Empathy and big five personality model in medical students and its relationship to gender and specialty preference: a cross-sectional study

The impact of empathy on medical students: an integrative review

INTRODUCTION

Empathy is considered the ability to understand or feel others emotions or experiences. As an important part of medical education, empathy can affect medical students in many ways. It is still lacking a comprehensive evaluation of the existing articles on empathy's impact on medical students, despite the existence of many articles on the topic.

OBJECTIVES

To summarize the impact of empathy on medical students during medical education from four perspectives: mental health, academic performance, clinical competence, and specialty preference.

METHODS

The search terms used for retrieval were "empathy", "medical student", "mental health", "depression", "anxiety", "burnout", "examinations", "academic performance", "clinical competence", "specialty preference" on PubMed, EBSCO, and Web of Science before January 2024. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed based on inclusion/exclusion criteria. A consensus was drawn on which articles were included.

RESULTS

Our results indicated that high empathy was a positive factor for mental health, However, students with high affective empathy were more likely to suffer from depression, anxiety, and burnout. Empathy was found to be unrelated to academic performance, but positively correlated with clinical competence, particularly in terms of communication skills. Medical students with high levels of empathy tended to prefer people-oriented majors.

CONCLUSIONS

Medical students who score higher on the self-reported empathy scales often have better mental health, better communication skills, and tend to choose people-oriented specialties. But empathy is not related to academic performance. Additionally, the different dimensions of empathy have different impacts on medical students. It is necessary to design targeted courses and training for medical students to enhance their empathy.

The level and determinants of empathy among medical students from Arabic speaking countries: A systematic review

Aim

This systematic review aims to investigate the level of empathy among medical students in Arabic speaking countries and analyze its determinants.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2022 (PRISMA), the authors conducted a systematic research of studies investigating the level and determinants of empathy among medical students in Arabic speaking countries. The databases PubMed, Scopus, web of science and google scholar were searched.

Results

Ten studies from six countries were included. Nine of which had a cross-sectional study design. Level of empathy was assessed using the Jefferson scale in seven studies and using the Interpersonal Reactivity Index in two studies. The mean of empathy scale ranges between 97.65±14.10 to 106.55±19.16 in studies used the Jefferson scale of empathy. The associated factors with empathy were gender; high levels of empathy were reported in female students. Other factors are explored in relation with empathy such as specialty preference (surgery or medicine, "people-orientated" specialties or ''technology-oriented specialties''), family factors (marital status of parents, satisfactory relationship with parents, parents level of education and household income) and factors related to medical education (academic performance, year of study and type of curriculum) but the results are heterogeneous.

Conclusion

This is the first systematic review, which illustrated the determinants of empathy in Arabic medical students. Our results revealed varied results on empathy determinants. Further studies may guarantee a full exploration of this ability in order to improve the doctor-patient relationship and patient management in the Arab world.

Impact of a longitudinal course on medical professionalism on the empathy of medical students

OBJECTIVE

Medical education should enhance empathy. We examined, using self-assessment instruments and standardized patients (SPs), the impact on empathy, of a multi-year intervention (years 4-6 of medical training) that uses reflective learning approaches.

METHODS

241 final-year medical students participated; 110 from the 2018 graduation class (non-intervention group) and 131 from the 2019 graduation class (intervention group). Participants completed two self-reported empathy questionnaires - the Jefferson Scale of Empathy-Students (JSE-S) and the Interpersonal Reactivity Index (IRI) - and a personality questionnaire, the NEO Five-Factor Inventory. Additionally, SPs in a simulated station assessed participants' empathy with two patient-reported instruments: the Consultation and Relational Empathy (CARE) scale and the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE).

RESULTS

Empathy scores were significantly higher in the intervention group compared to the non-intervention group when assessed by the SP (p < 0.001). No differences were found in self-reported questionnaires between the two groups.

CONCLUSION

A longitudinal, multi-year reflection-based intervention enhanced empathy amongst medical students as assessed by SPs, but not when assessed by student self-reported measures.

PRACTICE IMPLICATIONS

Multi-year reflective learning interventions during clinical training nurture empathy in medical students. Assessments completed by SPs or patients may enhance the evaluation of empathy.

Comparison of knowledge and awareness of epilepsy between medical students of two universities in Poland

BACKGROUND

Epilepsy is one of the most common neurological disorders. As a chronic disease, associated with long-term treatment with antiseizure medication, it can have a negative impact on patients' quality of life. Moreover, patients are faced with a significant psychosocial burden associated with the stigma surrounding epilepsy. Medical professionals should be well educated and free of prejudices in order to provide adequate care for patients with epilepsy. The aim of the study was to evaluate the knowledge and awareness of epilepsy among medical students of years 1-6 in Poland and examine if certain personality traits influence students' view of epilepsy.

METHODS

The study was conducted using snowball sampling of 166 Polish medical students from Medical University of Gdansk and Medical University of Warsaw. Participants completed a survey which consisted of their subjective assessment of knowledge of epileptology, actual knowledge of epileptology, and their view of stereotypes about epilepsy. In addition, students completed the IPIP-BFM-20 personality questionnaire.

RESULTS

Polish medical students have sufficient basic knowledge about epilepsy (mean scores of students from both universities is 14 out of 25 points). There is still room for improvement, especially in the field of epidemiology, semiology, factors provoking seizures, antiseizure medications, and most importantly about first aid during seizure (e.g., 7% of respondents believed it is necessary to put something between teeth of a patient during seizure). Age and the year of study were well correlated with knowledge score (p = 0.008) and level of awareness of the stereotypes. We found that most personality traits do not have a strong impact on the level of knowledge about epilepsy.

