Measurement properties and confirmatory factor analysis of the Jefferson Scale of Empathy in Italian medical students

Evaluating empathy level amongst the dental students using jefferson scale of physician empathy- health professional students

BACKGROUND

Empathy is described as one's ability to perceive and apprehend another person's feelings, situation, emotions, and problems as their own. Empathetic behavior increases patients' satisfaction, reduces discomfort, and helps with patient's satisfaction.

OBJECTIVE

To evaluate the psychometric properties of the Jefferson Empathy Scale and compare the measure of invariance within genders and amongst the public and private sector dental students.

METHOD

This cross-sectional study utilized JSE-HPS version for research purpose. An exploratory factor analysis was performed to detect underlying factors. Reliability of the study tool was evaluated using Cronbach alpha test. Mann Whitney U test was used to compare the differences in scores between genders and among public and private university students while Student's t analysis compared the scores according to different domains. The level of significance was ≤ 0.05.

RESULTS

Females demonstrated higher empathy levels (88.52 ± 14.19) along with private institute students (88.46 ± 13.98). Perspective taking and compassionate care domain was also scored highest by the females (31.73 ± 6.49 & 29.31 ± 6.22) and among second year students (33.30 ± 7.11 & 30.50 ± 7.16). PCA analysis extracted 4 factors namely (i) Health-care-provider's sense of humor contributed to improved outcome (ii) Health-care provider's understanding of patients' feelings and of their families influences treatment outcomes (iii) Understanding body language is as important as verbal communication and (iv) Patients feel better when their feelings are understood, which accounted for the 59.51% of the total variance.

CONCLUSION

The findings revealed that students from private institute and females demonstrated higher empathy score. Moreover, the Jefferson Scale of Empathy (JSE) was found to be a reliable and validated tool for assessment of empathy in our sample population.

Assessment of Empathy as a Prerequisite for Holistic Nursing: Psychometric Analysis of the Jefferson Scale of Empathy-Health Profession Students for Croatian BSc and MSc Nursing Students

Purpose: To translate the original Jefferson Scale of Empathy-Health Profession Students version in a group of nursing students and asses its psychometrical characteristics according to the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Design: A descriptive cross-sectional study. Methods: The study included 345 bachelor's and master's students in the nursing degree program. Construct validity was tested by exploratory factor analysis using principal component analysis with varimax rotation. Convergent validity was tested using the Pearson correlation coefficient to test the relationship between empathy and emotional intelligence. The reliability of internal consistency was estimated using Cronbach's alpha. Findings: The final version of the 16-item scale with its three-factor structure has a high reliability with a Cronbach's alpha value of 0.86, and the Pearson correlation coefficient revealed a positive and significant relationship between emotional intelligence and the total score of the empathy scale and the three subscales. Conclusion: The contribution of the study is significant as the instrument is qualitatively validated and its content is clinically and educationally important for understanding the concept of empathy, especially in the education of nursing students. The correct assessment of empathy contributes to a better understanding and implementation of the components of holistic care.

Measurement Properties of an Arabic Version of the Jefferson Scale of Empathy (JSE) in Moroccan Medical Students

Introduction

Empathy is an essential communication skill in the doctor-patient relationship. In fact, measuring its level in medical students is becoming increasingly important. There is a Lack of tools to measure it in Morocco. The aim of this study was to validate the Arabic version of the Jefferson Scale of Empathy (JSE) among Moroccan medical students.

Methods

The questionnaire was translated from its original English version to Arabic in accordance with international guidelines for cross-cultural adaptation of self-report measures. After translation and transcultural adaptation, the final Arabic version was administered to a sample of Moroccan medical students. Descriptive statistics at the item level and at the scale level were calculated. The internal consistency, reproducibility, criterion, and construct validity were assessed. A multitrait scale analysis was used to examine construct validity. To measure criterion validity, the Arabic JSE scale was correlated to a visual analog scale (VAS), measuring the level of empathy. The mean of score was compared by gender, year of medical training, and specialty preference using the Student (t) and ANOVA tests. All statistical analyses were performed by SPSS, Version 26.

Results

A total of 201 students participated in the study. The average empathy score was 105.1±13.4. It was higher in female than male students (P=0.003). The Cronbach alpha was 0.76. The instrument has moderate test-retest reliability (ICC=0.6). The results showed a positive and significant correlation between Arabic JSE and VAS ((r=0.28, p<0.0001). The multitrait scaling analysis by testing convergent and discriminant validity confirmed the original scale structure.

