Jefferson Scale Of Physician Empathy-Student Version Research Articles

Exploring Association of Level of Empathy with Demographic Factors among Medical and Dental Students, A Comparative Cross-Sectional Study

Being an effective physician, one must possess both clinical expertise and a specific range of emotional competencies, including empathy. Objective: To determine the empathy scores among medical and dental students and to correlate them with demographic factors like age, gender and academic year. Methods: A cross-sectional survey was conducted involving 324 students from medical and dental programs at a private medical and dental college in Lahore. Empathy levels were measured using Jefferson Scale of Physician Empathy- student version (JSPE-S). Data analysis was done using SPSS 24.0. Non-parametric tests were applied to find the significant difference between average scores of JSPE-S and all sub-scales across gender, age, academic year and medical program. Results: The mean empathy score on JSPE-S was 66.7. Difference of JSPE-S overall empathy score between age-groups was statistically significant (p-value 0.02). Among the medical and dental students significant difference was found between average scores of perceptive taking and compassionate care. No correlation was found between empathy scores and gender. However, empathy scores were low during initial years of medical school, being the highest in fourth year and then declining again. Conclusions: It was concluded that empathy is associated with demographical factors. Among the medical and dental students’ significant difference was found between average scores of perceptive taking and compassionate care. Although no difference in empathy scores was found between the two genders however, it declined as students gained more exposure to patients in their senior years

General empathy and medical empathy in Mexican medical students: Integration of an empathic profile.

To identify the association between general empathy and medical empathy. Detect predictors of the level of medical empathy from general empathy. To determine the psychosocial profile that describes the relationship between general empathy, medical empathy, and demographic and academic characteristics in medical students. Descriptive cross-sectional design. Medical students completed the Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Physician Empathy-student version (JSPE-S). Relatively high levels of general and medical empathy were detected. The total score of the IRI and the JSPE-S and their dimensions correlated positively (r = 0.14-0.52), except for the dimension personal distress of the IRI. The score of the IRI dimension empathic concern was the best predictor of the JSPE-S score and its dimensions (b = 0.27-0.54). Four profiles were detected: 1) men, preference for technology-oriented specialty, less empathy; 2) pre-clinical period students, less empathy; 3) students of the clinical period, greater empathy; and 4) women, preference for patient-oriented specialty, greater empathy. General and medical empathy are associated. Differentiated empathic profiles will allow the design of instructional strategies in empathy according to the specific needs of each one.

Evaluating Teaching Effectiveness of Medical Humanities in an Integrated Clerkship Program by a Novel Prospective Propensity Score Matching Framework.

Background: This study aims to rigorously compare the effectiveness of the educational programs of a new integrated clinical clerkship in medicine (3 months) and surgery (3 months) at a cancer center with the conventional subspecialty-based rotations at a tertiary teaching hospital, by this prospective, pre-post comparative method. Methods: Between 2013–2016, we compared 69 students who had selected the integrated clerkship that emphasized clinical competency and medical humanities training with 138 matched peers who had completed conventional clerkships during the same period. Outcome measures for medical humanities included empathy, patient-centeredness, and other values and skills related to holistic health care professionalism by introducing prospective propensity score matching (PSM). Results: At baseline, no significant between-group differences existed. At the completion of the core clerkships, students receiving the integrative clerkship had significantly higher scores on the Patient–Practitioner Orientation Scale (PPOS) and the Professionalism Climate in Clinical Teaching Environment (PCI), and similar Jefferson Scale of Physician Empathy Student Version (JSPE) scores, as compared with the comparison group. We also found that the students in this program did not perform worse than those in the traditional internship group in the comprehensive and formative OSCE medical clinical skills test. Conclusions: Our study develops an empirical basis for rigorous evaluation to design medical education to improve the medical humanities values and skills of interns. Features of the new integrated clerkship program that we developed include substantial participation by the students in patient-centered in-hospital culture, as well as reflection, discussion, and feedback on actual clinical cases.

