Purpose Despite its well-known clinical importance, physician empathy (PE) has been variably defined and its concepts among cultures are yet to be studied. This study aimed to develop a conceptual framework of PE and explore influencing factors on physicians’ empathetic behavior in the Korean clinical context.
Methods Forty-two faculty members and 67 residents participated in the two-round Delphi survey to arrive at a consensus regarding the conceptual framework of PE in 2019. To explore individual and external factors affecting physicians’ empathetic behavior, a Likert scale questionnaire based on an initial free-text response was administered to the same participants.
Results The conceptual framework of PE among Korean doctors consisted of basic communication skills and attitudes, cognitively understanding of patients’ thoughts and emotions, and communicating the doctors’ understandings to patients. Individual attributes and system- and patient-factors were revealed as influencing factors for PE in real practice. The former included communication ability, self-awareness and management, humanism, clinical competence, and good personality traits. Excessive workload, time constraints, aggressive attitudes, and negative preconceptions towards doctors were perceived as inhibiting or hindering empathy in patient care.
Conclusion PE in the Korean clinical context comprised behavioral and cognitive components. Individual attributes, as well as external factors including system- and patient-factors were identified to affect PE in clinical settings. Further studies are needed to enhance the conceptual clarity of PE and identify how to promote doctors’ empathetic practice even in less favorable healthcare environments.
Purpose Empathy levels have been observed to often decrease when medical undergraduates move to the clinical years, particularly in the Western countries. However, empathy either remains similar or increases in many Asian medical schools. This study investigated the longitudinal empathy profile of medical students in Singapore.
Methods Two cohorts of medical students who enrolled in 2013 and 2014 to the National University of Singapore were tracked for 5 years. The Jefferson Scale of Empathy–student version was used. Analyses on the mean of the empathy level and individual factors, year-wise and gender comparison were conducted.
Results Average response rates for cohort 1 and 2 were 68.1% (n=181–263) and 55.4% (n=81–265), respectively. For both cohorts, there was no significant change across year of study in the mean empathy score. Average scores for both cohorts were 113.94 and 115.66. Though not significant, we observed mean empathy to be lowest at the end of year 5 (112.74) and highest in year 2 (114.72) for cohort 1 while for cohort 2, the lowest level of empathy was observed in year 5 (114.20) and highest in year 4 (118.42). Analysis of subcomponents of empathy only showed a significant difference for cohort one factor 1 (perspective taking) and factor 3 (standing in patients’ shoes) across the study years.
Conclusion No significant change in empathy score was observed during the transition from pre-clinical to clinical years, unlike many Western and Far-Eastern studies. This might be due to the curriculum and influence of the Asian values.
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Results Of 488 participants, 462 provided responses (95% response rate), which were evaluated by thematic analysis. Students understood inpatients not only through their own hospitalization experience, but also through observations of and conversations with the inpatients they encountered, from a shared perspective of both. Students experienced the realities of hospital life, stress and psychological states of being an inpatient, and psychological pressure from physicians. In addition, students observed the distress of other inpatients and dedication of medical staff. Furthermore, through communication with these inpatients, students understood other inpatients’ anxiety about illness and empathy as one of the requirements of health care providers from the patients’ perspective.
Conclusion This qualitative study investigated the effectiveness of a course on the hospitalization experience. Results showed that medical students understood the perspectives, distress, and anxiety of being an inpatient, not only from their own experiences but also from observation and communication with other inpatients they encountered during their hospitalization. This experience appeared to be an effective teaching strategy for enhancing medical students’ empathy by improving their understanding of patients’ perspectives and feelings.
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Purpose The purpose of this study is to determine whether there is any change in the empathy scores of third-year medical graduate students after they have taken a clerkship and have begun gaining more opportunities to meet patients through the clerkship.
Methods The participants were 109 third-year students in 2014 and 110 fourth-year students in 2015 at Kyungpook National University, School of Medicine. The author measured empathy using a modified and expanded version of the Korean version of the Jefferson Scale of Empathy of Physician Empathy-Student version and used the Holland-III aptitude test-S to assess vocational aptitude.
