Purpose
Empathy is an essential trait for physicians that enables communication and trust cultivation with patients. While some studies report that empathy decreases throughout medical training due to the high demands of medical education, other studies suggest that claims of empathy decline are greatly exaggerated. Thus, this study compares medical students’ empathy scores throughout four different phases of medical school to assess the validity of the reported decline in empathy.

Methods
Empathy levels were measured on a 30-point scale using a validated survey administered to students from the classes of 2022-2027. Baseline scores were collected before starting medical school, with follow-up measurements collected at the end of pre-clinical education (P1), the clerkship phase (P2), and the fourth year (P3). Changes in empathy scores between phases were analyzed using pairwise t-tests.

Results
Baseline empathy scores (n=374, mean=24.23, SD=3.91) declined by an average of 1.05 points (t=3.01, p=0.003, Cohen’s d=0.24) by the end of P1 (n=305, mean=23.18, SD=4.94). By the end of P2 (n=241, mean=22.41, SD=5.08), baseline empathy scores declined by an average of 1.82 points (t=4.61, p=0.000008, Cohen’s d=0.41). Finally, by the end of P3 (n=156, mean=22.90, SD=4.79), baseline empathy scores declined by an average of 1.33 points (t=3.49, p=0.0006, Cohen’s d=0.32).

Conclusions
The results suggest that medical students experience a decline in empathy from the start of medical school to the end of all educational phases, with the greatest decline occurring by the end of clerkship year—when students begin engaging with patients. While the decline in empathy over the course of medical school is statistically significant, the low-to-moderate effect size may indicate limited clinical significance. Still, it remains that addressing even slight declines in empathy is important in ensuring the next generation of physicians provides compassionate, patient-centered care.