April 13, 2015

Teaching Empathy

by Kumaran Ramakrishnan, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

To teach the pathophysiology of Parkinson’s, a teacher can use a lecture with a PowerPoint. The lecture can teach the pathophysiology of the disease or the therapeutic guidelines for treating the symptoms.  But how can the student learn empathy for a patient with a debilitating condition like Parkinson’s disease?  Or how to understand and relate to the patient?  Numerous articles have been published stating that empathy increases not only are the patient’s positive perception of the physician but also health outcomes. One study found that patients who’s physicians had high empathy scores were more likely to achieve better disease control as evidence by lower A1c and LDL-C measurements.1 Similar results have been seen in patients with the other disease states such as the common cold. The Accreditation Council for Pharmacy Education (ACPE) requires schools of pharmacy to include empathy in the curriculum in order to provide high quality health care to patients with diverse backgrounds.

Unfortunately health professional students become less empathetic as they progress through school. One longitudinal study of medical students found the greatest erosion of empathy was in the third professional year.2 This erosion of empathy appears to occur when students focus too much on applying their classroom-based knowledge to real patient situations.  A similar longitudinal study has not been conducted in pharmacy students, but there have been reports that interventions can increase empathy among pharmacy students at different stages in their career. 

One study conducted in the second professional year of pharmacy school, engaged students in simulation activities.  Students were asked to act as though they had lost the use of their dominant hand, vision, and speech. There were small and large group discussions after each activity to engage the students.3 The Jefferson Scale of Empathy-Health Profession (JSE-HPS) was administered before the interventions, seven days, and ninety days after these activities. The JSE is a tool designed to measure empathy in medical students, and JSE-HPS has been adapted for other health professionals.4 The tool is widely used in studies to measure empathy for both students and practitioners alike. The results showed that while there was an increase in the scores seven days after the activities, JSE-HPS scores returned to baseline 90 days later. When comparing the scores with a control group, there is little difference in the net increase in empathy scores.3 

In another study, students watch a play featuring two actors — an elderly patient with a “demanding personality’ and an assistant manager who “cared more about rules and regulations than the elderly person’s concerns.” After the play, students engaged in a discussion about the stimulated encounter and how they would use the information in the future. The JSE was administered before the play, immediately after the play, seven days, and 26 days later. Similar to the previous study, while there was a significant increase between the pre-test and immediate posttest, by day 26, the scores were nearly back to baseline.5 

Several other methods have been employed to teach empathy.  Students have been asked to keep a nutritional diary,6 participate in a 7-day active learning assignment about diaetes,7 and use community resources for patients with a chronic disease.8 All of these studies show short-term increases in empathy but scores return to pre-intervention levels in the long run. This provides a unique challenge as any method used must not only increase empathy but maintain it. A solution might be use interventions throughout the curriculum. Accrediting agencies, such as the Accreditation Council for Pharmacy Education, have incorporated empathy into their standards. The ACPE standards mention empathy has an important component of professional communication, ethical behavior, and professionalism. Since empathy is such an important trait for effective health care professionals to possess, it is essential for teachers to understand how to teach empathy.  The studies have shown that several methods, while effective in the short term, have little effect in the long term.  For students to learn empathy and be effective professionals it is important to integrate empathy exercises throughout the curriculum – not just in one isolated course. 


  1. Hojat M, Louis D, Markham F, Wender R, Rabinowitz C, Gonnella J.  Physicians' empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359-364.
  2. Hojat M1, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, Veloski J, Gonnella JS. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med. 2009 Nov 2009;84(11):1182-91. 
  3. Lor K, Trong J, Ip E, Barnett, M. A randomized prospective study onoutcomes of an empathy intervention among second-year student pharmacists . APJE. 2015;79; Article 18
  4. Fjortoft N,Van Winkle L, Mohammadreza H. Measuring empathy in pharmacy students. AJPE 2011;75: Article 109.  
  5. Van Winkle L, Fjortoft N, Hojat M. Impact of aworkshop about aging on the empathy scores of pharmacy and medical students. AJPE. 2012 2012;76: Article 9
  6. Whitley H. Active-learning diabetes simulation in an advanced pharmacy practice experience to develop patient empathy. APJE. 2012;76; Article 203. 
  7. Trujillo J HY. A nutrition journal and diabetesshopping experience to improve pharmacy students’ empathy and cultural competence. APJE. 2009 37; Article 37.
  8. Chen JT, LaLopa J, Dang DK. Impact of patient empathy modeling on pharmacy students caring for the underserved. AJPE. 2008,;72: Article 40.

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