Caracterización psicométrica y distribución empática entre las áreas académicas en estudiantes de enfermería / Psychometric Characterization and Empathic Distribution between Academic Areas in Nursing Students

Resumen Objetivo: El objetivo del estudio es caracterizar psicométricamente los datos de empatía y sus dimensiones, así como determinar la distribución empática entre las áreas académicas en el proceso de formación de estudiantes de pregrado de enfermería. Métodos: Este es un estudio comparativo, no experimental y transversal. La muestra estudiada fue de 365 estudiantes de enfermería de ambos sexos pertenecientes a la Facultad de Enfermería de la Universidad Veracruzana, México. El total de la población fue de 425 estudiantes y la muestra constituyó el 85,88% del total de estudiantes (mayo a julio de 2022). Se estudiaron las propiedades psicométricas de la escala de Empatía para Profesionales de la Salud, versión estudiantes (fiabilidad, validez de constructo e invarianza del modelo). Para describir y comparar los grupos se utilizaron estadísticos descriptivos, análisis de varianza y gráficos de las medias con barras que representaban el intervalo de confianza al 95%. Resultados: La medida de empatía alcanza coeficientes de fiabilidad satisfactorios y presenta adecuados indicadores de validez de constructo, resultando una medida invariante según área académica y sexo. Se encontró la existencia de déficits en algunas de las dimensiones de empatía. Conclusión: El análisis psicométrico (modelo de dimensiones subyacentes e invarianza), previa a la estimación de los parámetros de la empatía, constituye una necesitad metodológica que garantiza teóricamente la estimación de los niveles de empatía y de la comparación entre grupos. La distribución de los niveles de empatía entre las áreas académicas se caracterizó por un déficit en las dimensiones cuidado con compasión y "caminar en los zapatos del paciente".

Abstract Aim: The objective of the study is to psychometrically characterize the empathy data and its dimensions, as well as to determine the empathic distribution among the academic areas in the process of training undergraduate nursing students. Methods: This is a comparative, non-experimental, cross-sectional study. The studied sample consisted of 365 nursing students of both sexes belonging to the Faculty of Nursing of the Universidad Veracruzana, México. The total population was 425 students and the sample constituted 85.88% of the total number of students (May to July 2022). The psychometric properties of the Empathy Scale for Health Professionals, student version (reliability, construct validity, and model invariance) were studied. To describe and compare the groups, descriptive statistics, analysis of variance, and graphs of the means with bars -representing the 95% confidence interval- were used. Results: The empathy measure reaches satisfactory reliability coefficients and it presents adequate indicators of construct validity indicators, resulting in an invariant measure according to academic area and sex. The existence of deficits in some of the dimensions of empathy was found. Conclusion: The psychometric analysis (model of underlying dimensions and invariance), prior to the estimation of the empathy parameters, constitutes a methodological necessity that theoretically guarantees the estimation of the empathy levels and the comparison between groups. The distribution of empathy levels between academic areas was characterized by a deficit in the dimensions of compassionate care and "walking in the patient's shoes".

Levels of Empathy in Students and Professors with Patients in a Faculty of Dentistry.

BACKGROUND: Empathy is an attribute that plays an essential role in the dentist-patient therapeutic relationship, clinical care, and treatment adherence, along with providing other benefits. The main objective of this research was to establish the validity, reliability, and invariance of the Jefferson Scale of Empathy and then characterize the empathy levels of students and teachers at a dental school. MATERIALS AND METHODS: An observational and cross-sectional study analyzed a sample of undergraduate students and professors from the Universidad Andrés Bello Faculty of Dentistry (Chile) (n = 1727 and n = 267, respectively). The Empathy Scale for Health Professionals (HP) and the same scale for students (HPS) were applied. RESULTS: The Jefferson Empathy Scale presents adequate psychometric properties. The empathy measure has adequate reliability and construct validity, confirming a fit of the three-factor empathy model to the data. The measurement is invariant within the university campus, the sex of the student, and between teacher and student. Teachers present greater empathy than students except in the Perspective Adoption dimension. CONCLUSIONS: The Jefferson Empathy Scale is reliable, valid, and invariant among Chilean dental students and professors. Students do not differ from their professors in the cognitive component of empathy, but they present a lower score in the affective component and global empathy. It is inferred that students can develop the affective component of empathy in their interactions with their professors, increasing their overall empathy. Understanding and fostering empathy in dental students and professors can significantly improve patient care and treatment adherence and increase patient and dentist satisfaction.

Resilience as a Modulating Factor of Empathy in Medical Students

Introduction: Empathy is a complex and multidimensional attribute. Attempts have been made to explain empathic behavior based on other variables. Empirical evidence shows that empathy could be the product of the influence of several factors. One of these factors could be resilience. There is still no developed theory and consistent empirical evidence demonstrating that empathy depends on resilience. Objective: The aim of this study is to determine if resilience can predict empathic behavior. Methodology: This study is non-experimental and ex post facto with a cross-sectional design. Variables. Dependent: Empathy; Independent: Resilience. Population: Medical students belonging to the Faculty of Health Sciences of the Universidad Autónoma de Santa Ana (UNASA), Santa Ana, El Salvador (N=579). The sample (n=465) consisted of students (both sexes). Convenience sampling. Jefferson Scale of Empathy for Healthcare Professionals, student version (JSE-HPS). Trait Resilience Scale (EEA). A Structural Equation Modelling (SEM) model was used. Additionally, the Comparative Fit Index (CFI) (>0.95), Tucker-Lewis Index (TLI) (>0.95), Root Mean Square Error of Approximation (RMSEA) (<0.08), and Standardized Root Mean Square (SRMR) (<0.08), Confirmatory Factor Analysis (CFA) were employed. The significance level employed was α < 0.05. Results: All these results show that both measurement models (empathy and resilience) are adequately represented and are suitable for the structural model. Discussion: Individual resilience is a variable that can predict empathic behavior in medical students belonging to a Faculty of Health Sciences. The results constitute indirect empirical evidence that it is possible to define empathy as a dependent variable and resilience as an independent variable.

