Empathy differences by gender and specialty preference in medical students: a study in Brazil

Empathy in undergraduate medical students: a multi-center cross-sectional study in China

BACKGROUND

Fostering empathy has been continuously emphasized in the global medical education. Empathy is crucial to enhance patient-physician relationships, and is associated with medical students' academic and clinical performance. However, empathy level of medical students in China and related influencing factors are not clear.

METHODS

This was a cross-sectional study among medical students in 11 universities. We used the Jefferson Scale of Empathy Student-version of Chinese version to measure empathy level of medical students. Factors associated with empathy were identified by the univariate and multivariate logistic regression analyses. Based on the variables identified above, the nomogram was established to predict high empathy probability of medical students. Receiver operating characteristic curve, calibration plot and decision curve analysis were used to evaluate the discrimination, calibration and educational utility of the model.

RESULTS

We received 10,901 samples, but a total of 10,576 samples could be used for further analysis (effective response rate of 97.02%). The mean empathy score of undergraduate medical students was 67.38 (standard deviation = 9.39). Six variables including gender, university category, only child or not, self-perception doctor-patient relationship in hospitals, interest of medicine, Kolb learning style showed statistical significance with empathy of medical students (P < 0.05). Then, the nomogram was established based on six variables. The validation suggested the nomogram model was well calibrated and had good utility in education, as well as area under the curve of model prediction was 0.65.

CONCLUSIONS

We identify factors influencing empathy of undergraduate medical students. Moreover, increasing manifest and hidden curriculums on cultivating empathy of medical students may be needed among medical universities or schools in China.

The impact of empathy on medical students: an integrative review

INTRODUCTION

Empathy is considered the ability to understand or feel others emotions or experiences. As an important part of medical education, empathy can affect medical students in many ways. It is still lacking a comprehensive evaluation of the existing articles on empathy's impact on medical students, despite the existence of many articles on the topic.

OBJECTIVES

To summarize the impact of empathy on medical students during medical education from four perspectives: mental health, academic performance, clinical competence, and specialty preference.

METHODS

The search terms used for retrieval were "empathy", "medical student", "mental health", "depression", "anxiety", "burnout", "examinations", "academic performance", "clinical competence", "specialty preference" on PubMed, EBSCO, and Web of Science before January 2024. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed based on inclusion/exclusion criteria. A consensus was drawn on which articles were included.

RESULTS

Our results indicated that high empathy was a positive factor for mental health, However, students with high affective empathy were more likely to suffer from depression, anxiety, and burnout. Empathy was found to be unrelated to academic performance, but positively correlated with clinical competence, particularly in terms of communication skills. Medical students with high levels of empathy tended to prefer people-oriented majors.

CONCLUSIONS

Medical students who score higher on the self-reported empathy scales often have better mental health, better communication skills, and tend to choose people-oriented specialties. But empathy is not related to academic performance. Additionally, the different dimensions of empathy have different impacts on medical students. It is necessary to design targeted courses and training for medical students to enhance their empathy.

The level and determinants of empathy among medical students from Arabic speaking countries: A systematic review

Aim

This systematic review aims to investigate the level of empathy among medical students in Arabic speaking countries and analyze its determinants.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2022 (PRISMA), the authors conducted a systematic research of studies investigating the level and determinants of empathy among medical students in Arabic speaking countries. The databases PubMed, Scopus, web of science and google scholar were searched.

Results

Ten studies from six countries were included. Nine of which had a cross-sectional study design. Level of empathy was assessed using the Jefferson scale in seven studies and using the Interpersonal Reactivity Index in two studies. The mean of empathy scale ranges between 97.65±14.10 to 106.55±19.16 in studies used the Jefferson scale of empathy. The associated factors with empathy were gender; high levels of empathy were reported in female students. Other factors are explored in relation with empathy such as specialty preference (surgery or medicine, "people-orientated" specialties or ''technology-oriented specialties''), family factors (marital status of parents, satisfactory relationship with parents, parents level of education and household income) and factors related to medical education (academic performance, year of study and type of curriculum) but the results are heterogeneous.

