Significantly higher levels of empathy were found in FCS-UBI students for the total score of JSPE, for the "Perspective taking" component and for 3rd year students still with higher scores in FCS-UBI.
These results are in line with the only study we found comparing the levels of empathy in two universities with different curricular models in a Pakistan study. 27 Another multi-institutional study revealed the influences of teaching scheme on the levels of medical students empathy though no specification of curricular model was reported28. Given the different socio-economic environments and medical and educational contexts between Portugal and Pakistan we can only recognise that Portuguese medicine students appear to be less empathic, the rasons for such being speculative.
Lower levels of empathy in FMUC students can possibly be explained by:
Teaching characteristics of each school.
FCS-UBI with more precocious in-practice classes the student with a skilled tutor learning and practicing after a tutorial for theory exposure. Analysing the curricula of both University Medical schools17,18 FCS-UBI had a larger number of curricular units related to humanistic sciences, with emphasis on the development of interaction and communication skills. Role-playing activities are conducted regularly with discussion and specific assessment of students' communicative and empathic abilities is made 8,22,23. FMUC lacks subjects related to the humanistic sciences and has a more superficial and limited approach to clinical practice started in the 4th year of MIM. The curricular unit of General Practice/Family Medicine, is the only one to include the discussion of topics such as empathy and communication and the performance of role-playing activities, is only taught in the 5th year. So by the 3rd year, FCS-UBI students already have had contact with clinical practice, whereas FMUC students have not17,18. Tutor’s characteristics influence the levels of student’s empathy 15,22. Thus, the differences between the two universities can also be so explained, and that deserves future study, supporting interventions in their tutors, upgrading them.
Other secondary factors can also help explain different levels of epathy:
Student-tutor ratio FMUC with a ratio of 18.5 (Portuguese average 7.53), contrasting with a 3.1 ratio in FCS-UBI. Higher student-tutor ratio at FMUC contributed to lower satisfaction with teaching, less clinical contact and less opportunities to develop empathic relationships with patients19. Author data affirm the need of adequate role-models for empathy. In fact in Coimbra students have a 13 ECTS content in General Practice ate the 1st year, 6 hours, 5th year one semester and 6th year two months with a dedicated General Practice tutor, comparing to 30 ECST in FCS-UBI, 1st, 2nd, 4th, 5th and 6th years and do most of their in-practice cases in a large over-crowded Central Hospital17,18, 20,21.
Sudent’s satisfaction: A student’s opinions pool, found out that FMUC was the national medicine school with the worst level of overall satisfaction and clinical teaching and study conditions, whereas FCS-UBI had the highest levels29.
So far no studies in specific students characteristics were performed to differentiate between FMUC and FCS-UBI except for entry marks, higher in Coimbra. Significant differences were only found in feminine gender and only in the total JSPE score and in the "Perspective taking" component, being higher in FSC-UBI, female students of FCS-UBI had higher levels of empathy than male ones.
Empathy is positively influenced by quality of life and negatively by fatigue, stress, and burnout for studies carried out in both universities that partook in this study showed that, FCS-UBI students have a better quality of life and are less vulnerable to stress and fatigue29,30.
The existence of differences in empathy between the two universities supports the need to consider the impact of the curriculum model and other MIM characteristics on the development of the empathic capacities of medical students. So several changes can be considered in order to increase the levels of empathy in medical students, in the long term, in order to improve and maintain the levels of empathy in medical students:
Educational interventions focused on empathic capacities by role-playing, video-watching and real consultations with patients with analysis and discussion of medical communication is deemed necessary23. Also lectures and practice of the importance of empathy and communication in the doctor-patient relationship and early integration of more contents of the human sciences area into the study plan, with a more reduced student-tutor ratio, preferably a one to one even if for shorter period of time 8,9. Even though “empathy is related to personality”, a matter this study did not focus on 31.
Research is to be continued in this area.
In spite of the attempts to minimize bias, there may have been distraction in reading the questionnaires. Attempts were made to close the selection bias through the random selection of the classes included in the study. The JSPE student’s version evaluates self-perception of empathy, which may be different from the actual empathic behaviour.