The effect of Humanitude care methodology on improving empathy: a six-year longitudinal study of medical students in Japan.

BACKGROUND: Empathy, which involves understanding another person's experiences and concerns, is an important component for developing physicians' overall competence. This longitudinal study was designed to test the hypothesis that medical students' empathy can be enhanced and sustained by Humanitude Care Methodology, which focuses on perception, emotion and speech. METHODS: This six-year longitudinal observational study examined 115 students who entered Okayama University Medical School in 2013. The study participants were exposed to two empathy-enhancing programs: (1) a communication skills training program (involving medical interviews) and (2) a Humanitude training program aimed at enhancing their empathy. They completed the Jefferson Scale of Empathy (JSE) seven times: when they entered medical school, before participation in the first program (medical interview), immediately after the first program, before the second program (Humanitude exercise), immediately after the second program, and in the 5th and 6th year (last year) of medical school. A total of 79 students (69% of the cohort) completed all seven test administrations of the JSE. RESULTS: The mean JSE scores improved significantly after participation in the medical interview program (p < 0.01) and the Humanitude training program (p = 0.001). However, neither program showed a sustained effect. CONCLUSIONS: The Humanitude training program as well as medical interview training program, had significant short-term positive effects for improving empathy among medical students. Additional reinforcements may be necessary for a long-term sustained effect.

Empathy as related to gender, age, race and ethnicity, academic background and career interest: A nationwide study of osteopathic medical students in the United States.

CONTEXT: Research on associations between medical student empathy and demographics, academic background and career interest is limited, lacks representative samples and suffers from single institutional features. This study was designed to fill the gap by examining associations between empathy in patient care, and gender, age, race and ethnicity, academic background and career interest in nationwide, multi-institutional samples of medical students in the United States and to provide more definitive answers regarding the aforementioned associations, with more confidence in the internal and external validity of the findings. METHODS: Four nationwide samples participated in this study (n = 10 751). Samples 1, 2, 3 and 4 included 3616 first-year, 2764 second-year, 2413 third-year and 1958 fourth-year students who completed a web-based survey at the end of the 2017-2018 academic year. The survey included questions on demographics, academic background and career interest, the Jefferson Scale of Empathy, and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire to control for the effect of 'good impression' response bias. RESULTS: Statistically significant and practically important associations were found between empathy scores and gender (in favour of women), race and ethnicity (in favour of African-American and Hispanic/Latino/Spanish), academic background (in favour of 'Social and Behavioural Sciences' and 'Arts and Humanities' in Samples 1 and 2) and career interest (in favour of 'People-Oriented' and 'Psychiatry' specialties). CONCLUSIONS: Special features of this study (eg, nationwide representative samples, use of a validated instrument for measuring empathy in patient care, statistical control for the effect of 'good impression' response bias, and consistency of findings in different samples from multiple institutions) provide more definitive answers to the issue of correlates of empathy in medical students and increase our confidence in the validity, reliability and generalisability of the results. Findings have implications for career counselling and targeting students who need more guidance to enhance their empathic orientation.

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.

The Jefferson Scale of Empathy: a nationwide study of measurement properties, underlying components, latent variable structure, and national norms in medical students.

The Jefferson Scale of Empathy (JSE) is a broadly used instrument developed to measure empathy in the context of health professions education and patient care. Evidence in support of psychometrics of the JSE has been reported in health professions students and practitioners with the exception of osteopathic medical students. This study was designed to examine measurement properties, underlying components, and latent variable structure of the JSE in a nationwide sample of first-year matriculants at U.S. colleges of osteopathic medicine, and to develop a national norm table for the assessment of JSE scores. A web-based survey was administered at the beginning of the 2017-2018 academic year which included the JSE, a scale to detect "good impression" responses, and demographic/background information. Usable surveys were received from 6009 students enrolled in 41 college campuses (median response rate = 92%). The JSE mean score and standard deviation for the sample were 116.54 and 10.85, respectively. Item-total score correlations were positive and statistically significant (p < 0.01), and Cronbach α = 0.82. Significant gender differences were observed on the JSE scores in favor of women. Also, significant differences were found on item scores between top and bottom third scorers on the JSE. Three factors of Perspective Taking, Compassionate Care, and Walking in Patient's Shoes emerged in an exploratory factor analysis by using half of the sample. Results of confirmatory factor analysis with another half of the sample confirmed the 3-factor model. We also developed a national norm table which is the first to assess students' JSE scores against national data.

