Changes in Dental Student Empathy During Training

Background: Because empathy in dentists is associated with improved patient outcomes, concern has been expressed over studies demonstrating that self-reported empathy declines during dental training. However, previous studies have used scales that fail to separate personal from professional contexts and emotive from cognitive types of empathy. Objectives: To better understand the effects of dental training on empathy, an instrument was developed that separately evaluates emotive (Emo) and cognitive (Cog) types of empathy in both personal (Per) and professional (Pro) contexts, resulting in four subscales (Per-Emo, Per-Cog; Pro-Emo, Pro-Cog). We hypothesized that declines would be limited to emotive empathy in professional contexts. Methods: All Ontario dental students Year (Y) 1-4 were recruited for an anonymous web-based self-report survey which included a depression inventory (WHO-MDI) and four 13-item empathy subscales constructed using items from validated instruments and modified to reflect Per and Pro scenarios. A 2x2x4 mixed design ANOVA was used to test differences in mean scores on the four subscales across the four years of training. Results: The response rate was 28% (n=178). All subscales showed good reliability and validity. Following a significant 3-way interaction in the primary ANOVA (F_3,174=2.80, p<.05), subsequent 2-way ANOVAs demonstrated no effect of training (F_3,174=1.43, ns) and no interaction (F_3,174=2.47, ns) with Per empathy measures, but a significant training by type interaction for Pro empathy measures (F_3,174=6.49, p<.001). Post-hoc analyses showed Y3 Pro-Emo scores were significantly lower than Y1 and Y2, while Y3 and Y4 Pro-Cog scores were significantly greater than Y1. Conclusions: This study suggests that changes in empathy in dental students during training are restricted to professional contexts. Professional emotive empathy appears to decrease whereas cognitive empathy appears to increase with training. These results are consistent with the development of a form of “professional empathy” described elsewhere as detached concern.