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

Evaluation of empathy levels of dentistry students in pediatric dentistry clinical practice education process

PURPOSE/OBJECTIVES

The objective of this study was to assess the empathy levels of dental students during their clinical practice training in pediatric dentistry and to evaluate various factors that influence changes in these empathy levels.

METHODS

The study evaluated the empathy levels of a total of 350 students (70 third-year, 140 fourth-year, and 140 fifth-year dental students) who received pediatric dentistry clinical practice training and/or observation between October 2022 and December 2023. The Jefferson Scale of Physician Empathy-Student Version was used to assess empathy levels before and after the training. The data were subjected to statistical analysis using the Mann-Whitney U test, Kruskal-Wallis test, Wilcoxon test, and Dunn Test (p < 0.05).

RESULTS

The response rate of the participants was 92.10%. The highest empathy level was observed in third-year students, while the lowest empathy level was observed in fifth-year students. A statistically significant relationship was found between these two variables (p < 0.001). Additionally, the empathy level of female students was statistically significantly higher than that of male students (p < 0.001). Following the completion of the pediatric dentistry training, a statistically significant increase was observed in the empathy levels of the students in comparison to the baseline (p < 0.001).

CONCLUSION

Empathy levels in students are found to be correlated with academic year, sibling count, and gender. It is of paramount importance to enhance empathy skills through training in order to foster the development of human-oriented physicians capable of effective patient communication.

Empathy Levels in Medical Students: A Single Center Study

Objectives To determine the level of empathy in medical students and to determine the difference in empathy levels between the two genders in a single center. Materials & methods This qualitative study was conducted at a medical college in Peshawar from March 2021 to July 2021. Institutional ethical committee approval was taken (RMI/RMI-REC/Approval/83) before commencing the study. All students admitted into the medical college in the current academic year 2020 to 2021 were included in the study. Any students that did not fill out the questionnaire completely were excluded. The Toronto Empathy Questionnaire (TEQ) was used in this study. The questionnaire was uploaded on google forms for data collection. All the resulting scores were entered into IBM SPSS version 23.0. The mean TEQ score was calculated. Box and whisker plots were made for respective years. An Independent sample t-test was used to determine the association between mean TEQ scores and gender. Results Of 367 students, 347 (94.6%) participated in this study, with a slight female predominance (53%). The mean age of the students was 21.44 (SD = 1.751) years. The participation rate was ≥70% from each class. Most participants across the years have an above-average empathy score (49.9%). Among the participants, the year I (67.6%) showed most participants with high empathy. Year IV (40.6%) has the highest proportion of below-average empathy scores. The mean empathy score of female students was 49.08 (S.D = 7.588), while the empathy score for male students was 44.59 (S.D = 7.58). Conclusion Empathy levels decline as medical education is progressed through the years. Females show a greater sense of empathy than their male counterparts. A slight increase in empathy levels is seen in the final year of medical school after a decline over the initial years.

Appraisal of empathy among dental interns and postgraduate students at King Abdulaziz University: A cross-sectional study

PURPOSE/OBJECTIVES

Empathetic communication of dentists with their patients is a primary characteristic of their health care. This study aims to evaluate dental students' empathy levels during the transitional period of internship and postgraduate studies of different specialties at one of the oldest dental schools in Saudi Arabia and explore how this empathy was affected by gender, age, and study duration.

METHODS

In this study, the self-reported empathy level among the participants was assessed using the Jefferson scale of empathy-student version (JSE-HPS). This survey includes a 20-question Likert scale formulated to measure clinical empathy in health care professionals. The JSE-HPS was distributed to all registered dental interns and postgraduate students during the academic year 2019-20 in King Abdulaziz University Faculty of Dentistry (KAUFD), Jeddah, Saudi Arabia.

RESULTS

Mean total score of empathy of the participants was (101.07 ± 14.8) with a response rate of 89%. A statistically significant higher empathy score appeared among dental postgraduate students in general (p = 0.04) and specifically among the females (p = 0.04) and those with postgraduate programs for more than four years, (p = 0.02). Dental postgraduate students scored significantly higher in the parameters of standing in patients' shoes (p = 0.02).