A level of empathy and spirituality among undergraduate medical students of a tertiary hospital in Telangana: A cross-sectional study

Introduction: Patients' care with empathy has shown a higher clinical competence with great rapport. It leads to an accurate diagnosis with fewer medical errors. Patients tend to be more satisfied with improved outcomes both psychologically and pharmacologically. Empathy supports medical students to achieve capabilities essential for patient-centered care and in development of affective skill, manners, and personal as well as professional growth.Aims and Objectives: To assess the level of empathy among medical students and to assess the level of spiritual well-being and its relation with empathy.Materials and Methods: The cross-sectional study was carried out from January 2021 to March 2021 period. A total of 200 medical students were selected for the study, fifty from each year. Jefferson Scale of Physician Empathy Student version (JSPE-S), Toronto Empathy Questionnaire (TEQ), Spiritual Well-Being Scale (SWBS), and Demographic Questionnaire were used for the collection of data.Results: The mean JSPE-S score was 108.41 (14.19), mean TEQ score was 44.89 (6.26), and mean SWBS was 80.58 (18.89). By JSPE-S, the mean empathy score decreased from the 3rd year and was lower in the final year (P = 0.00002). By TEQ, the empathy score was higher in the 2nd year followed by 3rd and 1st and was lower in the final year (P = 0.002). Females had higher empathy than males (P < 0.002 for JSPE-S and P < 0.00001 for TEQ). There was a significant positive relationship between spiritual well-being score with mean JSPE-S (r = 0.4429, P = 0.0012) and TEQ score (r = 0.5777, P = 0.00001).Conclusion: Medical students had an average level of empathy and spiritual well-being. Clinical empathy decreased from the 3rd year and was lower in final-year students. Spiritual well-being had a positive significant relationship with empathy. There was a statistically significant association between mean empathy scores with demographic variables such as gender, parental education, habit of doing meditation, permanent residence area, and year of study.

Gender differences in the effect of medical humanities program on medical students\u2019 empathy: a prospective longitudinal study

BackgroundPrevious studies have suggested that Medical students’ empathy declines during medical school, especially during the clinical studies. The aim of this study was to examine. Changes in medical students’ empathy during their first clinical experience, and to determine the impact of gender and humanities curriculum on empathy changes.MethodsIn this prospective longitudinal study, 262 4th year students from three consecutive classes were assessed. Empathy was assessed before and at 4th-year-end, using the Jefferson Scale of Physician Empathy-Student Version (JSPE-S). The three classes differed in humanities curriculum [limited Medical Humanities (MH(lim)) vs. extended Medical Humanities (MH(ext))], and in admission system [Personal Interview (PI) vs. multiple mini interviews (MMI)].ResultsOverall, there was a small but significant decrease in JSPE-S during the fourth year (114.40 ± 11.32 vs. 112.75 ± 14.19, p = 0.034). Among men there was a statistically significant decline in JSPE-S during the fourth year, and the MH(ext) (but not the MH(lim)) was associated with the decline (t(35) = 2.38, p = 0.023). Women students showed no decline in empathy during the fourth-year of studies, regardless of type of humanities program. In addition, women who participated in MH(ext) had a higher JSPE-S scores during the 4th -year as compared to women who participated in MH(lim).ConclusionPre-clinical humanities program was associated with a decline in empathy among men medical students during the fourth-year of medical studies. Gender differences in response to medical humanities programs require further study.

The Positive Association Between Empathy and Self-Esteem in Chinese Medical Students: A Multi-Institutional Study.

BackgroundEmpathy is an important element of the physician-patient relationship and is a critical personality trait for medical students. However, research has shown that it declines during undergraduate medical education. It is still unclear how empathy interrelates with the psychological elements of medical students, in particular, self-esteem. This study examined the relationship between empathy and self-esteem to explore other possible methods to improve medical students’ empathy.MethodsA stratified sampling strategy was used to select 1690 medical students from 3 medical institutions in Shanghai as study participants. The questionnaires used to collect data included the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), the Rosenberg Self-esteem Scale (RSES), and a self-made inventory on personal information. Descriptive analysis, independent t-test, One-Way ANOVA, and linear regression were used to analyze the data.ResultsThe mean empathy score among medical students was 102.73 with SD = 12.64. Multiple regression analysis revealed that, “age,” “perception of the importance of empathy,” “academic pressure,” “desire to be a doctor after graduation,” and “self-esteem” were significant predictors of empathy (P < 0.05) and the adjusted R2 was 0.462. The correlation matrix between empathy and self-esteem was significant (r = 0.510, P < 0.01). Self-esteem explained 15.5% of the variation of empathy in the final regression model.ConclusionThere was a positive association between self-esteem and empathy. Self-esteem is one of many factors which contribute to medical students’ empathy. Age, academic pressure, attitude toward empathy and future career also play a critical role in medical student empathy. Enhancing medical students’ self-esteem may be an efficacious way to improve medical students’ empathy.