CONCLUSIONS

Most students have a satisfying level of knowledge about epilepsy. Academic teachers should put more emphasis on first aid during seizures and awareness of psychosocial challenges associated with the disease. It is crucial for future physicians to not only possess sufficient theoretical knowledge, but also establish an empathetic doctor-patient relationship in order to provide better care for patients with epilepsy and other chronic diseases.

Prevalence and predictors of mental distress among Italian Red Cross auxiliary corps: A cross-sectional evaluation after deployment in anti-COVID-19 operations

The aim of the present study is to describe the prevalence and individual predictors of mental distress (anxiety, depression, and burnout) in a sample of volunteers engaged in emergency services. A total of 823 volunteers enrolled in the Red Cross auxiliary corps were surveyed between 28 June 2021 and 28 August 2021 (299 men and 524 women). After deployment in anti-COVID-19 operations, participants completed the Patient Health Questionnaire, Generalized Anxiety Disorder Questionnaire, Maslach Burnout Inventory, and Big Five Inventory through an online platform. A moderately severe risk of depression was found in 1.70% of the sample. A severe risk for anxiety disorders was found in 1.82%. A high risk for emotional exhaustion was found in 3.40%, depersonalization in 12.88%, and low personal accomplishment in 7.53%. Women showed a higher risk of both depression and anxiety in comparison to males. Personality factors were significant predictors for all dimensions. In contrast to the current literature, openness was found to be a predisposing personality factor in developing burnout dimensions. The relevance of the current findings for the development of effective screening tools before the deployment of reserve forces during medical crises is discussed.

Experiences of burnout, anxiety, and empathy among health profession students in Qatar University during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

The prevalence of burnout and anxiety is constantly increasing among health profession students worldwide. This study evaluates the prevalence of burnout and its relationship to anxiety and empathy during the COVID-19 pandemic among health profession students in the main governmental institution in Doha, Qatar using validated instruments.

METHODS

A cross-sectional survey of health profession students using validated instruments was employed. The Maslach Burnout Inventory-General Students Survey (MBI-GS(S)) to measure burnout; The Generalized Anxiety Disorder (GAD-7) to measure anxiety; and Interpersonal Reactivity Index (IRI) to measure empathy were utilized. Descriptive statistics and multivariable linear regression were used.

RESULTS

Of the 1268 eligible students, 272 (21.5%) completed the online survey. Burnout was found to be prevalent amongst the students. The mean scores for the MBI-GS(S) subscales of emotional exhaustion, cynicism, and professional efficacy were 4.07, 2.63, and 3.97, respectively. Anxiety was found to be a strong predictor for burnout and burnout was positively associated with empathy.

CONCLUSIONS

Findings from this study demonstrated relationships between health profession students' burnout, anxiety, and empathy. These findings might have an impact on the development of curriculum interventions to enhance student well-being. More burnout awareness and management programs that cater to the specific needs of health profession students are needed. Furthermore, findings of this study may have implications for future educational interventions during times of crisis or how this can be used to improve student experiences in normal times.

When Did the Empathy Die?: Examining the Correlation Between Length of Medical Training and Level of Empathy

Purpose

Empathy is an important skill for physicians as it can lead to improved patient outcomes and satisfaction. This study assessed self-reported empathy by medical students across all four years of medical school and potential differences in empathy across students interested in different subspecialties.

Method

All medical students enrolled at New York Medical College in August 2020 were invited to participate in this study. Participants completed the student version of the Jefferson Scale of Empathy.

Results

A total of 179 medical students participated. Mean empathy score in fourth-year students was significantly lower than that in first-year students. Mean empathy score was greatest among students interested in Pediatrics and was greater in participants who identified as women.

Conclusions

Self-reported empathy may be lower in upper-year medical students when compared to lower-year students. The potential reasons for lower empathy in the later years of training are discussed. A systematic curriculum for teaching and maintaining empathy should be developed and uniformly implemented across medical schools to combat a potential decline in empathy.

Learning burnout and its association with perceived stress, social support, and the Big Five personality traits in Chinese medical students during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Owing to the coronavirus disease 2019, medical learning burnout has attracted increasing attention in educational research. It has a serious negative impact on medical students and their service quality. This could impair the professional development of medical students; weaken their personal and professional quality; and lead to problems such as increased medical errors and reduced patient care quality and satisfaction. This study aimed to examine the effects of perceived stress, social support, and the Big Five personality traits on learning burnout among medical students.

METHODS

In November 2021, a cross-sectional survey was conducted at three medical universities in China. A self-administered questionnaire was distributed to 616 third- year students. Learning burnout, perceived stress, social support, and the Big Five personality traits (neuroticism, extroversion, openness, agreeableness, and conscientiousness) were anonymously measured. A total of 583 students were included in the final sample. Hierarchical linear regression was performed to explore the effects of perceived stress, social support, and Big Five personality traits on medical students' learning burnout.

RESULTS

Perceived stress was positively associated with learning burnout (emotional exhaustion: ß = 0.577, p < 0.001; cynicism: ß = 0.543, p < 0.001; low professional efficacy: ß = 0.455, p < 0.001) whereas social support was negatively related with it (low professional efficacy: ß = -0.319, p < 0.001). Neuroticism had a positive effect on emotional burnout (ß = 0.152, p = 0.009). Extraversion (ß = -0.116, p = 0.006) and conscientiousness (ß = -0.363, p < 0.001) had a negative effect on low professional efficacy. Agreeableness negatively affected emotional exhaustion (ß = -0.181, p < 0.001) and cynicism (ß = -0.245, p < 0.001) and positively affected low professional efficacy (ß = 0.098, p = 0.008). The associated factors together accounted for an additional variance of learning burnout (emotional exhaustion: 39.0%; cynicism: 36.8%; low professional efficacy: 48.7%).