Conclusion

The adapted Moroccan version of the Jefferson Scale of Empathy proved to be a valid instrument. It demonstrated an acceptable reliability and validity. Indeed, it can be used in national studies to measure empathy in medical students.

Psychometric properties of the Greek version of the Jefferson Scale of Empathy and empathy levels in Greek dental postgraduate students

PURPOSE

The aims of this study were to: (1) examine the psychometric properties of the Greek version of JSE-HP and (2) explore empathy among Greek dental postgraduate students.

METHODS

The JSE-HP scale was translated into Greek using the back translation method. The questionnaire was given to 111 dental postgraduate students between November 2017 and February 2018. A random sample of 25% was retested to assess test-retest reliability. The reliability of the Greek version of JSE-HP was measured with Cronbach's alpha (α) and Discrimination Indices (DIs). Exploratory Factor Analysis, with varimax rotation of the factorial axes, was used to examine the dimensionality and the factorial validity of the Greek version of the JSE-HP. Comparisons between groups of postgraduate students were performed as appropriate with the Kruskal-Wallis or the Mann-Whitney U test.

RESULTS

The response rate was 100%. The mean age was 28.9 years. The reliability, in the sense of internal consistency of the questionnaire was considered satisfactory (Cronbach's alpha: 0.76, average DI: 0.33.) The test-retest reliability was satisfactory (Pearson's r = 0.77, p < 0.001). Factor Analysis revealed 7 significant factors. No statistically significant differences in empathy scores were found among groups of postgraduate students.

CONCLUSIONS

The Greek version of the JSE-HP shows good psychometric properties. Empathy scores do not differ among Greek dental postgraduate students.

Emotional distress and psychiatric drug use among students in an Italian medical school: Assessing the role of gender and year of study

BACKGROUND

Previous studies have reported that medical students show high rates of depression, anxiety, and stress levels, but mixed findings were found regarding possible differences between gender and different years of medical training. This study evaluated depression, anxiety, and stress levels and psychiatric drug use in students in an Italian medical school and investigated the differences between gender and year of study.

MATERIALS AND METHODS

This cross-sectional study included 694 medical students in their 1^st (n = 286), 4^th (n = 209), and 6^th (n = 199) year of study. The questionnaire included demographic information, self-report questionnaires regarding depression, anxiety, and stress, and questions about psychiatric drug use. Data analysis was performed using SPSS/Ver 22 through descriptive and analytic statistics, including Mann-Whitney U-test, Fisher's exact test, and GLM two-way ANOVA.

RESULTS

Depression, anxiety, and stress symptoms were reported by 365 (52.6%), 428 (61.7%), and 545 (78.5%) medical students, respectively. Female students in their 4^th year of study reported higher depression levels than males of the same year (P = 0.004), whereas levels of anxiety were higher in 6^th-year female students compared with those in their 1^st and 4^th years (P = 0.001; P = 0.025). Stress levels were consistently higher in females than in males for all 3 years (1^st year: P = 0.041; 4^th year: P < 0.001; 6^th year: P = 0.004). No gender differences were found in the use of psychiatric and stimulant drugs.

CONCLUSION

This study provides preliminary evidence suggesting the importance of planning interventions aimed at reducing emotional distress among medical students that should be targeted on gender and year of the study.

Assessing empathy in final-year medical students using the Persian version of the Jefferson Scale of Physician Empathy

BACKGROUND

A doctor-patient relationship built on the concept of empathy is so essential to attain the best clinical outcomes in medicine. Since empathy has a positive role in interpersonal relationships and medical outcomes, its assessment is highly crucial. The aim of this study was to assess the empathy in last-year medical students using the Persian version of the Jefferson Scale of Physician Empathy (JSPE) and correlate empathy scores with demographic features.

MATERIALS AND METHODS

In this cross-sectional study, last-year medical students at Shiraz Medical School, Shiraz, Iran, were recruited for this study. In this research, we used the Persian version of JSPE. The validity and reliability of the Persian version of this tool were confirmed in the previous research. For the analysis of data, we employed descriptive statistics and the independent sample t-test.