Patient Interviews Improve Empathy Levels of Preclinical Medical Students

Objective: In order to cultivate and maintain empathy during medical school, an experiential learning program, “A Patient as a Human Being”, was designed to promote empathy in second-year medical students through interviews with patients focusing on their suffering and the difficulties arising from their illnesses and hospital stays. Methods: The second-year medical students were divided into groups of three and four. Each group was assigned a patient to interview under close supervision. The selected patients were informed beforehand about the interview and voluntarily agreed to participate. The Thai version of the Jefferson Scale of Physician Empathy–Student Version (JSPE-SV) was used to assess the students’ empathy levels. Results: The baseline JSPE-SV score (n = 310) was 114.10±10.20. After the interview, the scores significantly increased (1.19 [0.21-2.18], P = 0.009). Students in the lower-half group of baseline scores showed a higher improvement (2.64 [1.14–4.15], P < 0.001) than those in the upper-half group. The difference coefficient by multivariate analysis of the improved JSPE–SV scores between the two groups was 3.03 [1.08-4.98] ( p = 0.002), accompanied by a correlation between the pre-activity empathy score and the improved score ( = - 0.21, P-value < 0.01). Conclusion: The patient interviews improved the empathy levels of the preclinical medical students, especially those with lower baseline empathy levels.

Factors associated with professionalism in Chinese medical students: an exploratory cross-sectional study

BackgroundProfessionalism is a central part of medical practice, and medical organisations worldwide have mandated training on this topic for future medical doctors. In China, national guidelines were developed to make explicit expectations that were once implicit. Medical education reform over the past decade has emphasised topics such as medical humanities, life-long learning, and patient-centered learning in an effort to increase the professionalism of future physicians. Although the importance of teaching professionalism has been well recognised, few studies have evaluated its implementation at Chinese medical schools. MethodsWe recruited medical students from three medical schools deemed to be representative of different regions in China (Tongji University School of Medicine, Shanghai (national); Nanjing Medical University, Jiangsu (provincial); Qiqihar Medical University, Heilongjiang (local)). We used the Jefferson Scale of Physician Empathy- Student Version (JSPES), Chinese version of the General Health Questionnaire, Center for Epidemiologic Studies Depression Scale (CES-D), Chronic Fatigue Syndrome assessment, and other personality and social status instruments to collect cross-sectional data. Statistical analyses were done using SPSS (version 20). Ethical approval was obtained by the Institutional Review Board of National Yang-Ming University. FindingsWe recruited 914 participants to the study. The mean JSPES score of the total population was 105 (SD 20). National university (Tongji) medical students (109 [18]), female medical students (107 [20]), and medical students who had not yet reached their third year of medical school (110 [17]) had significantly higher levels of professionalism than those in their third year or above (99 [17]). Professionalism and empathy were significantly associated with chronic fatigue syndrome: those who had higher scores in professionalism scored less for chronic fatigue syndrome (Pearson Correlation, −0·203; p<0·0001. Professionalism was synergistically associated with personality, general health, and depression (p<0·0001). Statistically significant differences in personality (p<0·0001), general health (p=0·002), depression (p=0·001), and chronic fatigue syndrome (p<0·0001) were also found between students from the three universities. InterpretationChinese medical students in general have a positive disposition towards professionalism. Level of professionalism is highly associated with chronic fatigue syndrome, so medical educators should pay attention to curricular burden and provide support mechanisms aimed at reducing student stress. FundingRepublic of China Ministry of Science and Technologygrant MOST104-2511-S-010-003.