CONCLUSIONS

Social support is a positive resource for fighting medical students' burnout. Perceived stress was the strongest indicator of learning burnout. In addition to reducing perceived stress, developing extraversion, agreeableness, and conscientiousness should be included in burnout prevention and treatment strategies, particularly for medical students.

Sex difference in trait empathy is encoded in the human anterior insula

Females are considered the more empathic sex. This conventional view, however, has been challenged in the past few decades with mixed findings. These heterogeneous findings could be caused by the fact that empathy is a complex and multifaceted construct. To clarify whether sex differences exist in certain dimensions of empathy and whether they are associated with specific neural bases, this study measured trait empathy using the interpersonal reactivity index (IRI) and collected brain structural and functional magnetic resonance imaging data in a large sample of healthy participants (206 males vs. 302 females). We found that females scored higher in the personal distress (PD) subscale than males, but they were comparable to males in other IRI subscales. Sex difference in PD was encoded by brain structural (e.g. gray matter volume in left anterior insula [AI]) and functional (e.g. resting-state functional connectivity between left AI and temporoparietal junction/inferior frontal gyrus) characteristics. Notably, the relationship between sex and PD was indirect-only and serially mediated by AI-associated structural and functional characteristics. Altogether, our results suggested that sex difference existed in self-oriented affective empathy (i.e. PD) and highlighted the importance of the AI, both structurally and functionally, in mediating the sex difference in trait empathy.

Association of Personality Traits with Life and Work of Medical Students: An Integrative Review

BACKGROUND

Personality traits are the basic components of an individual's personality. Although there are many published articles about the impact of personality traits on medical students, there is a lack of integrative reviews of existing articles. To close this gap, this review aims to summarize the impact of personality traits on medical students from two perspectives: life and work.

METHODS

The search was performed using the following databases: PubMed, Web of Science, Google Scholar, and EMBASE. All publications that assessed the impact of personality traits on life and work until February 2022 were selected.

RESULTS

Ninety-seven studies were included. The results suggest that personality traits could affect life performance, health outcomes, life satisfaction, the formation of doctor-patient relationships, mastery of knowledge, academic performance, and career planning. Different personality traits can have positive or negative impacts on these aspects.

CONCLUSIONS

The results of this review suggest that personality traits can affect medical students' lives and work. Therefore, based on the evaluation of the personality traits of medical students, it is necessary to design targeted courses and training for students to improve their personality traits, to bring about better results in their lives and work.

The association between ballroom dance training and empathic concern: Behavioral and brain evidence

Dance is unique in that it is a sport and an art simultaneously. Beyond improving sensorimotor functions, dance training could benefit high-level emotional and cognitive functions. Duo dances also confer the possibility for dancers to develop the abilities to recognize, understand, and share the thoughts and feelings of their dance partners during the long-term dance training. To test this possibility, we collected high-resolution structural and resting-state functional magnetic resonance imaging (MRI) data from 43 expert-level ballroom dancers (a model of long-term exposure to duo dance training) and 40 age-matched and sex-matched nondancers, and measured their empathic ability using a self-report trait empathy scale. We found that ballroom dancers showed higher scores of empathic concern (EC) than controls. The EC scores were positively correlated with years with dance partners but negatively correlated with the number of dance partners for ballroom dancers. These behavioral results were supported by the structural and functional MRI data. Structurally, we observed that the gray matter volumes in the subgenual anterior cingulate cortex (ACC) and EC scores were positively correlated. Functionally, the connectivity between ACC and occipital gyrus was positively correlated with both EC scores and years with dance partners. In addition, the relationship between years with dance partners and EC scores was indirect-only mediated by the ACC-occipital gyrus functional connectivity. Therefore, our findings provided solid evidence for the close link between long-term ballroom dance training and empathy, which deepens our understanding of the neural mechanisms underlying this phenomenon.

An initial preparation for human cadaveric dissection ameliorates the associated mental distress in students

It is universally recognized that cadaveric dissection is an essential part of anatomy training. However, it has been reported to induce mental distress in some students and impair their intrinsic motivation (IM) to study. One of the postulated reasons for this behavior is the lack of adequate information and preparation of students for cadaveric dissection. Therefore, it is hypothesized that providing relevant information prior to cadaveric dissection will ameliorate the mental distress, enhance the IM of students, and improve their academic performance. A cohort of occupational therapy students enrolled in an anatomy course were psychologically prepared for cadaveric dissection. Students were provided with a curated list of YouTube videos and peer-reviewed journal articles related to cadaveric dissection prior to the commencement of the anatomy course. All students were also required to attend an oral presentation immediately before commencing dissection. The control group included students who had not been provided with any resources in preparation for cadaveric dissection. Compared to the control group, students who had been prepared demonstrated better quality of cadaveric dissection, improved academic performance, reported less mental distress and greater IM. Moreover, students reported the oral presentation to be most relevant and journal articles to be least useful in their preparation. Therefore, this is an effective approach in the amelioration of mental distress and improvement of performance in anatomy students. Consequently, this study represents a paradigm shift in the pedagogy of anatomy, and could represent a vital element in the evolution of a revitalized anatomy curriculum.

The relationship between empathy and personality traits in Saudi medical students

BACKGROUND

Empathy is regarded as a fundamental personal attribute for in-training and in-practice doctors. Several factors may play a significant role to facilitate or prevent the ability of doctors' empathy toward their patients. The objective of the present study is to investigate the relationship of empathy with personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience) among undergraduate medical students.

