Understanding Clinical Empathy in Medical Education: A Scoping Review

Introduction:  A physician’s ability to establish an empathic understanding of patients is essential to the development of a therapeutic relationship. Educating students to become empathic physicians is an important learning objective in medical education. In the backdrop of a physician burnout epidemic and efforts to deliver patient-centered care, clinical empathy remains variably defined and incompletely understood.

Objectives:  We performed a scoping review to explore the current understanding of clinical empathy and assess approaches to teach empathy to medical students.

Methods:  We used standard methodology and performed PubMed searches “empathy”, “clinical”, “education”, and “teaching” from 2010-23. Articles were screened and reviewed, with common concepts and findings identified and aggregated by consensus.

Results:  Clinical empathy most commonly includes two categories. “Cognitive empathy” is the ability to identify and understand another’s feelings and perspective, without invoking an emotional response. Felt to be an active skill that may be acquired and developed, cognitive empathy is aligned with historical Western medical culture of emotional detachment and objectivity. “Affective empathy” is the ability to subjectively experience and share in another’s psychological state or feelings. Longstanding beliefs on the merits of cognitive empathy and risks of affective empathy, particularly vis-à-vis burnout, have been increasingly challenged, with evidence that both are needed in balance. A third component, “compassionate empathy” is also now recognized as the ability to respond to another’s emotions with verbal or non-verbal communication, including tone of voice, facial expressions and body posture. Medical school programs to teach empathy vary widely, including didactics, skills training, experiential training, with moderate impact on quantitative empathy scores. Few were designed to specifically address one of the three components of empathy.

Conclusion: Clinical empathy remains variably defined and incompletely understood. Teaching empathy to medical students is moderately impactful. Further work is needed to define the best approaches.

Desired Impact: Programs to teach clinical empathy to medical students are moderately effective and generally are not intentionally and specifically designed to address one or more of the three clinical empathy components. Best practice approaches to teach clinical empathy to medical students need to be developed.