Results As a results, male students in their third year exhibited higher scores, but there was no significant difference in the fourth year. The empathy score increased slightly when third-year students became fourth-year students, but the difference was not statistically significant. There was no statistically significant change in the scores of both male and female students between the 2 years. The results of the vocational aptitude test showed that students who preferred person-oriented specialties had higher empathy scores when they entered their fourth academic year compared to objectively-oriented students.
Conclusion In this study, male students showed higher empathy scores than female students, an atypical finding that was inconsistent with the results of previous studies. However, the distribution of scores among male students was wider than that of female students, a finding consistent with previous studies. As such, individual differences need to be considered when developing curriculum in order to improve the empathy of medical students.
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Purpose Empathy is critical for medical doctors, as it enables them to conduct good patient-centred care. Medical students are expected to learn this ability as part of their education and training.
Methods Using a cross-sectional design, the present study was conducted to identify whether the empathy levels of medical students are affected by their stress levels. A translated version of the Perceived Stress Scale-10 was used to measure the students’ stress levels, while the Jefferson Scale of Physician Empathy was used to measure their empathy levels.
Results A total of 464 students from one medical school in Indonesia participated in the study. Stress levels among medical students peak in their first year of study and maintain a downward trend over the following years. The students’ empathy levels increased during their first 3 years, declined significantly upon entering the first clinical year, and increased during the second clinical year. However, no correlations were found between stress level and empathy level.
Conclusion These findings suggest that there may be other underlying factors that contribute to empathy decline among medical students upon entering their first clinical year. Further research should be conducted to identify these factors. The bounced-back of empathy level to a higher level in the second year highlights the importance of student adaptation in the clinical learning environment and the support system.
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Results The Instinctive triad, the Withdrawns, and the Positive outlook group were the most common, and the Feeling triad, the Assertives, and the Emotional realness group were the least common. Students in the Feeling triad and the Dutifuls had higher compassionate care (CC) scores as compared to their counterparts. Type 2 and 6 students showed the two highest empathy and CC scores. The empathy score of type 3 students was the lowest. Type 7 had the lowest CC score but the highest perspective taking score.
Conclusion These differences in empathy according to Enneagram personality types can be applied to medical education to maintain and improve medical students’ empathy.
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Purpose This study attempted to examine nursing students’ self-esteem, interpersonal relationships, and self-efficacy, to identify factors affecting empathy.
Methods A predictive correlational design was used. The participants in this study were nursing students from fours university of Korea. The questionnaires were administered to a convenience sample of 147 nursing students in the Republic of Korea.
Results Mean item scores for self-esteem, interpersonal relationship, self-efficacy, and empathy were 3.83, 3.63, 3.30, and 3.44, respectively (possible range, 1–5). Empathy was correlated with self-esteem, interpersonal relationships, and self-efficacy. The multiple regression analysis revealed that 45.9% of the variance in empathy is attributable to gender, major satisfaction, self-esteem, self-efficacy, and interpersonal relationships. The most important factor interpersonal relationship explained.
Conclusion Improving nursing students’ major satisfaction, self-esteem, self-efficacy, and interpersonal relationships are strategies that may foster empathy.
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Purpose Empathy is an important trait in physicians and a key element in the physician-patient relationship. Accordingly, one of the goals in medical education is developing empathy in students. We attempted to practically assess medical students’ empathy through their direct verbal expressions.
Methods The medical students’ empathy was measured using the modified Pencil-and-Paper Empathy Rating Test by Winefield and Chur-Hansen (2001). The students took 15 minutes or so to complete the scale, and it was then scored by one of two trained evaluators (0 to 4 points for each item, for a total score of 40). The subjects were 605 medical students, and the data were analyzed using descriptive analysis, independent t-test, and one-way analysis of variance in SPSS version 21.0.
Results The students’ empathy scores were low (mean, 12.13; standard deviation, 2.55); their most common responses (78.6%) registered as non-empathetic. Differences in empathy were observed by gender (female students>male students; t=-5.068, p<0.001), school system (medical school>medical college; t=-1.935, p=0.053), and academic level (pre-medical 1 year < other years; t=-4.050, p<0.001).
Conclusion Our findings lead us to the significant conclusion that there is the need for empathy enhancement training programs with practical content.