Introducción: La empatía es un atributo complejo y multidimensional. Se han realizado intentos para explicar el comportamiento empático basado en otras variables. La evidencia empírica muestra que la empatía podría ser el producto de la influencia de varios factores. Uno de estos factores podría ser la resiliencia. Aún no existe una teoría desarrollada y evidencia empírica consistente que demuestre que la empatía depende de la resiliencia. Objetivo: El objetivo de este estudio es determinar si la resiliencia puede predecir el comportamiento empático. Metodología: Este estudio es no experimental y ex post facto con un diseño transversal. Variables. Dependiente: Empatía; Independiente: Resiliencia. Población: Estudiantes de medicina pertenecientes a la Facultad de Ciencias de la Salud de la Universidad Autónoma de Santa Ana (UNASA), Santa Ana, El Salvador (N=579). La muestra (n=465) consistió en estudiantes (ambos sexos). Muestreo por conveniencia. Escala de Empatía de Jefferson para Profesionales de la Salud, versión estudiantil (JSE-HPS). Escala de Resiliencia de Rasgo (EEA). Se utilizó un modelo de Modelado de Ecuaciones Estructurales (SEM). Además, se emplearon el Índice de Ajuste Comparativo (CFI) (>0.95), Índice de Tucker-Lewis (TLI) (>0.95), Error Cuadrático Medio de Aproximación (RMSEA) (<0.08) y Error Cuadrático Medio Estandarizado (SRMR) (<0.08), Análisis Factorial Confirmatorio (CFA). El nivel de significancia empleado fue α < 0.05. Resultados: Estos resultados muestran que ambos modelos de medición (empatía y resiliencia) están adecuadamente representados y son adecuados para el modelo estructural. Discusión: Los resultados constituyen evidencia empírica indirecta de que es posible definir la empatía como una variable dependiente y la resiliencia como una variable independiente.

Psychometric Properties of the Family Adaptability and Cohesion Evaluation Scale III in Latin American University Dental Students.

OBJECTIVE: The Family Adaptability and Cohesion Evaluation Scale III (FACES III) is a self-report instrument that enables the assessment of the dimensions of adaptability and cohesion within a family, establishing whether or not that family is functional and classifying it according to categories within those dimensions. The objective of this research was to determine the psychometric properties of this instrument using a sample of dental students from 5 Latin American countries. MATERIALS AND METHODS: The FACES III was administered to a sample of 2888 university dental students from Colombia (35.3%), Chile (34.6%), the Dominican Republic (19%), Argentina (6%), and El Salvador (5.1%). Confirmatory factor analysis was used to examine the factorial structure of the scale, comparing 3 models proposed in the Latin American literature, establishing a multigroup analysis to examine invariance among countries. RESULTS: The results revealed a structure composed of 2 dimensions: cohesion and adaptability. These dimensions showed adequate structure and internal consistency. The invariance of the measurement model in the participating countries was confirmed. CONCLUSION: In general, this study offers evidence of the adequacy of the psychometric properties of FACES III in Colombian, Chilean, Dominican, Argentine, and Salvadoran dental students.

Empatía con el paciente en médicos especialistas que trabajan en un Hospital de Cuenca (Ecuador) / Empathy with the Patient in Medical Specialists Working in a Hospital in Cuenca ­ Ecuador / Empatia com o paciente em médicos especialistas que trabalham em um hospital em Cuenca, Equador

ntroducción: la empatía es uno de los componentes de la estructura de la humanización en la atención de los pacientes. Los médicos especialistas deben tener mucha empatía. El objetivo del artículo es des-cribir los índices de empatía en médicos que trabajan en un hospital de alta complejidad y explorar si existen diferencias entre las especialidades estudiadas. Métodos: se accedió a una muestra por conve-niencia de 237 médicos que representa el 53.55 % del total poblacional (n = 443). La empatía se midió con la Escala de Empatía para Profesionales de la Salud (hp), junto con análisis factorial confirmatorio y análisis multigrupo (para examinar la invarianza del modelo entre los sexos) y análisis de confia-bilidad (α de Cronbach, coeficiente de correlación intraclase y ω de McDonald). Resultados: la espe-cialidad de pediatría tuvo los mayores índices de empatía general y en las dimensiones "cuidado con compasión" y "caminando en los zapatos del paciente", no así en la dimensión "toma de perspectiva", donde es semejante a las especialidades de anestesiología, medicina crítica y terapia intensiva, y gine-cología. Conclusión: los valores de la empatía y los valores en las subescalas "cuidado con compasión" y "caminando en los zapatos del paciente" fueron (en valores absolutos, pero no estadísticos) mayores en la especialidad de pediatría. En la subescala "toma de perspectiva", las especialidades de pediatría, anestesiología, cirugía y clínica se observaron puntuaciones prácticamente iguales. Se requieren otros estudios que permita arribar a una explicación que permita entender por qué algunas especialidades tienen valores de empatía mayores que otras

Introduction: Empathy is one of the components of the structure of humanization in patient care. Medical specialists must have high levels of empathy. Objective: The aim of this paper is to describe the levels of empathy in doctors working in a highly complex hospital and to explore whether there are differ-ences between the specialties studied. Methods: A convenience sample of 237 physicians representing 53.55% of the total population (n = 443) was accessed. Empathy was measured using the Empathy Scale for Health Professionals (hp). Confirmatory factor analysis and multigroup analysis were performed to examine the invariance of the model between the sexes and reliability analyzes (Cronbach's α, intraclass correlation coefficient and McDonald's ω). Results: The specialty of pediatrics had the highest levels in general empathy and in the Compassionate Care and Walking in Patient Shoes subscales, but not in the Perspective Taking subescale where it presents levels similar to the specialties of anesthesiology, critical medicine and intensive care. and gynecology. Conclusions: The empathy values and the values in the compassionate care and "Walking in the patient's shoes" subscales were (in absolute values, but not sta-tistically) higher in the Pediatrics specialty. In the subscale Perspective Taking, Pediatrics, Anesthesiology, Surgery, and Clinic, practically the same scores were observed. Other studies are required to arrive at an explanation that allows us to understand why some specialties have higher empathy values than others.