Identifying potential engaging leaders within medical education: The role of positive influence on peers.

BACKGROUND: Previous research has paid little to no attention towards exploring methods of identifying existing medical student leaders. AIM: Focusing on the role of influence and employing the tenets of the engaging leadership model, this study examines demographic and academic performance-related differences of positive influencers and if students who have been peer-identified as positive influencers also demonstrate high levels of genuine concern for others. METHODS: Three separate fourth-year classes were asked to designate classmates that had significant positive influences on their professional and personal development. The top 10% of those students receiving positive influence nominations were compared with the other students on demographics, academic performance, and genuine concern for others. RESULTS: Besides age, no demographic differences were found between positive influencers and other students. High positive influencers were not found to have higher standardized exam scores but did receive significantly higher clinical clerkship ratings. High positive influencers were found to possess a higher degree of genuine concern for others. CONCLUSION: The findings lend support to (a) utilizing the engaging model to explore leaders and leadership within medical education, (b) this particular method of identifying existing medical student leaders, and

Empathy in Korean medical students: Findings from a nationwide survey.

BACKGROUND: Previous studies on empathy in Korean medical students were conducted on small populations or with different scales of measurement, resulting in low representativeness and generalisability of the findings. AIM: To evaluate empathy in Korean medical students throughout the country and to make suggestions to improve empathy. METHODS: The Jefferson Scale of Empathy (JSE) (Korean) was used, and the impact of sex, age, the medical school admission system, and grade of the respondents was investigated. RESULTS: We analyzed 5343 questionnaires and found a mean empathy score of 105.9 ± 12.8. Females and post-baccalaureate students had higher scores as compared with their counterparts. There was a significant difference between the admission systems after controlling for gender. Students from higher grade levels had lower scores than those from the lower grade levels. CONCLUSIONS: The JSE score of Korean medical students was lower than that of students in Western countries. The difference of gender and medical school admission system should be considered, and capability to apply empathy to clinical practice should be focused upon in medical training.

Overlap between empathy, teamwork and integrative approach to patient care.

BACKGROUND: Empathy, teamwork and an integrative approach to patient care share common denominators such as interpersonal skills and understanding patients' concerns. Thus, a significant overlap among measures of empathy, teamwork and integrative approach to patient care is expected. AIM: This study examined the magnitude of overlap (shared variance) among three measures of empathy, teamwork and an integrative approach to patient care. METHODS: Three-hundred seventy-three medical students completed the Jefferson Scale of Empathy (JSE), the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) and Integrative Patient Care (IPC). RESULTS: Significant overlaps were found among the three measures (p < 0.01), ranging from 13% (r = 0.36), between JSAPNC and IPC, to 18% (r = 0.42), between JSE and JSAPNC, and 30% (r = 0.55) between JSE and IPC for the total sample. Pattern of findings was similar for men and women. In a multiple regression model, a significant multiple correlation (R = 0.60, p < 0.01) was obtained in correlating scores on the JSE with the JSAPNC, and IPC scores, controlling for gender effect (men = 0 and women = 1). CONCLUSIONS: The significant links between empathy, teamwork and IPC support the common denominator assumption. The findings that IPC shares common variance with empathy and teamwork have implications for medical education curriculum, suggesting that implementation of integrative patient care can improve empathic engagement in patient care and orientation toward teamwork.

The Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffSATIC): development and multi-institution psychometric data.

This study was designed to develop a psychometrically sound instrument to measure attitudes toward interprofessional collaboration in health profession students and practitioners regardless of their professions and areas of practice. Based on a review of the literature a list of 27 items was generated, 12 faculty judged the face validity of the items, and 124 health profession faculty examined the content validity of the items. The preliminary version of the instrument was administered to 1976 health profession students in three universities (Thomas Jefferson University, n = 510; Midwestern University, n = 392; and Monash University, n = 1074). Twenty items that survived the psychometric scrutiny were included in the Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffSATIC). Two constructs of "working relationships" and "accountability" emerged from factor analysis of the JeffSATIC. Cronbach's α coefficients for the JeffSATIC ranged from 0.84 to 0.90 in the three samples. Women obtained significantly higher JeffSATIC mean scores than men. Medical students obtained lower mean score on the JeffSATIC than most other health profession students at the same university. Psychometric support from a relatively large sample size of students in a variety of health profession programs in this multi-institutional study is encouraging which adds to the credibility of the JeffSATIC.

