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. Author manuscript; available in PMC: 2017 Mar 1.
Published in final edited form as: Med Educ. 2016 Mar;50(3):300–310. doi: 10.1111/medu.12806

Assessing Empathy Development in Medical Education: A Systematic Review

Sandra H Sulzer 1, Noah Weeth Feinstein 2, Claire Wendland 3
PMCID: PMC4914035  NIHMSID: NIHMS788208  PMID: 26896015

Abstract

Introduction

Empathy in doctor-patient relationships is a familiar topic for medical scholars, and a crucial goal for medical educators. Nonetheless, there are persistent disagreements in the research literature concerning how best to evaluate empathy among physicians, and whether empathy declines or increases across medical education. Some researchers have argued that the instruments used to study “empathy” may not be measuring anything meaningful to clinical practice or to patient satisfaction.

Methods

We performed a systematic review to learn how empathy is conceptualized in medical education research. How do researchers define the central construct of empathy, and what do they choose to measure? How well do definitions and operationalizations match?

Results

Among the 109 studies that met our search criteria, 20% failed to define the central construct of empathy at all, and only 13% had an operationalization that was well-matched to the definition provided. The majority of studies were characterized by internal inconsistencies and vagueness in both the conceptualization and operationalization of empathy, constraining the validity and usefulness of the research. The methods most commonly used to measure empathy relied heavily on self-report and cognition divorced from action, and may therefore have limited power to predict the presence or absence of empathy in clinical settings. Finally, the large majority of studies treated empathy itself as a black box, using global construct measurements that are unable to shed light on the underlying processes that produce empathic response.

Discussion

We suggest that future research should follow the lead of basic scientific research that conceptualizes empathy as relational—an engagement between a subject and an object—rather than a personal quality that may be modified wholesale through appropriate training.

Introduction

Rationale

Empathy in doctor-patient relationships is a familiar topic for medical scholars, and a crucial goal for medical educators. Yet definitions of empathy are not consistent from one piece of scholarship to another, and sharp disagreement remains on some basic issues in the field.

Humanists, ethicists, and social scientists agree that empathy is critical—and very often lacking—in medical care. In his widely read book, The Silent World of Doctor and Patient, the ethicist Jay Katz1 examined the obstacles that prevent honest and empathic communication between physicians and the people they serve. Empathy is also a predictable theme in artistic depictions of medicine and medical training. Novels that portray the destruction of empathy, such as House of God, are handed down from one generation of medical students to the next, while the popular television show House, M.D. openly celebrates a doctor’s disregard for bedside manner, implicitly communicating that one can be a good doctor without mastering the interpersonal dimensions of the job.2 Such behavior is not confined to fiction: schooled in the hidden curriculum of clinical internships and residency, new doctors learn to mock certain groups of patients.3

While the development of empathy among medical trainees has been an important goal for medical educators, it has also been an intriguing conundrum for researchers: a substantial (if somewhat controversial) body of research has demonstrated that empathy typically decreases during medical training.4 Medical schools and medical associations take the problem seriously: the development of empathy in professional conduct is an explicit goal of both the American Association of Medical Colleges and the Accreditation Council for Graduate Medical Education. Yet despite a host of intervention strategies, “medical education still seems surprisingly ineffective in helping students walk a mile in their patients’ shoes.”5 This persistent problem has led some researchers to suggest that the problem is selection, rather than treatment—that medical schools must find ways to identify and recruit students who are more empathic or have better communication skills to begin with. The assumption underlying such proposals seems to be that empathy is a personal and relatively immutable characteristic: one either has it, or one does not.