Introdução: a empatia é um dos componentes da estrutura de humanização no atendimento ao paciente. Os médicos especialistas devem ter altos níveis de empatia. Objetivo: o objetivo deste artigo é descre-ver os níveis de empatia em médicos que trabalham em um hospital de alta complexidade e explorar se há diferenças entre as especialidades estudadas. Materiais e métodos: foi acessada uma amostra de conveniência de 237 médicos, representando 53,55% da população total (n = 443). A empatia foi medida usando a Escala de Empatia para Profissionais de Saúde. A análise fatorial confirmatória e a análise mul-tigrupo foram realizadas (para examinar a invariância do modelo entre os sexos) e a análise de confia-bilidade (α de Cronbach, coeficiente de correlação intraclasse e ω de McDonald). Resultados: a pediatria apresentou os níveis mais altos de empatia geral e nas dimensões "cuidado compassivo" e "estar no lugar do paciente", mas não na dimensão "tomada de perspectiva", em que os níveis foram semelhantes aos da anestesiologia, da medicina crítica e da terapia intensiva, e da ginecologia. Conclusões: os valores de empatia e os valores das subescalas "cuidado compassivo" e "estar no lugar do paciente" foram (em valo-res absolutos, mas não estatisticamente) mais altos na especialidade de pediatria. Na subescala "tomada de perspectiva", as especialidades de pediatria, anestesiologia, cirurgia e clínica tiveram pontuações quase iguais. São necessários mais estudos para explicar por que algumas especialidades têm valores de empatia mais altos do que outras

Family functioning in students of health sciences in four Latin American countries: a study of the structure and factorial invariance of the FACES III scale. A cross-sectional study.

BACKGROUND: Psychometric studies of the FACES III scale in Spanish-speaking countries show a lack of agreement on the factorial structure of the scale. In addition, most of the studies have only performed exploratory analyses of its factorial structure. OBJECTIVE: The objective of the present study was to confirm the structure and factorial invariance of the FACES III scale in nursing and obstetric students from Chile, Colombia, Peru, and Mexico. METHODS: A total of 3303 students from the four countries participated in this study (Colombia = 1559, Chile = 1224, Peru = 215, Mexico = 305). RESULTS: The results of the study showed that the Bi-factor model presents the best-fit indexes to the data from Colombia, Chile, and Mexico, but not from Peru. In addition, it was found that this model showed evidence of being strictly invariant among the three countries in the sequence of the invariance models proposed: metric invariance (ΔRMSEA = .000), scalar (ΔRMSEA = .008), and strict (ΔRMSEA = .008). The bi-factor model also showed adequate reliability indexes in the three countries. CONCLUSION: It is concluded that the FACES III scale shows adequate psychometric performance under a bi-factor model in nursing and obstetric students from Colombia, Chile, and Mexico. The lack of fit of the model in Peru could be associated with the small sample size.

Evaluation of the psychometric properties of the family adaptability and cohesion scale (FACES III) through item response theory models in students from Chile and Colombia.

BACKGROUND: A psychometric study of the Family Adaptability and Cohesion Scale (FACES III) has been conducted in Spanish-speaking countries from the perspective of the classical test theory. However, this approach has limitations that affect the psychometric understanding of this scale. OBJECTIVE: Accordingly, this study used the item response theory to investigate the psychometric performance of the items. Furthermore, it evaluated the differential performance of the items for Colombia and Chile. METHOD: For this purpose, 518 health science students from both countries participated. Confirmatory Factor Analysis was used. RESULTS: The study results revealed that the cohesion and adaptability items presented adequate discrimination and difficulty indices. In addition, items 5, 8, 13, 17, and 19 of cohesion indicated differential functioning between students from both countries, with Chilean students exhibiting a greater discriminatory power. Further, the Colombian group exhibited a greater discriminatory power for item 18 of adaptability. CONCLUSIONS: The study concluded that the items of FACES III indicated adequate psychometric performance in terms of their discriminative capacity and difficulty in Chile and Colombia.

Family functioning in students of health sciences in four Latin American countries: a study of the structure and factorial invariance of the FACES III scale. A cross-sectional study

Abstract Background Psychometric studies of the FACES III scale in Spanish-speaking countries show a lack of agreement on the factorial structure of the scale. In addition, most of the studies have only performed exploratory analyses of its factorial structure. Objective The objective of the present study was to confirm the structure and factorial invariance of the FACES III scale in nursing and obstetric students from Chile, Colombia, Peru, and Mexico. Methods A total of 3303 students from the four countries participated in this study (Colombia = 1559, Chile = 1224, Peru = 215, Mexico = 305). Results The results of the study showed that the Bi-factor model presents the best-fit indexes to the data from Colombia, Chile, and Mexico, but not from Peru. In addition, it was found that this model showed evidence of being strictly invariant among the three countries in the sequence of the invariance models proposed: metric invariance (ΔRMSEA = .000), scalar (ΔRMSEA = .008), and strict (ΔRMSEA = .008). The bi-factor model also showed adequate reliability indexes in the three countries. Conclusion It is concluded that the FACES III scale shows adequate psychometric performance under a bi-factor model in nursing and obstetric students from Colombia, Chile, and Mexico. The lack of fit of the model in Peru could be associated with the small sample size.

