Purpose Physician empathy is a core attribute in medical professionals, giving better patient outcomes. Medical school is an opportune time for building empathetic foundations. This study explores empathy change and focuses on contributory factors.
Methods We conducted a cross-sectional study involving 881 students (63%) from Years 1 to 5 in a Singaporean medical school using the Jefferson Scale of Physician Empathy-Student version (JSPE-S) and a questionnaire investigating the relationship between reported and novel personal-social empathy determinants.
Results Empathy declined significantly between preclinical and clinical years. Female and medical specialty interest respondents had higher scores than their counterparts. Despite strong internal consistency, factor analysis suggested that the JSPE model is not a perfect fit. Year 1 students had highest Perspective Taking scores and Year 2 students had highest Compassionate Care scores. High workload and inappropriate learning environments were the most relevant stressors. Time spent with family, arts, and community service correlated with higher empathy scores, whilst time spent with significant others and individual leisure correlated with lower scores. Thematic analysis revealed that the most common self-reported determinants were exposure to activity (community service) or socialisation, personal and family-related event as well as environment (high work-load).
Conclusion While the empathy construct in multicultural Singapore is congruent with a Western model, important differences remain. A more subtle understanding of the heterogeneity of the medical student experience is important. A greater breadth of determinants of empathy, such as engagement in arts-related activities should be considered.
Citations
Citations to this article as recorded by
Elaboração e validação de um instrumento de classificação da empatia clínica: ICEC-MES Cleuza Guimarães Teixeira, Liliane Faria Bernardes, Yohanna Teodoro Costa Fukuti, Camila do Carmo Said, José Maria Peixoto, Eliane Perlatto Moura Revista Brasileira de Educação Médica.2026;[Epub] CrossRef
Empathy among Undergraduate Medical Students and Its Relationship with Academic Performance Danish Rastogi, Abhishek Kumar Singh, Shraddha Singh International Journal of Health Sciences and Research.2026; : 108. CrossRef
Preparation and validation of a clinical empathy classification instrument: ICEC-MES Cleuza Guimarães Teixeira, Liliane Faria Bernardes, Yohanna Teodoro Costa Fukuti, Camila do Carmo Said, José Maria Peixoto, Eliane Perlatto Moura Revista Brasileira de Educação Médica.2026;[Epub] CrossRef
Sensibilisiert für den Umgang mit älteren Patient*innen Andrea Winzer, Mareike Breinbauer, Stefan Claus Zeitschrift für Allgemeinmedizin.2025; 101(1): 15. CrossRef
Unveiling the interplay of medical professionalism, mental well-being and coping in medical students: a qualitative phenomenological study Kamran Sattar, Muhamad Saiful Bahri Yusoff BMC Medical Education.2025;[Epub] CrossRef
The role of training and education for enhancing empathy among healthcare students: a systematic review of randomised controlled trials Caroline Teggi Schwartzkopf, Renata Tolêdo Alves, Pedro C. Lopes, Julien Braux, Filomena Capucho, Célia Ribeiro BMC Medical Education.2025;[Epub] CrossRef
Perceptions of mental health literacy, stigma, empathy, and confidence in managing patients with psychiatric disorders among doctors and nurses working in a Singapore emergency department Joo Shiang Ang, Howard Cai Hao Khoe, Jinghui Huang, Gabrielle Wann Nii Tay, Cyrus Su Hui Ho BMC Emergency Medicine.2025;[Epub] CrossRef
Physicians’ appraisal of parental concerns: a qualitative assessment Laura Cuypers, Cato Dessers, Birgitte Schoenmakers, Jaan Toelen British Journal of General Practice.2025; 75(758): e618. CrossRef
Medical Students’ Empathy Towards the Patient; Does Their Perceived Social Support Play a Role? A Cross-sectional Study Malihe Farid, Sahar Ghaderi Shiraz E-Medical Journal.2025;[Epub] CrossRef
The association between empathy and artistic practice: a cross-sectional study with medical students Martim Fornetti, Miguel Barbosa BMC Medical Education.2024;[Epub] CrossRef
