An Epidemiological Study on Empathy and its Correlates: A Cross-sectional Assessment among Medical Students of a Government Medical College of India

Empathy Among Medical Students: An Exploratory Cross-Sectional Survey

Context In the context of healthcare, effective communication and empathy are fundamental skills for physicians, as empathy correlates positively with patient satisfaction, compliance, treatment adherence, and lower rates of physician burnout, depression and anxiety. This study aimed to assess empathy levels and related factors among undergraduate medical students. Methods A cross-sectional study in a Central Indian medical institute examined empathy levels and factors associated with it among medical students, utilizing various scales and statistical analyses. Results This study found that while empathy levels were relatively high among undergraduate students, there was a decline as they progressed through medical education, particularly after the first year of clinical exposure. The study identified several factors associated with empathy levels, including perceived stress, emotional separation, and social support. Notably, individuals experiencing higher levels of stress and emotional separation tended to have higher empathy levels. Conclusions The study's findings suggest that medical education should incorporate interventions to enhance empathy, including addressing stress, providing social support, and exposing students to the emotional aspects of patient care.

Impact of Multimodal Intervention on Empathy Levels in Medical Students: A Questionnaire-Based Study

Background Empathy is essential for effective doctor-patient communication. It enables doctors to understand patients' emotions and concerns, facilitating personalized care and support. Empathy can be cultivated through various methods and training programs. Objective The study aims to assess the effectiveness of a multimodal intervention involving interactive lectures, peer role-play, and guided reflection in enhancing empathy levels among second-year medical undergraduate students in India. Methods This study utilized a questionnaire-based, pre- and post-test interventional design. Seventy-nine second-year medical students were included after obtaining their informed consent. The students received the intervention through an interactive lecture on communication skills, role-play on selected case studies, and guided reflection. The empathy levels were assessed using the Toronto Empathy Questionnaire (TEQ) before and after the intervention. The Mann-Whitney U test was utilized to compare pre-test and post-test TEQ scores. A univariate analysis of variance was conducted to explore the relationship between demographic variables and post-test TEQ scores. Statistical significance was considered at p ≤ 0.05. Results The TEQ score improved significantly (p=0.009) after the intervention. The univariate analysis indicated that gender, style of education, and place of residence did not have a statistically significant impact on post-test scores. Conclusion The study demonstrates that a multimodal intervention significantly enhances the empathy level of medical students, highlighting the potential of focused interventions to reduce gender disparities in empathy levels. There were no significant differences in empathy scores based on gender, place of residence, or schooling, suggesting the intervention's benefits may apply to all medical students.

The Level of Empathy Among Medical Students at the University of Tabuk, Saudi Arabia

Background and objective Empathy plays an important role in patient-provider relationships. It is a key aspect of therapy, ensuring accurate diagnosis, and improving compliance and outcomes, all of which contribute to clinician satisfaction. This study aimed to assess the level of empathy among medical students at the University of Tabuk. Methods A cross-sectional study was conducted among medical students at Tabuk University. Data were collected using a self-administered online questionnaire based on the Jefferson Scale of Physician Empathy-Student Version (JSPE-S). Results A total of 230 medical students participated in this study. The students' total empathy scores ranged between 55 and 131, with a mean of 99.05 ± 13.75. The highest item score was obtained for the question "Patients feel better when their physicians understand their feelings" (6.34 ± 0.99). Female students had a significantly (p=0.002) higher mean score (100.67 ± 13.06) than males (94.36 ± 14.70). Students from the clinical phase had a significantly higher mean total score compared to those from preclinical phases (100.26 ± 14.34 vs. 96.78 ± 12.33, p=0.043). Students choosing people-oriented specialties had significantly higher mean total scores than those selecting procedure-oriented specialties (100.59 ± 13.72 vs. 95.67 ± 14.46, p=0.033). Conclusion The degree of students' empathy with the patients at the Faculty of Medicine, University of Tabuk was found to be highest among females, students in the clinical phase, and students intending to select people-oriented specialties. These findings have implications for medical education programs, highlighting the importance of fostering empathy skills and addressing potential gender differences in empathy development.