RESULTS

One hundred and eighty-five final-year medical students were included in this study. The maximum score of the questionnaire was 140, and the total mean score of empathy was 98.15 ± 13.29. The females' total mean score (102.05 ± 11.89) was higher than the males' score (93.57 ± 13.46). The difference between the mean score of gender and empathy was significant (P value <.001), but there was no significant difference between empathy and the two other demographic factors (P > 0.05).

CONCLUSIONS

Although physicians would gain the essential characteristics of empathy during their career, attending professors and other responsible policymakers in medical education should focus more on the factors related to physicians' empathy to train better and more professional physicians.

The direct and indirect effects of clinical empathy on well-being among pre-medical students: a structural equation model approach

BACKGROUND

Empathy is a well-established facet of clinical competency that research suggests is associated with enhanced medical student well-being. Since little is known about empathy and well-being before students enter medical school-during pre-medical education-the main goal of this study is to test a conceptual model of how clinical empathy is related to two indicators of well-being, depression, and burnout among pre-medical students. The theoretical model hypothesizes that three dimensions of clinical empathy-Perspective-Taking, Compassionate Care, and Standing in Patients' Shoes- will be directly and negatively related to depression, as well as indirectly through its inverse relationship with three facets of burnout, Emotional Exhaustion, Poor Academic Efficacy, and Cynicism.

METHODS

Using survey data from a sample of 132 pre-medical students at an American Midwestern university, this study employs structural equation modeling (SEM) to test the theoretical model of the relationships between empathy, burnout, and depression among pre-medical students. We identify the direct effects of the three dimensions of the Jefferson Scale of Physician Empathy (JSE-S) on depression (CES-D), as well as the indirect effects of clinical empathy on depression through the three dimensions of the Maslach Burnout Inventory (MBI-S).

RESULTS

SEM analyses show that while none of the three dimensions of the JSE-S are directly related to depression, clinical empathy does significantly affect depression indirectly through burnout. Specifically, as predicted, we find that Perspective-Taking decreases Emotional Exhaustion, but, contrary to expectations, Compassionate Care increases it. And, the positive relationship between Compassionate Care and Emotional Exhaustion is particularly strong. In turn, Perspective-Taking and Compassionate Care are associated with depression in opposite directions and to different degrees.

CONCLUSIONS

Findings suggest that clinical empathy as measured by the JSE-S produces both positive and negative effects on personal well-being. We conclude that further conceptual clarity of clinical empathy is needed to better discern how the different dimensions impact different indicators of well-being. Given that pre-medical education is a crucial time for emotional socialization, the challenge for medical education will be fostering the positive, cognitive aspects of clinical empathy while simultaneously mitigating the adverse effects of affective empathy on medical student well-being.

Empathy in Japanese paramedicine students: A cross-sectional study

Empathy is an important characteristic for healthcare students and professionals that may improve the quality of healthcare interactions. Empathy has predominantly been studied within medicine, but also among various allied health personnel. Within paramedicine, empathy has previously been examined internationally, but not within Japan. This study used a descriptive, cross-sectional methodology which aimed to examine self-reported empathy in Japanese paramedic students using the Jefferson Scale of Empathy, and compare results with similar international cohorts. Empathy levels in the Japanese cohort were higher among females compared to males. In addition, there was a decrease in empathy with each subsequent year of the paramedic program, and a general decrease as age increased. This contrasts with comparable Australian cohorts which demonstrate no significant change in empathy levels during the undergraduate program. Empathy levels measured in the Japanese paramedic cohort were generally lower than for Australian cohorts. The reasons for the differences are unclear at present and thus further research in this area is required to fully determine and describe the contributing factors.

Empathy for patient care in medical students: new evidence on the importance of self-transcendence

Empathy is essential in clinical care to achieve patient satisfaction, treatment adherence and health outcomes. Understanding how personality traits might influence the development of medical students' empathy for patient care is important in medical education. Previous studies have shown associations between medical students' personality and empathy. This study aims to explore the associations between temperament and character and empathy for patient care in a sample of young medical students. Participants were 299 second-year Italian medical students. They completed the Italian versions of the Jefferson Scale of Empathy for medical students (JSE-S) and the Temperament and Character Inventory (TCI-140). Correlation and regression analyses were performed. Significant positive low correlations were found between empathy and Reward Dependence, Cooperativeness and Self-transcendence. The regression model of the sex and personality dimensions explained 14% of the variance in empathy with two significant predictors: sex (B = 4.034) and Self-transcendence (B = 0.361). This study confirms that female medical students are more empathetic than males. It also suggests that the greater students' Self-transcendence is, the more empathetic towards patient care they are. Attention to medical students' personality should be present within medical curricula, as it may help to generate methods of enhancing and sustaining the empathy of students.

