Comparing empathy in medical students of two Portuguese medicine schools

RESEARCH ARTICLE Open Access Compa ing empa hy in medical s uden s o wo Po uguese medicine schools Luiz Miguel San iago 1,2,3* , Inês Rosendo 1,4,5 , Mona-Lisa Cou inho 1 , Ka ia Sophie Mau ício 1 , Isabel Ne o 6 and José Augus o Simões 6,7,5 Abs ac Backg ound: Empa hy is pa amoun in he doc o -pa ien ela ionship being a comp ehensi e and mul idimensional concep . Sel - a ings o empa hy change ac oss he yea s o medical educa ion only when he Je e son Scale o Physicians Empa hy is used, wi h a wo ying dec ease being ound h oughou he yea s in Medicine Schools. As he e a e only ew s udies on he ac o s in luencing medical s uden ’s empa hy, pa icula ly o he cu icula model, his s udy aimed o compa e he le els o empa hy o medicine s uden s o wo Schools wi h di e en cu icula models in cen al Po ugal, he Facul y o Medicine - Uni e si y o Coimb a (FMUC) and he Facul y o Heal h Sciences - Uni e si y o Bei a In e io (FCS-UBI). Me hods: C oss-sec ional obse a ional s udy wi h he Je e son Scale o Physician Empa hy –s uden s’Po uguese e sion (JSPE –sp ) o 1s , 3 d and 6 h yea s uden s o he 2017/2018 academic yea wi h desc ip i e and in e en ial s a is ical analysis (p<0.05). Resul s: Size ep esen a i e sample o 795 s uden s. Highe o al empa hy sco e (TES) (p=0.008)and“Pe spec i e aking”(p= 0.001) in FCS-UBI we e ound. JSPE-TES was highe in FCS-UBI, 3 d yea (p= 0.038). Highe FCS-UBI “Pe spec i e aking”in he 1s yea (p=0.030)and6 hyea (p= 0.044), o “Compassiona e ca e”in he 3 d (p=0.019) and o “S anding in he pa ien ’sshoes”in he 1s yea (p= 0.018) and in FMUC o “Compassiona e ca e”in he 1s yea (p= 0.037) and he “S anding in he pa ien ’sshoes”in yea 3 (p= 0.002) we e ound. Highe le els o empa hy we e ound in FCS-UBI emale s uden s, o JSPE-TES (p=0.045)and“Pe spec i e aking”(p=0.001). Conclusion: Highe empa hy le els in FCS-UBI we e ound, wi h di e en esul s in he hi d yea sugges ing in luence o he medical cou se eaching cha ac e is ics be ween he wo Medicine schools, s uden ’s empa hy le els being highe when ea lie and mo e in ense con ac wi h pa ien s accompanied by skilled u o s was de eloped. Keywo ds: Medical empa hy, Medical s uden s, Doc o -pa ien ela ionship, JSPE, Medical educa ion, S uden ’sempa hy Backg ound Empa hy is pa amoun in he doc o -pa ien ela ionship, con ibu ing o pa ien sa is ac ion wi h hei doc o , ease in p o iding ele an in o ma ion, be e adhe ence o he apy and clinical esul s, lowe li iga ion a es o medical mal-p ac ice and le els o s ess and p o essional bu nou [1–4]. Empa hy is a comp ehensi e and mul idimensional con- cep . Hoja e al. ha e desc ibed i as a p edominan ly cog- ni i e ( a he han emo ional) a ibu e ha in ol es he abili y o unde s and ( a he han eel) he pa ien ’sexpe i- ences, conce ns, and pe spec i es associa ed wi h he abil- i y o communica e ha same unde s anding [5]. Empa hy can be augh and ained h ough educa- ional p ocesses and e lec ion [6–9]. © The Au ho (s). 