Eleven Years of Data on the Jefferson Scale of Empathy-Medical Student Version (JSE-S): Proxy Norm Data and Tentative Cutoff Scores.

OBJECTIVE: This study was designed to provide typical descriptive statistics, score distributions and percentile ranks of the Jefferson Scale of Empathy-Medical Student version (JSE-S) of male and female medical school matriculants to serve as proxy norm data and tentative cutoff scores. SUBJECTS AND METHODS: The participants were 2,637 students (1,336 women and 1,301 men) who matriculated at Sidney Kimmel (formerly Jefferson) Medical College between 2002 and 2012, and completed the JSE at the beginning of medical school. Information extracted from descriptive statistics, score distributions and percentile ranks for male and female matriculants were used to develop proxy norm data and tentative cutoff scores. RESULTS: The score distributions of the JSE tended to be moderately skewed and platykurtic. Women obtained a significantly higher mean score (116.2 ± 9.7) than men (112.3 ± 10.8) on the JSE-S (t2,635 = 9.9, p < 0.01). It was suggested that percentile ranks can be used as proxy norm data. The tentative cutoff score to identify low scorers was ≤ 95 for men and ≤ 100 for women. CONCLUSIONS: Our findings provide norm data and cutoff scores for admission decisions under certain conditions and for identifying students in need of enhancing their empathy.

Personality assessments and outcomes in medical education and the practice of medicine: AMEE Guide No. 79.

In a paradigm of physician performance we propose that both "cognitive" and "noncognitive" components contribute to the performance of physicians-in-training and in-practice. Our review of the relevant literature indicates that personality, as an important factor of the "noncognitive" component, plays a significant role in academic and professional performances. We describe findings on 14 selected personality instruments in predicting academic and professional performances. We question the contention that personality can be validly and reliably assessed from admission interviews, letters of recommendation, essays, and personal statements. Based on conceptual relevance and currently available empirical evidence, we propose that personality attributes such as conscientiousness and empathy should be considered among the measures of choice for the assessment of pertinent aspects of personality in academic and professional performance. Further exploration is needed to search for additional personality attributes pertinent to medical education and patient care. Implications for career counseling, assessments of professional development and medical education outcomes, and potential use as supplementary information for admission decisions are discussed.

Psychostimulant drug abuse and personality factors in medical students.

BACKGROUND: Psychostimulants have a high abuse potential and are appealing to college students for enhancing their examination performance. AIM: This study was designed to examine the prevalence of psychostimulant drug abuse among medical students and to test the hypothesis that medical students who use psychostimulant drugs for non-medical reasons are characterized by a sensation seeking and aggressive-hostility personality and exhibit lower empathy. METHODS: The Zuckerman-Kuhlman personality questionnaire and the Jefferson scale of empathy were completed anonymously on-line by 321 medical students in 2010-2011 academic year. RESULTS: A total of 45 students (14%) reported that they had abused psychostimulant medications either before or during medical school. RESULTS of multivariate analysis of variance provided support for one of our research hypothesis: students who reported using psychostimulant compared to the rest, obtained a significantly higher average score on the aggressive-hostility personality factor. No other significant differences were observed. CONCLUSION: Further research is needed to confirm the rate of psychostimulant drug abusers among medical students in other medical schools. In particular, it is desirable to examine if such psychostimulant drug abusers are likely to abuse other substances in medical school and later in their professional career.

Enhancing and sustaining empathy in medical students.