Other researchers question whether this much-lamented empathy decline is actually real, pointing to problems in study design and instrumentation.6 Two recent reviews of changes in empathy among medical students and residents reached disparate conclusions. In a systematic review, Neumann and colleagues found that empathy declines during medical training as students engage more with patients.7 Colliver and colleagues conducted a meta-analysis drawing on much of the same research and concluded that declines in empathy during medical training are minimal, perhaps even nonexistent.6 This second group also argued that the instruments used to study “empathy” may not be measuring anything meaningful to clinical practice or to patient satisfaction. (For example, most past research has utilized student self-assessments, which may be an ineffective way to measure empathy.) The discrepancy between these two reviews poses serious concerns for researchers and educators seeking to maximize empathy in medical practice. Furthermore, although there is controversy over the effect of medical training on empathy, there is relatively little controversy surrounding the need for more empathic medical practice; under such circumstances, it would be unfortunate to take solace in the possibility that empathy does not decline during medical training.

Objectives

To foster better and more useful research on empathy in medical training, we designed a systematic review to learn how empathy is defined and operationalized in medical education research—how do researchers define the central construct of empathy, and what do they choose to measure?—as well as how well definitions compare to the operationalizations used. Our review is unusual in that it focuses on the conceptualization of empathy in empirical research studies, rather than the results of those studies. Certain features common to most systematic reviews, such as a consideration of bias in the reporting and interpretation of results, are therefore not appropriate for our review. Whereas most systematic reviews and meta-analyses focus on the methods and results of empirical research, we believe that conceptual and definitional issues that precede methodological decisions are key to understanding the state of the field—that an incomplete, poorly articulated understanding of empathy is at the root of both the discordant results and the limited success in educational intervention. In this view, an analysis of the existing state of empathy definitions and operationalization is the first step to rethinking medical education research on empathy.

Methods

Information Sources and Search

We systematically queried the following databases for relevant English-language studies published before November 1, 2012: PubMed, EMBASE, Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Web of Science, PsycInfo, and Education Resource Information Center (ERIC). The following terms were used in combination to search all databases: professional education or clinical education or medical education; medical students, nursing students, psychology students, and dental students; empathy or empathi*. With the guidance of a library science expert, we added search terms tailored to each database. Synonyms for each of the above terms used in specific databases were also searched. For more details on the search strategies used within each database, see Appendix 1.

Eligibility Criteria

For this systematic review, we included English-language publications that (1) examined physicians, medical students or residents, (2) operationalized empathy in an empirical study, and (3) included some quantitative component. Under the guidance of our library science expert, we included all studies published before November 1, 2012 and did not exclude articles published before any particular time point. The time range of publications does vary for each database and is noted in Appendix 1. While our initial search terms included non-physician health care personnel, we ultimately excluded studies in which the study’s main focus was not physicians or physician trainees. We also excluded editorials or essays that lacked an empirical component, and publications for which our librarians could not locate a full-text article. We elected to include only studies that had a quantitative component. This necessarily removes many high quality studies from consideration of how empathy is being assessed in medical education.

Study Selection: Title and Abstract Review

Our initial search yielded 1,811 articles. After removing duplicates, 1,210 articles remained. The first author (S.S.) and a trained research assistant independently reviewed the title and abstracts of each article for appropriate population and subject area, which resulted in a total of 305 articles. Any articles the reviewers disagreed on or that lacked sufficient information were included for full text review.

Data Collection Process and Data Items

For the remaining 305 articles, the full text was examined for goodness of fit with the study criteria. 196 additional publications were excluded based on this review, leaving 109 articles.4,8–115 Subsequently, the following information was extracted from each remaining article: the definition of empathy (if present), and whether the definition incorporated thinking, feeling, acting or more than one of these components. Additionally, we extracted the means by which empathy was operationalized, including the scales, questionnaires, or other mechanisms used to measure empathy when these could be identified. We also coded articles for the party evaluating empathy: self, patient, or other. Two authors (S.S. and C.W.) each coded full-text articles, and resolved discrepancies by reaching a consensus.

Data Analysis and Summary Measures

We entered the above data categories into an Excel file, and calculated descriptive statistics for each variable. We analyzed the presence or absence of empathy definitions, and the complexity and variation in definitions in relation to various forms of operationalization. As noted above, our central questions concerned the strength of the conceptual foundations on which this body of research has been built, rather than the research designs within which concepts of empathy have been deployed. Therefore, we deemed it inappropriate to evaluate study strength through meta-analytic measures. The approach we used instead provides a comparison of the underlying conceptual frameworks within empathy research in medical education.

