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Empathy is fundamental to physician-patient relationships, and a critical trait medical education promotes. Yet, studies report students’ empathy to decrease during medical school, especially in the U.S. Empathy declines have been linked to student-patient interactions, which occur in years 3 and 4 of traditional curricula. Research at non-U.S. schools has not confirmed this trend, reporting stable or positive empathy trajectories. Curricular differences and early patient interactions have been proposed as explanations. We examined empathy among five student cohorts at a U.S. medical school, that integrates student-patient interaction early and throughout the curriculum. Results showed significant increases or no differences in empathy. Findings suggest empathy trajectories can remain stable or increase among U.S. students. Important implications for curriculum design are discussed.