CONCLUSION

Gender, academic level, and duration of postgraduates' studies influenced empathy more than the age of the dental graduates in KAUFD. Our recommendation is to integrate empathy into the dental curriculum emphasizing interactive communication skills and early patient contact.

Does nonviolent communication education improve empathy in French medical students?

OBJECTIVES

To evaluate the impact of nonviolent communication (NVC) training on five aspects of medical students' empathy skills using implicit and explicit measures.

METHODS

312 third-year French medical students were randomly allocated to an intervention group (n = 123) or a control group (n = 189). The intervention group received 2.5 days of NVC training. For each group, empathy-related skills were measured implicitly using three cognitive tests (Visuo-Spatial Perspective Taking, Privileged Knowledge, Empathy for Pain evaluation) and explicitly using two self-rating questionnaires (Jefferson Scale of Physician Empathy, Empathy Quotient). Both groups completed tests and questionnaires before (pre-test) and three months after training (post-test). Responses were collected via online software, and data were analyzed using paired linear mixed models and Bayes Factors.

RESULTS

We found a significant increase in the Jefferson  Scale of Physician Empathy (JSPE) score between pre- and post-tests in the intervention group compared to the control group (linear mixed models: 0.95 points [0.17, 1.73], t₍₁₅₈₎ = 2.39, p < 0.05), and an expected gender effect whereby females had higher JSPE scores (1.57 points [0.72, 2.42], t₍₂₆₂₎ = -3.62, p < 0.001). There was no interaction between these two factors.

CONCLUSIONS

Our results show that brief training in nonviolent communication improves subjective empathy three months after training. These results are promising for the long-term effectiveness of NVC training on medical students' empathy and call for the introduction of NVC training in medical school. Further studies should investigate whether longer training will produce larger and longer-lasting benefits.

A systematic scoping review of approaches to teaching and assessing empathy in medicine

BACKGROUND

Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed.

METHODS

This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data.

RESULTS

In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum.

CONCLUSIONS

Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one's professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.

Empathy among dental students: A systematic review of literature

BACKGROUND

Empathy is just as relevant within dentistry, although research is limited in this field and very less is available in the current literature. The demonstration of empathy by dentists has been correlated with decreased dental fear. The authors systematically reviewed the literature to investigate empathy levels among dental students.

METHODS

A systematic review of the literature was undertaken concerning dental students' empathy, published from November 2016 to June 2018, using manual methods and the PubMed, PMC, PsycINFO, and other databases. Articles not in English and not concerned with dentistry were excluded, and intervention studies intended to enhance empathy, opinion articles, and reviews or reports of nonoriginal research were excluded. Eligible studies were those published from January 1, 2005, to May 31, 2017, in English language. A total of 34 full-text articles were obtained and assessed. Of these 34 papers, only seven publications were considered to have met the inclusion criteria and were directly related to the aim of literature search.

RESULTS

Only seven articles that provided data and evidence describing empathy among dental students were included. Four studies reported that the difference in mean empathy level across the year of study was statistically significant (P < 0.05), and one reported that there was no significant difference in empathy scores between the year levels of study. Three articles reported that males had higher mean empathy score than females, whereas vice versa was found in the remaining four articles.

CONCLUSION

This article demonstrates that there is only a limited evidence to provide the understanding of empathy among dental students. The results indicated that as patient exposure increases, the empathy level decreases among dental students. Furthermore, it is observed that education in behavioral sciences may be effective in increasing self-reported empathy, and further training may be necessary to maintain high levels.

Curricula for empathy and compassion training in medical education: A systematic review

Background

Empathy and compassion are vital components of health care quality; however, physicians frequently miss opportunities for empathy and compassion in patient care. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective.

Methods

We searched CENTRAL, MEDLINE, EMBASE, and CINAHL using a previously published comprehensive search strategy. We screened reference lists of the articles meeting inclusion criteria to identify additional studies for potential inclusion. Study inclusion criteria were: (1) intervention arm in which subjects underwent an educational curriculum aimed at enhancing empathy and/or compassion; (2) clearly defined control arm in which subjects did not receive the curriculum; (3) curriculum was tested on physicians (or physicians-in-training); and (4) outcome measure assessing the effect of the curriculum on physician empathy and/or compassion. We performed a qualitative analysis to collate and tabulate effects of tested curricula according to recommended methodology from the Cochrane Handbook. We used the Cochrane Collaboration’s tool for assessing risk of bias.