BACKGROUND: Empathy is an important component of physician competence that needs to be enhanced. AIM: To test the hypotheses that medical students' empathy can be enhanced and sustained by targeted activities. METHODS: This was a two-phase study in which 248 medical students participated. In Phase 1, students in the experimental group watched and discussed video clips of patient encounters meant to enhance empathic understanding; those in the control group watched a documentary film. Ten weeks later in Phase 2 of the study, students who were in the experimental group were divided into two groups. One group attended a lecture on empathy in patient care, and the other plus the control group watched a movie about racism. The Jefferson Scale of Empathy (JSE) was administered pre-post in Phase 1 and posttest in Phase 2. RESULTS: In Phase 1, the JSE mean score for the experimental group improved significantly (p < 0.01); no change in the JSE scores was observed in the control group. In Phase 2, the JSE mean score improvement was sustained in the group that attended the lecture, but not in the other group. No change in empathy was noticed in the control group. CONCLUSION: Research hypotheses were confirmed.

The Jefferson Scale of Physician Empathy: a preliminary psychometric study and group comparisons in Korean physicians.

BACKGROUND: Empathy is an important element of professionalism in medicine. Thus, evaluation and enhancement empathy in physicians is important, regardless of geographical boundaries. AIM: This study was designed to evaluate the psychometrics of a Korean version of the Jefferson Scale of Physician Empathy (JSPE) among Korean physicians. METHODS: The Korean version of JSPE was completed by 229 physicians in Korea. RESULTS: Item-total score correlations were all positive and statistically significant. Cronbach's coefficient alpha was 0.84. The mean score was 98.2 (SD = 12.0), which was lower than that reported for American and Italian physicians. The emerged factor structure of the translated version was somewhat similar to that reported for American physicians, although the order was different. Significant differences in the mean empathy scores were observed between men and women and among physicians in different specialties. CONCLUSION: Our findings provide evidence in support of reliability and construct validity of the Korean version of JSPE for assessing empathy among Korean physicians. The disparity between Korean physicians and physicians from other countries may be explained by differences in the culture of medical education and medical practice. It suggests an exploration of cross-cultural differences in physician empathy.

Psychometrics of the scale of attitudes toward physician-pharmacist collaboration: a study with medical students.

BACKGROUND: Despite the emphasis placed on interdisciplinary education and interprofessional collaboration between physicians and pharmacologists, no psychometrically sound instrument is available to measure attitudes toward collaborative relationships. AIM: This study was designed to examine psychometrics of an instrument for measuring attitudes toward physician-pharmacist collaborative relationships for administration to students in medical and pharmacy schools and to physicians and pharmacists. METHODS: The Scale of Attitudes Toward Physician-Pharmacist Collaboration was completed by 210 students at Jefferson Medical College. Factor analysis and correlational methods were used to examine psychometrics of the instrument. RESULTS: Consistent with the conceptual framework of interprofessional collaboration, three underlying constructs, namely "responsibility and accountability;" "shared authority;" and "interdisciplinary education" emerged from the factor analysis of the instrument providing support for its construct validity. The reliability coefficient alpha for the instrument was 0.90. The instrument's criterion-related validity coefficient with scores of a validated instrument (Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration) was 0.70. CONCLUSIONS: Findings provide support for the validity and reliability of the instrument for medical students. The instrument has the potential to be used for the evaluation of interdisciplinary education in medical and pharmacy schools, and for the evaluation of patient outcomes resulting from collaborative physician-pharmacist relationships.

Measurement and correlates of empathy among female Japanese physicians.

BACKGROUND: The measurement of empathy is important in the assessment of physician competence and patient outcomes. The prevailing view is that female physicians have higher empathy scores compared with male physicians. In Japan, the number of female physicians has increased rapidly in the past ten years. In this study, we focused on female Japanese physicians and addressed factors that were associated with their empathic engagement in patient care. METHODS: The Jefferson Scale of Empathy (JSE) was translated into Japanese by using the back-translation procedure, and was administered to 285 female Japanese physicians. We designed this study to examine the psychometrics of the JSE and group differences among female Japanese physicians. RESULTS: The item-total score correlations of the JSE were all positive and statistically significant, ranging from .20 to .54, with a median of .41. The Cronbach's coefficient alpha was .81. Female physicians who were practicing in "people-oriented" specialties obtained a significantly higher mean empathy score than their counterparts in "procedure-" or "technology-oriented" specialties. In addition, physicians who reported living with their parents in an extended family or living close to their parents, scored higher on the JSE than those who were living alone or in a nuclear family. CONCLUSIONS: Our results provide support for the measurement property and reliability of the JSE in a sample of female Japanese physicians. The observed group differences associated with specialties and living arrangement may have implications for sustaining empathy. In addition, recognizing these factors that reinforce physicians' empathy may help physicians to avoid career burnout.

