Empathic Attitudes in Medical Students: using of the Jefferson Scale of Empathy

Introduction: Empathy is a communication ability which reflects an understanding of another person’s experiences, concerns, and perspectives and the ability to express such an understanding. Empathic understanding is the core of the interaction between the medical team and the patients. The ability to understand the patient's condition and feelings and to carry out effective and quality care is referred to as empathy with the patient. Based on the recommendations by the American Society for Training in Medical Sciences, schools of medicine must train the medical students in a way that such an empathy increases. They should also take the patients’ understanding, feelings, and perceptions as well as their social, economic, cultural, religious, and linguistic backgrounds into careful consideration. In the recent decade, considering the advancements in the science of medicine, researchers have raised such questions as whether medical students experience some kind of emotional analgesia during school years and whether medical graduates are more hardened. This study, therefore, aims to evaluate the degree of empathy in medical students studying at different medical schools in Tehran. Methods: The present study is a descriptive cross-sectional study carried out between September and October in 2015. Using random quota sampling, 400 students studying general medicine at Shahid Beheshti, Iran, Tehran, and Shahed Universities of Medical Sciences were selected. The inclusion criterion was studying general medicine and the exclusion criteria were being a guest, transferred, or drop-out student, or withdrawing from the study. To collect the data, Jefferson Scale of Empathy-Student Version was used. This scale consists of 20 items and three subscales including adopting a view (10 items), empathetic care (7 items), and putting oneself in patients’ positions (2 items). Ten negative items of this scale are scored reversely. The total score falls in the range of 20 to 140. The more the scale score is, the more empathy it shows. This scale has a content validity index (CVI) higher than 0.79, and in terms of reliability, it has a proper internal consistency with Cronbach's alpha coefficient of 0.63. The data were analyzed using SPSS 16 statistical software. In order to investigate the differences among empathy scores based on gender, independent sample t-test was run; and to investigate the differences based on marital status, education level, and the type of university, one-way ANOVA and Pearson correlation coefficient were used. Ethical Considerations : Participants verbal consent was obtained and anonymously and confidentiality of the completing questionnaires was assured to them. Results: Of the 400 questionnaires distributed, 373 (93.25 percent) were returned. The mean score of empathy was 82.94±7.08, with 45% of participants’ scores being below the mean score and 55% higher than the mean. The highest score was for adopting an empathic view (54.37±7.05). A significant correlation was found between empathy and the age of the participants. Students of the younger age group had higher empathy scores than students of older age (r=-0.833; P=0.01). Aging, accompanied by clinical work, along with such other possible reasons as fatigue and stress associated with the increased years of education reduces the amount of empathy with the patients. In addition, there was a significant correlation between the empathy and students’ gender (P=0.010): women had higher empathy scores. In terms of gender, the degree of empathy among the students who participated in the study was significantly different. Female students had higher empathy scores than the male ones. In terms of mental structure and psychological empathic characteristics, empathy is more observed in women than men. This difference may be due to the fact that women respond to emotional signals more, and that female therapists spend more time giving care to patients. The mean score of empathy was also higher with married students (P=0.30). On the other hand, empathy scores were significantly decreased as the education level of the students increased (r=0.826; P=0.001): intern students had less empathy. Discussion and Conclusion: The results of the study showed that the degree of empathy in different categories based on education level were statistically different; empathy scores significantly decreased in higher education levels. Students’ empathy had been higher before entering the fields of health services and reaching the higher levels of education in which there is more technical work and more attention is focused on specialized activities. This indicates a gradual distance from the status of being a student towards being a professional, a decline in interest in patient-centered treatment, and a greater focus on mere employment of the techniques in providing the services. This may make the communication with patients wane and ultimately result in a decrease in empathy. The highest scores of empathy were respectively found in the fields of psychiatry, pediatrics, obstetrics, and gynecology while the lowest scores were found in radiology, radiotherapy, and physical medicine, respectively (P=0.06). There was a significant relationship between empathy and the participants’ specialized fields of interest. The greatest amount of empathy was found among the groups interested in obtaining expertise in the fields of psychiatry and pediatrics. Still, to have an effective treatment and to eliminate the risks, higher degrees of empathy are required when treating children. At the bottom of the list, there are such (instrument-based) fields as radiology and radiotherapy in which diagnosis is often done based on technology- unrelated to para-clinical care, where doctors have less interaction with the patients. Therefore, choosing the desired field of specialization can provide a person with the ground for more empathic interaction. This is probably owing to the fact that people who are more prone to empathy choose those specialized medical fields that are based on interaction with patients. By evaluating the medical students’ empathic perspective and strengthening it, it is possible to help them grow in their specialized fields. No statistically significant relationship was observed between empathy scores and the type of universities (P=0.08). This is probably due to the same admission criteria for students without evaluating their patient-centered perspective. Therefore, educational planning to strengthen empathy between students and patients seems necessary. Thus, it is recommended that some longitudinal studies be designed to find the amount of change in the degree of medical students’ empathy during their education in clinical practice. Moreover, larger nationwide studies on medical graduates’ empathic behavior and interactions with patients will make the results more generalizable. Given the importance of empathy as a moral virtue, it is also recommended that in order to promote the students’ and patients’ mental and spiritual health, the students be provided with all their educational needs through planning to strengthen the empathic atmosphere between the students and patients and including the concept of empathy with patients in the curriculum. Please cite this article as: Rafati S, Rejeh N, Davati A, Foroutani F. Empathic Attitudes in Medical Students: using of the Jefferson Scale of Empathy. Med Ethics J 2016; 10(36): 25-34.