Psychometry and estimation of cutoff points of Jefferson Scale of empathy in dental students

OBJECTIVE

The objective of this study was to determine the psychometric properties of the 3-dimensional latent model of empathy on the Jefferson Scale of Physician Empathy instrument (version S), and to verify the existence of cutoff points capable of differentiating empathy measures classified as: "high," "medium," and "low" using data collected from observations of students from 11 dental faculties of 5 Central American and Caribbean countries (n = 3082) between 2015 and 2019.

METHODS

This is an exploratory, "a posteriori," and non-experimental study. Factor structure and factor invariance by country and gender were analyzed. Hierarchical cluster analysis and bifactorial analysis were applied, and the data were normalized by cluster and by percentiles within them.

RESULTS

Confirmatory factor analysis showed that the original model was replicable and fit the data, while multigroup analysis allowed assuming an invariant factor structure by country and by gender. There is reliability in the measurement made by the scale and its dimensions.

CONCLUSIONS

The instrument has adequate psychometric properties, and cutoff values obtained allow people with lower or higher levels of empathy and its components to be classified. Therefore, these results solve the problem of comparing the scores and observed levels of empathy between dental schools within and between countries and between genders. Such comparisons were only possible since the original data of each study were made available for traditional statistical methods.

Empathy and Personality Styles in Medical Students

This study aimed to establish the relationship between empathy and personality styles in medical students, considering the differences by gender. The participants were 278 students of the medical career of the Universidad del Azuay, Ecuador. They were evaluated using the Jefferson empathy scale and the Millon Index of Personality Styles. Relationships between empathy and personality styles were examined using Pearson's correlation coefficient and hierarchical multiple linear regression analysis, for comparisons by gender and educational levels; with both Student's t test and analysis of variance used respectively. Results indicated that the factor structure of the empathy scale is invariant between men and women, noticing gender differences in care with compassion and total empathy, with women presenting a higher mean. Differences are observed by educational level, where the general empathy in the first three years grows progressively, and then slightly decrease. In conclusion,  female students present a mean score of total empathy greater than men, with differences of empathy according to educational level

A systematic review of psychometric assessment of the Jefferson Scale of Empathy using the COSMIN Risk of Bias checklist

INTRODUCTION

Empathic communication in health care may enhance positive patient and health care professional relationships, patient satisfaction and can buffer professional burnout. The Jefferson Scale of Empathy (JSE) was developed based on the need to quantitatively measure levels of empathy, particularly in health care settings. Evaluating the utility of empathy is underpinned by the psychometric rigour of the instruments used to measure it. The aim of this study was to critically evaluate the current evidence on the measurement properties of the JSE.

METHODS

Two reviewers independently searched six databases for papers describing psychometric assessment of the JSE from January 2000 to July 2018 inclusive. The studies were independently assessed for methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist.

RESULTS

The search strategy resulted in the retrieval of 985 papers, of which 59 were included in this study. The majority of papers reported on measures of structural validity and internal consistency, and it was in these areas which the highest quality of reporting was demonstrated. Additionally, there was a generally very good quality in reporting of convergent validity. Reliability, measurement error, cross-cultural validity were reported with less than optimum quality.

CONCLUSION

The JSE demonstrates robust structural validity, internal consistency, and convergent validity. These measurement properties are generally well reported in the literature in studies of good methodological quality, and thus may be interpreted with relative confidence when used in empathy research. However, current evidence is limited for the properties of reliability, measurement error, and cross-cultural validity. Thus, a degree of caution should be considered in drawing conclusions when using the JSE with regard to these properties. It is recommended that future examinations of the JSE refer to the COSMIN guidelines to ensure complete and well-reported psychometric data are included.