Results

Definition of Empathy

Other authors have noted that there is little consensus on definitions of empathy.116 Those definitions that exist may emphasize cognitive, emotional, or behavioral elements—or some combination thereof. In our review, 22 of 109 articles (20%) included no definition of empathy at all. For the 87 articles that did provide definitions, we coded whether those definitions included elements related to thinking, feeling, or acting. A definition could incorporate one, two, or all three elements, and we included verbal communications under the rubric of “acting.” A list of words used to identify thinking, feeling, and action can be found in Appendix 2. Seventy-four articles (82% of articles providing a definition) defined empathy as consisting in part or entirely of a cognitive, thinking process. Thirty-two (37%) defined empathy as consisting in part or entirely of a feeling process. And 53 (61%) defined empathy as including an action component. Overall, the majority of definitions included components from more than one domain (see Figure 2). Thinking or cognitive processes were the most prevalent component of empathy definitions, and present in the top four categories. Feeling or affective processes are the least prevalent in definitions.

Figure 2.

Figure 2

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Frequency of Components in Empathy Definitions

Operationalization of Empathy

All of the studies included in our sample (109) operationalized empathy in the sense that every study sought to measure, assess, or evaluate it in some way. Ninety-five (87%) used some sort of scalar tool to evaluate empathy, and 43 (39%) used a non-scalar tool (for instance, asking patients to describe physicians’ empathy). Twenty-nine studies (27%) used both. The most common scalar instrument was the Jefferson Scale of Physician Empathy (JSPE). Forty-five (41%) studies used either the JSPE or the JSPE-Student Version. Nineteen (17%) used the Interpersonal Reactivity Index (IRI). Five (5%) used the Hogan Empathy Scale. The Balanced Emotional Empathy Scale (BEES), the Barrett-Lennard Scale, the Accurate Empathy Scale and the Consultation and Relational Empathy Measure (CARE) were each used four times (4% for each). More than a dozen other scales were used more rarely, typically in a single study.

Assignment of Empathy

We evaluated who determined the presence or absence of empathy in the context of each study. Studies most commonly used self-report: 66 of 109 (61%) used only self-reporting tools, while an additional thirteen articles used self-report in combination with another source of evaluation. In total, 79 used self-report (72%), 18 relied on patient or standardized-patient reports (17%), and 28 (26%) used a third-party report such as that of a faculty member, a trained observer, or a peer. Few studies (fourteen, or 13% of the total) used reports from multiple perspectives, typically combining self-report with that of an observer.

Empathy as a Construct

To assess operationalization, we examined each instrument used to quantify empathy, to identify whether it assessed physicians’ (or trainee physicians’) cognitive processes, feelings, or behaviors. In seven cases, we were unable to assess details of the scale used, because it was either proprietary or in a non-English language (despite publication of the study in English).

The same word list used to assess definitions was used to assess operationalizations (see Appendix 2). For instance, one study trained coders to examine videotaped encounters between physicians and patients; the coders counted several specific physician behaviors, both verbal (such as interrupting, supportive talk, etc.) and non-verbal (eye contact, silence, etcetera) and divided them by the total number of utterances in the encounter.25 This operationalization was coded as “acting.”

Finally, we extracted whether empathy was conceptualized as (a) a global construct to be measured in presence, absence or degree; or (b) a summation of multiple component parts. Among the papers for which we could assess details of operationalization, eighty operationalized empathy as a global construct (78%), and 45 (44%) operationalized empathy as a composite construct, as in the example above. Fifteen publications (15%) operationalized empathy in both ways.