Evaluar la evolución de la empatía en el tiempo en estudiantes de odontología

Objetivo. evaluar la evolución de la empatía y sus dimensiones en dos períodos anuales diferentes y determinar las fortalezas y las deficiencias observadas en la empatía y en sus dimensiones. Material y Métodos. estudio no experimental, descriptivo y transversal. La población la conforman estudiantes colombianos de odontología. La muestra se conformó de dos cohortes: n=326 estudiantes, 100% de la población (cohorte 2016) y n=207 estudiantes, 87,34 % de la población (cohorte 2022). La empatía fue medida por el instrumento JES-HPS. Se aplicó un análisis factorial confirmatorio, fiabilidad e invarianza. Las comparaciones de empatía entre las cohortes se realizaron mediante un análisis de la varianza factorial. Resultados. se cumplió el modelo teórico de tres dimensiones de la empatía en ambas cohortes estudiadas. Los niveles de confiabilidad fueron aceptables. No se encontraron diferencias estadísticas relevantes entre las cohortes y se observa una declinación en el segundo y quinto curso de la empatía y de las dimensiones en general. Conclusiones. los valores de la empatía y sus dimensiones se han mantenido sin cambios en el tiempo y la empatía clasifico como "nivel medio" Como consecuencia de lo anterior, los niveles medios de la empatía podrían asociase a un déficit en la capacidad de entender la subjetividad del pensamiento del paciente y, esta situación, complica una actitud empática normal.

Objective: evaluate empathy and its dimensions in two different annual periods and determine the strengths and weaknesses observed in empathy and its dimensions. Material and methods: non-experimental, descriptive, cross-sectional study. The population was made up of Colombian dental students. The sample consisted of two cohorts: n=326 students, 100% of the population (cohort 2016} and n=207 students, 87,34% of the population (cohort 2022}. Empathy was measured by the JES-HPS instrument. A confirmatory factor analysis, reliability and invariance was applied. Comparisons of empathy between cohorts were performed by factorial analysis of variance. Results: the three-dimensional theoretical model was met in both cohorts studied. Reliability levels were acceptable. No relevant statistical differences were found between the cohorts and a decline is observed in the second and fifth grades of empathy and dimensions in general. Conclusions: the values of empathy and its dimensions have remained unchanged over time and empathy is classified as "medium level" As a consequence of the above, medium levels of empathy could be associated with a deficit in the ability to understand the subjectivity of thought. of the patient and, this situation, complicates a normal empathic attitude.

La empatía de los enfermeros con los pacientes en los hospitales públicos / Working nurses' empathy with patients in public hospitals / A empatia dos enfermeiros com os pacientes em hospitais públicos

Objetivo: determinar los niveles de empatía en profesionales de enfermería de un hospital de alta complejidad, relacionar la edad con la empatía (y cada una de sus dimensiones), y establecer si existen diferencias entre estos niveles según el tipo de jornada laboral. Método: diseño comparativo, correlacional y transversal. La muestra utilizada (n=271) constituyó el 40,9% del total de profesionales de enfermería. Se estudiaron las propiedades psicométricas de la Escala de Empatía de Jefferson para Profesionales de la Salud. Se calcularon estadísticos descriptivos: media y desviación estándar. La asociación entre empatía y edad se estimó mediante ecuaciones de regresión y significancia estadística de los coeficientes de regresión, luego de evaluar el tipo de curva mediante análisis de varianza. Resultados: se identificó el modelo subyacente de las tres dimensiones de la empatía. Los valores de los estadísticos descriptivos observados fueron relativamente bajos en empatía y sus dimensiones. Los niveles de empatía no se asociaron con el rango de edad. No se encontraron diferencias en la empatía entre los tipos de horarios de trabajo. Se encontró variabilidad en las dimensiones: "cuidado compasivo" y "ponerse en los zapatos del paciente". Conclusión: estos resultados muestran que los niveles de empatía observados pueden implicar un desempeño deficiente en el cuidado empático de los pacientes.

Objective: to determine the levels of empathy in professional nurses of a high-complexity hospital, to relate age to empathy (and each one of its dimensions), and to establish if there are differences between these levels according to the type of working schedules. Method: comparative, correlational and cross-sectional design. The sample used (n=271) constituted 40.9% of the total number of nursing professionals. Psychometric properties of the Jefferson Scale of Empathy for Health Professionals were studied. Descriptive statistics were calculated: mean and standard deviation. The association between empathy and age was estimated using regression equations and statistical significance of the regression coefficients, after evaluating the type of curve using variance analysis. Results: the underlying model of three dimensions of empathy was identified. The values of the descriptive statistics observed were relatively low in empathy and its dimensions. Empathy levels were not associated with the age range. No differences in empathy were found between the types of work schedules. Variability was found in the dimensions: "compassionate care" and "Walking on the patient's shoes". Conclusion: these results show that the levels of empathy observed may imply a deficient performance in empathetic care for patients.

Objetivo: determinar os níveis de empatia em enfermeiros profissionais de um hospital de alta complexidade, relacionar a idade com a empatia (e cada uma das suas dimensões) e verificar se existem diferenças entre esses níveis, de acordo com o tipo de horário de trabalho. Método: delineamento comparativo, correlacional e transversal. A amostra utilizada (n=271) constituiu 40,9% do total de profissionais de enfermagem. Foram estudadas as propriedades psicométricas da Escala de Empatia de Jefferson para Profissionais da Saúde. Foram calculadas estatísticas descritivas: média e desvio padrão. A associação entre empatia e idade foi estimada por meio de equações de regressão e significância estatística dos coeficientes de regressão, após avaliação do tipo de curva por meio de análise de variância. Resultados: o modelo subjacente de três dimensões de empatia foi identificado. Os valores das estatísticas descritivas observados foram relativamente baixos em empatia e suas dimensões. Níveis de empatia não foram associados com a faixa etária. Não foram encontradas diferenças de empatia entre os tipos de horários de trabalho. Foi encontrada variabilidade nas dimensões: "cuidado compassivo" e "colocar-se no lugar do paciente". Conclusão: esses resultados mostram que os níveis de empatia observados podem implicar em um desempenho deficiente no atendimento empático aos pacientes.