2020 Open Access This a icle is licensed unde a C ea i e Commons A ibu ion 4.0 In e na ional License, which pe mi s use, sha ing, adap a ion, dis ibu ion and ep oduc ion in any medium o o ma , as long as you gi e app op ia e c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons licence, and indica e i changes we e made. The images o o he hi d pa y ma e ial in his a icle a e included in he a icle's C ea i e Commons licence, unless indica ed o he wise in a c edi line o he ma e ial. I ma e ial is no included in he a icle's C ea i e Commons licence and you in ended use is no pe mi ed by s a u o y egula ion o exceeds he pe mi ed use, you will need o ob ain pe mission di ec ly om he copy igh holde . To iew a copy o his licence, isi h p://c ea i ecommons.o g/licenses/by/4.0/. The C ea i e Commons Public Domain Dedica ion wai e (h p://c ea i ecommons.o g/publicdomain/ze o/1.0/) applies o he da a made a ailable in his a icle, unless o he wise s a ed in a c edi line o he da a. * Co espondence: [email p o ec ed] 1 Facul y o Medicine o he Uni e si y o Coimb a, Coimb a, Po ugal 2 Gene al P ac ice/Family Medicine Clinic o he Uni e si y o Coimb a, Coimb a, Po ugal Full lis o au ho in o ma ion is a ailable a he end o he a icle San iago e al. BMC Medical Educa ion (2020) 20:153 h ps://doi.o g/10.1186/s12909-020-02034-3 Thus, i is impo an o p omo e e ec i e educa ional in e en ions ha can imp o e and main ain he le els o empa hy in s uden s, physicians o be as well in p ac- icing doc o s, con ibu ing o he s eng hening o he doc o -pa ien ela ionship and o a be e heal hca e sys em [6,8,9]. Despi e he consensus on he impo ance o empa hy in medical educa ion and p ac ice [6], a wo ying de- c ease in he empa hy o medical s uden s h oughou hei yea s in Medicine Schools is epo ed [6,10–14]. A ecen me a-analysis indica es signi ican e idence o sel - a ings o empa hy changing ac oss he yea s o medical educa ion only when he JSPE is used [9]. Sca ce Po uguese li e a u e ocused on he e olu ion o empa hy in po uguese medical s uden s. A mul i- ins i u ional s udy e eals ha empa hy and pe sonali y o medical s uden s a e closely ela ed [7]. C oss-cul u al adap a ion and alida ion o he Je e son Scale o Phys- ician Empa hy –s uden s’Po uguese e sion (JSPE – sp ) has al eady been made [1,5,15]. The e a e ew s udies on he ac o s ha can in luence he empa hy o medical s uden s, pa icula ly he in lu- ence o he cu icula model p ac iced in he di e en Medicine Schools [2]. This s udy aimed o compa e he le els o empa hy o medicine s uden s o wo Schools wi h di e en cu icu- la models, allowing in es iga ion on he di e ences and in luences o he eaching sys em in s uden ’s empa hy. We compa ed he Facul y o Medicine o he Uni e - si y o Coimb a (FMUC) and he Facul y o Heal h Sci- ences o he Uni e si y o Bei a In e io (FCS-UBI). To pu i in o con ex , he wo Medicine Schools ha e he same admission p ocess o incoming s uden s, mos o hem admi ed h ough a compe i i e na ional exam [16,17], emales en e ing mo e in bo h schools a an ap- p oxima e 3:1 a io, highe ma ks being obse ed o en ande a FMUC han a FCS-UBI. FMUC ecei ing 350 s uden s a yea and FCS-UBI 150. In bo h Schools, he cou se is 6 yea s long [16,17] bu he s uden - u o a io is highe a FMUC 18.5 o FMUC and 3.1 o FCS-UBI [17,18]. FMUC’s eaching is semes e ial, ap- plies a non-in eg a ed eaching sys em, based on he compa men aliza ion o con en s in o subjec s, empha- sizes he “s o age”o in o ma ion [16,18,19] and e alu- a