Empathy Levels Among Healthcare Professionals: An Asian Multi-professional Cross-Sectional Study Song He, Rehena Sultana, Devanand Anantham, Huey Peng Loh, Jamie X Zhou , Joo Ying Tang, Mabel Sim, Tracy Carol Ayre, Kok Yong Fong, Kok Hian Tan Cureus.2024;[Epub] CrossRef
The Greek Jefferson Scale of Empathy—Medical Student Version (JSE-S): Psychometric Properties and Its Associated Factors Polychronis Voultsos, Petros Galanis, Marianna-Foteini A. Dafni, Venetia-Sofia Velonaki, Georgia-Neta Andreou, Leda Kovatsi Behavioral Sciences.2024; 14(3): 195. CrossRef
Assessment of Empathy among Health Professional Students in a Government Medical College in South India Bhavani R, Sneha Simon, Fathima Shoukath Ali, Rudrakshala Divyasri Healthline.2024; 15(3): 208. CrossRef
Diets and leisure activities are associated with curiosity Satoshi Morita, Toshiaki Sueyasu, Hisanori Tokuda, Yoshihisa Kaneda, Takayuki Izumo, Kazuji Nishikawa, Takashi Kusumi, Yoshihiro Nakao, Giuseppe Di Vita PLOS ONE.2024; 19(12): e0314384. CrossRef
Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies Jeremy Howick, Maya Dudko, Shi Nan Feng, Ahmed Abdirashid Ahmed, Namitha Alluri, Keith Nockels, Rachel Winter, Richard Holland BMC Medical Education.2023;[Epub] CrossRef
Medical Humanities in Undergraduate Psychiatry Teaching: Learner Assessment and Mediators of Better Learning Outcomes Arvind Rajagopalan, Qian Hui Chew, Kang Sim Journal of Medical Education and Curricular Development.2023;[Epub] CrossRef
The relationship between medical students’ empathy and burnout levels by gender and study years Hyoung Seok Shin, Hyunmi Park, Young-Mee Lee Patient Education and Counseling.2022; 105(2): 432. CrossRef
Finding Echoes: An Exploration of Empathy Among Physiotherapists and Physiotherapy Students in Singapore Elsie Kim Hiok Lim, Gordon Jian Ting Loh, Ren Yong Ong, Rachel Ruizhen Tan, Clement Chee Kin Yan, Katherin Shilin Huang, Melissa Yi Ching Chan, Meredith Tsz Ling Yeung Proceedings of Singapore Healthcare.2022;[Epub] CrossRef
Understanding moral empathy: A verbatim‐theatre supported phenomenological exploration of the empathy imperative Dilshan Pieris, Hartley Jafine, Shane Neilson, Ellen Amster, Joyce Zazulak, Connie Lam, Lawrence Grierson Medical Education.2022; 56(2): 186. CrossRef
Development of student empathy during medical education: changes and the influence of context and training Dujeepa D. Samarasekera, Shuh Shing Lee, Su Ping Yeo, Gominda Ponnamperuma Korean Journal of Medical Education.2022; 34(1): 17. CrossRef
Beyond empathy decline: Do the barriers to compassion change across medical training? Clair X. Y. Wang, Alina Pavlova, Antonio T. Fernando, Nathan S. Consedine Advances in Health Sciences Education.2022; 27(2): 521. CrossRef
Reliability of Greek version of the Toronto empathy questionnaire in medical students and associations with sociodemographic and lifestyle factors Polychronis Voultsos, Fotios Chatzinikolaou, Angeliki Papana, Aspasia Deliligka BMC Psychology.2022;[Epub] CrossRef
Impact of an aging simulation workshop with different debrief methods on the development of empathy in pharmacy undergraduates Zachary Weijie Fong, Shuh Shing Lee, Kai Zhen Yap, Hui Ting Chng Currents in Pharmacy Teaching and Learning.2021; 13(6): 683. CrossRef
Medical students’ preclinical service-learning experience and its effects on empathy in clinical training Yi-Sheng Yang, Pei-Chin Liu, Yung Kai Lin, Chia-Der Lin, Der-Yuan Chen, Blossom Yen-Ju Lin BMC Medical Education.2021;[Epub] CrossRef
Mapa da Empatia em Saúde como instrumento de reflexão em cenário de ensino não assistencial Luíza Uchôa de Resende Sousa, Eliane Perlatto Moura, José Maria Peixoto, Janaina de Souza Aredes, Camila do Carmo Said Revista Brasileira de Educação Médica.2021;[Epub] CrossRef
The Health Empathy Map as an instrument of reflection in a non-care teaching scenario Luíza Uchôa de Resende Sousa, Eliane Perlatto Moura, José Maria Peixoto, Janaina de Souza Aredes, Camila do Carmo Said Revista Brasileira de Educação Médica.2021;[Epub] CrossRef
Assessing empathy in final-year medical students using the Persian version of the Jefferson Scale of Physician Empathy Marzieh Nasiri, Mitra Amini, Arash Mani, Somayeh Delavari, Mahsa Kiani, Mohammad Mahdi Sagheb, Parinaz Tabari Journal of Education and Health Promotion.2021;[Epub] CrossRef