Working nurses' empathy with patients in public hospitals. / La empatía de los enfermeros con los pacientes en los hospitales públicos.

OBJECTIVE: to determine the levels of empathy in professional nurses of a high-complexity hospital, to relate age to empathy (and each one of its dimensions), and to establish if there are differences between these levels according to the type of working schedules. METHOD: comparative, correlational and cross-sectional design. The sample used (n=271) constituted 40.9% of the total number of nursing professionals. Psychometric properties of the Jefferson Scale of Empathy for Health Professionals were studied. Descriptive statistics were calculated: mean and standard deviation. The association between empathy and age was estimated using regression equations and statistical significance of the regression coefficients, after evaluating the type of curve using variance analysis. RESULTS: the underlying model of three dimensions of empathy was identified. The values of the descriptive statistics observed were relatively low in empathy and its dimensions. Empathy levels were not associated with the age range. No differences in empathy were found between the types of work schedules. Variability was found in the dimensions: "compassionate care" and "Walking on the patient's shoes". CONCLUSION: these results show that the levels of empathy observed may imply a deficient performance in empathetic care for patients. (1) The levels of empathy are low in the nursing professionals studied. (2) These levels are not associated with age and type of work performed. (3) Low levels of empathy could imply a negative alteration of humanized attention.

Family Functioning as an Explanatory Factor of Empathic Behavior in Argentine Medical Students.

Empathy is a relevant competence in the study and practice of medicine whose development could depend on the functioning style of each family. This study aims to compare the distribution of empathy levels, about functionality or dysfunction, and the three styles, which can be derived from family functioning in the families of Argentine medical students. Previously providing evidence of the validity of the family functioning measure. As well as provide evidence of the validity of the measure of family functioning. METHODS: Ex post facto design: 306 Argentine medical students who had already taken the Jefferson Scale of Empathy-Spanish Edition (JSE-S) and the abbreviated Spanish Family Adaptability and Cohesion Evaluation Scale (FACES-20). A gender-weighted linear regression analysis was made, establishing an ANOVA and multiple comparisons via DMS to determine the effect of functional and dysfunctional families' balanced, intermediate and extreme functioning styles concerning empathy. RESULTS: Students who presented dysfunction in familial cohesion and adaptability showed measures of empathy greater than those classified as functional. Differences of cohesion were statistically significant in compassionate care, perspective taking and general empathy. These components were significantly higher in students from families classified as extreme than balanced ones. Students classified within families with either extreme or dysfunctional styles showed greater levels of empathy than more adaptive and functional ones, except in the 'walking in patient's shoes' component where differences were not observed. CONCLUSIONS: Individual resilience as an intervening variable in the presence of empathy is discussed. IMPLICATIONS: The study of empathy, its associated variables, and the conditions of its development remains a central theme in relation to students and professionals of the health sciences. To achieve an effective professional practice, it is necessary to develop human capacities such as empathy and personal resilience.

Empathy, psychometrics, cut-off points in nursing students from Latin America.

BACKGROUND: Currently, there are no cut-off points for levels of empathy, making it difficult to assess the change experienced in its development or as a result of its intervention. It is an unsolved problem. INTRODUCTION: Empathy is a cognitive-affective attribute that enables nursing staff to maintain a professional relationship that entails various benefits for the patient. Its strengthening and development during university education is desirable. Empathy studies in Latin American nursing students are based on the direct scores obtained on an empathy test, based on which the variable is described and groups are compared. Statistical comparisons are not enough to discriminate substantive changes since two statistical values can show differences without implying that the post-intervention levels may correspond to a higher category in relation to those of pre-intervention or that two compared groups are qualitatively different. The above applies to empathic behaviour and is valid for students and professionals of health. This study aimed to establish cut-off points that allow defining ordinal categories in empathy. METHODS: In this multicenter and cross-sectional study, 3712 students from 11 Latin American nursing schools participated. The Jefferson Empathy Scale (JES) was applied; the psychometric properties were confirmed by Factor Analysis Confirmatory and Invariance. RESULTS: The JSE empathy scale is a measure with adequate reliability and construct validity. Examined cut-offs determined a structure of five empathy intervals that allowed them to be classified as empathy values in very high, high, medium, low and very low. DISCUSSION: The sequence of statistical tests carried out allowed us to determine ranges of categorical values in the empathy levels of groups of students. However, the determined categories may constitute a specific characteristic of them. It is not possible to extrapolate these results to regions other than those of Latin America. CONCLUSION: The estimated rankings allow comparing levels of empathy between groups of nursing students and the real effect of empathic interventions. IMPLICATIONS FOR NURSING: To contribute with strategies to evaluate changes in the empathic skills of nursing students, resulting in a well-valued skill in health services. IMPLICATIONS FOR NURSING POLICY: The cut-off points define evaluative categories (very low, low, medium, high and very high) that allow objective classification of levels of empathy achieved after (for example) an empathic intervention. This allows assessment of substantive changes experienced by nursing students (and professionals).