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Medical Students’ Perspectives on Empathy: A Systematic Review and Metasynthesis Emmanuel Costa-Drolon, Laurence Verneuil, Emilie Manolios, Anne Revah-Levy, Jordan Sibeoni Academic Medicine.2021; 96(1): 142. CrossRef
Purpose Physician empathy is a core attribute in medical professionals, giving better patient outcomes. Medical school is an opportune time for building empathetic foundations. This study explores empathy change and focuses on contributory factors.
Methods We conducted a cross-sectional study involving 881 students (63%) from Years 1 to 5 in a Singaporean medical school using the Jefferson Scale of Physician Empathy-Student version (JSPE-S) and a questionnaire investigating the relationship between reported and novel personal-social empathy determinants.
Results Empathy declined significantly between preclinical and clinical years. Female and medical specialty interest respondents had higher scores than their counterparts. Despite strong internal consistency, factor analysis suggested that the JSPE model is not a perfect fit. Year 1 students had highest Perspective Taking scores and Year 2 students had highest Compassionate Care scores. High workload and inappropriate learning environments were the most relevant stressors. Time spent with family, arts, and community service correlated with higher empathy scores, whilst time spent with significant others and individual leisure correlated with lower scores. Thematic analysis revealed that the most common self-reported determinants were exposure to activity (community service) or socialisation, personal and family-related event as well as environment (high work-load).
Conclusion While the empathy construct in multicultural Singapore is congruent with a Western model, important differences remain. A more subtle understanding of the heterogeneity of the medical student experience is important. A greater breadth of determinants of empathy, such as engagement in arts-related activities should be considered.
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Purpose Recent studies have emphasized the importance of empathy in the physician-patient relationship (PPR). The purpose of this study was to examine the association between empathy scores, as measured by the student version of the Jefferson Scale
of Empathy, Korean edition (JSE-S-K), and PPR scores on the clinical performance examination (CPX).
Methods The sample comprised 104 third-year medical students. Prior to undertaking 12 cases on the CPX, the students completed the JSE-S-K and Myers-Briggs Type Indicator. We analyzed the differences in empathy and PPR scores according to their sociodemographic characteristics and personality types and verified the link between empathy and PPR scores by stepwise multiple linear regression analysis.
Results PPR scores were positively associated with total JSE-S-K scores (r=0.232, p<0.05) and its affective domain scores (r=0.229, p<0.05). Education program (undergraduate or graduate entry) and empathy score were the best predictors of PPR score (R2=0.153).
Conclusion The positive association between empathy and PPR scores suggests that empathy is an important factor that influences the PPR.
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Measuring medical students’ empathy using direct verbal expressions Yera Hur, A Ra Cho, Sun Kim Korean Journal of Medical Education.2016; 28(3): 305. CrossRef
Purpose Empathy is an important trait of a physician and a key element in the physician-patient relationship. This study evaluated the ability to express empathy in medical students.
Methods Medical student empathy was measured by the modified Pencil-and-Paper Empathy Rating Test of Winefield and Chur-Hansen. The subjects comprised 110 medical students. The data were analyzed by descriptive analysis and t-test using SPSS version 21.0 (IBM Corp.).
Results Empathy rating test scores were low-level in medical students (mean, 12.59). There were no differences in the level of ability to express empathy between genders (t=-1.714, p=0.089).
Conclusion Our results suggest that practical training in expressing empathy should be included in medical education and that an empathy training program must be focused on changes in behavior.
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PURPOSE The purpose of this study was to identify the correlation between communication skills for emotional empathy and academic achievement on the Clinical Performance Examination (CPX).
METHODS One hundred twelve medical school students were observed to determine the extent to which they applied communication skills for emotional empathy (preparation stage: interview attitude, respect; rapport stage: encouragement, active listening, will for support; empathy stage: verbal expression empathy, nonverbal expression empathy, acceptance) to the CPX, as well as their level of understanding of these skills to calculate the Pearson r, which can be used to determine the correlation between communication skills and academic achievement (hematochezia, fatigue, abnormal menstruation, chest pain, alcohol problems).
RESULTS Male students had higher scores than females for all communicational skills except verbal expression empathy.