MATERIALS AND METHODS

This study was based on a correlational, cross-sectional design and was conducted from January 2020 to April 2020. The sample consisted of 301 undergraduate medical students studying in different medical colleges situated in Riyadh, Saudi Arabia. Personal information form, the big-five personality inventory, and the interpersonal reactivity index scales were administered. Obtained data were analyzed by applying several methods such as mean, standard deviation, Mann-Whitney U test, Pearson's correlation coefficient, and multivariable linear regression.

RESULTS

Regression analysis revealed that personality dimensions accounted for 10-19% of the variance in scores of empathy sub-dimensions of perspective-taking, empathetic concern, fantasy, and personal distress. Agreeableness was found to be associated with empathetic concern and perspective-taking. Openness to experience was found to be significantly related to perspective-taking and fantasy, whereas extraversion was negatively associated with perspective-taking. Neuroticism had an association with personal distress, empathetic concern, and fantasy. Additionally, no gender difference was observed and students with people-oriented specialty preferences showed significantly higher scores on empathy sub-domains than technology-oriented students.

CONCLUSION

This study confirmed that personality dimensions play a notable role to predict empathetic behaviors among Saudi undergraduate medical students. This study would help to design individualized strategies by incorporating personality dimensions in the training program to enhance empathetic behavior among medical students.

Are empathy profiles and perceived social support associated with depressive and grief-related symptoms in suicide survivors?

OBJECTIVE

To investigate the link between empathy, perceived social support, and depressive and grieving symptoms in suicide survivors.

METHODS

Scores on the Beck Depression Inventory (BDI), Inventory of Complicated Grief (ICG), Prolonged Grief Disorder (PGD), Interpersonal Reactivity Index (IRI), and the Social Support section of the Interpersonal Questionnaire were collected from 265 survivors. Relations were tested via multivariate regression models.

RESULTS

Lower Perspective Taking (PT) was related with higher levels of BDI score, and higher Personal Distress (PD) was associated with higher BDI, ICG, and PGD scores. Higher levels of Social Support were related with higher BDI and ICG (but not PGD) scores.

CONCLUSION

Empathic PD and PT, and perceived social support are differently associated with depression and grief-related symptoms. Empathy-focused psychotherapies and empowerment of social support may reduce symptoms in suicide survivors.

The Norwegian Adaptation of the Big Five Inventory-2

Two studies were conducted to assess the psychometric properties of scores from the Norwegian adaptation of the Big Five Inventory-2 (BFI-2). In Study 1, the BFI-2 was translated to Norwegian and the scores from a convenience sample (N = 606) demonstrated good psychometric properties. BFI-2 scores from subsamples correlated in expected ways with self- and other ratings of the Big Five, and with self-ratings of empathic concern and perspective taking. In Study 2, after some minor improvements in translation, the psychometric properties of BFI-2 scores were assessed in a new sample (N = 409). Results from random intercept EFA of scores supported the proposed model. The psychometric properties of two shorter versions of the inventory, the BFI-2-S and BFI-2-XS, were also examined. Overall, the results suggest that the Norwegian adaptation of the BFI-2 provide reliable and valid scores.

Medical empathy in medical students in Madrid: A proposal for empathy level cut-off points for Spain

This study evaluates the degree of empathy among medical students and its influencing factors at three critical moments of their degree studies (beginning of first year and end of third and sixth years) as well as establishes low-, medium-, and high-empathy cut-off points to obtain valid and reliable results that can be extrapolated to the general population. This cross-sectional study of the eight (public and private) medical schools in the province of Madrid, used an electronic questionnaire with the Jefferson Scale of Empathy (JSE), Medical Student Well-Being Index, and other independent characteristics as measuring instruments. Of the 2,264 student participants, 1,679 (74.0%) were women, with a 50.7% participation rate. No significant differences were found in empathy levels by academic year. Regarding range, percentile and cut-off point tables were established to identify students with high, medium, and low empathy levels. Women (p<0.001), volunteer workers (p<0.001), and those preferring general specialties (internal medicine, psychiatry, pediatrics, or family medicine) scored higher on the JSE (p<0.02). Moreover, 41.6% presented high level of psychological distress. Women reported a lower well-being level and a higher risk of psychological distress (p = 0.004). In sum, the empathy of medical students in Madrid did not differ among the three critical moments of their university studies. The established cut-off points could be taken into account when accessing the medical degree and identifying students with low levels of empathy to implement curricular interventions to rectify this perceived deficiency. There was a high percentage of medical students with high levels of psychological distress.

Personality characteristics of empathy profiles - practical implications for education of medicine students

BACKGROUND

Empathy plays the key role in the doctor - patient relationship. The research of empathy determinants plays an important role in formulating practical guidelines for the education of medical students. The aim of this study was to analyse personality characteristics of empathy profiles among students of medicine, with consideration of chief personality factors and their subdimensions according to the FFM model.

METHODS

During workshops in Clinical Psychological Skills, 153 students (M = 57, F = 96; mean age 23 years) analysed their psychological functioning styles by examining their personality profiles and empathy indicators. Empathic Sensitiveness Scale (ESS) and Personality Inventory (NEO-PI-R) were applied for this purpose. The analyses of empathy indicators were presented by means of cluster analysis. Variance analysis with post hoc Tukey-b test was performed for differences between clusters and to differentiate between personality factors and their components in empathy clusters. This study was approved by the Jagiellonian University Bioethics Committee (approval number: 1072.6120.175.2018 date: 28.06.2018).