Conclusion

This is the first systematic review, which illustrated the determinants of empathy in Arabic medical students. Our results revealed varied results on empathy determinants. Further studies may guarantee a full exploration of this ability in order to improve the doctor-patient relationship and patient management in the Arab world.

The Effect of the COVID-19 Pandemic on the Factors Influencing Iranian Medical Residents' Specialty Selection: A Qualitative Study

Background

Medical students' specialty selection influences the composition of the physician workforce and the effectiveness of health systems. Therefore, the identification of factors that influence the choice of specialty is critical for an evidence-based health policy. This study aimed to investigate the effect of the Coronavirus Disease 2019 (COVID-19) pandemic on the determinants of specialty choice among Iranian medical residents.

Methods

In early 2022, this qualitative study was conducted among Iranian medical residents in seven provinces, including Tehran, Isfahan, Fars, Khorasan Razavi, Kerman, Kermanshah, and Khuzestan. The participants were selected using a purposeful sampling method. Data were collected using 74 semi-structured in-depth face-to-face interviews. Finally, a thematic content analysis (conventional content analysis) method was applied for data synthesis.

Results

The participant's mean age was 28.7±2.5 years, and more than 52% (N=39) were men. Following data synthesis, 10 sub-themes and four main themes were identified, including educational aspects affected by the pandemic, career-related hazards, personal and professional lifestyles affected by the disease, and experiences and beliefs regarding the pandemic.

Conclusion

The COVID-19 pandemic has had a significant impact on medical students' educational, professional, and personal aspects of specialty choices. This study demonstrated how the disease affected the choice of specialty. Therefore, the findings could be used for developing national health policy and planning.

Empathy levels in physiotherapy students: a four-year longitudinal study

BACKGROUND

Empathy is a key value in health-related occupations such as physiotherapy.

PURPOSE

This longitudinal study aimed to determine the empathy levels of students in a four-year bachelor of physiotherapy program.

METHODS

A total of 120 physiotherapy students at a non-governmental university in Istanbul participated in the study between 2016 and 2019. The Turkish adaptation of the student version of the Jefferson Scale of Physician Empathy was used. Empathy scores were compared according to year of study and gender.

RESULTS

Most participants were women (n = 101, 84.2%). Empathy scores differed by years of study (p < .001) being highest in the first year and lowest in the fourth year. There was no difference in empathy scores between women and men (p = .26).

CONCLUSION

This is the first longitudinal study to contribute data on empathy levels in Turkish physiotherapy students. The decline in empathy seen in fourth-year physiotherapy students is associated more with the academic program and clinical practice than with any other factor. Further studies are warranted to explore why there are variations in empathy levels in physiotherapy students during their education. Ensuring students develop awareness and skills related to empathy during their undergraduate studies could result in a higher quality of care early in their professional practice.

The Level of Empathy Among Medical Students at the University of Tabuk, Saudi Arabia

Background and objective Empathy plays an important role in patient-provider relationships. It is a key aspect of therapy, ensuring accurate diagnosis, and improving compliance and outcomes, all of which contribute to clinician satisfaction. This study aimed to assess the level of empathy among medical students at the University of Tabuk. Methods A cross-sectional study was conducted among medical students at Tabuk University. Data were collected using a self-administered online questionnaire based on the Jefferson Scale of Physician Empathy-Student Version (JSPE-S). Results A total of 230 medical students participated in this study. The students' total empathy scores ranged between 55 and 131, with a mean of 99.05 ± 13.75. The highest item score was obtained for the question "Patients feel better when their physicians understand their feelings" (6.34 ± 0.99). Female students had a significantly (p=0.002) higher mean score (100.67 ± 13.06) than males (94.36 ± 14.70). Students from the clinical phase had a significantly higher mean total score compared to those from preclinical phases (100.26 ± 14.34 vs. 96.78 ± 12.33, p=0.043). Students choosing people-oriented specialties had significantly higher mean total scores than those selecting procedure-oriented specialties (100.59 ± 13.72 vs. 95.67 ± 14.46, p=0.033). Conclusion The degree of students' empathy with the patients at the Faculty of Medicine, University of Tabuk was found to be highest among females, students in the clinical phase, and students intending to select people-oriented specialties. These findings have implications for medical education programs, highlighting the importance of fostering empathy skills and addressing potential gender differences in empathy development.

