Parker Palmer (2007) calls for humanity in higher education. He sees today’s professional education stripped of feelings and concentrated on skills and techniques. He is right in this on many levels. Further proof is offered by a research done on medical students, comparing their  balanced emotional empathy scale scores (BBES) through medical school using a survey. This survey was used as a measure of vicarious empathy, or sympathy, of the students.

Figure 1. Measurement of BEES in medical students at different states of career. Higher score refers to higher level of sympathy. M1= freshmen, M2= sophomore, M3= junior, M4= senior. Core= internal medicine, family medicine, pediatrics, gynecology, psychiatry. Non-Core= surgery, pathology, radiology etc. Number of students surveyed was 419.  (Newton et al. 2008)

Figure 1 above shows the results of Newton’s study. For both sexes in all disciplines of medicine the emotional empathy scores decreased as the students advanced in medical school curriculum. The decline was lower in women compared to men with lowest decrease in empathy scores (13%) for women in core disciplines like internal medicine or pediatrics. Largest drop in empathy scores (38%) was seen in men at non-core disciplines like surgery or pathology (Newton et al. 2008). This decrease of empathy could be connected to Dr. Parker Palmer’s perceived lack of humanity in professionals.

More interestingly these empathy responses are different in all physicians on brain chemistry level compared to non-physicians. This was shown in a study where physicians and control group watched videos of needles and q-tips being stuck on hands. Their brain activity was measured with functional MRI, and their perception of pain intensity and unpleasantness in the videos was recorded via questionnaire (Cheng et al. 2007).

Figure 2. below shows how physicians did not have the same reaction to pain. The brain areas activating were different and the intensity of activity in those areas was lower compared to control group. In addition the physicians perceived the pain to be less intense and less unpleasant than control group (Cheng et al. 2007).

A) Control brain and physician’s brain activate different areas when viewing needles being put in other peoples hands. B) Pain intensity and unpleasantness are scored lower by physicians compared to controls. C) The intensity of neural signals in different parts of brain are stronger in controls compared to physicians. Q-tip touching instead of needle was used as a control measure to make sure the measurement method was valid. No significant changes were seen between controls and physicians in terms of pain perception for q-tip touching. (Cheng et al. 2007)

If these kinds of lowered empathy responses are seen in physicians starting already in medical school, the education must at least partially be the cause of it. It could be a way to protect one’s psyche from overloading when seeing suffering every day in hospital environment. It could also be just plain numbing effect. The students get simply used to seeing the pain, and pain loses it’s intensity in their minds. I would be interested to see if the pain perception of physicians is same as the control groups, when they themselves are poked with needles…

To fix this lack of empathy, we need to change the way the students learn, or at least constantly remind them that pain is real and devastating to people experiencing it. This humanization of professionals could take different forms in their studies varying from thoughtful problem based learning assignments to mentoring sessions. The way we teach has an impact on how students brain chemistry works, and we should be aware of this huge responsibility.

References:

• Cheng, Y., Lin, C.-P., Liu, H.-L., Hsu, Y.-Y., Lim, K.-E., Hung, D., & Decety, J. (2007). Expertise Modulates the Perception of Pain in Others. Current Biology, 17(19), 1708-1713. doi: http://dx.doi.org/10.1016/j.cub.2007.09.020
• Newton, B. W., Barber, L., Clardy, J., Cleveland, E., & O’Sullivan, P. (2008). Is There Hardening of the Heart During Medical School? Academic Medicine, 83(3), 244-249 210.1097/ACM.1090b1013e3181637837.
• Palmer, P. J. (2007) A New Professional: The Aims of Education Revisited, Change, Carnegie Foundation for the Advancement of Teaching. (http://www.carnegiefoundation.org/change/sub.asp?key=98&subkey=2455, when accessed. Now no longer there.)