RESULTS

The first cluster included students who presented high empathetic concern for others, understood their perspective and needs characterised by medium level of Neuroticism, high levels of other dimensions The second group included students who could understand others very well, yet with lower tendency to react emotionally to suffering, characterised by medium level of Neuroticism, Extraversion, Openness, high Conscientiousness and low Agreeableness. The third cluster included students who react strongly to painful and unpleasant reactions of others, characterised by high Neuroticism and Agreeableness, low Extraversion.

CONCLUSIONS

Each empathy profile is manifested in relations with patients in a specific way. Medical education in empathy holds great potential to reduce anxiety, stress, and burnout associated with the medical profession. Discussion of individual results with students, gives an opportunity to talk about how their empathy and personality characteristics may influence their everyday medical practice.

Non-academic factors influencing the development of empathy in undergraduate nursing students: a cross-sectional study

BACKGROUND

Empathy is described as a core competence of nursing. There is abundant research evidence supporting that empathy varies according to personal characteristics and targeted training. The aim of this study was to characterize non-academic factors (personal and environmental) influencing the development of empathy in undergraduate nursing studies who are not receiving a targeted training in empathetic abilities in their nursing schools.

METHODS

A cross-sectional study was performed in the three nursing schools located in Cusco city, Peru (two private and one public). The Jefferson Scales of Empathy, Attitudes toward Physician-Nurse Collaboration, and Lifelong Learning, the Emotional Loneliness Scale for Adults, and the Scale of Life Satisfaction, were applied as the main measures. Also, information regarding gender, nursing school, and age, were collected. After psychometric properties were assessed, all measures were used in the development of a multivariate regression model to characterize factors of influence in empathy.

RESULTS

In a sample composed by 700 undergraduate nursing students (72 males and 628 females), a multivariate linear regression model was created. This model explained the 53% of variance of empathy and fitted all conditions necessary for inference estimations. Teamwork abilities, loneliness, age, sex, subjective well-being, and nursing school, appeared as factors influencing the development of empathy in patients' care.

CONCLUSIONS

Findings have indicated that, in absence of a targeted training, individual characteristics and characteristics associated with social and family environments play an important role of influence in the development of empathy in nursing students. These findings are also in consonance with others previously reported in different cultural settings including high-, middle- and low-income countries.

A Holistic Approach of Personality Traits in Medical Students: An Integrative Review

Personality is one of the most crucial aspects of human life, since it influences all human behaviours in both personal and social life, and might also trigger important conflicts with a person’s surroundings in the setting of incompatible traits and characteristics. It is true that ‘one must be born’ for a certain medical specialty, but several components of personality might be educated with proper training. Increased levels of Conscientiousness, Agreeableness, and Openness associated with lower levels of Neuroticism might represent the key combination for achieving professional satisfaction in the medical profession. Medical students should receive proper interprofessional education, since effective interprofessional relationships among healthcare providers definitely improve patients’ safety. Empathy contributes to effective patient–physician communication, improving patient trust, compliance, and satisfaction, being positively correlated with Openness, Agreeableness, Conscientiousness and Extraversion. Emotional intelligence—the capacity to respond to one’s own and others’ emotions—was proven to contribute, in a synergistic way with empathy, to increasing empathic ability. Clinical communication skills represent a key component in medical students in order to achieve the best patient care, and they are certainly related and/or influenced by empathy, interprofessional collaboration skills, emotional intelligence and, especially, personality traits. Taking into account the complex interactions mentioned above, the implementation of effective courses based on these concepts in medical students, intending to promote the development of clinical communication skills, represents a real emergency, since it might result in a reduction in medical errors and subsequent related deaths. A thorough understanding of students’ personality is mandatory before designing these courses in order to provide a training tailored to their personality styles.

Empathy and its associations with age and sociodemographic characteristics in a large UK population sample

OBJECTIVES

Empathy is fundamental to social cognition, driving prosocial behaviour and mental health but associations with aging and other socio-demographic characteristics are unclear. We therefore aimed to characterise associations of these characteristics with two main self-reported components of empathy, namely empathic-concern (feeling compassion) and perspective-taking (understanding others' perspective).

METHODS

We asked participants in an internet-based survey of UK-dwelling adults aged ≥18 years to complete the Interpersonal Reactivity Index subscales measuring empathic concern and perspective taking, and sociodemographic and personality questionnaires. We weighted the sample to be UK population representative and employed multivariable weighted linear regression models.

RESULTS

In 30,033 respondents, mean empathic concern score was 3.86 (95% confidence interval 3.85, 3.88) and perspective taking was 3.57 (3.56. 3.59); the correlation between these sub-scores was 0.45 (p < 0.001). Empathic concern and perspective taking followed an inverse-u shape trajectory in women with peak between 40 and 50 years whereas in men, perspective taking declines with age but empathic concern increases. In fully adjusted models, greater empathic concern was associated with female gender, non-white ethnicity, having more education, working in health, social-care, or childcare professions, and having higher neuroticism, extroversion, openness to experience and agreeableness traits. Perspective taking was associated with younger age, female gender, more education, employment in health or social-care, neuroticism, openness, and agreeableness.

CONCLUSIONS

Empathic compassion and understanding are distinct dimensions of empathy with differential demographic associations. Perspective taking may decline due to cognitive inflexibility with older age whereas empathic concern increases in older men suggesting it is socially-driven.

Intensity, dynamics and deficiencies of empathy in medical and non-medical students

BACKGROUND

Empathy is an important competence in the professional development of medical students. The purpose of our study was to compare the levels and scales of empathy in people studying in different educational strategies.

METHODS

The study was conducted between April 2019 and March 2020. Medicine, nursing, midwifery, physiotherapy, psychology, pedagogy and sociology students were the participants of this study. University students preparing for medical professions (n = 1001) and students of programs unrelated to medicine (n = 700) underwent the Empathy Quotient test (EQ-40). We have compared results in both study groups with the use of the distribution of density, analysis of variance and student's t-test.