Consistency between Definition and Operationalization

Rather than measuring the empirical quality of the studies, our conceptually focused analysis judged quality by assessing whether or not a study’s definition of empathy was aligned with how the authors chose to operationalize and evaluate empathy. Specifically, we compared our coding of the definitions of empathy with our coding for operationalizations of empathy. For example, several studies used the definition of empathy provided by Hojat and colleagues, developers of the Jefferson Scale of Physician Empathy: “a predominantly cognitive (as opposed to affective or emotional) attribute that involves an understanding (as opposed to feeling) of patients’ experiences, concerns, and perspectives combined with a capacity to communicate this understanding.”117p74 We coded this definition as including thinking and acting components, but not feeling. An examination of the items in the JSPE scale shows an extensive focus on thinking, with no items on action. A study that used this definition and operationalized it with the JSPE alone would be considered non-matching. Each study in the database for which we could assess operationalization was coded in this way. Studies that did not include a definition were automatically rated as non-matching. Only 13 of 102 studies (13%) had matching operationalizations and definitions across these dimensions.

Discussion

Summary of Evidence

Empirical studies on empathy in medical education, though increasingly common, are still outnumbered by commentaries. Furthermore, our analysis reveals that many of these studies are characterized by internal inconsistencies and vagueness in both the conceptualization and operationalization of empathy, limiting the validity and usefulness of the research.

One-fifth of the studies in our sample failed to define the central construct of empathy, either (a) relying on commonsense notions of empathy, or (b) using a scale or other instrument as a de facto definition of empathy. Relying on commonsense ideas presumes a consensus about the definition and characteristics of empathy that is notably absent from the literature. Using a measurement tool as an implicit definition is problematic because it is the construct definition that enables other scholars to judge whether a particular instrument is appropriate and the resulting claims are valid.

All of the studies that defined empathy incorporated at least one of the three domains thinking, feeling, and acting, although there was no consensus about which of these were the key components. Twelve studies (14%) integrated all three dimensions. For example, Shanafelt and colleagues defined empathy as “the ability to listen to a patient, understand their perspective, sympathize with their experience, and express understanding, respect, and support.”96 Another 51 (59%) included two dimensions, most commonly thinking and acting (34, or 39%). Thus, in a 2004 paper Hojat and colleagues defined empathy as “a cognitive attribute that involves an understanding of the inner experiences and perspectives of the patient as a separate individual, combined with a capability to communicate this understanding to the patient.”118p935 Only a quarter of the studies that defined empathy included its feeling dimension—and some quite specifically excluded it—despite the etymological origins of empathy in “feeling in” or “feeling with.”

A surprising majority of studies contained internal contradictions, with definitions that focused on different dimensions (i.e., thinking, feeling, and acting) than the accompanying scales or research instruments. Of the 81 studies that defined empathy, and whose instruments we were able to access and code, only 11 studies (14%) defined and operationalized empathy consistently.

Looking across all studies included in the review, our analysis reveals that the methods used to study empathy have limited power to predict the presence or absence of empathy in clinical settings. The most common instruments for measuring empathy rely on self-report, which as Colliver and colleagues remind us, is only loosely correlated with behavior.6 Furthermore, many instruments place a heavy emphasis on cognition—thoughts related to empathy. The best research on medical thought and clinical judgment has always paired cognition with its action consequences because the predictive value of cognition alone is limited.119 In short, by focusing on what doctors and medical trainees self-report, and especially on the thoughts that they report, existing research on empathy offers a tenuous connection to clinical settings.

This research focuses on the conceptual quality of empirical research on empathy in medical education, and as such is only half of the story. It should ideally be read in the context of other research, such as that done by Colliver and colleagues, that sheds light on the technical quality of research in the field. Furthermore, by omitting studies that lacked a clear quantitative component, we present a somewhat narrow view of research in the field. Although excluding purely qualitative research removed many potentially high-quality studies from our sample, we believe our focus on quantitative and mixed-methods studies is justified by both the influential role of quantitative research in the medical education literature (as exemplified by the two prominent reviews described above) and the particular problems of operationalizing a complex variable in quantitative research. Finally, given the widespread heterogeneity in approaches, our analysis was limited in its ability to deeply explore the characteristics of any specific subset of approach.