A comparison of medical students' self-reported empathy with simulated patients' assessments of the students' empathy.

BACKGROUND: Empathy is necessary for communication between patients and physicians to achieve optimal clinical outcomes. AIM: To examine associations between Simulated Patients' (SPs) assessment of medical students' empathy and the students' self-reported empathy. METHODS: A total of 248 third-year medical students completed the Jefferson Scale of Physician Empathy (JSPE). SPs completed the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and a global rating of empathy in 10 objective clinical skills examination encounters during a comprehensive end of third-year clinical skills examination. RESULTS: High correlation was found between the scores on the JSPPPE and the global ratings of empathy completed by the SPs (r = 0.87, p < 0.01). A moderate but statistically significant correlation was observed between scores of the JSPE and the JSPPPE (r = 0.19, p < 0.05). Significant differences were observed on the JSPE and global ratings of empathy among top, middle and low scorers on the JSPPPE in the expected direction. CONCLUSIONS: While significant associations exist between students' self-reported scores on the JSPE and SPs' evaluations of students' empathy, the associations are not large enough to conclude that the two evaluations are redundant.

An instrument for measuring pharmacist and physician attitudes towards collaboration: preliminary psychometric data.

This study was designed to develop an instrument for measuring attitudes toward pharmacist-physician collaborative relationships for administration to practicing pharmacists and physicians, as well as to students in pharmacy and medical schools. Based on a review of literature, a preliminary version of an instrument was developed (30 items), and through a pilot study of face validity and content validity with 12 pharmacists and 10 physicians, 18 items were chosen for quantitative analyses. We asked 88 respondents (61 pharmacists, 27 physicians) to judge the relevance, clarity, and representativeness of each item to the concept of pharmacist-physician collaborative relationships. Sixteen items with a relevancy endorsement greater than 85% and significant item-total score correlations were retained. The following underlying constructs emerged from factor analysis: "collaboration and team work," "accountability," "overlapping responsibility," and "authority". These factors supported the multidimensionality and construct validity of the instrument. No gender difference was observed; however, pharmacists scored higher than physicians on the total score of the instrument. The Cronbach's coefficient alpha was .81 for pharmacists, .92 for physicians, and .87 for the combined sample. Encouraged by these preliminary findings, we plan to undertake further research to examine the instrument's psychometric properties including criterion-related and predictive validities with larger and more representative samples of pharmacists, physicians, and students in pharmacy and medical schools.

Measuring empathy in healthcare profession students using the Jefferson Scale of Physician Empathy: health provider--student version.

While empathy is commonly accepted as a mutually beneficial aspect of the health provider-patient relationship, evidence exists that many health profession students are unable to demonstrate this important skill. This study, the initial phase of a 2-year longitudinal series, examined measurement properties of the Jefferson Scale of Physician Empathy (JSPE) adapted for administration to health profession students (JSE-HPS version), and investigated group differences of empathy scores in the baccalaureate nursing (BSN) program within the College of Health Professions at a public university in the southeastern part of the USA. The 20-item survey and a demographic questionnaire were completed by 265 BSN students. Correlational analyses, t-test, and analysis of variance were used to examine internal relationships and group differences. Results showed the median item-total score correlation was statistically significant (0.42). The internal consistency of the scale (Cronbach's coefficient α) was 0.78, falling within the generally agreed standard. Test-retest reliability coefficients were acceptable at 0.58 (within 3 months interval) and 0.69 (within 6 months interval) between testing. Women scored higher than men and older students outscored younger classmates. No significant relationship was found between empathy scores and ethnicity, previous non-nursing degree, or importance of religion to the participant. These findings support measurement properties of the JSE-HPS version, and can bolster the confidence of researchers in using the Scale for measuring empathy in diverse health profession students, as one component of program evaluation as well as evaluating interprofessional learning activities among diverse healthcare professional students and interprofessional collaboration.