Family Functioning as a Possible Factor that Modulates Empathy Levels in Dental Students

Aim: The objective of this paper is to explore whether there are differences in the levels of empathy and its dimensions between family typologies in dental students. Methodology: A quantitative and not experimental study, with a cross-sectional descriptive design, a population of dental students from the Evangelical University of El Salvador, and a convenience sample were applied. The levels of empathy and family functioning were evaluated using the Jefferson Scale of Empathy for Health Professions students and the Brief Scale of Family Functioning. The construct validity of both instruments was estimated using Confirmatory Factor Analysis. The reliability was estimated using McDonald's omega and Cronbach's alpha. Comparisons of empathy and its dimensions between family typologies were made using a two-factor analysis of variance. Results: No statistical differences were observed in empathy and its dimensions based on family typologies. It was found that women are more empathic than men. This result is not in accordance with other studies carried out in Latin America on dental and medical students evaluating empathy and family functioning with the same instruments. Conclusions: The distribution of empathy levels and their dimensions are similar among the family typologies studied. Therefore, it was not found that family functioning can influence empathy in the population studied. It is necessary to continue these studies to obtain more empirical evidence regarding the influence of family functioning on empathy.

Objetivo: El objetivo del presente trabajo es determinar la existencia de diferencias de los niveles de empatía y de sus dimensiones entre las tipologías familiares en estudiantes de odontología. Metodología: Estudio cuantitativo y no experimental, con un diseño descriptivo transversal, una población de estudiantes de odontología de la Universidad Evangélica de El Salvador y una muestra por conveniencia. Fueron evaluados los niveles de empatía y el funcionamiento familiar mediante la Escala de Empatía de Jefferson para estudiantes de profesiones de la salud y la Escala Breve de Funcionamiento Familiar. Se estimó la validez de constructo de ambos instrumentos mediante Análisis Factorial Confirmatorio y la confiabilidad mediante omega de McDonald y alfa de Cronbach. Las comparaciones de la empatía y sus dimensiones entre las tipologías familiares fueron realizadas mediante análisis de varianza bifactorial. Resultados: No se observaron diferencias estadísticas en la empatía y en sus dimensiones en función de las tipologías familiares. Se encontró que las mujeres son más empáticas que los hombres. Este resultado no está en concordancia con otros estudios realizados en América Latina en estudiantes de odontología y medicina, evaluando la empatía y el funcionamiento familiar con los mismos instrumentos. Conclusiones: La distribución de los niveles de empatía y de sus dimensiones son semejantes entre las tipologías familiares estudiadas. Por lo tanto, no se constató que el funcionamiento familiar tenga un efecto sobre la empatía en la población estudiada. Es necesario continuar estos estudios para obtener mayor evidencia empírica respecto de la influencia del funcionamiento familiar en la empatía.

Empathy levels among dental students and professors from a dental school in the Dominican Republic / Empatía en estudiantes y profesores de una escuela de odontología de República Dominicana

Abstract Introduction: The concept of empathy has been incorporated as one of the key elements for the achievement of the teaching-learning process goals in health science students. Objective: To estimate and compare the levels of empathy among dental students and professors in the undergraduate dental medicine program at the Universidad Central del Este (Dominican Republic). Materials and methods: Cross-sectional study. The study population (n=264) was divided into two groups: the first consisted of students in their first to fifth year of dental school (N=223; n=215), distributed in two areas (basic-preclinical and clinical courses), while the second group comprised professors working in both areas in the dental school of the university (N=53; n=49). The Jefferson Scale of Empathy (S-Version) was used. The descriptive analysis of the data included the estimation of means, standard deviations and percentages, and the reliability of the data was estimated using Cronbach's alpha. In addition, a two-way ANOVA was performed, calculating the effect size and the statistical power of the test; furthermore, when the Fisher's exact test was significant for any factor, Tukey's test was used to estimate differences between means. A significance level of α<0.05 and β<0.20 was established. Results: Overall empathy scores and compassionate care dimension scores among the professor group did not differ significantly from the scores obtained by the students (basic-preclinical and clinical area), but there were differences between students from both areas (p<0.05). There were no significant differences between the three subgroups in the Perspective Taking and Walking in the Patient's Shoes dimensions (p=0.428 and p=0.866). Conclusion: The levels of empathy and compassionate care dimension of professors are similar to those of students in general (regardless of the area).

Resumen Introducción. El concepto de empatía se ha integrado como uno de los elementos centrales para el logro final del proceso de enseñanza-aprendizaje en estudiantes de ciencias de la salud. Objetivo. Estimar y comparar los niveles de empatía entre estudiantes y profesores de pregrado de odontología de la Universidad Central del Este (República Dominicana). Materiales y métodos. Estudio transversal. La población de estudio (n=264) se dividió en dos grupos: el primero, compuesto por estudiantes de primero a quinto año de la carrera de odontología (N=223; n=215) distribuidos en dos áreas (básica-preclínica y clínica), y el segundo, por los docentes de ambas áreas en la escuela de odontología de la universidad (N=53; n=49). Se utilizó la Escala de Empatía Médica de Jefferson (Versión-S). El análisis descriptivo de los datos incluyó la estimación de medias, desviaciones estándar y porcentajes, y la confiabilidad de los datos se estimó mediante CC de Cronbach; además, se realizó un ANOVA bifactorial, calculándose el tamaño del efecto y la potencia de la prueba, y en los casos en que la prueba exacta de Fisher fue significativa para algún factor, se utilizó la prueba de Tukey para estimar las diferencias entre las medias. El nivel de significancia estadística utilizado fue α<0.05 y β<0.20. Resultados. Los valores globales de empatía y de la dimensión Cuidado con compasión en los profesores no difirieron significativamente con los obtenidos por los estudiantes (área básica-preclínica y clínica), pero sí hubo diferencias entre los estudiantes de ambas áreas (p<0.05). En las dimensiones Adopción de perspectiva y Ponerse en los zapatos del otro no existieron diferencias entre los tres subgrupos (p=0.428 y p=0.866). Conclusión. Los niveles de empatía y de la dimensión Cuidado compasivo de los profesores no difieren de los de los estudiantes en general (ambas áreas).

Psychometry and Cut-off Points of the Jefferson Scale of Empathy in Medical Students in Central America and the Caribbean.