RESULTS

The average results received by students of the university preparing for medical professions were lower (M = 42.6) than those of the non-medical university students (M = 45.3) and the differences between the universities turned out to be statistically important (t = - 5.15, df = 1699, p < 0.001). As many as 14.6% of the students in the 1st EQ class were preparing for various medical professions while 9% studied social sciences. 18.2% of all medical programme students (n = 412) manifested the lowest empathy class. Our research has revealed that the students with Asperger profile (AP) and high-functioning autism (HFA) studied at universities preparing for medical professions (n = 18) more frequently than at non-medical universities (n = 5).

CONCLUSIONS

We have noticed a serious indicator of erosion in the levels of empathy in medical students and an increase in the number of people with AP and HFA. Empathy decreases in students after the third year of their studies, regardless of the kind of university. We recommend an introduction of career counselling when specialization is being chosen.

Open and empathic personalities see two things at the same time: the relationship of big-five personality traits and cognitive empathy with mixed percepts during binocular rivalry

Does our personality predict what we see? This question was studied in 100 university students with binocular rivalry paradigm by presenting incompatible images to each eye, allowing multiple interpretations of the same sensory input. During continuous binocular presentation, dominance of perception starts to fluctuate between the images. When neither of the images is fully suppressed, the two images combine into mixed percepts. We focused on the link between mixed percepts, big-five traits, and empathy. The results revealed that openness and agreeableness correlated with the occurrence of mixed percepts after the first dominant perception. However, these correlations of openness and agreeableness were mediated by cognitive empathy. In addition, openness had a direct association with reporting the initial percept in the onset of stimulation as a mixed percept, suggesting a mechanism that is separate from the one mediated by cognitive empathy. Overall, the results provide preliminary evidence suggesting that personality predicts what we see. Such individual differences in perceptual interpretations may be linked to both higher level cognitive mechanisms as well as lower level visual mechanisms.

Medical Students' Personalities: A Critical Factor for Doctor-Patient Communication

The aim of this study was to assess the level of creativity and personality traits and their mutual influence on medical students using the DECAS and BWAS. We performed a prospective descriptive study on 119 medical students from Târgu Mureș, Romania between November 2020 and July 2021, who answered questions relating to the BWAS and DECAS scales to evaluate their creativity and personality traits. Our findings pointed out a reverse correlation between age and both the original and revised BWAS (r = −0.2037, p = 0.0263; r = −0.1931, p = 0.0354). In terms of extraversion, we found a significant positive correlation for both openness (r = 0.3032, p = 0.0008) and emotional stability (r = 0.2868, p = 0.0016) and a negative correlation between extraversion and agreeability (r = −0.2394, p = 0.0087). Regarding creativity, we found positive correlations between emotional stability and both the original and revised BWAS (r = 0.20, p = 0.0279; r = 0.20, p = 0.0245). Medical students’ creativity might be positively influenced by emotional stability and seems to decrease with age. Higher extraversion scores could be related to increased openness and emotional stability as well as decreased agreeability.

Differences in personality related determinants of empathetic sensibility in female and male students of medicine

The issues of personality and its relations with the level of empathetic sensibility of medical doctors are broadly discussed in the literature. The aim of this study was an assessment of personality related predictors of empathy indicators in female and male students of medicine with consideration of gender differences. Methods applied were Empathic Sensitiveness Scale (ESS) and Personality Inventory (NEO-PI-R). The study included 153 participants, who were students of the fifth year of medical studies. Students filled in questionnaires during workshops in clinical psychological skills. Participation in the study was voluntary and anonymous. The statistical analysis was performed using Statistica 13 PL and PS IMAGO PRO (SPSS). Linear regression analysis with the interaction component was performed to explore the relationship between personality factors and gender and their interaction with the variable dependent level of empathy. The analysis showed that Extraversion, Openness and Agreeableness are associated with the level of Empathic Concern. Neuroticism, Extraversion, Agreeableness and Conscientiousness are associated with the level of Personal Distress. Extraversion, Openness, Agreeableness and Conscientiousness are associated with the level of Perspective-taking. The regression analysis with the interactive component showed that there is no relationship between gender and the level of empathy, therefore the interactions were insignificant. Empathetic sensibility is related to personality dimensions of the students of medicine. Although there has been no interaction among chief personality dimensions, empathy indicators and gender, detailed analysis of personality dimensions’ components has shown differences between men and women.

Empathetic Factors and Influences on Physical Performance: A Topical Review

Performance is dependent upon both physical and psychological factors. As a social animal, human behaviors are influenced by interactions with others. Empathy is based on social interactions and is defined as the understanding, awareness of, sensitivity to, and ability to vicariously experience the feelings, thoughts, and experience of another. There are few investigations on the influence of empathy in relation to individual and team performance and activity. There is some initial research suggesting that observing sad photos or videos or fatiguing exercise can adversely affect subsequent performance. Possible mechanisms may be attributed to mirror neurons or the affordance competition hypothesis. The relative degree of empathetic influences can be modulated by sex, age, personal familiarity, cultures and other factors. With the limited research in sport and exercise science, there is a need for more research to investigate the role of empathy on individual and team performances. The objective of this topical review was to examine the possible effects of empathy on physical performance, the potential underlying mechanisms and influencing variables moderating the association between empathy and performance?