Conclusions

The various conceptual flaws noted above—lack of definition, mismatch between definition and operationalization, an over-reliance on cognition and self-report—raise significant challenges to the validity of research on empathy in medical education.

Our greatest concern, however, is the degree to which empirical studies treat empathy itself as a black box, and are thus incapable of shedding light on the mechanisms that underlie clinician empathy. Most studies (61%) assessed empathy solely through self-assessment by clinicians or students, an operationalization that presumes it to be a quality inherent in the individual and independent of any given relationship. Nearly two thirds of the studies in this review operationalized empathy solely as a global construct that increases or decreases monolithically, rather than something with interacting component parts. Should educators focus on cognitive or affective interventions to enhance clinician empathy? Without understanding the underlying mechanisms, we cannot know. Furthermore, it is entirely possible that there are multiple pathways leading to empathic response. Research into the mechanisms of clinician empathy is needed to help medical educators guide students to a better understanding of their own strengths.

Basic scientific research (including evolutionary psychology and primate studies) offers some leads that medical social science might follow in investigating the underlying mechanisms of empathy.14 Rather than a personal quality that may be modified wholesale through appropriate training, this research suggests that empathy is relational–an engagement between a subject and an object. Furthermore, this research suggests that empathy favors individuals who we perceive as similar to ourselves.8 Shielding oneself from identifying with another—a widely noted consequence of medical education—may actually reduce empathy.15 This hypothesis requires in-depth investigation—yet if confirmed, it would reveal a far-reaching problem with medical education. It is challenges like these that research on empathy should strive to identify and address. Understanding the mechanisms that shape empathy in the doctor-patient relationship deserves more careful attention.

Figure 1.

Figure 1

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Systematic Review Inclusion Process

Appendix 1: Search Terms

  • PubMED search: (Education, professional OR “Professional Education” OR “Medical Students” OR “Nursing Students” OR “Psychology Students”) AND (Empathy OR Empathi*)

    183 articles found.

    MeSH Term: “Professional Education”

    Date: 1887 (UNC Library site)

  • EMBASE search: (Medical Education OR Clinical Education OR Medical School OR “Medical Students” OR “Nursing Students” OR “Psychology Students”) AND (Empathy OR Empathi*)

    465 articles found.

    Emtree for “Professional Education” resulted in the substitution for Medical Education, Clinical Education, and Medical School.

    EMBASE has been indexed since 1947.

  • Scopus search: (Education, professional OR “Professional Education” OR “Medical Education” OR “Medical Students” OR “Dental Students” OR “Nursing Students” OR “Psychology Students”) AND (Empathy OR Empathi*)

    794 articles found.

    Date: 1996 (UNC Library cite)

  • CINAHL search: (“Clinical Education” OR “Health Sciences Education” OR “Medical Education” OR “Professional Education” OR “Medical Students” OR “Dental Students” OR “Nursing Students” OR “Psychology Students”) AND (Empathy OR Empathi*)

    48 articles found.

    Headings

    Support website said 1937, but UNC Library site said 1982.

  • Web of Science search: (“Health Sciences Education” OR “Medical Education” OR “Clinical Education” OR “Professional Education” OR “Medical Students” OR “Dental Students” OR “Nursing Students” OR “Psychology Students”) AND (Empathy OR Empathi*)

    80 articles found.

    Date: 1955 (UNC Library site)

  • PsycInfo search: (“Health Sciences Education” OR “Medical Education” OR “Clinical Education” OR “Professional Education” OR “Medical Students” OR “Dental Students” OR “Nursing Students” OR “Psychology Students”) AND (Empathy OR Empathi*)

    228 articles found.

    Headings

    Date: 1887 (UNC Library site)

  • ERIC search: (“Health Sciences Education” OR “Medical Education” OR “Clinical Education” OR “Professional Education” OR “Medical Students” OR “Dental Students” OR “Nursing Students” OR “Psychology Students”) AND (Empathy OR Empathi*)

    13 articles found.

