Empathy score among medical students in Mashhad, Iran

Study of the Jefferson Scale of Physician Empathy

Authors

  • Seyed Reza Habibzadeh Shojaei Student Research Committee, Department of Orthopedics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Keywords:

Empathy, Medical students, Jefferson scale of Physician Empathy

Abstract

Background: Empathy is one of the essential components of physician-patient relationship that has a significant effect on treatment outcomes.  Objective: The aim of this study was to assess the empathy score among medical students in Mashhad, Iran.  Methods: In this cross-sectional study in 2015, 624 medical students at Mashhad University of Medical Science (Iran) completed the Jefferson Scale of Physician Empathy (JSPE). Data were analyzed by SPSS ver. 16, using independent-samples t-test, Chi-square, MANOVA, Spearman correlation, and Confirmatory factor analysis. Results: Of the 38.4% males and 65% females who participated in this study, the mean score of JSPE in the sample was 103.67 (±15.34) which was higher in women than in men. Also, the mean scores for each of the three factors of the scale were calculated. The total empathy score, compassionate care, and taking perspectives among different age groups were significant (p=0.000). Furthermore, students having high interest in their field were more empathic (p=0.008). Empathy of interns in relation to three areas of basic sciences (the first year, the second year and the first half of the third year), physiopathology (the second half of the third year, and the fourth year), and clinical trainings (the fifth year, and the first half of the sixth year), experienced significant reduction (p≤0.001). Conclusions: This study showed that empathy was higher in women in their first medical year and who were of younger age. The overall rate of empathy in the basic sciences period was more than that in the clinical period. Therefore, the initial exposure to clinical education, especially patient education and empathy, has a very prominent effect on the ability of medical students.

References

Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, et al. The devil is in the third

year: a longitudinal study of erosion of empathy in medical school. Academic Medicine. 2009; 84(9): 1182- 91. doi: 10.1097/ACM.0b013e3181b17e55. PMID: 19707055.

Shariat SV, Habibi M. Empathy in Iranian medical students: Measurement model of the Jefferson Scale of

Empathy. Medical teacher. 2013; 35(1): e913-8.

Neumann M, Scheffer C, Tauschel D, Lutz G, Wirtz M, Edelhäuser F. Physician empathy: definition,

outcome-relevance and its measurement in patient care and medical education. GMS Z Med Ausbild. 2012;

(1): 11. doi: 10.3205/zma000781. PMID: 22403596, PMCID: PMC3296095.

Dixon D, Sweeney K, Gray D. The physician healer: ancient magic or modern science? Br J Gen Pract.

; 49(441): 309-12. PMID: 10736913, PMCID: PMC1313401.

Usherwood T. Understanding the consultation: evidence, theory and practice. McGraw-Hill International;

Lewis JR. Patient views on quality care in general practice: literature review. Social science & medicine.

; 39(5): 655-70. doi: 10.1016/0277-9536(94)90022-1.

Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002; 52(Suppl): S9-12. doi:

1093/fampra/cmh621. PMID: 15528286.

Mercer SW, Maxwell M, Heaney D, Watt GC. The consultation and relational empathy (CARE) measure:

development and preliminary validation and reliability of an empathy-based consultation process measure.

Fam pract. 2004; 21(6): 699-705. doi: 10.1093/fampra/cmh621. PMID: 15528286.

Hojat M, Gonnella JS, Mangione S, Nasca TJ, Veloski JJ, Erdmann JB, et al. Empathy in medical students

as related to academic performance, clinical competence and gender. Medical education. 2002; 36(6): 522- 7. doi: 10.1046/j.1365-2923.2002.01234.x. PMID: 12047665.

Spiro H, Curnen MGM, Peschel E, James DS. Empathy and the practice of medicine: beyond pills and the

scalpel. Yale University Press; 1996.

Jha V, Bekker HL, Duffy SR, Roberts TE. A systematic review of studies assessing and facilitating

attitudes towards professionalism in medicine. Medical Education. 2007; 41(8): 822-9. doi: 10.1111/j.1365- 2923.2007.02804.x. PMID: 17661891.

Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians' empathy and

clinical outcomes for diabetic patients. Academic Medicine. 2011; 86(3): 359-64. doi:

1097/ACM.0b013e3182086fe1. PMID: 21248604.

Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, et al. The relationship between physician

empathy and disease complications: an empirical study of primary care physicians and their diabetic

patients in Parma, Italy. Academic Medicine. 2012; 87(9): 1243-9. doi: 10.1097/ACM.0b013e3182628fbf.

PMID: 22836852.

Hojat M. Empathy in patient care: Antecedents, development, measurement, and outcomes. Springer

Science & Business Media; 2007.

Hojat M, Vergare M, Isenberg G, Cohen M, Spandorfer J. Underlying construct of empathy, optimism, and

burnout in medical students. Int J Med Educ. 2015; 6: 12. doi: 10.5116/ijme.54c3.60cd. PMID: 25633650,

PMCID: PMC4332366.

Narváez VPD, Palacio LMA. Empathic orientation among medical students from three universities in

Barranquilla, Colombia and one university in the Dominican Republic. Arch Argent Pediatr. 2014; 112(1):

-9.

Hojat M, Gonnella JS, Nasca TJ, Mangione S, Veloksi JJ, Magee M. The Jefferson Scale of Physician

Empathy: further psychometric data and differences by gender and specialty at item level. Academic

Medicine. 2002; 77(10): S58-60.