ions a e mainly by heo e ical exams. FCS-UBI has a qua e ly pe iod o ganiza ion and applies an in eg a ed eaching sys em p omo ing sel -di ec ed lea ning using, whene e possible, p oblem-based lea ning [17,20]. Ac- co ding o Eu opean “Bologna Decla a ion”[h ps://ec. eu opa.eu/educa ion/policies/highe -educa ion/bologna- p ocess-and-eu opean-highe -educa ion-a ea_p accessed on he 19 h Decembe 2019] medicine s uden s a e o pe o m a Thesis a he end o hei s udies, so ac- qui ing a Mas e on Medicine deg ee (MIM). De ails on cu icula in o ma ion can be ob ained a e he Medicine School’s websi e [16,17,19,20]. In b ie , analysing he cu iculum o each acul y, FCS-UBI in- cludes mo e con en s in he a ea o human sciences, mo e ole-playing ac i i ies and an ea lie clinical in- p ac ice con ac wi h pa ien s [8,21,22]. This s udy objec i es we e o unde s and he di e - ences iuni e si ies n le els o empa hy be ween FMUC and FCS-UBI medical s uden s, and o compa e hem by gende and schola yea . Me hods We pe o med a c oss-sec ional obse a ional s udy ap- plying an ins umen o measu e he le els o empa hy o i s , hi d and six h-yea s uden s a ending he MIM in FMUC and FCS-UBI a e app o al by he E hics Commi ee o Heal h o he Cen al Regional Heal h Adminis a ion o Po ugal was g an ed. The JSPE-sp , a sel -adminis e ed ques ionnai e allowing e alua ion o he s uden ’s sel -pe cep ion o empa hy in pa ien ca e, was used [5]. I is conside ed a eliable ins u- men wi h e idence ha suppo s i s alidi y [1,5,15,23, 24]. Wi h 20 i ems, o be answe ed on a Like scale om 1 (s ongly disag ee) o 7 poin s (s ongly ag ee) i s udies h ee componen s: “Pe spec i e aking”(10 i ems; e e s o he abili y o analyse ano he pe son’sp oblem om he ou side), “Compassiona e ca e”(8 i ems, de ined by he ac- i i y in a ou o he one we see su e ing) and “S anding in he pa ien ’sshoes”(2 i ems; e e s o he ac o hinking as i we we e in he o he pe son’splace)[5,15,23]. The o al sco e a ies om 20 o 140, and he highe he sco e he highe he le el o empa hy [15,23]. The sample size was calcula ed a e he o al numbe o s uden s o be en olled in each acul y in he aca- demic yea 2017/2018 pe yea o a endance. FMUC 471 s uden s in he 1s yea , 328 in he 3 d yea and 314 in he 6 h yea and FCS-UBI 186 in he 1s yea , 136 in he 3 d yea and 141 in he 6 h yea . The sample size calcula ion was made using he si e “The Su ey Sys em - Sample Size Calcula o ”[25] o ep esen he uni e se wi h a 95% con idence le el and a 5% ma gin o e o . The s udy ins umen was dis ibu ed in pape du ing p ac ical classes o he i s , hi d and six h cu icula yea in bo h uni e si ies, in 2018 Ap il and May. Re- sponsible P o esso s o each andomly chosen class we e p e iously in o med and g an ed consen . The numbe o s uden s o be en olled, implied a d aw o each yea classes o achie e he needed sample size, wi h ex a classes o sample collec ion secu i y easons. S u- den ’s pa icipa ion was indi idual, olun a y, anonym- ous and wi h w i en in o med consen . In o ma ion on gende (male / emale) and MIM yea ( i s / hi d / six h) was ob ained. San iago e al. BMC Medical Educa ion (2020) 20:153 Page 2 o 6 The SPSS®) So wa e o Windows e sion 24.0″was used o s o age, desc ip i e and in e en ial s a is ical analysis o