Fourth-year students had statistically more significant correlations than third-year students with regard to the rapport stage 'active listening' and empathy stage 'nonverbal expression' and abnormal menstruation and chest pain. Correlations were also more significant for hematochezia in the preparation stage 'interview attitude,' rapport stage 'encouragement,' and empathy stages 'verbal and nonverbal expression' and 'acceptance.' The empathy stage 'nonverbal expressions' was more significant for fourth-year students with alcohol problems. Third-year students largely had negative correlations between emotional empathy communication skills and CPX academic achievement, especially between the preparation stage 'respect' and abnormal menstruation, and between the rapport stage 'encouragement' and hematochezia.
CONCLUSION There was a significant correlation between hematochezia, wherein MS students deliver bad news to patients, and communication skills for emotional empathy.
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PURPOSE This study investigated the relationship between empathy and medical education system, grades, and personality in medical college (MC) students and medical school (MS) students.
METHODS One hundred fifty-five MC students and 137 MS students participated in this study, completing questionnaires on sociodemographic data, Jefferson Scale of Empathy, S-version, Korean edition (JSE-S-K), and Temperament and Character Inventory (TCI).
RESULTS Reward Dependence (RD), Cooperativeness (C), and Self-directedness+ Cooperativeness (SC), which are subscales of the TCI, correlated significantly with JSE-S-K score.
Third-year students had significantly higher scores on the JSE-S-K than first-year students. MS students had significantly higher scores on the JSE-S-K and the SC subscale of the TCI than MC students. However, there were no significant differences in empathy with regard to age, sex, motivation toward medical science, club activity, and applied specialty.
CONCLUSION These results suggest that empathy is associated with personality traits, such as RD, C, and SC, and medical education curriculum contributes incrementally to empathy for students. The difference in test scores for empathy between MC students and MS students might be due to differences in personality traits, such as SC.
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Effects of micro- and subtle-expression reading skill training in medical students: A randomized trial Eun Ho Yu, Eun Jung Choi, Sang Yeoup Lee, Sun Ju Im, So Jung Yune, Sun Yong Baek Patient Education and Counseling.2016; 99(10): 1670. CrossRef
Measuring medical students’ empathy using direct verbal expressions Yera Hur, A Ra Cho, Sun Kim Korean Journal of Medical Education.2016; 28(3): 305. CrossRef
Empathy in Korean medical students: Findings from a nationwide survey Kyung Hye Park, Hyerin Roh, Dae Hun Suh, Mohammadreza Hojat Medical Teacher.2015; 37(10): 943. CrossRef
Reconsidering the “decline” of medical student empathy as reported in studies using the Jefferson Scale of Physician Empathy-Student version (JSPE-S) Sue Roff Medical Teacher.2015; 37(8): 783. CrossRef
Medical students’ empathy and its effect on the physicianpatient relationship Min Young Chun, Sang Ho Yoo, Hoon-Ki Park Korean Journal of Medical Education.2015; 27(4): 283. CrossRef
Changes of empathy in medical college and medical school students: 1-year follow up study Minha Hong, Won Hye Lee, Jae Hyun Park, Tai Young Yoon, Duk Soo Moon, Sang Min Lee, Geon Ho Bahn BMC Medical Education.2012;[Epub] CrossRef
Empathy in Korean psychiatric residents Minha Hong, Geon Ho Bahn, Won Hye Lee, Su Jin Moon Asia-Pacific Psychiatry.2011; 3(2): 83. CrossRef
Potential use of δ 13C, δ 15N, N concentration, and Ca/Al of Pinus densiflora tree rings in estimating historical precipitation pH Jin-Hyeob Kwak, Sang-Sun Lim, Scott X. Chang, Kye-Han Lee, Woo-Jung Choi Journal of Soils and Sediments.2011; 11(5): 709. CrossRef
Correlation of Communication Skills for Emotional Empathy and Academic Achievement on Clinical Performance Examinations Seon Suk Jang, Ji Hyun Seo, Gyeong Jae Cho, Soon Chan Hong, Hyang Ok Woo Korean Journal of Medical Education.2010; 22(2): 121. CrossRef
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