Factor structure of the Jefferson Scale for Empathy among medical undergraduates from South India

Background

Empathy is a multidimensional construct and is considered an essential attribute among healthcare professionals. The Jefferson Scale for Empathy (JSE) is a commonly used tool to measure physician empathy and has been used in medical students as well; however, the psychometric properties have not been well studied in India. We aimed to study the factor structure of JSE among medical undergraduates.

Methods

This was a secondary analysis of baseline data obtained from the Stigma, Empathy and Attitude module study among medical undergraduates (N = 157). The scores obtained on the 20-item JSE Medical Student Version were subjected to principal component analysis with varimax rotation. Eigenvalues greater than unity, scree plot, and Horn's parallel analysis were used for identifying the factors. Items with loading more than 0.4 were included based on Steven's recommendation.

Results

The sample was adequate for factor analysis (Kaiser-Meyer-Olkin (KMO) measure 0.832). Five factors were extracted using principal component analysis, which explained 60% of the variance. The first three appeared as stable factors, and the last two factors had two items each. The first factor was the strongest (explained 18.8% of variance) with loadings from nine items. The second factor (explained 15.6% of variance) had loadings from six items, and two of the items showed correlation with the first factor.

Conclusions

JSE has a multidimensional structure with five factors in our sample of medical undergraduates.

Clinical Empathy and Its Correlates Among Indian Medical Students: A Cross-Sectional Study of Bihar

Background Clinical empathy is standing in the patient's shoes and perceiving his/her emotions to experience the patient's feelings. Practicing empathy ensures an enticing prospect in patient care. This study was done among undergraduate medical students to assess their empathy level and the factors affecting it. Methods This was a cross-sectional study conducted with 400 medical students in Bihar, India. Students not willing to participate were excluded from the study. The coding system was designed to strictly maintain anonymity. The study tools included the Jefferson Scale for Physician Empathy - Student Version (JSPES), a semi-structured questionnaire on the general profile, a perceived stress scale (PSS), and a multidimensional scale of perceived social support (MSPSS). Participants were allotted 20 minutes to complete the test and submit their responses. Results were expressed as means and standard deviations (SDs), with appropriate statistical tests applied. The data were presented in tables, and statistical significance was checked at a 5% level. All statistical analyses were conducted using SPSS software. Results The arithmetic mean (±SD) of empathy scores was 99.87±14.71. Empathy was found to be positively correlated with social support and negatively with stress. The factors found to be significantly associated with empathy on univariate analysis were subjected to stepwise multiple linear regression, which provided a six-factor model comprising gender, choice of future specialty, stress, social support, residence, substance abuse, and stay in hospital as an attendant. Conclusions Stress and social support were found to be significant predictors of empathy. The female gender, living in urban areas, and having previous experience of hospital stay as an attendant of a patient were positively associated with empathy. In contrast, choosing a technical branch as a future specialty and substance abuse were negatively associated with empathy. Stress management, enhancement of social support, and avoidance of habit-forming substances could be beneficial in improving empathy among doctors. Since we could only identify a few factors, we recommend further studies on this topic to explore other factors.

Trends of Change in Empathy Among Indian Medical Students: A Two-Year Follow-Up Study

Background

The development of an empathic approach is essential for doctor-patient relationships. Medical training is a challenging time that may affect empathy. This study aimed to assess the change in empathy in students during medical education.

Methods

One hundred and fifty MBBS students were recruited at admission and assessed for empathy, interpersonal reactivity, and general health. They were followed for two years and assessed at three intervals.

Results

A significant decline was seen in empathy for both male and female students. The decline was correlated with psychological stress. Gender, family structure, having siblings, and increasing General Health Questionnaire score predicted change in empathy.

Conclusion

Empathy declines with advancing training, varying with constitutional and situational factors. The medical curriculum should include skills like empathic communication as well.