Investigating the psychometric properties of the Jefferson Scale of Physician Empathy in a sample of Malaysian medical students

ObjectiveThe purpose of this present study was to investigate the psychometric properties of the Jefferson Scale of Physician Empathy – student version (JSPE-S).Subjects and methodsThis study recruited 193 Malaysian medical students enrolled in year one and year two studies. A principal-component analysis with Varimax rotation was conducted. Procrustes rotation was used to confirm the item to model fit, which allows for a comparison of actual structure against an ideal hypothesized structure. Items were systematically removed based on low communalities of < 0.3 and poor loading of items onto components.ResultsA two-component solution was found, comprised of “perspective taking” and “compassionate care”. Following item removal, eleven items remained. A Procrustes analysis revealed that this eleven-item measure demonstrated an excellent model fit. A possible third component was identified, though is not recommended for use, due to construct underrepresentation.ConclusionThis study found the Jefferson Scale of Physician Empathy fitted best to a two-component model using eleven items. Item, component, and overall congruence were very high, and scale reliabilities were adequate. The results of this study suggest that the eleven-item, two-component solution demonstrates excellent psychometric properties and structural validity in a Malaysian medical student population. Future research could consider using the short eleven-item measure in both student and health care profession samples to investigate the role of empathy in health care.

Measuring Empathy Levels among Kurdish Medical Students in Erbil City, Iraq: Cross-sectional study.

Empathy is a crucial attribute within the physician-patient relationship. This study aimed to evaluate the empathy levels of students in the College of Medicine at Hawler Medical University (HMU) in Erbil city, Iraq. This cross-sectional study took place between January and May 2015 and included all medical undergraduates enrolled at HMU (n = 989). The validated self-administered English language version of the Jefferson Scale of Physician Empathy-Student Version (JSPE-SV) was used to measure empathy levels. Students reported their conformity to each statement of the 20-item questionnaire on a 7-point Likert scale. Levels of empathy were considered directly relative to their final score. A total of 927 students completed the questionnaire (response rate: 93.7%). The male-to-female ratio was 0.72:1 and the mean age was 21.3 ± 1.4 years. The mean empathy score was 101.9 ± 19.2. Female students had significantly higher empathy (P = 0.023) and more frequently chose people-oriented specialties (P = 0.001) than males. First-year students reported the highest mean score (112.9 ± 20.1) while fourth-year students had the lowest (92.7 ± 16.0). There was a significant decline in mean scores between first- and second-year male students (P = 0.020) and first- and fourth-year male students (P = 0.050). Students who chose people-oriented specialties had significantly higher scores than those who chose technology-oriented specialties (P = 0.002). The studied cohort of HMU students demonstrated low empathy levels. As such, the inclusion of empathy instruction in medical school curricula is recommended to promote professionalism and patient welfare.

Complex and novel determinants of empathy change in medical students.

Purpose:Physician empathy is a core attribute in medical professionals, giving better patient outcomes. Medical school is an opportune time for building empathetic foundations. This study explores empathy change and focuses on contributory factors.Methods:We conducted a cross-sectional study involving 881 students (63%) from Years 1 to 5 in a Singaporean medical school using the Jefferson Scale of Physician Empathy-Student version (JSPE-S) and a questionnaire investigating the relationship between reported and novel personal-social empathy determinants.Results:Empathy declined significantly between preclinical and clinical years. Female and medical specialty interest respondents had higher scores than their counterparts. Despite strong internal consistency, factor analysis suggested that the JSPE model is not a perfect fit. Year 1 students had highest Perspective Taking scores and Year 2 students had highest Compassionate Care scores. High workload and inappropriate learning environments were the most relevant stressors. Time spent with family, arts, and community service correlated with higher empathy scores, whilst time spent with significant others and individual leisure correlated with lower scores. Thematic analysis revealed that the most common self-reported determinants were exposure to activity (community service) or socialisation, personal and family-related event as well as environment (high work-load).Conclusion:While the empathy construct in multicultural Singapore is congruent with a Western model, important differences remain. A more subtle understanding of the heterogeneity of the medical student experience is important. A greater breadth of determinants of empathy, such as engagement in arts-related activities should be considered.

Is the Empathy Level of Medical Students at KAU Changeable along their Study Years? What is behind this Change?

Although empathy is considered one of the essential attributes of professionalism for medical students, the empathy level of the Saudi medical students was not assessed till now while it was assessed worldwide. This study aimed to determine the level of empathy among medical students in different study years at Faculty of Medicine (FOM), King Abdulaziz University (KAU), Jeddah, and to explore in depth the factors that affect it. This comparative cross sectional study used a translated Arabic version of the Jefferson Scale of Physician Empathy-student version (JSPE-SV). It was distributed to all medical students in different study years at KAU during the academic year 2014-2015 and the response rate was 58.3 %. Data were collected and analyzed using the statistical package of Social sciences (SPSS) version 22. The mean empathy score was 106.55±19.16 and it was higher, but nonsignificant, in females than males. It increases along with the study year and its level among the 6th year students was significantly higher (p=0.004) than that of the 2nd year. Intact marital status of parents (p=0.012), satisfactory relationship with mother and father (p=0.009, p=0.012), having a patient in the family (p=0.002) were significantly associated with higher empathy level. Student’s empathy level was relatively low but it was increasing throughout the study years denoting the positive impact of the medical curriculum. More highlights on the patients physician relationship all through the medical curriculum is needed to emphasize and promote empathy of the student.

