Changes in dental student empathy during training.

Because empathic patient interactions by dentists are associated with improved patient outcomes, self-reported declines in empathy during dental student training are a concern. This study examined differences in empathy in 178 dental students at the University of Toronto and the University of Western Ontario from years one through four using an anonymous self-report web-based survey in a cross-sectional design. To localize the effects of training on empathy, an instrument that separately evaluated emotive (Emo) and cognitive (Cog) types of empathy in both personal (Per) and professional (Pro) contexts was developed, using items modified from previously validated scales and resulting in an empathy scale with four thirteen-item subscales (Per-Emo, Per-Cog, Pro-Emo, Pro-Cog). The response rate was 36.5 percent, and all subscales showed good reliability and validity. A 2x2x4 mixed design ANOVA tested differences in mean scores among the four subscales across the four years of training. Following a significant three-way interaction, subanalyses demonstrated no significant effects in the Per-context, but a significant year by empathy-type interaction in the Pro-context. Post hoc analyses of Pro measures indicated year three emotive empathy scores were significantly lower than earlier years, whereas years three and four cognitive empathy scores were significantly higher. This isolated decrease in Pro-Emo empathy with an increase in Pro-Cog empathy is consistent with the development of "professional empathy," described elsewhere as detached concern.