    No mesh terms, just field term

    Indexing and abstracting since 1966.

Appendix 2: Coding Terms

(Note: Two authors (SS and CW) brainstormed this list of terms before coding began. In each case, cognates were also included. In most cases, definitions using these terms explicitly referred to cognitive, behavioral, or affective components to which they were linked.)

  • THINKING

  • Cognition

  • perspective-taking

  • imagination/imagining

  • apprehension

  • understanding

  • seeing

  • perceiving

  • processing

  • comprehend

  • appreciation of

  • knowledge

  • recognize

  • identification

  • controlled

  • intellectually sense

  • role-taking

  • grasp

  • identify with

  • FEELING

  • Compassion

  • feeling

  • emotion

  • concern

  • “joining with patient’s feelings”

  • to enter into or join with feelings

  • socio-emotional

  • care

  • emotional participation

  • affective

  • vicarious emotional response

  • generation of similar feelings

  • sharing of emotions

  • sense

  • emotional contagion

  • sympathize

  • match/experience someone’s emotional state

  • emotive

  • specific feeling words: e.g. angry, enjoy, care, sad, etcetera

  • ACTION

  • Communication

  • Conveying

  • behavioral

  • express

  • listen

  • interrupt

  • eye contact

Appendix 3: Table of Extracted Codes

Coding of Definitions Coding of Operationalizations
Year     Last Name of First Author Thinking Feeling Acting No Definition Scalar Non Scalar Thinking Feeling Acting Self-report Patient Assess Other 3rd Party Global Empathy Composite Empathy
2011 Berg 1 1 1 1 1 1 1 1
1985 Jarski 1 1 1 1 1 1 1 1 1
2007 Chen 1 1 1 1 1 1 1
2013 Costa 1 1 1 1 1 1 1
2007 Austin 1 1 1 1 1 1 1
2007 West 1 1 1 1 1 1 1 1 1
2011 Abreu 1 1 1 1 1 1 1 1 1
2012 Garroutte 1 1 1 1 1
2010 Michalec 1 1 1 1 1 1
2004 Hojat 1 1 1 1 1 1 1
1988 Jarski 1 1 1 1 1 1 1 1 1
1982 Malpiede 1 1 1 1 1 1 1
2010 Wimmers 1 1 1 1 1 1 1 1 1
1996 Yarnold 1 1 1 1 1 1 1 1
1998 Colliver 1 1 1 1 1
2001 Gallagher 1 1 1 1 1
2011 Lim 1 1 1 1 1 1 1 1 1 1 1
2012 Paro 1 1 1 1 1 1
2009 Spiegel 1 1 1 1 1
2013 Consoli 1 1 1 1 1 1 1 1
2008 Stratton 1 1 1 1 1 1 1 1
2013 Kondo 1 1 1 1 1
2012 Chen 1 1 1 1 1 1 1 1
2009 Crandall 1 1 1 1 1 1 1
2008 Harlak 1 1 1 1 1 1
2012 Dehning 1 1 1 1 1 1 1 1 1
2010 Chen 1 1 1 1 1 1 1 1 1