Reconsidering the “decline” of medical student empathy as reported in studies using the Jefferson Scale of Physician Empathy-Student version (JSPE-S)

Introduction: The suggestion that empathy “declines” or “erodes” as students progress through medical school has largely rested on observations reported from Jefferson Medical College in the United States using the Jefferson Scale of Physician Empathy (JSPE) developed by Hojat and colleagues. Now that the student version of JSPE has been administered to medical students in more than a dozen countries, it is timely to consider whether or not the Jefferson “case study” and the conclusions drawn from it are generalisable.Methods: A literature research was conducted on MEDLINE in mid-2014 to identify studies reporting administrations of the Student version of JPSE (JSPE-S) to cohorts of medical students and the means for studies and their sub-parts conducted in Japan, South Korea, China, Kuwait, India, Iran, UK, USA, Australia, Brazil, Colombia, the Dominican Republic and Portugal.Results: The means of these studies from a dozen countries outside the USA consistently cluster round 75% out of the possible maximum of 140 unlike the early Jefferson studies (although the later Jefferson means are also <120).Conclusions: These observations may support Costa et al.’s contention that “a latent growth model suggests that empathy of medical students does not decline over time” (p. 509) – or at least not significantly. But in order to understand the maturation process of medical students and trainees we need to develop more sophisticated, integrated models that combine culturally-sensitive concepts of emotional intelligence and moral reasoning with far more refined understandings of the nature of empathy required for the safe practice of patient-centred medicine.

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

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.

Clinical examiners, simulated patients, and student self-assessed empathy in medical students during a psychiatry objective structured clinical examination.

This study aims to assess and compare objective and subjective scores of empathy in final-year medical students by using firstly a validated student self-assessment just prior to the psychiatry objective structured clinical examination (OSCE), and then comparing this to clinical examiner's and simulated patient's (SP's) assessments of empathy of students using a Global Rating of Empathy scale (GRE) during a psychiatry OSCE. In 2011, all final-year medical students in the University College Dublin were invited to complete a subjective, self-assessed empathy questionnaire (The Jefferson scale of physician empathy-student version (JSPE-S)). They were also assessed for empathy in four OSCEs by the clinical examiner and the SP acting in that OSCE scenario. Included in the analysis were 163 of 184 final-year students JSPE-S (88.6%) questionnaires. The female students scores on the JSPE-S were significantly higher than those of their male peers (t=3.34, p=0.001). Concurrent validity was greater between the SPs' assessments of empathy in the OSCE and the JSPE-S score than between the clinical examiners assessments of empathy and the JSPE-S score (r=0.23, p<0.005; r=0.14, p<0.08). Inter-rater reliability of SP's and clinical examiner's using the GRE was found to be high (F=0.868 (df=171, 171), p value<0.001). SPs may be valid assessors of empathy in medical students during an OSCE.

Maintaining empathy in medical school: It is possible

Background: Empathy is an indispensable skill in medicine and is an integral part of ‘professionalism’. Yet, there is still increasing concern among medical educators and medical professionals regarding the decline in medical students’ empathy during medical education.Aims: This article aims at comparing the levels of empathy in medical school students across the different years of undergraduate medical education. It also aims at examining differences in empathy in relation to gender, year of study, cultural and religious backgrounds, previous tertiary education and certain programmes within the curriculum.Method: The Jefferson Scale of Physician Empathy, Student version (JSPE-S) was employed to measure empathy levels in medical students (years one to five) in a cross-sectional study. Attached to the scale was a survey containing questions on demographics, stage of medical education, previous education, and level of completion of particular programmes that aim at promoting personal and professional development (PPD).Results: Four hundred and four students participated in the study. The scores of the JSPE-S ranged from 34 to 135 with a mean score of 109.07 ± 14.937. Female medical students had significantly higher empathy scores than male medical students (111 vs. 106, p < 0.001) across all five years of the medical course. There was no significant difference in the total empathy scores in relation to year of medical education. Yet, the highest means were scored by year five students who had completed personal and professional development courses.Conclusions: Our findings suggest that there is a gender difference in the levels of empathy, favouring female medical students. They also suggest that, despite prior evidence of a decline, empathy may be preserved in medical school by careful student selection and/or personal and professional development courses.