da a. Checking he non-no mali y o he da a dis ibu ion wi h he Kolmogo o -Smi no es , non- pa ame ic es s (Mann-Whi ney es ) was used o s a - is ical analysis. A p alue o < 0.05 was conside ed o signi ican di e ence. Resul s A ep esen a i e sample size o a leas 286 ques ion- nai es a FMUC and 210 a FCS-UBI was es ima ed. Fo his s udy a sample o 795 medical s uden s, 420 om FMUC and 375 om FCS-UBI was s udied. I s desc ip- ion acco ding o he uni e si y, he MIM yea a ended and gende is shown in Table 1. The Kolmogo o - Smi no es showed no nume ic da a wi h no mal dis- ibu ion (p< 0.001). Using he chi-squa e es and he Mann-Whi ney U es , no signi ican di e ences we e ound be ween uni e si ies o gende (p= 0.096) and yea o MIM (p= 0.408). Table 2shows he di e ences in he mean alue o he answe s sco es be ween uni e si ies o o al JSPE and each one o i s componen s (“Pe spec i e aking,”“Com- passiona e ca e”,“S anding in he pa ien ’s shoes”). Wi h he Mann-Whi ney U es signi ican di e ences we e ound be ween he wo Schools o he o e all JSPE sco e (p= 0.008) and he “Pe spec i e aking”compo- nen sco e (p= 0.001) wi h a highe sco e in FCS-UBI. Table 3 e eals he mean alue o he esponses pe Medicine School and pe yea o MIM o he o al JSPE and o each o i s componen s pe yea be ween Scholls (“Pe spec i e aking”,“Compassiona e ca e”,“S anding in he pa ien ’s shoes”) and o gende , again wi h Mann-Whi ney U es . The e was signi ican di e ence in he 3 d yea (p= 0.038), highe sco e in he FCS-UBI. Fo “Pe spec i e aking” he e we e signi ican di e - ences in he 1s (p= 0.030) and in he 6 h yea (p= 0.044), bo h sco es being highe in he FCS-UBI. Fo he “Compassiona e ca e”componen , he e was a di e ence in he 1s yea (p= 0.037), and in he 3 d yea wi h highe sco es in he FCS-UBI (p= 0.019). Rega ding he “S anding in he pa ien ’s shoes”compo- nen , signi ican di e ences we e ound in he 1s yea (p= 0.018), FCS-UBI sco ing be e , and in he 3 d yea (p= 0.002) highe a he FMUC. By gende be ween uni e si ies o o al JSPE and o each o i s componen s he e was a s a is ically signi i- can di e ence, be e o emale s uden s, o he o al JSPE sco e (p= 0.045) and he “Pe spec i e aking”sco e (p= 0.001), again wi h a highe sco e in FCS-UBI. Discussion Signi ican ly highe le els o empa hy we e ound in FCS-UBI s uden s o he o al sco e o JSPE, o he “Pe spec i e aking”componen and o 3 d yea s u- den s s ill wi h highe sco es in FCS-UBI. These esul s a e in line wi h he only s udy we ound compa ing he le els o empa hy in wo uni e si ies wi h di e en cu icula models in a Pakis an s udy [26]. An- o he mul i-ins i u ional s udy e ealed he in luences o eaching scheme on he le els o medical s uden ’s em- pa hy hough no speci ica ion o cu icula model was epo ed [27]. Gi en he di e en socio-economic en i- onmen s and medical and educa ional con ex s be ween Po ugal and Pakis an we can only ecognise ha Table 1 Sample acco ding o Uni e si y, yea o equency o Mas e In Medicine (MIM) and gende FMUC n (%) FCS-UBI n (%) To al n (%) Yea o MIM (p= 0,408) a 1° 152 (36.2) 153 (40.8) 305 (38.4) 3° 164 (39.0) 137 (36.5) 301 (37.9) 6° 104 (24.8) 85 (27.7) 189 (23.8) To al 420 (100) 375 (100) 795 (100) Gende (p= 0,096) Female 278 (69.8) 282 (75.2) 560 (72.4) Male 120 (30.2) 