Results

Fifty-two studies (total n = 5,316) met inclusion criteria. Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure. We identified the following key behaviors to be effective: (1) sitting (versus standing) during the interview; (2) detecting patients’ non-verbal cues of emotion; (3) recognizing and responding to opportunities for compassion; (4) non-verbal communication of caring (e.g. eye contact); and (5) verbal statements of acknowledgement, validation, and support. These behaviors were found to improve patient perception of physician empathy and/or compassion.

Conclusion

Evidence suggests that training can enhance physician empathy and compassion. Training curricula should incorporate the specific behaviors identified in this report.

Trait Emotional Intelligence and Its Correlates in Oman Medical Specialty Board Residents

BACKGROUND

As part of the globalization of medical education, residency programs in Oman have adopted competency-based standards by the Accreditation Council for Graduate Medical Education International (ACGME-I). Correctly perceiving the emotions of others and managing one's own emotions are essential to high-quality patient care.

OBJECTIVE

We tested the reliability and construct validity of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and assessed trait Emotional Intelligence (EI) in Oman Medical Specialty Board (OMSB) residents in multiple specialties. We explored for correlations with trainees' sociodemographic background data.

METHODS

We conducted a cross-sectional, observational study between February and August 2017. Participants were OMSB residents. We administered the TEIQue-SF and collected sociodemographic data from participants. Multiple linear regression analysis was conducted to identify independent predictors of trait EI.

RESULTS

The present cohort scored high in the trait EI subscale of Well-being, followed by Sociability, Self-control, and Emotionality. Among sociodemographic factors, female gender and high income were significant predictors of TEIQue-SF's Well-being subscale and high income and living in a rented home were significant predictors of the Sociability subscale.

CONCLUSIONS

This is the first study conducted among medical residents in Oman regarding trait EI and its correlates. Our findings of overall high EI and several socioeconomic predictors echo the literature on the assessment of EI in trainees. The findings add to the evidence of cross-cultural applicability of instruments to measure trait EI, and use assessments of EI in resident selection and education.

Can communication skills training improve empathy? A six-year longitudinal study of medical students in Japan

BACKGROUND

Empathy is an important component of overall clinical competence; thus, enhancing empathy in medical education is essential for quality patient care.

AIM

This longitudinal study was designed to address the following questions: 1. Can a targeted educational program in communication skills training enhance empathy in medical students? and 2. Can such a program have a sustained effect?

METHODS

Study participants included 116 students who entered Okayama University Medical School in 2011. Students participated in a communication skills training program aimed to enhance their empathy, and completed the Jefferson Scale of Empathy (JSE) five times: at the beginning of medical school, prior to participation in the program, immediately after the program, and in last years of medical school. A total of 69 students, representing 59% of the cohort, completed the JSE in all five test administrations.

RESULTS

Students' total scores on the JSE and its two factors (Perspective Taking and Compassionate Care) increased significantly (p < 0.001) after participation in the communication skills training program. However, the program did not have a sustained effect.

CONCLUSIONS

Targeted educational programs to enhance empathy in medical students can have a significant effect; however, additional reinforcements may be needed for a sustained effect.

Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school

Background

Empathy is one of the cardinal components for physician-patient relationships, optimal outcomes in patient care, improved patient satisfaction, greater adherence to therapy, and lower malpractice liability. It is also considered an essential quality for health-care professionals to practice medicine. The aim of the present study was to assess the empathy level of medical students of Universiti Pertahanan Nasional Malaysia (UPNM) National Defense University of Malaysia, Kuala Lumpur, Malaysia.

Methods

This was a cross-sectional study conducted in 2017 which recruited medical students of UPNM. The Empathy Quotient, a self-reported questionnaire, was utilized for data collection. The total empathy score of the questionnaire is 80.

