Reconsidering the "decline" of medical student empathy as reported in studies using the Jefferson Scale of Physician Empathy-Student version (JSPE-S).

INTRODUCTION: The suggestion that empathy "declines" or "erodes" as students progress through medical school has largely rested on observations reported from Jefferson Medical College in the United States using the Jefferson Scale of Physician Empathy (JSPE) developed by Hojat and colleagues. Now that the student version of JSPE has been administered to medical students in more than a dozen countries, it is timely to consider whether or not the Jefferson "case study" and the conclusions drawn from it are generalisable.
METHODS: A literature research was conducted on MEDLINE in mid-2014 to identify studies reporting administrations of the Student version of JPSE (JSPE-S) to cohorts of medical students and the means for studies and their sub-parts conducted in Japan, South Korea, China, Kuwait, India, Iran, UK, USA, Australia, Brazil, Colombia, the Dominican Republic and Portugal.
RESULTS: The means of these studies from a dozen countries outside the USA consistently cluster round 75% out of the possible maximum of 140 unlike the early Jefferson studies (although the later Jefferson means are also <120).
CONCLUSIONS: These observations may support Costa et al.'s contention that "a latent growth model suggests that empathy of medical students does not decline over time" (p. 509) - or at least not significantly. But in order to understand the maturation process of medical students and trainees we need to develop more sophisticated, integrated models that combine culturally-sensitive concepts of emotional intelligence and moral reasoning with far more refined understandings of the nature of empathy required for the safe practice of patient-centred medicine.