Differences in history-taking skills between male and female chiropractic student interns

OBJECTIVE

The purpose of this study was to determine if there was a difference in history-taking skills between male and female chiropractic student interns.

METHODS

This study included 2040 patient histories collected by student interns over a 3-year period. Students were assessed by chiropractic college clinicians on reasoning (ability to derive clinically relevant information using a mnemonic for taking a history), communication, and professionalism using a modified Dreyfus model scoring system on a 1-4 scale (1 = novice, 4 = proficient). Ordinal dependent variables were scores for reasoning, communication, and professionalism. The categorical independent variable was sex of the student intern (male or female). A Mann-Whitney U test was used to compare for differences in nonparametric dependent variables by the sex of the students.

RESULTS

The Mann-Whitney U test revealed that communication scores were greater for female chiropractic interns compared with male chiropractic interns (p < .001, with a small effect size (r = -.08). There was no statistically significant effect for sex on reasoning (p = .263) or professionalism (p = .098).

CONCLUSION

Female chiropractic student interns scored higher than male interns on communication skills during a history-taking patient encounter. This supports the trend seen among female medical school students and physicians that women score higher than men on communication-related assessments.

Perceived leadership quality and empathy among Indian undergraduate medical students

BACKGROUND

Efficient leaders from the medical fraternity may understand healthcare in depth. Empathy is important for patient care, job satisfaction, and the psychological well-being of doctors. Empathic leadership is concerned with an interest in the people around them. This study aimed to observe the perceived leadership quality and empathy among Indian medical undergraduate students, find any correlation between them, and assess age, sex, and semester of study as predictor variables for leadership and empathy.

MATERIALS AND METHODS

An online cross-sectional survey was conducted on Google Forms with undergraduate medical students in India with a convenient snowball sample. The Abbreviated Self Leadership Quality (ASQL) was used to find the leadership quality and the eight-item Empathy Quotient (EQ-8) to find the empathy. Spearman's correlation coefficient was calculated between ASQL and EQ-8 score. Age, sex, and semester were used as predictor variables in regression analysis with leadership and empathy as dependent variables.

RESULT

A total of 439 (50.8% male, 49.2% female) Indian undergraduate students participated in the study. Males showed higher leadership qualities. There was no gender difference in empathy. Leadership was positively correlated (rs =0.13, P = .006) with empathy in the overall sample. The age (P = .001), sex (P < .0001), and semester of study (P < .0001) successfully predicts leadership (F = 57.167, P < .0001). Although age, sex, and semester combined successfully predict empathy (F = 5.31, P = .001), individually, only a semester of study (P = .009) significantly contributes to the prediction.

CONCLUSION

Male and female medical students show a similar level of empathy but male shows higher leadership quality. Leadership and empathy are positively correlated; hence, students with higher leadership quality would show higher empathy and vice versa. The age, sex, and semester of study are determinants of leadership whereas semester of study is the determinant of empathy.

Matching of advanced undergraduate medical students' competence profiles with the required competence profiles of their specialty of choice for postgraduate training

BACKGROUND

Matching between undergraduate students and their chosen specialty has implications for their personal job satisfaction and performance as well as societies' needs regarding health care quality. Knowledge regarding student-specialty fit can help improve students' decisions and detect potential deficiencies in specific competences. In this study, we compare self-assessed competence profiles of medical students close to graduation with the competence profiles of their specialty of choice for postgraduate training.

METHODS

Self-assessed competence profiles were collected with the modified requirement-tracking (R-Track) questionnaire from 197 final-year medical students close to graduation in 2022. To determine student-specialty fit, difference scores between students' self-assessed competences and physicians' requirements for specific specialties were calculated across the R-Track's six competence areas "Motivation", "Personality traits", "Social interactive competences", "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities", which were assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Mean difference scores across competence areas were calculated and compared between specialties with multivariate analysis of variance. Student-specialty fit was also calculated independent of students' choices.

