Why might medical student empathy change throughout medical school? Protocol for a systematic review and thematic synthesis of qualitative studies

BMJ Open. 2022 Nov 18;12(11):e067157. doi: 10.1136/bmjopen-2022-067157.


Introduction: Several studies suggest that medical student empathy declines throughout medical school. However, no studies have systematically investigated why. The objective of our proposed review is to conduct a systematic review and thematic synthesis of qualitative studies investigating the reasons empathy may change throughout medical school.

Methods and analysis: This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We have searched MEDLINE, Scopus, CINAHL, ERIC and APA PsycINFO for relevant studies. We will also search reference lists of included studies and contact experts to identify additional studies. We will include any qualitative study investigating the reasons why empathy changes throughout medical school. We will use the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. We will use thematic analysis to synthesise our results. For all included studies, we will summarise the main characteristics including the number of participants, medical school year, country and gender. In our discussion, we will summarise the limitations of the evidence (including the risk of bias and inconsistency), and provide a general interpretation of the results and important implications.

Ethics and dissemination: This study will not require ethical approval since no original data will be collected. The results of this review will be published through peer-reviewed publications and conference presentations. Additionally, this review will inform changes to the enhanced empathy curriculum at the Leicester Medical School.


Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Empathy
  • Humans
  • Qualitative Research
  • Research Design
  • Schools, Medical*
  • Students, Medical*
  • Systematic Reviews as Topic