OBJECTIVE: The objective of this study was to determine cut-off points that can be used to differentiate measures of empathy, which would then be classified as high, medium, or low. To do so, we used data from students from 7 medical schools in Colombia, El Salvador, and the Dominican Republic, after determining the psychometric properties of the 3-dimensional model of empathy in the Jefferson Scale of Empathy, S-version (for medical students). MATERIALS AND METHODS: This non-experimental descriptive study had a sample that consisted of 6291 students. The structure and factor invariance were analyzed by country and sex. A hierarchical cluster analysis and a bifactorial analysis of variance were applied. RESULTS: The measure of empathy was reliable on the global scale (α = .82; ω = .88). A confirmatory factor analysis showed that the original model was replicable and adjusted to the data (comparative fit index [CFI] = .90; goodness of fit index = .94), while the multigroup analysis allowed to assume an invariant factor structure by country and gender (ΔCFI < .01). Tables were constructed with cut off points for empathy and its dimensions. DISCUSSION AND CONCLUSION: Our study solves the problem of comparing the scores and the levels of empathy observed in the medical students at different schools of medicine, making said comparisons within and between countries and between genders. The instrument used has adequate psychometric properties and the cut-off values obtained allow the classifying of people with lower or higher levels of empathy.

Variability of empathy among dental students. Implications not yet understood in Latin America / Variabilidad empática en estudiantes de odontología. Consecuencias aún no entendidas en América Latina

Abstract Introduction: Empathy is a quality that allows dentists to build an intersubjective relationship with their patients, which, among other benefits, contributes to the effectiveness of the treatment. Objective: To determine whether there is variability in empathy levels between two populations of dental students and to describe theoretically the general implications of this variability for intervention strategies. Materials and methods: Exploratory cross-sectional study. The study population consisted of 1st-5th year dental students from the Universidad Santiago de Cali, Colombia (n=610; N=647) and the Universidad San Sebastián, Chile (n=535; N=800). In both groups, empathy was measured using the Jefferson Scale of Empathy (S-Version) Scale. Descriptive statistics (mean and standard deviation) were used for data analysis. Internal consistency of data was estimated using Cronbach's alpha and the intraclass correlation coefficient. A factorial analysis of variance was performed, and three factors were studied: University (U), Course (C), and Sex (S). The statistical significance level used was α≤ 0.05 and β ≤0.20. Results: Differences in empathy level and in some of its three dimensions were observed between students from both universities and among courses (lst-5th year). No differences were found between sexes. Conclusions: There is variability in empathy levels among dental students from both universities. Thus, the implementation of specific empathy intervention strategies in each dental medicine program offered in Latin America is required to increase empathy levels in this population.

Resumen Introducción. La empatía es un atributo que permite a los odontólogos establecer una relación intersubjetiva con sus pacientes, lo que contribuye a un tratamiento exitoso, entre otros beneficios. Objetivo. Determinar si hay variabilidad en los niveles de empatía entre dos poblaciones de estudiantes de odontología y describir teóricamente las implicaciones generales de esta variabilidad en estrategias de intervención. Materiales y métodos. Estudio exploratorio transversal. La población de estudio consistió de estudiantes de odontología de 1er a 5to año de la Universidad Santiago de Cali, Colombia (n=610; N=647) y la Universidad San Sebastián, Chile (n=535; N=800). En ambos grupos, la empatía se midió con la Escala de Empatía Médica de Jefferson (Versión S). Para el análisis de los datos se utilizó estadística descriptiva (media y desviación estándar). La consistencia interna de los datos se estimó mediante el coeficiente alfa de Cronbach y el coeficiente de correlación intraclase. Se realizó un análisis de varianza factorial: tres factores estudiados: Universidad (U), Curso (C) y Sexo (S). El nivel de significancia estadística utilizado fue de α≤0.05 y β≤0.20. Resultados. Se observaron diferencias en el nivel de empatía y algunas de sus tres dimensiones entre los estudiantes de ambas universidades y entre los cursos (1er-5to año). No se observaron diferencias entre sexos. Conclusiones. Existe variabilidad en los niveles de empatía entre los estudiantes de ambas universidades. Para aumentar los niveles de empatía en esta población en Latinoamérica se requiere implementar estrategias específicas de intervención empática en cada programa de odontología ofrecido en la región.

Empathy in Professors and Students of a School of Dentistry in the Caribbean

Abstract Objective: To estimate and compare the levels of empathy between undergraduate dentistry students and professors at a university in the Dominican Republic. Material and Methods: Cross-sectional and descriptive study. The studied population consisted of two groups. The first: students of the Dentistry Career (N=520; n=335: 64.42% of total students) were distributed in two areas, basic-preclinical and clinical, while the second group corresponded of teachers who work in both areas (N=92; n=56; 60.87% of all teachers). The total sample was n = 391. The Jefferson Scale of Physician Empathy (S-Version) was used. Reliability was estimated using Cronbach's α and intraclass correlation coefficient, descriptive statistics, two-way analysis of variance, Tukey's test, effect size, and power of the test. Significance level: α≤0.05 and β≤0.20. Results: The empathy and dimension values were, in general, higher in the professors of the clinical area in relation to the other areas studied, with the exception of the compassionate care dimension. Conclusion: The finding that clinical teachers have a greater value of empathy is potentially an advantage for training students, especially in the clinical area (AU).