RESULTS

The competence area "Motivation" scored highest for both students and physicians across specialties. However, students' scores were lower than physicians' requirements for "Motivation" as well as "Personality traits" across all specialties. Difference scores for "Social interactive competences" were either close to zero or showed higher scores for students. A similar competence pattern for internal medicine, general medicine, paediatrics, and gynaecology was identified with higher than required student scores for "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities". All other specialties showed higher physicians' requirements for at least one of these competence areas. Independent of students' specialty choice, we found the highest difference score in favour of student scores for general medicine (0.31) and the lowest difference score for internal medicine (-0.02).

CONCLUSIONS

Students' competence profiles overall show better fit with person-oriented specialties. "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities" show higher requirement scores for more technique-oriented specialties. Students interested in such specialties could focus more on basic skill development in undergraduate training or will develop specific skills during residency.

Empathy levels among undergraduate medical students in Karachi, Pakistan: a cross-sectional study

Empathy is a concept native to the field of medicine. However, over the course of medical school, empathy levels are expected to decline. The aim of this study was to assess the empathy levels among medical students in relation to their year of study and specialties of choice in the future.

MATERIALS AND METHODS

A cross-sectional study was conducted to assess empathy levels among students from medical colleges in Karachi, Pakistan, using an online survey. The total duration of the study was 2 months. The authors analyzed the data using SPSS version 20.

RESULTS

A total of 463 undergraduate medical students participated in this survey. The overall mean empathy score was 101.9±16.3 with 104.6±14.1 for females, which was significantly higher than the male participants. The highest empathy levels were demonstrated in fourth-year medical students with a mean empathy score of 104.1±16.3, whereas, the lowest empathy levels were found in second-year medical students with a mean empathy score of 99.8±9.4. Study participants considering emergency medicine, neurology, obstetrics/gynecology, and oncology as their specialty of choice demonstrated the highest empathy levels followed by pediatrics and internal medicine.

CONCLUSION

On average, there was a female preponderance in empathy levels among undergraduate medical students. Empathy levels among fourth-year students involved in clinical practice were greater as compared to students in their initial years of study. Further investigations are required to validate the findings of this study.

Clinical Empathy and Its Correlates Among Indian Medical Students: A Cross-Sectional Study of Bihar

Background Clinical empathy is standing in the patient's shoes and perceiving his/her emotions to experience the patient's feelings. Practicing empathy ensures an enticing prospect in patient care. This study was done among undergraduate medical students to assess their empathy level and the factors affecting it. Methods This was a cross-sectional study conducted with 400 medical students in Bihar, India. Students not willing to participate were excluded from the study. The coding system was designed to strictly maintain anonymity. The study tools included the Jefferson Scale for Physician Empathy - Student Version (JSPES), a semi-structured questionnaire on the general profile, a perceived stress scale (PSS), and a multidimensional scale of perceived social support (MSPSS). Participants were allotted 20 minutes to complete the test and submit their responses. Results were expressed as means and standard deviations (SDs), with appropriate statistical tests applied. The data were presented in tables, and statistical significance was checked at a 5% level. All statistical analyses were conducted using SPSS software. Results The arithmetic mean (±SD) of empathy scores was 99.87±14.71. Empathy was found to be positively correlated with social support and negatively with stress. The factors found to be significantly associated with empathy on univariate analysis were subjected to stepwise multiple linear regression, which provided a six-factor model comprising gender, choice of future specialty, stress, social support, residence, substance abuse, and stay in hospital as an attendant. Conclusions Stress and social support were found to be significant predictors of empathy. The female gender, living in urban areas, and having previous experience of hospital stay as an attendant of a patient were positively associated with empathy. In contrast, choosing a technical branch as a future specialty and substance abuse were negatively associated with empathy. Stress management, enhancement of social support, and avoidance of habit-forming substances could be beneficial in improving empathy among doctors. Since we could only identify a few factors, we recommend further studies on this topic to explore other factors.

