Background: Several authors have reported that medical students' empathy declines over time as they start their clinical work. However, such observations, performed in cross-sectional or longitudinal studies, were mainly based on self-reports measuring cognitive/affective empathy. The aim of the study was to measure both the cognitive and affective dimensions of empathy as well as and behavioural empathy between fourth- and sixth-year medical students.

Methods: Fourth- and sixth-year medical students at the Faculty of Medicine in Geneva were invited to partake to a videotaped formative objective structured clinical examination (OSCE) with standardized patients (SPs). They were asked to fill in the Cognitive and Affective Empathy Scale (QCAE) (31-124 scale) and Jefferson Scale of Empathy (JSE- Student version; 20-140 scale) measuring the cognitive/affective dimensions of empathy. Based on the videotapings, students' verbal empathy was measured using the Verona Coding Definitions of Emotional Sequences (VR-CoDES-P). Nonverbal behaviour was assessed along five dimensions, using a 1-5 Likert scale. Differences of scores between fourth- and sixth-year medical students were analysed using analyses of variance (ANOVA).

Results: 26 fourth-year and 30 sixth-year medical students participated. Their mean scores on two different self-reported cognitive/affective empathy scales were similar (mean ± standard deviation: Jefferson: 114.65 ± 8.17 vs. 116.97 ± 8.56; p = 0.308) (QCAE: 91.46 ± 9.98 and 94.93 ± 9.64; p = 0.192). There is some evidence that fourth year medical students expressed more verbal empathy in response to patients' cues and concerns than sixth year medical students (0.28 ± 0.19 vs. 0.18 ± 0.15; p = 0.028). There was no difference in nonverbal behaviour between the two groups of students (18.90 ± 2.33 vs. 18.80 ± 2.79; p = 0.92).

Conclusions: There was no difference of scores in self-reported scales of cognitive/affective empathy between fourth and sixth-year medical students. Differences in behavioural empathy observed between fourth- and sixth- year medical students seemed to be due to changes in verbal empathy more than in nonverbal behaviour.