93 (24.8) 213 (27.6) To al 398 (100) 375 (100) 773 (100) FMUC Facul y o Medicine o he Uni e si y o Coimb a, FCS-UBI Facul y o Heal h Sciences o he Uni e si y o Bei a In e io . (*) Mann-Whi ney U Table 2 Di e ences in he mean alue o he answe s pe uni e si y o he o al JSPE and o each one o i s componen s “Pe spec i e aking”,“Compassiona e ca e”and “S anding in he pa ien ’s shoes”by Uni e si y FMUC FCS-UBI p (*) JSPE o al (Max = 140) N 420 375 0.008 Mean ± SD 89.2 ± 7.6 90.6 ± 7.6 95% ic 88,2 o 89,14 89,75 o 91,34 Pe pec i e aking (Max = 70) N 420 375 0.001 Mean ± SD 59.4 ± 5.8 60.7 ± 6.7 95% ic 58,44 o 59,21 60,04 o 61,39 Compassiona e ca e (Max = 56) N 420 375 0.800 Mean ± SD 15.1 ± 4.1 15.2 ± 4.3 95% ic 14,71 o 15,21 14,75 o 15,61 S anding in he pa ien ’s shoes (Max = 14) N 420 375 0.399 Mean ± SD 7.4 ± 2.3 7.3 ± 2.5 95% ic 7,32 o 7,59 7,01 o 7,52 FMUC Facul y o Medicine o he Uni e si y o Coimb a, FCS-UBI Facul y o Heal h Sciences o he Uni e si y o Bei a In e io . (*) Mann-Whi ney U San iago e al. BMC Medical Educa ion (2020) 20:153 Page 3 o 6 Po uguese medicine s uden s appea o be less em- pa hic, he asons o such being specula i e. Lowe le els o empa hy in FMUC s uden s can pos- sibly be explained by: Teaching cha ac e is ics o each school. FCS-UBI cu iculum p o iding in-p ac ice classes wi h he s uden accompanied by skilled u o oge he wi h p ac ical sessions ollowing a heo e ical u o ial. Analysing he cu icula o bo h Uni e si y Medical schools [16,17]. FCS-UBI had a la ge numbe o cu icula uni s ela ed o humanis ic sciences, wi h emphasis on he de elopmen o in e ac ion and com- munica ion skills. Role-playing ac i i ies a e conduc ed egula ly wi h discussion and speci ic assessmen o s uden s’communica i e and empa hic abili ies is made [8,21,22]. FMUC lacks subjec s ela ed o he humanis- ic sciences and has a mo e supe icial and limi ed ap- p oach o clinical p ac ice s a ed in he 4 h yea o MIM. The cu icula uni o Gene al P ac ice/Family Medicine, is one o he wo cu icula uni s o include he discussion o opics such as empa hy and communi- ca ion and he pe o mance o ole-playing ac i i ies, is only augh in he 5 h yea . So by he 3 d yea , FCS-UBI s uden s al eady ha e had con ac wi h clinical p ac ice, whe eas FMUC s uden s ha e no [16,17]. Tu o ’s cha ac e is ics in luence he le els o s uden ’s empa hy [14,21]. Thus, he di e ences be ween he wo uni e - si ies can also be so explained, and ha dese es u u e s udy, suppo ing in e en ions in hei u o s, upg ading hem. O he seconda y ac o s can also help explain di e en le els o epa hy: S uden - u o a io FMUC wi h a a io o 18.5 (Po uguese a e age 7.53), con as ing wi h a 3.1 a- io in FCS-UBI. Highe s uden - u o a io a FMUC con ibu ed o lowe sa is ac ion wi h eaching, less clinical con ac and less oppo uni ies o de elop empa hic ela ionships wi h pa ien s [18]. Au ho Table 3 Di e ences in he mean alue o he esponses pe uni e si y and pe yea o MIM and gende o he o al JSPE and o each o i s componen s “Pe spec i e aking”,“Compassiona e ca e”and “S anding in he pa ien ’s shoes” Yea o a endance FMUC FCS-UBI p (be ween uni e si ies) (*) 1° 3° 6° 1° 3° 6° 1° 3° 6° JSPE o al (Max = 140) N 152 164 104 153 137 85 0.215 0.038 0.308 Mean ± SD 90.3 ± 9.1 90.4 ± 5.7 85.7 ± 6.9 91.8 ± 7.4 91.5 ± 7.6 86.8 ± 7.1 Pe pespec i e aking (Max = 70) N 152 164 104 153 137 85 0.030 0.108 0.044 Mean ± SD 59.0 ± 6.1 60.4 ± 5.6 58.5 ± 5.8 60.8 ± 7.3 61.0 ± 6.5 60.1 ± 5.8 Compassiona e ca e (Max = 56) N 152 164 104 153 137 85 0.037 0.019 0.741 Mean ± SD 16.8 ± 4.5 13.9 ± 3.6 14.5 ± 3.1 15.9 ± 5.0 14.9 ± 3.7 14.5 ± 3.6 S anding in he pa ien ’s shoes (Max = 14) N 152 164 104 153 137 85 0.018 0.002 0.611 Mean ± SD 6.6 ± 2.3 8.2 ± 2.2 7.2 ± 2.2 7.3 ± 2.4 7.4 ± 2.6 7.0 ± 2.5 Gende Female Male Female Male Female Male JSPE o al (Maximum = 140) N 278 120 282 93 0.045 0.071 Mean ± SD 89.0 ± 8.1 89.8 ± 6.8 90.4 ± 7.7 91.0 ± 7.4 Pe spec i e aking (Max = 70) N 278 120 282 93 0.001 0.777 Mean ± SD 59.7 ± 5.7 58.9 ± 6.1 61.3 ± 6.4 58.8 ± 7.0 Compassiona e ca e (Max = 56) N 278 120 282 93 0.874 0.174 Mean ± SD 14.8 ± 3.9 15.9 ± 4.1 14.7 ± 4.1 16.6 ± 4.4 S anding in he pa ien ’s shoes (Max = 14) N 278 120 282 93 0.321 0.704 Mean ± SD 7.3 ± 2.4 7.6 ± 2.3 7.1 ± 2.5 7.7 ± 2.4 FMUC Facul y o Medicine o he Uni e si y o Coimb a, FCS-UBI Facul y o Heal h Sciences o he Uni e si y o Bei a In e io . (*) Mann-Whi ney U San iago e al. BMC Medical Educa ion (2020) 20:153 Page 4 o 6 da a a i m he need o adequa e ole-models o em- pa hy. In ac FMUC s uden s ha e a 13 ECTS con- en in Gene al P ac ice a e he 1s yea , 6 h, 5 h yea one semes e and 6 h yea 2 mon hs wi h a dedica ed Gene al P ac ice u o , compa ing o 30 ECST in FCS-UBI, 1s , 2nd, 4 h, 5 h and 6 h yea s and do mos o hei in-p ac ice cases in a la ge o e -c owded Cen al Hospi al [16,17,19,20]. Suden ’s sa is ac ion: A s uden ’s opinions pool, ound ou ha FMUC was he na ional medicine school wi h he wo s le el o o e all sa is ac ion and clinical each- ing and s udy condi ions, whe eas FCS-UBI had he highes le els [28]. So a no s udies in speci ic s uden ’s cha ac e is ics we e pe o med o di e en ia e be ween FMUC and FCS-UBI excep o en y ma ks, highe in Coimb a. Sig- ni ican di e ences we e only ound in eminine gende and only in he o al JSPE sco e and in he “Pe spec i e aking”componen , being highe in FSC-UBI, emale s uden s o FCS-UBI had highe le els o empa hy han male ones. Empa hy is posi i ely in luenced by quali y o li e and nega i ely by a igue, s ess, and bu nou . S udies ca ied ou in bo h uni e si ies ha pa ook in his s udy showed ha , FCS-UBI s uden s ha e a be e quali y o li e and a e less ulne able o s ess and a igue [28,29]. The exis ence o di e ences in empa hy be ween he wo uni e si ies suppo s he need o conside he im- pac o he cu iculum model and o he MIM cha ac e - is ics on he de elopmen o he empa hic capaci ies o medical s uden s. So se e al changes can be conside ed in o de o inc ease he le els o empa hy in medical s u- den s, in he long e m, in o de o imp o e and main- ain he le els o empa hy in medical s uden s: Educa ional in e en ions ocused on empa hic capaci- ies by ole-playing, ideo-wa ching and eal consul a- ions wi h pa ien s wi h analysis and discussion o medical communica ion is deemed necessa y [22]. Also lec u es and p ac ice o he impo ance o empa hy and communica ion in he doc o -pa ien ela ionship and ea ly in eg a ion o mo e con en s o he human sciences a ea in o he s udy plan, wi h a mo e educed s uden - u o a io, p e