When Did the Empathy Die?: Examining the Correlation Between Length of Medical Training and Level of Empathy

Purpose

Empathy is an important skill for physicians as it can lead to improved patient outcomes and satisfaction. This study assessed self-reported empathy by medical students across all four years of medical school and potential differences in empathy across students interested in different subspecialties.

Method

All medical students enrolled at New York Medical College in August 2020 were invited to participate in this study. Participants completed the student version of the Jefferson Scale of Empathy.

Results

A total of 179 medical students participated. Mean empathy score in fourth-year students was significantly lower than that in first-year students. Mean empathy score was greatest among students interested in Pediatrics and was greater in participants who identified as women.

Conclusions

Self-reported empathy may be lower in upper-year medical students when compared to lower-year students. The potential reasons for lower empathy in the later years of training are discussed. A systematic curriculum for teaching and maintaining empathy should be developed and uniformly implemented across medical schools to combat a potential decline in empathy.

Measuring Empathy in Iranian Pharmacy Students Using the Jefferson Scale of Empathy-Health Profession Student Version

Objective. To assess validity of the Farsi-translated version of the Jefferson Scale of Empathy-Health Profession Student version (JSE-HPS) and measure empathy scores of Iranian pharmacy students.Methods. The JSE-HPS questionnaire was administered to 504 Iranian pharmacy students in 2019. Confirmatory factor analysis and exploratory factor analysis were used to explore the underlying components and construct validity. Group comparisons of the empathy scores and the underlying components were conducted using statistical tests.Results. Based on 496 useable survey questionnaires, three domains of empathy among Iranian pharmacy students were confirmed by confirmatory factor analysis: compassionate care, perspective taking, and standing in a patient's shoes. Two items in the JSE-HPS were removed, as their factor loadings were under the permissible limits in exploratory factor analysis. Empathy scores were significantly higher among female pharmacy students.Conclusion. These findings support the validity and reliability of the Farsi version of the JSE-HPS among Iranian pharmacy students.

Eleven years of data on the Jefferson Scale of Empathy - medical student version: Japanese norm data and tentative cutoff scores

BACKGROUND

More and more studies investigate medical students' empathy using the Jefferson Scale of Empathy (JSE). However, no norm data or cutoff scores of the JSE for Japanese medical students are available. This study therefore explored Japanese norm data and tentative cutoff scores for the Japanese translation of the JSE-medical student version (JSE-S) using 11 years of data obtained from matriculants from a medical school in Japan.

METHODS

Participants were 1,216 students (836 men and 380 women) who matriculated at a medical school in Japan from 2011 to 2021. The JSE-S questionnaire was administered to participants prior to the start of the program. Data were summarized using descriptive statistics and statistical tests were performed to show the norm data and tentative cutoff scores for male and female students separately.

RESULTS

The score distributions of the JSE-S were moderately skewed and leptokurtic for the entire sample, with indices -0.75 and 4.78, respectively. The mean score (standard deviation) for all participants was 110.8 (11.8). Women had a significantly higher mean score (112.6) than men (110.0; p < 0.01). The effect size estimate of gender difference was 0.22, indicating a small effect size. The low and high cutoff scores for men were ≤ 91 and ≥ 126, respectively, and the corresponding scores for women were ≤ 97 and ≥ 128, respectively.

CONCLUSIONS

This study provides JSE-S norm data and tentative cutoff scores for Japanese medical school matriculants, which would be helpful in identifying those who may need further training to enhance their empathy.

Differences in clinical reasoning between female and male medical students

Background

In undergraduate medical education virtual patients (VPs) are a suitable method to teach clinical reasoning and support the visualization of this thinking process in a safe environment. The aim of our study was to investigate differences in the clinical reasoning process and diagnostic accuracy of female and male medical students.