Feeling for the Other With Ease: Prospective Actors Show High Levels of Emotion Recognition and Report Above Average Empathic Concern, but Do Not Experience Strong Distress

Differences in empathic abilities between acting, dance, and psychology students were explored, in addition to the appropriateness of existing empathy measures in the context of these cohorts. Students (N = 176) across Higher Education Institutions in the United Kingdom and Europe were included in the online survey analysis, consisting of the Reading the Mind in the Eyes (RME) test, the Interpersonal Reactivity Index (IRI), the Empathy Quotient (EQ), and the E-drawing test (EDT), each measuring particular facets of empathy. Based on existing evidence and our understanding of the discipline practices, we predicted that acting students would perform the best at identifying people’s emotional expressions but might lack other cognitive or affective empathy skills, particularly those related to emotional reactions. This cohort thus provides an opportunity to evaluate different empathy measures. While actors showed significantly higher RME scores than dancers, the difference between actors and psychologists was marginal. Moreover, actors’ scores did not differ significantly on other empathy measures, such as their concern for others’ emotional wellbeing or fantasy, both measured by IRI subscales. Psychology students scored highest in the IRI perspective taking subscale and the data supported anecdotal evidence that psychologists were more concerned for others’ emotional wellbeing than dancers or actors. Dancers seemed the least concerned with others’ perspectives and emotional states, which we explained through a somatosensory ‘inward’ focus required by their art form. Nevertheless, compared to the general population, our groups reported higher empathic abilities on all IRI subscales except for personal distress. Altogether, our study shows that the RME, the IRI, and the EDT vary in their susceptibility to different facets of empathic abilities in acting, dance, and psychology students whereas the EQ does not. Emotions can be expressed and perceived through language, facial expressions, or behavior. As many empathy tests focus on one type of signal they might miss other strategies. Where empathy tests are applied to individuals that have a predominance to read or respond to others in a particular way, as we showed through these three disciplines, they might not capture these empathic strategies. We thus propose that empathy tests must evolve by means of integrating varied forms of communication.

Empathy and the ability to experience one's own emotions modify the expression of blatant and subtle prejudice among young male adults

Prejudices can lead to discrimination, social exclusion, and violence particularly among young male adults. Previous findings suggest that the degree of holding prejudices is linked to low levels of empathy, while low levels of empathy have been associated with alexithymia, the inability to experience one's own feelings. We tested the hypothesis that the impact of a lack of empathy on reporting blatant and subtle prejudices is moderated by the inability to identify one's own feelings. In a sample of n = 136 young male adults aged 21 years (mean = 21.5 years; sd = 0.3), we conducted correlation and moderator analyses to determine possible relationships between prejudices, empathy, and alexithymia as assessed by self-report questionnaires. Prejudices were assessed by the Blatant and Subtle Prejudice Scale (BSPS), empathy was assessed by the German modified version of the Interpersonal Reactivity Index (IRI), and alexithymia by the 20-item Toronto Alexithymia Scale (TAS-20). Self-reported empathy levels were correlated with the strength of subtle and blatant prejudices. The moderation analyses revealed that the negative association between empathy and subtle prejudice increased with decreasing alexithymia. The negative association between empathy and blatant prejudice, on the other hand, was significant only for participants with low levels of alexithymia. These results suggest that empathy can limit the expression of blatant and to some degree also subtle prejudice when subjects are capable to identify their own feelings in a group of young males.

Chilean Version of the Empathy Quotient (EQ) Scale: Adaptation and Psychometric Properties

We evaluated the psychometric properties of the empathy quotient (EQ) scale translated to Spanish in Chile. We estimated its structural validity, and its construct validity with other convergent measures of empathy and attachment, as well an inversely associated construct such as aggression. We used a general sample of students and community individuals (n = 336). Participants completed the EQ, Interpersonal Reactivity Index (IRI), and Buss-Perry Aggression Questionnaire (BPAQ). Another exclusively community group (n = 102) completed Collins Adult Attachment scale and the EQ. CFA and ESEM analyses confirmed the structural model fit of the data to three previously reported dimensions of the EQ: cognitive empathy (CE), emotional reactivity (ER) and social skills (SS). Sex-differences in emotional reactivity, and the predicted relationships with the convergent measures were observed. The current Chilean version of the EQ resulted in an appropriate multidimensional measurement of empathy. Finally, providing a specific social skills dimension extends the traditional conception of cognitive and affective empathy to the social realm in the Chilean context.

Empathy trajectories throughout medical school: relationships with personality and motives for studying medicine

Empathy remains a widely discussed topic within medical education research. Studies on empathy changes among medical students are not univocal: empathy may decline, remain stable or increase. A largely unexplored research question regards inter-individual variability in empathy change, namely if different longitudinal trajectories of empathy exist. Evidence on the association of empathy trajectories with personality and motives for studying medicine is also scarce. Here, latent growth modeling examined empathy (measured with the Jefferson Scale of Empathy) among 201 medical students (M_age = 20.74, 57% females) across three assessments: at entry year (Year 1) and during the first two clinical years (Years 4 and 5). Associations between empathy trajectories, personality in Year 1 and motives for studying medicine in Years 4 and 5 were tested. We identified two empathy trajectory groups: lower and decreasing (n = 59; 29%) and higher and stable (n = 142; 71%). Regression analyses indicated that higher openness in Year 1 was associated with an increased probability of higher and stable group membership (controlling for motives in Year 1). The effect of openness disappeared controlling for motives in Years 4 and 5 while caring for patients (in Years 4 and 5) and altruism (in Year 4) were positively associated with an increased probability of higher and stable group membership. In sum, we observed that empathy remains stable in most medical students and declines in fewer; openness and patients-oriented motives for studying medicine are associated with higher and stable empathy. Encouraging medical students' patients-oriented motives from preclinical throughout clinical years may prevent empathy decline.