Fernández Pinto I, López Pérez B, Márquez M. Empatía: Medidas, teorías y aplicaciones en revisión.

Anales de Psicología. 2008; 24(2).

Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Annals of Internal

Medicine. 1984; 101(5): 692-6.

Falvo D, Tippy P. Communicating information to patients: patient satisfaction and adherence as associated

with resident skill. J Fam Pract. 1988; 26(6): 643-7.

Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication: the

relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997; 277(7):

-9.

Kataoka HU, Koide N, Ochi K, Hojat M, Gonnella JS. Measurement of empathy among Japanese medical

students: psychometrics and score differences by gender and level of medical education. Academic

Medicine. 2009; 84(9): 1192-7. doi: 10.1097/ACM.0b013e3181b180d4. PMID: 19707056.

Rahimi-Madiseh M, Tavakol M, Dennick R, Nasiri J. Empathy in Iranian medical students: a preliminary

psychometric analysis and differences by gender and year of medical school. Medical Teacher. 2010;

(11): e471-8.

Morling B, Lamoreaux M. Measuring culture outside the head: A meta-analysis of individualism–

collectivism in cultural products. Personality and Social Psychology Review. 2008.

Mostafa A, Hoque R, Mostafa M, Rana MM, Mostafa F. Empathy in Undergraduate Medical Students of

Bangladesh: Psychometric Analysis and Differences by Gender, Academic Year, and Specialty

Preferences. ISRN psychiatry. 2014. doi: 10.1155/2014/375439.

Wen D, Ma X, Li H, Liu Z, Xian B, Liu Y. Empathy in Chinese medical students: psychometric

characteristics and differences by gender and year of medical education. BMC Med Educ. 2013; 13: 130.

doi: 10.1186/1472-6920-13-130. PMID: 24053330, PMCID: PMC3848862.

Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition,

components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002; 159(9): 1563- 9. PMID: 12202278.

Preusche I, Lamm C. Reflections on empathy in medical education: What can we learn from social

neurosciences? Adv Health Sci Educ Theory Pract. 2016; 21(1): 235-49. doi: 10.1007/s10459-015-9581-5.

PMID: 25597025.

Paro HB, Silveira PS, Perotta B, Gannam S, Enns SC, Giaxa RR, et al. Empathy among medical students:

is there a relation with quality of life and burnout? PloS One. 2014; 9(4): e94133. doi:

1371/journal.pone.0094133. PMID: 24705887, PMCID: PMC3976378.

Khademalhosseini M, Khademalhosseini Z, Mahmoodian F. Comparison of empathy score among medical

students in both basic and clinical levels. J Adv Med Educ Prof. 2014; 2(2): 88-91. PMID: 25512926,

PMCID: PMC4235551.

Sherman JJ, Cramer A. Measurement of changes in empathy during dental school. J Dent Educ. 2005;

(3): 338-45. PMID: 15749944.

Vallabh K. Psychometrics of the student version of the Jefferson Scale of Physician Empathy (JSPE-S) in

final-year medical students in Johannesburg in 2008. South African Journal of Bioethics and Law. 2011;

(2): 63-8. 33) van Ryn M, Hardeman RR, Phelan SM, Burke SE, Przedworski J, Allen ML, et al. Psychosocial predictors

of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A

report from the CHANGES study. Patient education and counseling. 2014; 96(3): 367-75. doi:

1016/j.pec.2014.06.009. PMID: 25065328, PMCID: PMC4195739.

Prabhu S, Kumar V, Prasanth S, Kishore S. Standing in patients' shoes—survey on empathy among dental

students in India. Journal of Education and Ethics in Dentistry. 2014; 4(2): 69. doi: 10.4103/0974- 7761.148990.

Roh MS, Hahm BJ, Lee DH, Suh DH. Evaluation of empathy among Korean medical students: a cross- sectional study using the Korean Version of the Jefferson Scale of Physician Empathy. Teaching and

learning in medicine. 2010; 22(3): 167-71. doi: 10.1080/10401334.2010.488191. PMID: 20563934.

Magalhães E, Salgueira AP, Costa P, Costa MJ. Empathy in senior year and first year medical students: a

cross-sectional study. BMC Med Educ. 2011; 11(1): 52, doi: 10.1186/1472-6920-11-52. PMID: 21801365,

PMCID: PMC3163625.

Hojat M, Mangione S, Nasca TJ, Rattner S, Erdmann JB, Gonnella JS, et al. An empirical study of decline

in empathy in medical school. Med Educ. 2004; 38(9): 934-41. doi: 10.1111/j.1365-2929.2004.01911.x.

PMID: 15327674.

Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy.

Journal of General Internal Medicine. 2007; 22(10): 1434-8. doi: 10.1007/s11606-007-0298-x. PMID:

, PMCID: PMC2305857.

Allen D, Wainwright M, Mount B, Hutchinson T. The wounding path to becoming healers: medical

students' apprenticeship experiences. Med Teach. 2008; 30(3): 260-4. doi: 10.1080/01421590701758665.

PMID: 18484452.

Bellini LM, Shea JA. Mood change and empathy decline persist during three years of internal medicine

training. Acad Med. 2005; 80(2): 164-7. doi: 10.1097/00001888-200502000-00013. PMID: 15671323.

Published

2021-12-24

Issue

Section

Articles