Results

Majority of the respondents were male (60.9%), year-V students (26.6%), Malay (70.5%), and cadet officer (69.6%). The overall mean score achieved by the respondents was 36.76 ± 9.18, and 74.4% of the respondents scored more than 30. The empathy scores of the students were significantly affected by the gender (t = 2.371; df = 205; P < 0.05), year of study (F = 2.553; df = 4/202; P < 0.05), and examination grades (F = 3.488; df = 2/204; P < 0.05). The findings showed that female students are more empathetic than their male counterparts. Further, the post hoc Tukey test analysis revealed that Year-V students are more empathetic than their junior counterparts and students who got highest grade are more empathetic.

Conclusions

To improve the empathy level of the UPNM medical students, appropriate educational strategies and interventions should be designed and implemented in the curriculum to inculcate, maintain, and enhance empathy.

Diversity of Emotional Intelligence among Nursing and Medical Students

Objectives

The purpose of this study is to identify the types of perception of emotional intelligence among nursing and medical students and their characteristics using Q methodology, and to build the basic data for the development of a program for the would-be medical professionals to effectively adapt to various clinical settings in which their emotions are involved.

Methods

Data were collected from 35 nursing and medical students by allowing them to classify 40 Q statements related to emotional intelligence and processed using the PC QUANL program.

Results

The perceptions of emotional intelligence by nursing and medical students were categorized into three types: “sensitivity–control type”, “sympathy–motivation type”, and “concern–sympathy type”.

Conclusion

The perceptions of emotional intelligence by nursing and medical students can represent an effective coping strategy in a situation where emotion is involved. In the medical profession, an occupation with a high level of emotional labor, it is important to identify the types of emotional intelligence for an effective coping strategy, which may have a positive effect on the performance of an organization. Based on the findings of this study, it is necessary to plan an education program for vocational adaptability for nursing and medical students by their types.

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

OBJECTIVE

The purpose of this present study was to investigate the psychometric properties of the Jefferson Scale of Physician Empathy - student version (JSPE-S).

SUBJECTS AND METHODS

This 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.

RESULTS

A 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.

CONCLUSION

This 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.

Empathy levels in undergraduate paramedic students: A three-year longitudinal study

Empathetic behaviour is regarded as a positive trait amongst healthcare professionals and has been attributed to increased patient compliance, greater patient satisfaction, and greater diagnostic accuracy and reduced rates of clinical errors. In particular, paramedic students have typically displayed lower rates of empathy when compared to their healthcare counterparts. The objective of this study is to assess both the level of empathy and changes in empathy in undergraduate paramedic students over a 3-year period at a single tertiary institution. A cross sectional study employing a convenience sample of first, second and third year undergraduate paramedic students at Monash University. Student empathy scores where measured with the Jefferson Scale of Empathy-Health Profession Student version (JSE-HPS); a validated, self-reporting questionnaire. 552 students were enrolled in the study. The mean overall JSE-HPS score for the cohort was 108.60 (SD = 12.50). Female students displayed significantly higher empathy scores of 110.27 (SD = 11.62) compared to males at 105.36 (SD = 13.57). There was also a significant difference (p = 0.03) noted between the 2008 JSE-HPS score 106.32 (SD = 14.02), when compared to the 2009 cohort, 110.18 (SD = 12.91). Results from this study suggest that paramedic students display lower empathy than those reported by fellow healthcare students within the literature.

Levels of empathy in undergraduate emergency health, nursing, and midwifery students: a longitudinal study

PURPOSE

This research examines the extent and nature of empathy among emergency health (paramedic), nursing, and midwifery students at one Australian university and investigates the longitudinal changes in empathy levels across the course of study.

METHODS

First-, second-, and third-year students at Monash University completed the Jefferson Scale of Empathy-Health Professional (JSE-HP) in 2008, 2009, and 2010, and the resulting mean empathy scores were analyzed by course, year of course, year of study, age, and sex.

RESULTS

Midwifery students were found to have higher empathy levels than nursing and emergency health students. Second- and third-year students scored higher than their counterparts in the first year. Empathy levels dipped in 2009 and rose in 2010. Students aged 26-30 years and 31-35 years recorded higher scores than their younger colleagues, and female students were found to be more empathic than their male counterparts.

CONCLUSION

The finding that empathy levels are relatively stable over the term of study contributes to the understanding of how empathy evolves over the course of study and offers insights into the importance of incorporating and promoting empathy in health care curricula.