Empatía y percepción del riesgo del cambio climático en estudiantes de Ciencias de la Salud

Para determinar el aumento de los niveles de empatía y percepción del riesgo del cambio climático en estudiantes universitarios de la salud se realizó un estudio cuasi-experimental. La intervención fue una estrategia educativa. Se seleccionaron por conveniencia dos grupos de estudiantes de ciencias de la salud. Los niveles de empatía se midieron con la Escala de Empatía Médica de Jefferson versión estudiantes y de la Encuesta de percepción sobre riesgo al cambio climático como una amenaza para la salud humana se midieron dos ítems: índice de percepción de riesgo y conocimiento sobre los efectos en la salud por causa del cambio climático. Se encontraron diferencias entre pre y post-test (p < 0,05). En el pre-test ambos grupos presentaron niveles de empatía altos con un promedio de 107. Para el post-test, el grupo experimental, presentó un aumento estadísticamente significativo en los niveles de empatía. Se establecieron correlaciones significativas entre empatía global y factores de empatía: cuidado con compasión y toma de perspectiva; y correlación significativa entre el factor de empatía Cuidado con compasión y Conocimiento sobre los efectos en la salud por el cambio climático. Este trabajo evidenció como una estrategia educativa puede fomentar la empatía en estudiantes de la salud.

Validation to the Spanish of the Jefferson empathy scale health professions students version and its psychometric properties in nursing students

The ability to empathize with patients has a positive effect on health outcomes and quality of care. This study aimed to evaluate the psychometric characteristics of the Spanish version of the Jefferson Scale of Empathy-Health Profession Student version (JSE-HPS) in a sample of 422 nursing students and to compare their factorial structure with that of the original scale. In this study, the Cronbach α value was 0.828. These analyses showed that the scale has a factorial structure with three dimensions and all the items loaded adequately (>0.36) except for item 18 (0.266). The main factor, ̔Perspective taking̕ grouped 10 items; the second factor, ̔Compassionate care̕, grouped 6 items, and the third factor, ̔Standing in the patient's shoes̕, grouped 3 items; 42.2% of the variance was explained. The results of the confirmatory factor analysis suggest that the Spanish version of the JSE-HPS is a valid and reliable way to evaluate the empathic capacity of nursing students.

Measuring empathy in a group of South African undergraduate medical students using the student version of the Jefferson Scale of Empathy

Background

Patient-centred care is a model of care that demands healthcare providers change their focus from the disease to the patient and his or her perceived physical and psycho-social needs. This model requires healthcare workers to listen actively and to have effective communication skills and well-developed levels of empathy.

Aim

The aim of this study was to determine the suitability of the Jefferson Scale for Empathy (JSE-S) as a valid test for empathy in third-year medical students at a South African university and also to determine the baseline level of empathy in this same group of students.

Setting

The study took place at a medical school in the Western Cape, South Africa. This medical degree (MB ChB) is a 6-year programme. Students are first exposed to patients within their second year of training, but it is during their third-year that they start their clinical rotations. We wanted to test whether our empathy training would give students the necessary skills and enable them to establish good empathic communication habits in order to prevent a fall in empathy during this vulnerable period.

Methods

This article explores the suitability of the student version of the JSE-S as a valid test for empathy, within the South African medical school context. We briefly discuss the psychometrics and the scores against what is already known in countries like ours, specifically, developing nations where cultural and language differences exist in the student populations. Furthermore, we explore whether the JSE-S is a valid scale for pre- and post-intervention measurement of medical student empathy within our context and discuss the limitations of self-assessment. We also report on baseline levels of empathy in third-year medical students.

Results

Two hundred and six third-year medical students (69% females) completed the JSE-S prior to the intervention. Females and students aged 25 years and older had significantly higher scores than males and those 22 years old or less. The mean JSE was 109.98 (SD = 12.54), which is lower than most internationally reported scores. The Cronbach’s alpha coefficient was 0.81, indicating scale reliability and consistency, but graded item response testing highlighted variance in three reverse-scored questions.

Conclusion

The JSE-S is an appropriate and valid scale for measuring levels of empathy in undergraduate medical students in South Africa. However, language may need to be clarified in the negatively phrased items.

Empathy among dental students in a Nigerian institution

OBJECTIVES

To determine the reliability and validity of the Jefferson Scale of Empathy-Health Profession Students (JSE-HPS) version as a tool to measure the empathy levels in undergraduate dental students in Nigeria.

METHODS

A cross-sectional study conducted from 15 December 2015 to 12 January 2016 among 234 undergraduate dental students of the University of Lagos, Nigeria. Participants were proportionately selected from the first to sixth year by systematic sampling technique. Data were collected with a self-administered JSE-HPS questionnaire with internal consistency determined by Cronbach's α-coefficient reliability test. Data were analysed with SPSS software. Exploratory factor analysis was used to test for the fundamental construct validity of the scale among the students. P values <0.05 were considered significant.