Characterizing changes in student empathy throughout medical school

Background: Empathy is important in the physician–patient relationship. Prior studies suggest that medical student empathy declines with clinical training.Aims: We examined the trend of empathy longitudinally; determined differences in empathy according to gender and medical specialty preferences; and determined empathy and career preference differences among students admitted through different medical school admission pathways.Method: The data for this study were collected using a longitudinal cohort design and included 2652 observations nested within 1162 individuals. Participants were medical students at a university-based medical school surveyed yearly from 2007 through 2010. Empathy was measured by the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a validated, 20-item self-administered questionnaire. Predictors of JSPE-S scores included gender, age, anticipated financial debt upon graduation and future career interest.Results: Empathy scores of students in preclinical years were higher than in clinical years. Gender was a significant predictor of empathy, with women having higher empathy scores than men. Students preferring technology-oriented specialties had lower empathy scores. When career preference was controlled, higher levels of debt were significantly associated with greater empathy. Students with high baseline empathy decreased less than students with low baseline empathy during medical school. Students in traditional four-year medical school programs had higher baseline empathy than those in early pathway programs.Conclusions: Self-reported empathy for patients, a possibly critical factor in high-quality patient-centered care, wanes as students advance in clinical training, particularly among those entering technology-oriented specialties. In the era of new health care policy and primary care shortages, our research may have implications for the medical education system and admission policy.

Comparing a Self-Administered Measure of Empathy with Observed Behavior Among Medical Students

Studies show that measures of physician and medical students' empathy decline with clinical training. Presently, there are limited data relating self-reported measures to observed behavior. This study explores a self-reported measure and observed empathy in medical students. Students in the Class of 2009, at a university-based medical school, were surveyed at the end of their 2nd and 3rd year. Students completed the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a self-administered scale, and were evaluated for demonstrated empathic behavior during Objective Structured Clinical Examinations (OSCEs). 97.6% and 98.1% of eligible students participated in their 2nd and 3rd year, respectively. The overall correlation between the JSPE-S and OSCE empathy scores was 0.22, p < 0.0001. Students had higher self-reported JSPE-S scores in their 2nd year compared to their 3rd year (118.63 vs. 116.08, p < 0.0001), but had lower observed empathy scores (3.96 vs. 4.15, p < 0.0001). Empathy measured by a self-administered scale decreased, whereas observed empathy increased among medical students with more medical training.

A Cross-sectional Measurement of Medical Student Empathy

Empathy is important in the physician-patient relationship. Prior studies have suggested that physician empathy may decline with clinical training. To measure and examine student empathy across medical school years. A cross-sectional study of students at Boston University School of Medicine in 2006. Incoming students plus each class near the end of the academic year were surveyed. The Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a validated 20-item self-administered questionnaire with a total score ranging from 20 to 140. JSPE-S scores were controlled for potential confounders such as gender, age, anticipated financial debt upon graduation, and future career interest. 658 students participated in the study (81.4% of the school population). The first-year medical student class had the highest empathy scores (118.5), whereas the fourth-year class had the lowest empathy scores (106.6). Measured empathy differed between second- and third-year classes (118.2 vs 112.7, P < .001), corresponding to the first year of clinical training. Empathy appears to increase from the incoming to the first-year class (115.5 vs 118.5, P = .02). Students preferring people-oriented specialties had higher empathy scores than students preferring technology-oriented specialties (114.6 vs 111.4, P = .002). Female students were more likely than male students to choose people-oriented specialties (51.5 vs 26.9%, P < .001). Females had higher JSPE-S scores than males (116.5 vs 112.1, P < .001). Age and debt did not affect empathy scores. Empathy scores of students in the preclinical years were higher than in the clinical years. Efforts are needed to determine whether differences in empathy scores among the classes are cohort effects or represent changes occurring in the course of medical education. Future research is needed to confirm whether clinical training impacts empathy negatively, and, if so, whether interventions can be designed to mitigate this impact.