2004 Fields 1 1 1 1 1 1 1
1996 Carmel 1 1 1 1 1 1 1 1 1
2004 Easter 1 1 1 1 1
2007 Hojat 1 1 1 1 1 1
2013 Chang 1 1 1 1 1
1974 Charles 1 1 1 1 1 1 1 1 1
2009 Bunn 1 1 1 1 1 1 1 1
2007 Neumann 1 1 1 1 1 1 1
2013 Imran 1 1 1 1 1 1 1 1
2005 Tai t 1 1 1 1 1 1 1
1998 Kliszcz 1 1 1 1 1 1 1 1 1 1
2005 Stratton 1 1 1 1 1 1 1 1 1
2002 Bylund 1 1 1 1 1 1
2011 Hojat 1 1 1 1 1 1 1 1 1
1988 Hornblow 1 1 1 1 1 1
2013 Lelorai n 1 1 1 1 1 1 1 1
2007 Wickramasekera 1 1 1 1 1 1 1 1
2001 Bailey 1 1 1 1 1 1 1 1 1 1
1982 Elizur 1 1 1 1 1 1 1 1 1 1 1 1
1977 Fine 1 1 1 1 1
2013 Goncalves-Pereira 1 1 1 1 1 1
1992 Higgins 1 1 1 1 1 1 1 1 1 1
2005 Hojat 1 1 1 1 1 1 1
2011 Hojat 1 1 1 1 1 1 1 1
1984 Hong 1 1 1 1 1 1 1 1 1
2011 Magalhaes 1 1 1 1 1 1 1
1996 Ogle 1 1 1 1 1 1 1 1 1 1
2008 Rahimi-Madiseh 1 1 1 1 1 1 1 1
2008 Shariat 1 1 1 1 1 1
2010 Tavakol 1 1 1 1 1 1
2013 Hojat 1 1 1 1 1 1 1
1993 Tamburrino 1 1 * * * 1 1
2000 Winefield 1 1 * * * 1 1
2011 Baykan 1 1 1 1 * * * 1 1
2005 Bylund 1 1 1 1 1 1 1
2013 Lim 1 1 1 1 1 1 1
2007 Thomas 1 1 1 1 1 1 1 1
2011 Rosenthal 1 1 1 1 1 1 1
2009 Bonvicini 1 1 1 1 1
2008 Fernandez-Olano 1 1 1 1 1 1
1989 Kramer 1 1 1 1 1
2000 Morton 1 1 1 1 1 1 1
2008 Newton 1 1 1 1 1 1 1 1
1980 Poole 1 1 1 1 1
2012 Kataoka 1 1 1 1 1 1 1
1993 Evans 1 1 1 1 1 1 1
2011 Berg 1 1 1 1 1 1 1 1 1 1
2008 Morse 1 1 1 1 1
2005 Bellini 1 1 1 1 1 1 1 1
2008 Bonvicini 1 1 1 1 * * * 1 1 1
2003 Hojat 1 1 1 1 1 1 1
2011 Pollak 1 1 1 1 1
2001 DeCoster 1 1 1 1 1 1
2011 Hojat 1 1 1 1 1 1 1
2011 Tavakol 1 1 1 1 1 1
2005 Shanafelt 1 1 1 1 1 1 1 1 1 1
2007 Glaser 1 1 1 1 1 1 1
2005 Hojat 1 1 1 1 1 1 1
2010 Colliver 1 1 1 1 1 1 1 1
2013 Preusche 1 1 1 1 1 1 1 1
2000 Switzer 1 1 1 1 1 1 1
1980 Sanson-Fisher 1 1 1 1 1 1
2011 Faye 1 1 1 * * * 1 1 1
2013 Batt-Rawden 1 1 1 1 1 1 1 1
2009 Hojat 1 1 1 1 1 1 1
2012 Passalacqua 1 1 1 * * * 1 1
2011 Weng 1 1 1 1 1 1 1
2004 Kim 1 1 1 1 1 1 1
2011 Neumann 1 1 1 1 1 1 1
2007 Nicolai 1 1 1 1 1 1
2009 Di 1 1 1 1 1 1 1
2001 Hojat 1 1 1 1 1 1
2012 Suh 1 1 1 1 1 1
2012 Canale 1 1 1 1 1 1
1979 Christiansen 1 1 1 1 1 1 1
2009 Spreng 1 1 1 1 1 1 1
2011 Bayne 1 1 1 1 1 1 1
2013 Garcia 1 1 1 1 1 1 1
1978 Sanson-Fisher 1 1 1 1 1
2007 Silvester 1 1 1 * * * 1 1
2002 Bellini 1 1 1 1 1 1 1
2013 Newton 1 1 1 1 1 1 1
TOTALS 74 32 53 22 95 43 75 75 55 79 18 28 82 43
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