The Long-Term Effectiveness of Empathic Interventions in Medical Education: A Systematic Review

The Association of American Medical Colleges recognizes that empathy is an important part of providing excellent patient care and lists empathy as a Core Entrustable Professional Attribute for physicians. This study is a review of the literature focusing on studies with an educational intervention to promote empathy and at least one year follow-up data. After reviewing the 4910 abstracts retrieved from PubMed, PsycInfo, Cochrane, Web of Science, CINAHL, and Embase; the coauthors selected 61 articles for full-text review and completed a medical education research study quality instrument (MERSQI) to ensure all selected studies scored at least 7 or above. Five studies from the US and seven international studies met our inclusion criteria and formed the basis for the study. Few longitudinal studies with a post-intervention follow-up exist to confirm or disprove the effectiveness and durability of empathy training. Of the published studies that do conduct long-term follow-up, study design and measures used to test empathy are inconsistent. Despite the high degree of heterogeneity, the overwhelming majority demonstrated declining empathy over time. Little evidence was identified to support the ability to augment the empathy of physician trainees in sustained fashion. A model is presented which explains the observed changes. Alternative solutions are proposed, including the selection of more prosocial candidates.

Empathy Enhancement Based on a Semiotics Training Program: A Longitudinal Study in Peruvian Medical Students

Background

Empathy, as a core element of medical professionalism, is part of leadership in medicine. This attribute, predominantly cognitive, involves understanding and communication capacity. Empathy can be enhanced with courses on medical semiotics. It appears adequate to apply this enhancement in the early stages of professional training. Based on this, this study was performed with the purpose of demonstrating the positive effect that an academic course on medical semiotics has on the development of empathy in medical students.

Methods

A quasi-experimental study was conducted in one School of Medicine in Peru, where medical students had to attend a 17-week course on medical semiotics as part of their regular training. The sample, composed by 269 students, included two cohorts of third-year medical students. As main measures, the Jefferson Scales of Empathy (JSE), inter-professional collaboration (JSAPNC), and lifelong learning (JeffSPLL), were used. In addition, students’ scores evaluating theoretical and practical aspects of the course were collected once the course was finished. Pre- and post-tests were administered in week 1 and in week 17. Analyses compared measures in both moments and in time. Inter-professional collaboration and lifelong learning scores and empathy scores were used as discriminant and convergent validity measures of students’ course scores, respectively.

Results

Gender differences on empathy appeared, but only at the beginning. In the entire sample, empathy enhancement was confirmed in time (p < 0.001), with a large effect size (r = 0.45). This effect was also observed in both gender groups, separately. On the contrary, no changes appeared in inter-professional collaboration and in lifelong learning abilities in time. In addition, a positive correlation was observed among empathy, inter-professional collaboration and lifelong learning abilities at the beginning and at the end, confirming that the improvement observed was specific for empathy and explained by the educational intervention assessed.

Conclusion

These findings bring empiric evidence supporting the positive effect that training in medical semiotics has on empathy. In addition, these findings highlight some gender differences in the development of empathy in medical students.

Comparing empathy in medical students of two Portuguese medicine schools

BACKGROUND

Empathy is paramount in the doctor-patient relationship being a comprehensive and multidimensional concept. Self-ratings of empathy change across the years of medical education only when the Jefferson Scale of Physicians Empathy is used, with a worrying decrease being found throughout the years in Medicine Schools. As there are only few studies on the factors influencing medical student's empathy, particularly of the curricular model, this study aimed to compare the levels of empathy of medicine students of two Schools with different curricular models in central Portugal, the Faculty of Medicine - University of Coimbra (FMUC) and the Faculty of Health Sciences - University of Beira Interior (FCS-UBI).

METHODS

Cross-sectional observational study with the Jefferson Scale of Physician Empathy - students' Portuguese version (JSPE - spv) to 1st, 3rd and 6th year students of the 2017/2018 academic year with descriptive and inferential statistical analysis (p < 0.05).

RESULTS

Size representative sample of 795 students. Higher total empathy score (TES) (p = 0.008) and "Perspective taking" (p = 0.001) in FCS-UBI were found. JSPE-TES was higher in FCS-UBI, 3rd year (p = 0.038). Higher FCS-UBI "Perspective taking" in the 1st year (p = 0.030) and 6th year (p = 0.044), for "Compassionate care" in the 3rd (p = 0.019) and for "Standing in the patient's shoes" in the 1st year (p = 0.018) and in FMUC for "Compassionate care" in the 1st year (p = 0.037) and the "Standing in the patient's shoes" in year 3 (p = 0.002) were found. Higher levels of empathy were found in FCS-UBI female students, for JSPE-TES (p = 0.045) and "Perspective taking" (p = 0.001).

CONCLUSION

Higher empathy levels in FCS-UBI were found, with different results in the third year suggesting influence of the medical course teaching characteristics between the two Medicine schools, student's empathy levels being higher when earlier and more intense contact with patients accompanied by skilled tutors was developed.

Do university students' personality traits affect their attitudes towards gender roles?

PURPOSE

Attitudes of individuals towards gender roles may be affected by their experiences such as personality traits. This study is to identify the relationship between university students' personality traits and their attitudes towards gender roles.

DESIGN AND METHODS

This cross-sectional was conducted with 301 university students between November 2018 and January 2019.

FINDINGS

The students who had introverted personality traits had traditional attitudes according to the egalitarian gender role subscale (P < 0.05). Students who had neurotic personality trait had more traditional attitudes according to the female, marriage, traditional, and male gender role subscales (P < 0.05).

PRACTICE IMPLICATIONS

It may be advisable to enable students with an introverted and neurotic personality to develop an egalitarian attitude towards gender roles through women health nursing and psychiatric nursing studies.