Uncovering the “hidden curriculum” that drains medical students’ empathy

A “hidden curriculum” in medical school is responsible for reducing the empathy of students, finds research led by the University of Leicester. Published today in BMC Medical Education, the study is the first to demonstrate systematically why empathy declines during medical training and raises important questions about the fitness of medical education.

Empathy is a core value in healthcare delivery, known to reduce pain experienced by patients, improve their satisfaction with care, and protect against doctor burnout. Yet levels of empathy in medical students declines significantly as their training progresses.

In their systematic review, the researchers analysed data from 16 studies and 771 medical students and found that when medical students enter the clinical, patient-facing phase of their training they are met with a hidden, informal curriculum.

This stems from subtle, non-formal influences over students such as a stressful workload, organisational culture in healthcare settings, poor role models, and an undue focus on the biomedical model of disease. The researchers report that students in the study then adapted by developing cynicism and becoming emotionally distanced and desensitised.

Lead author of the study, Professor Jeremy Howick, Director of the University of Leicester’s Stoneygate Centre for Empathic Healthcare, said: “Empathy helps patients and doctors, so we would expect medical schools to foster it. Instead, albeit inadvertently via a hidden curriculum, the opposite happens. By bringing the cause of empathy decline to light, our study paves the way for educational programmes that foster and maintain empathy in medical students.

“Reducing the empathy decline involves implementing an ‘empathic hidden curriculum’ to provide students with direct experiences of what it is like to be a patient, alongside peer support, resilience training, empathy lectures and training for role models to display enhanced empathy.”

The University of Leicester’s Stoneygate Centre for Empathic Healthcare was set-up in 2022 to pioneer a robust new approach to medical education and training with empathy at its core. The initiative is the first of its kind in the UK and aims to provide the NHS with the most empathetic and resilient junior doctors possible.

While the studies included in the systematic review were small, the researchers argue that following further research, newly developed methods of medical education should seek to stem the decline of empathy in medical schools so both patients and doctors can benefit from a more empathic healthcare system.


Reference to study: Howick J, Dudko M, Feng SN, Ahmed A, Alluri N, Nockels K, Winter R, Holland R. Why might medical student empathy change throughout medical school? A systematic review and thematic synthesis of qualitative studies. BMC Medical Education https://doi.org/10.1186/s12909-023-04165-9