Stigma, Empathy, and Attitude (SEA) educational module for medical students to improve the knowledge and attitude towards persons with mental illness

OBJECTIVE

The objective was to develop an educational module on stigma, empathy, and attitude towards mental illness and evaluate its effectiveness among undergraduate medical students.

METHODS

In phase I, the authors developed the Stigma, Empathy, and Attitude (SEA) module consisting of interactive teaching-learning components through an experts-based consensus (two rounds of Delphi). In phase II, the effectiveness of the module was evaluated. SEA module (one-hour interactive lecture and three hours' small group teaching) was delivered to the fifth-semester undergraduate medical students (N = 240) once during their psychiatry rotation. Students were assessed with the Mental Health Knowledge Schedule (MHKS), Mental Illness: Clinician's Attitudes (MICA) scale, Jefferson Scale for Empathy (JSE), and Social Distance scale (SDS), to measure mental health knowledge, attitude, empathy, and stigma, at baseline and after delivery of the module. Feedback on the module was obtained from the participating students and faculty.

RESULTS

Baseline data was obtained for 157 students, and post-intervention assessment was completed for 66 students. There was a significant increase in MHKS score (p < 0.001, Cohen's d = 0.59) and a significant reduction in the MICA score (p = 0.016, Cohen's d = 0.31) after the intervention. However, there was no change in empathy and social distance, as measured by JSE (p = 0.23) and SDS (p = 0.31). A majority of the faculty and students were satisfied with the module and felt it should be part of the psychiatry curriculum.

CONCLUSIONS

The SEA module was found to improve medical students' knowledge and attitude towards mental illness and could be integrated as part of the psychiatry curriculum. However, it was ineffective in changing empathy and stigma in the students.

Effect of a Single-Session Communication Skills Training on Empathy in Medical Students

OBJECTIVE

Empathy scores have been found to decline over the years spent in medical school. The authors aimed to evaluate the change in empathy levels in medical students following a single-session communication skills training.

METHODS

Eighty-two second-year medical students were randomized into intervention and control groups. The intervention comprised of a single-session empathetic communication skills training using PowerPoint, video clips, and roleplay. Empathy was assessed using the Jefferson Scale of Empathy-Student version (JSE) at baseline, post-intervention (for the intervention group), and at follow up after 3 weeks.

RESULTS

The mean JSE score of the intervention group was 109.7 ± 11.8 at baseline, with significant improvement post-intervention (114.2 ± 10.6, p = 0.014). However, the score declined at the 3-week follow-up (106.8 ± 11.8). The mean baseline JSE score of the control group was 107.5 ± 12.4, with a decline at follow-up (101.8 ± 16.0). Though both groups showed a decline in the JSE score at follow-up, the decline was significant only for the control group (p = 0.020), which did not receive the training.

CONCLUSIONS

The study showed significant improvement immediately, and lower decline at follow-up, in empathy levels following a communication skills training. The findings suggest a need to incorporate a regular training program into the existing medical curriculum, to enhance empathy and prevent its decline over the years.

Relationship between Mentalizing and Working Conditions in Health Care

Mentalizing describes the human ability to comprehend one's own and others' mental states and is seen as one of the core competencies of psychotherapists. Current research has emphasized the importance of both early dyadic attachment as well as broader sociocultural environmental input on the development of mentalizing. This study investigates whether mentalizing skills, operationalized via reflective functioning (RF), might be influenced by training and working conditions. This study was a matched case-control comparison, cross-sectional study. RF was assessed in a total of 10 psychotherapy trainees working in private practice at the beginning (group A; n = 5) and end (group B; n = 5) of their psychotherapy training (training association: Gestalt Therapy, Institute of Integrative Gestalttherapy Vienna) and in a total of 40 health professionals (institution: General Hospital Vienna-Social Medical Center South, Vienna, Department of Psychiatry, acute psychiatric ward) at the beginning of (group C; n = 20) and without (group D; n = 20) mentalization based therapy training. The participants differed from each other regarding their training, but participants of the same institution were matched. RF scores were significantly higher in group A and B than in group C and D (A,C: p = 0.0065, Odds Ratio (OR): 0.0294; A,D: p = 0.0019, OR: 0.0132; B,C: p = 0.0065, OR: 0.0294, B,D: p = 0.0019, OR: 0.0132). RF scores were not significantly different among groups A and group B (A,B: p > 0.9999) or between groups C and D (C,D: p = 0.6050). The current study suggests that mentalizing skills might be rather slow to improve by training, but that they might be influenced by the context.

