Combating Obstacles to Empathy

Combating Obstacles to Empathy: A Replicable Small Group Discussion Series for Medical Students

Author: Francesca P. Kingery, M.S.1*, Alexander Bajorek, M.D. M.A.2, Amber Zimmer Deptola, M.D.3 Karen Hughes Miller, Ph.D.4, Craig Ziegler Ph.D.5, Pradip D. Patel M.D.6

Author Affiliations:

1School of Medicine, University of Louisville, Louisville, KY, USA.

2Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA, USA.

3Washington University School of Medicine, St. Louis, MO, USA.  

4Graduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.

5Office of Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.

6Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.

[button link=”” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

Corresponding Author: Francesca P. Kingery,

Key Words: Medical Humanities, Bioethics, Curriculum, Student-led, Empathy, Medical Education, Pre-Clinical



The expression of humanism in patient encounters is a core component of the medical profession and evolving national medical student curriculum. Growing evidence suggests that empathetic care improves patient outcomes and diagnostic accuracy while decreasing physician stress and rates of litigation. Unfortunately, multiple recent studies using different scales and survey tools have consistently shown empathy to decrease during the third and fourth years of medical school. We developed a replicable, case-based, student and expert-driven, small-group discussion series designed to address this decline. Over two years, the series included four separate discussions over controversial topics seldom addressed by formal courses (Chronic Pain Management vs. Prescription Drug Abuse, Balancing Business and Medicine, and Domestic Violence). We utilized pre- and post-session surveys to qualitatively and quantitatively evaluate the program. Our results demonstrated significant improvement in participants’ comfort with the subject matter and desire to approach faculty and peers regarding humanistic patient care. Future and more frequent interactions, combined with optimization of the format could further uncover the utility of this program. Ultimately, we believe our discussion series could be replicated on other medical campuses.


Published on date: March, 2016


DOI: 10.15404/msrj/03.2016.0001

Citation: Kingery et al. Combating Obstacles to Empathy: A Replicable Small Group Discussion Series for Medical Students Medical Student Research Journal (2016). doi: 10.15404/msrj/03.2016.0001


  1. Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine. October 2007;22(10):1434-8.
  2. 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. Academic Medicine. September 2009;84:1182–1191.
  3. Mangione S, Kane GC, Caruso JW, Gonella JS, Nasca TJ, Hojat M. Assessment of empathy in different years of internal medicine training. Medical Teacher. July 2002;24:370–3.
  4. Newton BW, Barber L, Clardy J, et al. Is there hardening of the heart during medical school? Academic Medicine. March 2008;83:244–249.
  5. Rosenthal S, Howard B, Schlussel YR, et al. Humanism at heart: preserving empathy in third-year medical students. Academic Medicine. March 2011;86(3):350-8.
  6. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Academic Medicine. January 2006; 81(1):82-5.
  7. Gold A, Gold S. Humanism in medicine from the perspective of the Arnold Gold Foundation: challenges to maintaining the care in health care. Journal of Child Neurology. June 2006;21(6): 546-9.
  8. Mueller PS. Incorporating professionalism into medical education: the Mayo Clinic experience. Keio Journal of Medicine. September 2009;58(3):133-43.
  9. Shiau S, Chen CH. Reflection and critical thinking of humanistic care in medical education. Kaohsiung Journal of Medical Science. July 2008;24(7):367-72.
  10. Swick HM. Viewpoint: professionalism and humanism beyond the academic health center. Academic Medicine. November 2007;82(11):1022-8.
  11. Bikker AP, Mercer SW, Rielly D. A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow Homoeopathic Hospital. J Altern Complement Med. August 2005;11(4):591-600.
  12. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. The Lancet. March 2001;357(9258):757-762.
  13. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. September 2004;27(3):237-51.
  14. Wensing M, Jung HP, Mainz J, Olesen F, Grol R. A systematic review of the literature on patient priorities for general practice care, part 1: description of the research domain. Social Science & Medicine. November 1998;47(10):1573-1588.
  15. Schattner, A. The silent dimension: expressing humanism in each medical encounter. Archives of Internal Medicine. June 2009;169(12):1095-9.
  16. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor– patient relationship and malpractice: lessons from plaintiff depositions. Archives of Internal Medicine. June 1994; 154:1365–1370.
  17. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. The relationship with malpractice claims among primary care physicians and surgeons. Journal of the American Medical Association. February 1997;277:553–9.
  18. Neumann M, Bensing J, Mercer S, Ernstmann N, Ommen O, Pfaff H. Analyzing the “nature” and “specific effectiveness” of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Education and Counseling. March 2009;74(3):339-46.
  19. Association of American Medical Colleges Medical School Objectives Project. Learning Objectives for Medical Student Education: Guidelines for Medical Schools. Washington, DC: Association of American Medical Colleges. Available from: upload/Learning%20Objectives%20for %20Medica l%20Student%20Educ%20Report%20I.pdf. Accessed December 28, 2014.
  20. Accreditation Council for Graduate Medical Education. General Competency and Assessment: Common Program Requirements. June 9, 2013; Available from: Accessed December 28, 2014.
  21. Medical professionalism in the new millennium: A physician’s charter. Project of the ABIM Foundation, ACP-ASIM Foundation and the European Federation of Internal Medicine. Annals of Internal Medicine. February 2002;136:243–246.
  22. Lehmann LS, Kasoff WS, Koch P, Federmann DD. A survey of medical ethics education at U.S. and Canadian medical schools. Academic Medicine. July 2004;79:682–689.
  23. Medical residency application to recognize student achievement in humanism in medicine [news release]. Englewood Cliffs, NJ: Arnold P. Gold Foundation; Nov 12, 2014. Accessed January 10, 2015.
  24. Benbassat J, Baumal R, Borkan JM, Ber R. Overcoming barriers to teaching the behavioral and social sciences to medical students. Academic Medicine. April 2003;78(4):372-80.
  25. Wachtler C, Lundin S, Troein M. Humanities for medical students? A qualitative study of a medical humanities curriculum in a medical school program. BMC Medical Education. March 2006;6:16.
  26. Doukas DJ, McCullough LB, Wear S. Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Academic Medicine. March 2012;87(3):334-41.
  27. Patel PD, Kischnick DB, Bickel SG, Ziegler CH, Miller KH. Evaluating the Utility of Peer- Assisted Learning in Pediatrics. Medical Science Educator. December 2011;21(4):316-319.
  28. Pandit NR. The Creation of Theory: A recent application of the Grounded Theory Method. The Qualitative Report. December 1996;2(4):1-20.
  29. Moyer CA, Arnold L, Quaintance J, et al. What factors create a humanistic doctor? A nationwide survey of fourth-year medical students. Academic Medicine. November 2010; 85(11):1800-7.
  30. Reichert J, Bognar S, Greenberg LW, Godoy M, Durgans KY. New educational modules offer tough case studies around humanistic issues. Journal of Cancer Education. February 2011; 26(2):386-7.
  31. Wen LS, Baca JT, O’Malley P, Bhatia K, Peak D, Takayesu JK. Implementation of small-group reflection rounds at an emergency medicine residency program. Canadian Journal of Emergency Medicine. May 2013; 5(3):175-7.
  32. Misch, DA. Evaluating physicians’ professionalism and humanism: the case for humanism “connoisseurs”. Academic Medicine. June 2002;77(6):489-95.
  33. Self, DJ, Olivarez M, Baldwin DC Jr. The amount of small-group case- study discussion needed to improve moral reasoning skills of medical students. Academic Medicine. May 1998;3(5):521-3.