 This systematic review and thematic synthesis of qualitative studies investigated why empathy may change during medical school. The authors found that increased complexity in patients and their diseases, together with the hidden curriculum, including a stressful workload, prioritization of biomedical knowledge, and sometimes poor role models, led to student adaptations, such as cynicism and desensitization. Additionally, students' prior lives and professional experiences appeared to exacerbate the decline in empathy. Despite these findings, the authors noted that many of the included studies had biased concerns, which could limit the generalizability of the results. This article was authored by Jeremy Howick, Maya Dudko, Shennan Feng, and others.