e ably a one o one e en i o sho e pe iod o ime [8,9]. E en hough “empa hy is ela ed o pe sonali y”, a ma e his s udy did no ocus on [30,31]. Resea ch is o be con inued in his a ea. In spi e o he a emp s o minimize bias, he e may ha e been dis ac ion in eading he ques ionnai es. A - emp s we e made o close he selec ion bias h ough he andom selec ion o he classes included in he s udy. The JSPE s uden ’s e sion e alua es sel - pe cep ion o empa hy, which may be di e en om he ac ual empa hic beha iou . As p ac ical poin s om ou s udy we mus emphasize ha (1) empa hy is a pa amoun elemen o he doc o - pa ien ela ionship ha can be ained h ough an edu- ca ional p ocess, (2) s uden ’s empa hy le els we e highe when ea lie and mo e in ense con ac wi h pa- ien s accompanied by skilled u o s was de eloped and (3) eassessmen o cu icula pa icula i ies mus bea in mind p ac ical ac i i ies in eal wo ld con ex , ecog- nizing ha each s uden has i s own in insic psycho- logic cha ac e is ics. Conclusion The le els o empa hy o FCS-UBI medical s uden s we e highe han hose ound in FMUC s uden s. Compa ing he esul s pe yea o MIM, he di e ence was mainly in he 3 d yea wi h be e esul s in FCS- UBI. By gende emales sco e s a is ically di e en be ween he wo Schools, be e in FCS-UBI. These esul s suppo he need o eassess he lea ning cu iculum and he eaching con ex , wi h he objec i e o p omo ing e ec i e educa ional in e en ions in he de elopmen o s uden empa hy. Abb e ia ions MIM: In eg a ed Mas e ’s deg ee in Medicine; FMUC: Facul y o Medicine o he Uni e si y o Coimb a; FCS-UBI: Facul y o Heal h Sciences o he Uni e si y o Bei a In e io ; JSPE –sp : Je e son Scale o Physician Empa hy – s uden s’Po uguese e sion; TES: o al empa hy sco e Acknowledgemen s None a e o be done. P ac ice Poin s 1. Empa hy, a pa amoun elemen o he doc o -pa ien ela ionship, can be ained h ough an educa ional p ocess. 2. S uden ’s we e highe when mo e p ecocious con ac wi h pa ien s was de eloped. 3. So eassessmen o cu icula pa icula i ies mus ba e in mind p ac ical ac i i ies in eal wo ld con ex , bea ing he in insic cha ac e is ics o he s uden ’s popula ion. Au ho s’con ibu ions MLC: concep ion, da a analysis, w i ing, e ising and manusc ip app o al. IRS: concep ion, da a analysis, w i ing, e ising and manusc ip app o al. IN: concep ion, da a ga he ing and analysis, w i ing, e ising and manusc ip app o al. KM: manusc ip e ision in English scien i ic e ision and app o al. JAS: scien i ic e ision and app o al. LMS: concep ion, da a ga he ing and analysis, w i ing, e ising, manusc ip app o al and submission p ocessing. All he au ho s ha e ead he manusc ip and ag ee in i s submission o BMC Medical Educa ion and consen i is done. Funding No unding we e ob ained o his s udy which was been made in ou o au ho s wo king job hou s. A ailabili y o da a and ma e ials All da a will become a ailable i eques ed. E hics app o al and consen o pa icipa e This s udy has had an e hics commi ee app o al, by he “Comissão de É ica da ARS-C”. San iago e al. BMC Medical Educa ion (2020) 20:153 Page 5 o 6 Consen o publica ion All da a we e ob ained a e w i en in o med consen o answe and o da a o be analysed and published. 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