RESULTS

The response rate of the respondents was 90.60% with 212 completed questionnaires with a mean age (SD) of 21.18 years (2.43) and internal reliability (Cronbach's α-coefficient) was 0.84. Factor analysis revealed "Compassionate Care," "Standing in Patients' Shoes" and "Perspective Taking" as first, second and third factors, respectively. The total mean empathy score (SD) was 104.01 (19.64). The mean empathy for females (SD) of 105.34 (17.31) was not significantly higher than the males (P = 0.08). There was a significant difference in empathy levels between the second- and the fourth-year students (P = 0.01).

CONCLUSION

The mean JSE-HPS score was comparable to those reported for dental, medical and other health professions students and physicians. Thus, this study demonstrates the construct validity and reliability of the JSE-HPS for measuring empathy among Nigerian dental students.

Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016)

BACKGROUND

Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.

AIM

To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.

METHODS

A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I² statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.

RESULTS

Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.

CONCLUSION

The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.

Association between emergency physician self-reported empathy and patient satisfaction

Background

Higher physician self-reported empathy has been associated with higher overall patient satisfaction. However, more evidence-based research is needed to determine such association in an emergent care setting.

Objective

To evaluate the association between physician self-reported empathy and after-care instant patient-to-provider satisfaction among Emergency Department (ED) healthcare providers with varying years of medical practice experience.

Research design

A prospective observational study conducted in a tertiary care hospital ED.

Methods

Forty-one providers interacted with 1,308 patients across 1,572 encounters from July 1 through October 31, 2016. The Jefferson Scale of Empathy (JSE) was used to assess provider empathy. An after-care instant patient satisfaction survey, with questionnaires regarding patient-to-provider satisfaction specifically, was conducted prior to the patient moving out of the ED. The relation between physician empathy and patient satisfaction was estimated using risk ratios (RR) and their corresponding 95% confidence limits (CL) from log-binomial regression models.

Results

Emergency Medicine (EM) residents had the lowest JSE scores (median 111; interquartile range [IQR]: 107–122) and senior physicians had the highest scores (median 119.5; IQR: 111–129). Similarly, EM residents had the lowest percentage of “very satisfied” responses (65%) and senior physicians had the highest reported percentage of “very satisfied” responses (69%). There was a modest positive association between JSE and satisfaction (RR = 1.04; 95% CL: 1.00, 1.07).

Conclusion

This study provides evidence of a positive association between ED provider self-reported empathy and after-care instant patient-to-provider satisfaction. Overall higher empathy scores were associated with higher patient satisfaction, though minor heterogeneity occurred between different provider characteristics.

The Association of Readiness for Interprofessional Learning with empathy, motivation and professional identity development in medical students

BACKGROUND

The Readiness for Interprofessional Learning Scale is among the first scales developed for measurement of attitude towards interprofessional learning (IPL). However, the conceptual framework of the RIPLS still lacks clarity. We investigated the association of the RIPLS with professional identity, empathy and motivation, with the intention of relating RIPLS to other well-known concepts in healthcare education, in an attempt to clarify the concept of readiness.

METHODS

Readiness for interprofessional learning, professional identity development, empathy and motivation of students for medical school, were measured in all 6 years of the medical curriculum. The association of professional identity development, empathy and motivation with readiness was analyzed using linear regression.

RESULTS

Empathy and motivation significantly explained the variance in RIPLS subscale Teamwork & Collaboration. Gender and belonging to the first study year had a unique positive contribution in explaining the variance of the RIPLS subscales Positive and Negative Professional Identity, whereas motivation had no contribution. More compassionate care, as an affective component of empathy, seemed to diminish readiness for IPL. Professional Identity, measured as affirmation or denial of the identification with a professional group, had no contribution in the explanation of the variance in readiness.

CONCLUSIONS

The RIPLS is a suboptimal instrument, which does not clarify the 'what' and 'how' of IPL in a curriculum. This study suggests that students' readiness for IPE may benefit from a combination with the cognitive component of empathy ('Perspective taking') and elements in the curriculum that promote autonomous motivation.

Stereotactic EEG-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy

OBJECTIVE

To determine the outcomes of combined stereo-electroencephalography-guided and MRI-guided stereotactic laser interstitial thermal therapy (LITT) in the treatment of patients with drug-resistant mesial temporal lobe epilepsy (mTLE).