Methods

During the summer term 2020, we provided access to 15 VPs for undergraduate students enrolled in a medical school in Bavaria, Germany. All interactions of the 179 learners within the VP system CASUS were recorded, exported, and analyzed.

Results

We found significant differences in the clinical reasoning of female and male learners. Female students documented more findings, differential diagnoses, tests, and treatment options and more often created a summary statement about the VP. Their overall performance was higher than those of their male peers, but we did not see any significant differences in diagnostic accuracy.

Conclusions

The significant differences between male and female medical students should be considered when planning teaching and research activities. A future study should investigate whether these differences can also be found in physicians.

A cross-sectional study of student empathy across four medical schools in Denmark-associations between empathy level and age, sex, specialty preferences and motivation

BACKGROUND

Professional empathy has been associated with a range of positive patient- and clinician outcomes and is therefore considered important to develop for future physicians. Measuring changes in empathy scores among medical students by using the Jefferson Scale of Empathy (Student version) (JSE-S) has led to mixed results. So far, no investigation of Danish medical students' empathy development has been conducted. The aim of this study was therefore to examine the associations between empathy scores among Danish medical students and medical school, year of curriculum, age, sex, co-habitation, and parental status, specialty preferences and motivations for choosing medicine as a future profession.

METHODS

This was a cross-sectional questionnaire study. All medical students from four medical schools in Denmark in their first, third and sixth year (N = 4,178) were invited to participate in the study in October 2020. The associations between JSE-S sum score and the above explanatory factors were analysed by uni- and multivariable linear regression models.

RESULTS

The JSE-S was completed by 672 medical students. The overall mean score was 112.7. There were no statistically significant differences in empathy between medical schools, first, third- and sixth- year medical students, age groups or parental status. Female students and students living with a spouse or partner scored higher on JSE-S than male students or students living alone, and the sex difference remained statistically significant in the multivariable regression. In both the univariable and multivariable setting, preference for future medical specialty was statistically significant, with a decrease in scores for students choosing surgery-specialties. Motivational factors were not statistically significantly associated with empathy, although there was a slight upwards trend for one of the motivational categories, named "personal experiences".

CONCLUSIONS

Overall, our results showed neither decrease nor increase but instead rather stable empathy scores across years of curriculum of medical students in Denmark, adding to the mixed picture of empathy development among medical students. Our findings are consistent with positive associations found in international studies between empathy scores and higher age, female sex, specialty preferences for psychiatry and general practice and altruistic motivations for choosing to enroll. Although specialty preferences are changing during medical education, they may be used meaningfully as predictors of individual student empathy levels.

The relationship between empathy and personality traits in Saudi medical students

BACKGROUND

Empathy is regarded as a fundamental personal attribute for in-training and in-practice doctors. Several factors may play a significant role to facilitate or prevent the ability of doctors' empathy toward their patients. The objective of the present study is to investigate the relationship of empathy with personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience) among undergraduate medical students.

MATERIALS AND METHODS

This study was based on a correlational, cross-sectional design and was conducted from January 2020 to April 2020. The sample consisted of 301 undergraduate medical students studying in different medical colleges situated in Riyadh, Saudi Arabia. Personal information form, the big-five personality inventory, and the interpersonal reactivity index scales were administered. Obtained data were analyzed by applying several methods such as mean, standard deviation, Mann-Whitney U test, Pearson's correlation coefficient, and multivariable linear regression.

RESULTS

Regression analysis revealed that personality dimensions accounted for 10-19% of the variance in scores of empathy sub-dimensions of perspective-taking, empathetic concern, fantasy, and personal distress. Agreeableness was found to be associated with empathetic concern and perspective-taking. Openness to experience was found to be significantly related to perspective-taking and fantasy, whereas extraversion was negatively associated with perspective-taking. Neuroticism had an association with personal distress, empathetic concern, and fantasy. Additionally, no gender difference was observed and students with people-oriented specialty preferences showed significantly higher scores on empathy sub-domains than technology-oriented students.

CONCLUSION

This study confirmed that personality dimensions play a notable role to predict empathetic behaviors among Saudi undergraduate medical students. This study would help to design individualized strategies by incorporating personality dimensions in the training program to enhance empathetic behavior among medical students.

