The devil is in the third year: a longitudinal study of erosion of empathy in medical school.

PURPOSE: This longitudinal study was designed to examine changes in medical students\u27 empathy during medical school and to determine when the most significant changes occur. METHOD: Four hundred fifty-six students who entered Jefferson Medical College in 2002 (n = 227) and 2004 (n = 229) completed the Jefferson Scale of Physician Empathy at five different times: at entry into medical school on orientation day and subsequently at the end of each academic year. Statistical analyses were performed for the entire cohort, as well as for the matched cohort (participants who identified themselves at all five test administrations) and the unmatched cohort (participants who did not identify themselves in all five test administrations). RESULTS: Statistical analyses showed that empathy scores did not change significantly during the first two years of medical school. However, a significant decline in empathy scores was observed at the end of the third year which persisted until graduation. Findings were similar for the matched cohort (n = 121) and for the rest of the sample (unmatched cohort, n = 335). Patterns of decline in empathy scores were similar for men and women and across specialties. CONCLUSIONS: It is concluded that a significant decline in empathy occurs during the third year of medical school. It is ironic that the erosion of empathy occurs during a time when the curriculum is shifting toward patient-care activities; this is when empathy is most essential. Implications for retaining and enhancing empathy are discussed

Personality scale validities increase throughout medical school

Admissions and personnel decisions rely on stable predictor–criterion relationships. The authors studied the validity of Big Five personality factors and their facets for predicting academic performance in medical school across multiple years, investigating whether criterion-related validities change over time. In this longitudinal investigation, an entire European country’s 1997 cohort of medical students was studied throughout their medical school career (Year 1, N 627; Year 7, N 306). Over time, extraversion, openness, and conscientiousness factor and facet scale scores showed increases in opera-tional validity for predicting grade point averages. Although there may not be any advantages to being open and extraverted for early academic performance, these traits gain importance for later academic performance when applied practice increasingly plays a part in the curriculum. Conscientiousness, perhaps more than any other personality trait, appears to be an increasing asset for medical students: Operational validities of conscientiousness increased from.18 to.45. In assessing the utility of person-ality measures, relying on early criteria might underestimate the predictive value of personality variables. Implications for personality measures to predict work performance are discussed

A return-on-investment analysis of impacts on James Cook University medical students and rural workforce resulting from participation in extended rural placements

Introduction: Although all medical students at James Cook University (JCU), Queensland, Australia, undertake rural placements throughout their course, a proportion (currently about 20 per year out of 170-190 final-year students) undertake extended rural placements in rural and remote towns - 5-month Integrated Rural Placement (IRP) or 10-month Longitudinal Integrated Clerkship (LIC) programs. This study uses a return-on-investment (ROI) approach to quantify student and rural medical workforce benefits arising from these 'extended placements' between 2012 and 2018. Methods: Seventy-two JCU MBBS graduates participated in extended rural placements between 2012 and 2018. In 2019, 46 of these graduates who had reached at least postgraduate year 2 and provided consent to be contacted for health workforce research were emailed a link to an online survey. Questions explored the key benefits to students' development of competencies and to rural medical workforce as a direct result of student participation in the IRP/LIC activities, as well as estimations of costs to students, deadweight (how much change would have occurred without participating in an extended placement), and attribution (how much change was due to other programs or experiences). The key student and rural medical workforce benefits were each assigned a 'financial proxy' to allow calculation of ROI from 2013 to 2019 as a dollar value, compared with the costs to students and to the JCU medical school from implementing the IRP/LIC programs between 2012 and 2018. Results: Twenty-five of the 46 JCU medical graduates who undertook an extended placement responded (response rate 54%), reporting that the most common (96%) and most important benefit (56%) from their extended placement was 'greater depth and breadth of clinical skills'. Seventy-five percent (18/24; one missing response for this question) of the respondents also reported intending to have a full-time career in rural and remote practice. The overall cost of undertaking an IRP or LIC program for students between 2012 and 2018 was calculated to be $60,264, while the cost to the JCU medical school for sending 72 students out on extended rural placements was calculated as$32,560, giving total costs of $92,824. Given the total value of benefits ($705,827) calculated for the key student benefit of increased clinical skills and confidence in the internship year from participating in an extended placement ($32,197) and for the key rural medical workforce benefit of willingness to work in a rural or remote town ($673,630), the ROI from the extended rural programs between 2013 and 2019 (after students graduated and entered the workforce) is calculated at $7.60 for every dollar spent. Conclusion: This study confirms that undertaking an extended placement has significant positive impacts on final-year medical students' clinical confidence, clinical skills and communication skills into their internship year. In addition, the extended placements have longer-term impacts on the non-metropolitan health workforce by inspiring more JCU medical graduates to take up rural generalist, rural general practitioner or generalist specialist positions in rural and remote towns. This positive ROI from extended rural placements is important evidence for shifting the conversation around supporting these programs from one of cost to one of value

Charting medical students’ attitudes and beliefs towards people with chronic pain as they progress through their undergraduate programme: an observational study

Background: Healthcare professionals' (HCPs') attitudes towards pain influence their pain management. Attitudes about pain should be aligned with the evidence-base at the undergraduate stage of an HCP's career but pain education at undergraduate level is often lacking, and negative attitudes can pervade HCP practice. Previous studies investigating change in pain attitudes in undergraduate HCPs are cross-sectional in nature and frequently report minimal change in pain attitudes. Objectives: To investigate medical students' attitudes and beliefs towards people with chronic pain over the course of their Scottish undergraduate programme. Design: Five year observational study. Setting: A Scottish university medical school. Participants: Medical students were recruited in first year and followed up to their final year (year one n=205/244, year two n=190/245, year three n=132/279, year four n=110/262, year four n=159/260) for five years. Outcome Measure: The Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS with scores ranging from 15-105) was completed annually. Results: A two-way ANOVA found that attitudes and beliefs improved significantly (p<0.01) from first to final year (10.0 10.0). Medics showed a gradual reduction in scores (signifying improved attitudes) annually. Conclusions: This is the first known published study to chart changes in the same cohort of medical students' attitudes and beliefs towards people with chronic pain over time. Changes in attitudes improved steadily over the five year medical degree course. Future work should explore which aspects of degree courses, if any, impact upon attitudes and beliefs towards people with chronic pain so that courses can be enhanced accordingly