365.

Hojat M. Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes. New York, NY: Springer, 2007.

Halpern J. What is clinical empathy? J Gen Intern Med 2003;18(8):670-674. 1497.2003.21017.x

Reynolds WJ. The Measurement and Development of Empathy in Nursing. 1st ed. London: Routledge, 2000.

Halpern J. From Detached Concern to Empathy: Humanizing Medical Practice. New York, NY: Oxford

University Press, 2001.

Linley PA, Joseph S. Therapy work and therapists’ positive and negative well-being. J Soc Clin Psychol


Hojat M, Gonnella JS, Nasca TJ, Mangione S, Veloksi JJ, Magee M. The Jefferson scale of physician empathy:

Further psychometric data and differences by gender and specialty at the item level. Acad Med 2002;77(Suppl


Halpern J. From idealised clinical empathy to empathic communication in medical care. Med Health Care

Philosophy 2014;17(2):301-311.

Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval

Health Prof 2004;7(3):237-251.

Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: A systematic review. Br J Gen

Pract 2013;63(606):76-84.

Decety J, Fotopoulou A. Why empathy has a beneficial impact on others in medicine: Unifying theories. Front

Behav Neurosci 2015;8:457.

Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical

interview. JAMA 1997;277:678-682.

Norfolk T, Birdi K, Walsh D. The role of empathy in establishing rapport in the consultation: A new model. Med

Educ 2007;41(7):690-697.

Barrett‐Lennard GT. The phases and focus of empathy. Br J Clin Psychol 1993;66(1):3-14. https://doi.

org/10.1111/j.2044-8341. 1993.tb01722.x

Main A, Walle EA, Kho C, Halpern J. The interpersonal functions of empathy: A relational perspective. Emot Rev 2017;9(4):358-366.

Halpern J. From idealised clinical empathy to empathic communication in medical care. Med Health Care Philosophy 2014;17(2):301-311.

Jeffrey D. Communicating with a human voice: Developing a relational model of empathy. J R Coll Physicians Edin 2017;47(3):266-270.

Decety J. Empathy in medicine: What it is, and how much we really need it. Am J Med 2020;133(5):561-566.

Hirsch EM. The role of empathy in medicine: A medical student’s perspective. AMA J Ethics 2007;9(6):423-427. 47. Hojat M, DeSantis J, Gonnella JS. Patient perceptions of clinician’s empathy: Measurement and psychometrics.

J Patient Exp 2017;4(2):78-83.

Eikeland HL, Ørnes K, Finset A, Pedersen R. The physician’s role and empathy – a qualitative study of third-year

medical students. BMC Med Educ 2014;14:165.

Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: An updated, systematic review. Acad Med 2013;88(8):1171-1177.

Kozlowski D, Hutchinson M, Hurley J, Rowley J, Sutherland J. The role of emotion in clinical decision making: An integrative literature review. BMC Med Educ 2017;17.

Kerasidou A, Horn R. Making space for empathy: Supporting doctors in the emotional labour of clinical care. BMC Med Ethics 2016;17.

Heyhoe J, Birks Y, Harrison R, O’Hara JK, Cracknell A, Lawton R. The role of emotion in patient safety: Are we brave enough to scratch beneath the surface? J R Soc Med 2016;109(2):52-58. https://doi. org/10.1177/0141076815620614

Ratanawongsa N, Teherani A, Hauer KE. Third-year medical students’ experiences with dying patients during the internal medicine clerkship: A qualitative study of the informal curriculum. Acad Med 2005;80(7):641-647.

Van Dijke J, van Nistelrooij I, Bos P, Duyndam J. Towards a relational conceptualisation of empathy. Nurs Philosophy 2020;21(3):e12297.