Having Heart: Affective and Cognitive Empathy Scores vs. Residency Specialty Match at an Osteopathic Medical School

BACKGROUND

Past studies examining the cognitive empathy of medical school graduates grouped the various residency selections vs. parsing them out. This study examines both affective and cognitive empathy scores of osteopathic medical school graduates entering eleven different residency specialties.

METHODS

Participants from the Campbell University Jerry M. Wallace School of Osteopathic Medicine (CUSOM) classes of 2017-2019 completed the Balanced Emotional Empathy Scale (BEES; measuring affective empathy) and the Jefferson Scale of Empathy, Student version (JSE-S; measuring cognitive empathy). Empathy scores were compared to residency choice upon graduation. The specialty choices were broken into two groups: Core specialties (i.e., people-oriented) that include Family Medicine, Internal Medicine, Obstetrics and Gynecology (OB/Gyn), Pediatrics, and Psychiatry. The remaining specialties are considered Non-Core specialties (i.e., technical/procedure-oriented) and included Anesthesiology, Diagnostic Radiology, Emergency Medicine, General Surgery, Neurology, and Orthopedics. Results are compared to data from the nationwide Project in Osteopathic Medical Education and Empathy (POMEE).

RESULTS

Women graduates tended to have larger BEES and JSE-S scores than men. Affective empathy scores were the largest for students selecting Core specialties. Four of these Core specialties were in the top four positions out of the eleven specialties selected by eight or more graduates. None of the eleven specialties was ranked higher than the 50th percentile compared to BEES score norms. Cognitive empathy scores were also the largest for students selecting Core specialties. All five of the Core specialties were in the top six positions out of the eleven specialties. None of the eleven specialties ranked greater than the 39th percentile when compared to OMS-III and OMS-IV POMEE data. Only women entering Psychiatry had a JSE-S score that was greater than the 50th percentile.

CONCLUSIONS

Osteopathic graduates selecting the five Core specialties have BEES and JSE-S scores that are, usually, larger than students entering Non-Core specialties. For either survey instrument, both Pediatrics and Family Medicine were first and second out of a possible 11 positions, respectively. Most CUSOM graduates had JSE-S scores lower than their peers in other osteopathic medical schools that participated in the POMEE study. When the CUSOM data are compared to allopathic data, there is no clear evidence that osteopathic students have substantially higher affective or cognitive empathy scores than their allopathic peers. Therefore, it appears that medical students who select osteopathy for its tenant of a more holistic approach to patient care are no more empathetic than students studying allopathic medicine. Several suggestions are made on how to potentially increase student empathy during undergraduate medical education.

Humanitarian approach in medicine: A study on clinical empathy among medical students and graduates using the Jefferson Scale of Empathy

Background Empathy is one of the pillars of professionalism in the medical field associated with better patient satisfaction and outcome. This study aimed to assess and compare the empathy score with other institutes within and outside India using the Jefferson Scale of Empathy-Student version (JSE-S). Methods We did a cross-sectional study for undergraduate medical students and interns of Pramukhswami Medical College, Karamsad, for 4 months from October 2019. Voluntary participants completed the JSE-S, an internationally validated 20-item survey questionnaire. Results The mean empathy score of 575 voluntary participants out of 631 was 100.75, with women having higher and significant scores than men (F 102.1 [11.5]; M 98.3 [12.5]; p<0.001). The highest empathy score was observed in the first year (102 [10.8]), which increased and decreased in different years of medical education with a maximum dip in the second year (99.4 [11.5]). The choice of specialty of participants showed a lower significant difference as per the JSE-S score. A lower empathy score was identified among participants compared to medical students studying in international medical institutes. Conclusion There is a need to organize workshops with training modules to cater to the empathy aspect of professional care, as a continuous process, starting from the first year till the completion of internship.

The relationship between medical students' empathy and burnout levels by gender and study years

OBJECTIVE

To investigate the multifaceted factors affecting empathy in medical students.