A multi-institutional and cross-sectional study on empathy in Chinese medical students: differences by student cadre or not, future career preference, and father's education status

BACKGROUND

The aims of this study were to examine the factor structure of the Chinese version of the Jefferson Scale of Empathy for medical students (JSE-S) and investigate differences in empathy scores among Chinese medical students according to gender, student cadre or not, future career preference, and parents' education.

METHODS

Medical students from three universities completed an online questionnaire containing the JSE-S. Exploratory factor analysis was conducted to determine the factor structure, and group comparisons of empathy scores were examined via t-tests and analysis of variance.

RESULTS

Four factors emerged from the factor analysis: "perspective taking," "compassionate care," "standing in the patient's shoes," and an uninterpretable factor. The results indicated that students who were female, held positions as student cadres, preferred to become a doctor, and whose fathers had a high school education or below tended to have more empathy.

CONCLUSIONS

Overall, the findings provide information on the dimensions of empathy applicable to Chinese medical students and confirm the factors found in the original measure. The dimensions have implications for developing empathy among medical students throughout the world. Educators can use the information to design interventions to foster empathy among students in the context of medical education reform in many countries, including China.

Correlation analysis of empathy satisfaction and empathy, mental resilience, and social support in elderly patients with functional dyspepsia

BACKGROUND

The development direction of empathic satisfaction as helping industry is gradually shifting from medical personnel to patients. The level of empathy satisfaction is closely related to the levels of empathy ability, social support, and mental resilience.

AIM

To explore the correlation among empathy satisfaction, empathy ability, mental resilience, and social support in elderly patients with functional dyspepsia (FD).

METHODS

One hundred and thirty elderly patients with FD who were admitted to our hospital from June 2017 to August 2019 were selected as the study subjects. The professional quality of life scale, the Chinese-version Jefferson empathy scale, the comprehension social support scale, and the self-recovery strength scale were used for investigations.

RESULTS

The scores of empathy competence, mental resilience, social support, and empathy satisfaction in elderly FD patients were 106.94 ± 9.36, 35.72 ± 6.87, 67.83 ± 8.34, and 33.94 ± 4.90, respectively, all of which were positively correlated [r = 0.765- (-0.423), P < 0.05]. Regression analysis was conducted with empathy ability as the independent variable, mental resilience as the mediating variable, and empathy satisfaction as the dependent variable. The results showed that both empathy (β = 0.189, P < 0.01) and resilience (β = 0.282, P < 0.01) positively predicted empathy satisfaction, and the predictive effect of empathy on empathy satisfaction was decreasing (β = 0.153, P < 0.01), indicating that psychological resilience has a mediating effect between empathy ability and empathy satisfaction. The moderating effect test program of the mediating variable was used for multiple regression analysis, and equation 1 and equation 2 were established, respectively, with mental resilience and empathy satisfaction as the dependent variables. The results showed that in equation 1, the moderating effect of mental resilience on empathy × social support was not significant (β = -0.031, P > 0.05). In equation 2, empathy satisfaction had a significant moderating effect on psychological resilience × social support (β = 0.179, P < 0.01).

CONCLUSION

The level of empathy in elderly FD patients is low, which may be related to age and course of disease. Empathy ability, psychological resilience, social support, and empathy satisfaction are positively correlated, so we should attach importance to the role of psychological resilience in clinical work and provide a high level of social support, so as to improve the empathy satisfaction of elderly FD patients.