Civic-Mindedness Sustains Empathy in a Cohort of Physical Therapy Students: A Pilot Cohort Study Kerstin M Palombaro, Jill D Black, Robin L Dole, Sidney A Jones, Alexander R Stewart Journal of Patient Experience.2020; 7(2): 185. CrossRef
A systematic review of psychometric assessment of the Jefferson Scale of Empathy using the COSMIN Risk of Bias checklist Brett Williams, Bronwyn Beovich Journal of Evaluation in Clinical Practice.2020; 26(4): 1302. CrossRef
Cultura, ensino e aprendizagem da empatia na educação médica: scoping review Cezar Kayzuka Cotta Filho, Fernanda Berchelli Girão Miranda, Hiromi Oku, Giovanna Cristina Conti Machado, Gerson Alves Pereira Junior, Alessandra Mazzo Interface - Comunicação, Saúde, Educação.2020;[Epub] CrossRef
A multi-institutional and cross-sectional study on empathy in Chinese medical students: differences by student cadre or not, future career preference, and father’s education status Kangqi Yi, Mingyi Kang, Dongju Li, Zhipeng Wang, Jinsong Bai, Huiming Xu, Shulan Ma BMC Medical Education.2020;[Epub] CrossRef
Empathy amongst dental students: An institutional cross‐sectional survey in Poland and Croatia Ivana Brekalo Prso, Katarzyna Mocny‐Pachońska, Agata Trzcionka, Sonja Pezelj‐Ribaric, Ema Paljevic, Marta Tanasiewicz, Romana Persic Bukmir European Journal of Dental Education.2020; 24(4): 687. CrossRef
Medical Students’ Empathy Level Differences by Medical Year, Gender, and Specialty Interest in Akdeniz University Özge Akgün, Melahat Akdeniz, Ethem Kavukcu, Hasan Hüseyin Avcı Journal of Medical Education and Curricular Development.2020;[Epub] CrossRef
Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016) Konstantinos C Fragkos, Ioannis Sotiropoulos, Christos C Frangos World Journal of Meta-Analysis.2019; 7(1): 1. CrossRef
Understanding medical students’ empathy based on Enneagram personality types HyeRin Roh, Kyung Hye Park, Hyo Jeong Ko, Dong Kyu Kim, Han Bin Son, Dong Hyeok Shin, Seung Hyeon Lee, Hee Young Jung, Dong Heo Korean Journal of Medical Education.2019; 31(1): 73. CrossRef
Differences and changes in the empathy of Korean medical students according to gender and vocational aptitude, before and after clerkship Sanghee Yeo Korean Journal of Medical Education.2019; 31(4): 343. CrossRef
Understanding Medical Students’ Experience with Stress and Its Related Constructs: A Focus Group Study from Singapore Julia Farquhar, Desiree Lie, Angelique Chan, Mandy Ow, Arpana Vidyarthi Academic Psychiatry.2018; 42(1): 48. CrossRef
Empathy and burnout: a study on residents from a Singapore institution PT Lee, J Loh, G Sng, J Tung, KK Yeo Singapore Medical Journal.2018; 59(1): 50. CrossRef
Comment on: Empathy and burnout: a study on residents from a Singapore institution J Ong, C Swift Singapore Medical Journal.2018; 59(3): 166. CrossRef
Authors’ reply: Comment on: Empathy and burnout: a study on residents from a Singapore institution PT Lee, G Sng, J Loh, J Tung, KK Yeo Singapore Medical Journal.2018; 59(3): 168. CrossRef
Changing characteristics of the empathic communication network after empathy-enhancement program for medical students Je-Yeon Yun, Kyoung Hee Kim, Geum Jae Joo, Bung Nyun Kim, Myoung-Sun Roh, Min-Sup Shin Scientific Reports.2018;[Epub] CrossRef
Evaluación de la empatía en estudiantes de Medicina Armand Grau, Pere Toran, Alberto Zamora, Miquel Quesada, Carme Carrion, Esther Vilert, Antoni Castro, Carlos Cerezo, Susanna Vargas, Bibiana Gali, Ferran Cordon Educación Médica.2017; 18(2): 114. CrossRef
The mediating effect of calling on the relationship between medical school students’ academic burnout and empathy Su Jin Chae, So Mi Jeong, Yoon-Sok Chung Korean Journal of Medical Education.2017; 29(3): 165. CrossRef
Research trends in studies of medical students’ characteristics: a scoping review Sung Soo Jung, Kwi Hwa Park, HyeRin Roh, So Jung Yune, Geon Ho Lee, Kyunghee Chun Korean Journal of Medical Education.2017; 29(3): 137. CrossRef
Emotional intelligence and academic performance of medical undergraduates: a cross-sectional study in a selected university in Sri Lanka Chandrani Nirmala Wijekoon, Heshan Amaratunge, Yashica de Silva, Solith Senanayake, Pradeepa Jayawardane, Upul Senarath BMC Medical Education.2017;[Epub] CrossRef
First
Prev