METHODS

We prospectively assessed the surgical and neuropsychological outcomes in 21 patients with medically refractory mTLE who underwent LITT at the University of Chicago Medical Center. We further compared the surgical outcomes in patients with and without mesial temporal sclerosis (MTS).

RESULTS

Of the 21 patients, 19 (90%) underwent Invasive EEG study and 11 (52%) achieved freedom from disabling seizures with a mean duration of postoperative follow-up of 24±11 months after LITT. Eight (73%) of 11 patients with MTS achieved freedom from disabling seizures, whereas 3 (30 %) of 10 patients without MTS achieved freedom from disabling seizures. Patients with MTS were significantly more likely to become seizure-free, as compared with those without MTS (P=0.002). There was no significant difference in total ablation volume and the percentage of the ablated amygdalohippocampal complex between seizure-free and non-seizure-free patients. Presurgical and postsurgical neuropsychological assessments were obtained in 10 of 21 patients. While there was no group decline in any neuropsychological assessment, a significant postoperative decline in verbal memory and confrontational naming was observed in individual patients.

CONCLUSIONS

MRI-guided LITT is a safe and effective alternative to selective amygdalohippocampectomy and anterior temporal lobectomy for mTLE with MTS. Nevertheless, its efficacy in those without MTS seems modest. Large multicentre and prospective studies are warranted to further determine the efficacy and safety of LITT.

Psychometric properties of the Spanish version of the Jefferson Scale of Empathy: making sense of the total score through a second order confirmatory factor analysis

BACKGROUND

Empathy is a key aspect of the physician-patient interactions. The Jefferson Scale of Empathy (JSE) is one of the most used empathy measures of medical students. The development of cross-cultural empathy studies depends on valid and reliable translations of the JSE. This study sought to: (1) adapt and assess the psychometric properties in Spanish students of the Spanish JSE validated in Mexican students; (2) test a second order latent factor model.

METHODS

The Spanish JSE was adapted from the Spanish JSE-S, resulting in a final version of the measure. A non-probabilistic sample of 1104 medical students of two Spanish medical schools completed a socio-demographic and the Spanish JSE-S. Descriptive statistics, along with a confirmatory factor analysis, the average variance extracted (AVE), Cronbach's alphas and composite reliability (CR) coefficients were computed. An independent samples t-test was performed to access sex differences.

RESULTS

The Spanish JSE-S demonstrated acceptable to good sensitivity (individual items - except for item 2 - and JSE-S total score: -2.72 < Sk < 0.35 and -0.77 < Ku < 7.85), convergent validity (AVE: between 0.28 and 0.45) and reliability (Cronbach's alphas: between 0.62 and 0.78; CR: between 0.62 and 0.87). The confirmatory factor analysis supported the three-factor solution and the second order latent factor model.

CONCLUSIONS

The findings provide support for the sensitivity, construct validity and reliability of the adapted Spanish JSE-S with Spanish medical students. Data confirm the hypothesized second order latent factor model. This version may be useful in future research examining empathy in Spanish medical students, as well as in cross-cultural studies.

[Empathy-related factors in Nursing students of the Cartagena University]

OBJECTIVE

To determine empathy levels and its relationship with sociodemographic, academic and family factors in nursing students.

METHOD

Cross-sectional study, 196 nursing students were randomly selected at the University of Cartagena, Colombia. A questionnaire that asked about sociodemographic, family and academic factors and the Scale of Physician Empathy Jefferson-version S were applied. Shapiro-Wilk test was used to assess the normality assumption. t Student, ANOVA, Pearson test and simple linear regression were used to establish the relationship (p<0.05).

RESULTS

The global empathy score was 108.6±14.6; statistically significant associations between global empathy with the training year (p=0.004) and grade point average (R(2)=0.058; p=0.001; r=0.240) were found. Moreover, the "perspective taking" dimension with provenance (rural/urban) (p=0.010) and family functioning (p=0.003); the "compassionate care" dimension with the training year (p=0.002) and the "putting themselves in the place of the patient" dimension with academic performance (p=0.034).

CONCLUSION

The empathy levels in nursing students may vary depending on various personal and academic factors,these characteristics should be taken into account for implementing teaching strategies to promote higher empathy levels since the early training years.

