Empathy levels among first year Malaysian medical students: an observational study.

Abstract

Dear editor This letter is in response to the article by Williams et al titled “Empathy levels among first year Malaysian medical students: An observational study” published in Advances in Medical Education and Practice, May 2014.1 This observational study addresses the issue of educating medical students about empathy as an attribute – a matter which is often not given enough importance – and including the topic in the academic curriculum, in view of the declining empathy levels observed in clinical practice. We would like to raise some concerns regarding the methods used for data analysis in the paper. The authors have analyzed the data using descriptive statistics such as means and standard deviation (SD) that are not appropriate parameters since the instrument used a seven-point Likert scoring scale. It would have been better if they had used median with minimum and maximum rather than the mean and SD. Paired t-test was used to compare the scores before and after the intervention. As the data do not follow a normal distribution, it is better to use Wilcoxon signed rank test than the t-test. In the Results section, it is mentioned that mean and SD are 112.08±10.67 and 117.93±13.13 respectively before and after intervention and that the difference is statistically significant. The effect size calculated was 0.48, with no mention of how the value was derived. Additionally, as a Likert scale with 1 to 7 scale points has been used, the interpretation cannot be precise. The coefficient of variation within the two groups, according to our calculations, was 9.5% in the before-workshop group and 11.1% in the after-workshop group. The researchers have used the difference in mean scores whereas the coefficient of variation would have been more appropriate. Furthermore, the mean, standard deviation and coefficient of variation are not the recommended measures for ordinal scale values. Our query is also applicable to the comparison of the empathy scores before and after among the males and the females. The authors have used Cronbach alpha to measure the reliability of Jefferson Scale of Physician Empathy–Student Version (JSPE-S), as mentioned in the Results and Discussion sections (α=0.70, before workshop and α=0.83, after workshop). The Cronbach alpha is used to determine the reliability of the tool during its construction: Why the authors have calculated the same before and after the interaction is not clear. In Table 2, the confidence interval (CI) and its P-value are given. Here, too, the normality assumption is used. Many of the P-values and CIs do not match. In some places the CI includes the value zero and is indicated as being significant, whereas in some others the value zero is not included and is described as being not significant. Also, why the authors considered the negative value for mean difference is not clear.