Decline in empathy levels and sex differences in medical students from the Caribbean / Declinación empática y diferencias según el sexo en estudiantes de medicina del Caribe

Abstract Introduction: Empathy is an important trait in the training of medical students, as it has been shown that it improves the doctor-patient relationship. Objective: To evaluate the decline of empathy levels and possible sex differences in undergraduate medical students from the Universidad Central del Este, Dominican Republic. Materials and methods: Exploratory cross-sectional study. A Spanish version of the Jefferson Scale of Empathy for Medical Students (S-version) Scale was administered in September 2018 to 1 144 1st-year to 5th-year medical students (887 women and 257 men). Data reliability was verified using the Cronbach's alpha and the intraclass correlation coefficient (ICC). A generalized linear equation model (Type III) was applied to analyze data and the Wald chi-squared test was used to determine differences in overall empathy levels and the mean scores obtained in each of its three components based on the year of medical training and sex. Results: Cronbach's alpha was satisfactory (0.839), and the ICC was 0.834 (F=5.68; p=0.005). The variability of the estimated curves in relation to empathic behavior by course (year of medical training) and sex was observed using linear and non-linear regression equations: Wald x2=115.6, p=0.0001 between courses; and Wald x2 =12.85, p=0.001 between men and women. Conclusions: Sex differences were observed regarding empathy levels in the study population. Moreover, a decline in empathy levels (overall empathy and Compassionate Care component in men and Walking in the Patient's Shoes component in men and women) was also observed as students progressed in their medical training. The behavior of these data raises questions regarding the need to determine the factors causing these differences and the decline in empathy levels.

Resumen Introducción. La empatia es un rasgo importante en los estudiantes de medicina, ya que se ha demostrado que mejora la relación médico-paciente. Objetivo. Evaluar la declinación empática y las posibles diferencias según el sexo en los niveles de empatia en estudiantes de pregrado de Medicina en la Universidad Central del Este, República Dominicana. Materiales y métodos. Estudio exploratorio transversal. La versión en español de la Escala de Empatia de Jefferson adaptada para estudiantes de medicina (versión S) fue aplicada a 1 144 estudiantes de medicina de 1° a 5° año (887 mujeres y 257 hombres). La confiabilidad de los datos se verificó mediante el alfa de Cronbach y el coeficiente de correlación intraclase (CCI). Los datos se analizaron utilizando un modelo de ecuación lineal generalizada (Tipo III) y se utilizó la prueba x2 de Wald para determinar las diferencias en los niveles globales de empatia y los puntajes promedio de sus tres componentes según el año de formación y el sexo. Resultados. El alfa de Cronbach fue satisfactorio (0.839) y el CCI fue de 0.834 (F=5.68; p=0.005). Mediante ecuaciones de regresión lineal y no lineal se observó variabilidad de las curvas estimadas en relación con el comportamiento empático según el curso (año de formación médica) y el sexo: entre cursos: x2 de Wald= 115.6; p=0.000i, y entre hombres y mujeres: x2 de Wald= 12.85; p=0.001). Conclusiones. Se observaron diferencias en los niveles de empatia según el sexo; también se evidenció una declinación en los niveles de empatia (empatia global y componente Cuidado con compasión en los hombres, y en el componente Ponerse en los zapatos del otro en hombres y mujeres) a medida que los estudiantes avanzaban en su formación. El comportamiento de estos datos genera interrogantes relacionados con la necesidad de determinar los factores que causan estas diferencias y dicha declinación empática.

Psicometria, escala de empatía médica de jefferson y atención médica en Ecuador / Psychometry, the Jefferson Medical Empathy Scale and Medical Care in Ecuador

RESUMEN Objetivo: Verificar que la estructura factorial de los datos observados estén en correspondencia con la estructura factorial teórica de la empatia. Estimar y comparar los niveles de empatía en las especialidades médicas evaluadas. Materiales y métodos: Estudio realizado en el cantón de Cuenca (Ecuador) en 2019. Diseño descriptivo y transversal. La muestra estuvo constituida por 223 médicos que trabajaban en el sector público, quienes respondieron voluntariamente la Escala de Empatia Médica de Jefferson. Variables dependientes: niveles de empatia y sus dimensiones. Independientes: género, nivel de atención y especialidad. Se estimó la normalidad y homocedasticidad, Análisis Factorial Confirmatorio, Invarianza entre grupos, análisis de varianza trifactorial y de un factor, t-Student y d de Cohen. El nivel de significación fue a< .05. Resultados: Se observa una adecuada consistencia interna, se confirma el modelo de tres dimensiones del instrumento original. No existen diferencias entre los géneros (p> .05), pero sí entre los tipos de atención y entre las especialidades (p< .05). Los datos observados tienen la estructura factorial teórica asociada al instrumento empleado en la medición de la empatía. Conclusión: El análisis multigrupo permite asumir invarianza factorial de la empatía entre los géneros, sin que se logre especificar un modelo según tipos de atención al paciente. Los niveles de empatía global fueron mayores en la atención primaria en relación con la hospitalaria y mayor en las especialidades de Pediatría y Medicina Familiar (unidas).

ABSTRACT Objective: To verify that the factorial structure of the data observed in doctors corresponds with the theoretical factorial structure of empathy. Estimate and compare the levels of empathy in the evaluated medical specialties. Materials and Methods: The study was carried out in the canton of Cuenca (Ecuador) in 2019. It has a descriptive and cross-sectional design. The sample consisted of 223 physidans who worked in the Public Sector, who voluntarily answered the Jefferson Medical Empathy Scale. Dependent variables: levels of empathy and their dimensions. Independent: gender, level of care, and specialty. Normality and homoscedasticity, Confirmatory Factor Analysis, Invariance between groups, trifactorial and one-factor analysis of variance, Student's t and Cohen's d were estimated. The level of significance was a< .05. Results: An adequate internal consistency is observed, the three-dimensional model of the original instrument is confirmed. There are no differences between genders (p> .05), but there are between types of care and between specialties (p <.05). Conclusion: The observed data have the theoretical factorial structure associated with the instrument used to measure empathy. The multigroup analysis makes it possible to assume factorial invariance of empathy between the genders without being able to specify a model according to types of patient care. The levels of global empathy were higher in primary care compared to hospital care and higher in the specialties of Pediatrics and Family Medicine (united).