Cross-Validation of the Spanish HP-Version of the Jefferson Scale of Empathy Confirmed with Some Cross-Cultural Differences

Context: Medical educators agree that empathy is essential for physicians' professionalism. The Health Professional Version of the Jefferson Scale of Empathy (JSE-HP) was developed in response to a need for a psychometrically sound instrument to measure empathy in the context of patient care. Although extensive support for its validity and reliability is available, the authors recognize the necessity to examine psychometrics of the JSE-HP in different socio-cultural contexts to assure the psychometric soundness of this instrument. The first aim of this study was to confirm its psychometric properties in the cross-cultural context of Spain and Latin American countries. The second aim was to measure the influence of social and cultural factors on the development of medical empathy in health practitioners.

Methods: The original English version of the JSE-HP was translated into International Spanish using back-translation procedures. The Spanish version of the JSE-HP was administered to 896 physicians from Spain and 13 Latin American countries. Data were subjected to exploratory factor analysis using principal component analysis (PCA) with oblique rotation (promax) to allow for correlation among the resulting factors, followed by a second analysis, using confirmatory factor analysis (CFA). Two theoretical models, one based on the English JSE-HP and another on the first Spanish student version of the JSE (JSE-S), were tested. Demographic variables were compared using group comparisons.

Results: A total of 715 (80%) surveys were returned fully completed. Cronbach's alpha coefficient of the JSE for the entire sample was 0.84. The psychometric properties of the Spanish JSE-HP matched those of the original English JSE-HP. However, the Spanish JSE-S model proved more appropriate than the original English model for the sample in this study. Group comparisons among physicians classified by gender, medical specialties, cultural and cross-cultural backgrounds yielded statistically significant differences (p < 0.001).

Conclusions: The findings support the underlying factor structure of the Jefferson Scale of Empathy (JSE). The results reveal the importance of culture in the development of medical empathy. The cross-cultural differences described could open gates for further lines of medical education research.

[Medical empathy of physicians-in-training who are enrolled in professional training programs. A comparative intercultural study in Spain]

Objetivo

Caracterizar algunos de los factores ambientales que intervienen en el desarrollo de la empatía y que son sensibles a las diferencias culturales en médicos residentes españoles y latinoamericanos.

Diseño

Estudio transversal y observacional mediante encuesta.

Emplazamiento

Servicios de atención primaria y hospitalaria del Sistema Riojano de Salud, Logroño, España.

Participantes

Médicos residentes que realizan los programas de formación médica especializada en los servicios de atención primaria y hospitalaria.

Mediciones principales

La empatía se midió mediante el cuestionario Jefferson de empatía médica, en su versión para profesionales sanitarios (JSE-HP). Se recogieron variables sociodemográficas e información sobre la experiencia académica y profesional.

Resultados

Ciento cuatro médicos residentes (67 españoles y 32 latinoamericanos) participaron en el estudio. El JSE-HP mostró adecuadas propiedades psicométricas. La puntuación media de empatía de los médicos españoles fue mayor que la de los latinoamericanos (p = 0,01). Se encontraron diferencias en el desarrollo de la empatía asociadas al desarrollo de modelos profesionales (p < 0,001), al encuentro positivo con otros profesionales (p = 0,001), y al desarrollo de una formación profesional continuada (p = 0,008).

Conclusiones

Algunos de los factores que intervienen en el desarrollo de la empatía y que son sensibles a la influencia cultural han podido ser caracterizados. Se proponen futuras líneas de investigación y desarrollo.

Working Together to Promote Diabetes Control: A Practical Guide for Diabetes Health Care Providers in Establishing a Working Alliance to Achieve Self-Management Support

The quality of the "patient-carer" relationship is the foundation of self-management support and has been shown to influence treatment outcome in relation to psychological and somatic illness, including diabetes. It has long been accepted within applied psychology that the quality of the client-therapist relationship--termed the working alliance--is of central importance to treatment outcome and may account for a significant degree of the overall treatment effect. Diabetes healthcare providers have recently expressed a need for further training in communication techniques and in the psychological aspects of diabetes. Could we take a page from the psychological treatment manual on working alliance in therapy to guide the diabetes healthcare provider in their role of supporting the person with diabetes achieve and maintain better metabolic control? This paper examines the role of the working alliance in diabetes care and offers a practical guide to the diabetes healthcare provider in establishing a working alliance with the person with diabetes in managing diabetes.