METHODS

1293 medical students from 15 South Korean medical schools participated in an online survey. Affective empathy was measured with the 'empathy concern' and 'personal distress' dimensions from the Interpersonal Reactivity Index for Medical Students (IRI-MS). Cognitive empathy was assessed with IRI-MS' 'perspective taking' and Jefferson Scales for Physician Empathy for Student (JSPE-S). Maslach Burnout Inventory for Medical Students (MBI-MS) assessed the burnout levels of the participants.

RESULTS

A significant gender difference in affective and cognitive empathy was found using JSPE-S. Different patterns were seen in the empathy dimensions between the study years and genders. Burnout scores showed no gender differences, while exhaustion and cynicism increased, and academic efficacy decreased with seniority. Academic efficacy was a consistently influential factor for both affective and cognitive empathy in both genders, all study years and the three domains of burnout.

CONCLUSION

Academic efficacy was a significant factor influencing both affective and cognitive empathy.

PRACTICAL IMPLICATIONS

The comprehensive nature of empathy in medical students may be better investigated by applying multi-dimensional empathy measurement tools and by analyzing multiple factors such as gender, study year and burnout.

Depression, anxiety, burnout and empathy among Spanish medical students

Medical Education studies suggest that medical students experience mental distress in a proportion higher than in the rest of the population In the present study, we aimed to conduct a nationwide analysis of the prevalence of mental health problems among medical students. The study was carried out in 2020 in all 43 medical schools in Spain, and analyzes the prevalence of depression, anxiety, empathy and burnout among medical students (n = 5216). To measure these variables we used the Beck Depression Inventory Test for assessing depression, the Maslach Burnout Inventory Survey for Students was used for burnout, the State-Trait Anxiety Inventory (STAI) was used to assess anxiety state and trait and the Jefferson Empathy Scale 12 to obtain empathy scores. In relation to depression, the data indicate an overall prevalence of 41%, with 23.4% of participants having moderate to severe levels, and 10% experiencing suicidal ideation. Burnout prevalence was 37%, significantly higher among 6^th year than among 1^st year students. Anxiety levels were consistent with those reported previously among medical students (25%), and were higher than in the general population for both trait and state anxiety. The prevalence of trait anxiety was higher among women. Empathy scores were at the top end of the scale, with the highest-scoring group (>130) containing a greater percentage of women. Similarly to those published previously for other countries, these results provide a clear picture of the mental disorders affecting Spanish medical students. Medicine is an extremely demanding degree and it is important that universities and medical schools view this study as an opportunity to ensure conditions that help minimize mental health problems among their students. Some of the factors underlying these problems can be prevented by, among other things, creating an environment in which mental health is openly discussed and guidance is provided. Other factors need to be treated medically, and medical schools and universities should therefore provide support to students in need through the medical services available within their institutions.

The role of difficulties in emotion regulation in predicting empathy and patient-centeredness in pre-clinical medical students: a cross-sectional study

While empathy and patient-centeredness (PC) are considered core variables in high-quality healthcare education and care, research suggests that empathy and PC decrease during the clinical years of study and that impairments in empathy and PC may be related to difficulties in emotion regulation. There is a growing interest in identifying the psycho-social variables that sustain and foster empathy and PC in medical students throughout their education. This study explored whether and to what extent emotion dysregulation predicted empathy and PC in medical students controlling for gender. Three hundred ninety-eight pre-clinical medical students enrolled at a university in northern Italy completed the Difficulties in Emotion Regulation Scale (DERS), the Interpersonal Reactivity Index (IRI) and the Patient-Practitioner Orientation Scale - 8 Items - Italian version (PPOS-8-IT). All statistically significant correlation coefficients between DERS, IRI and PPOS-8-IT scores were negative (rs from -.130 to -.336, ps ≤ 01), except for IRI Personal Distress and IRI Fantasy Scale that were mainly positively related to DERS scores (rs from .130 to .305, ps ≤ .01). Hierarchical multiple-regression analyses showed that DERS scores accounted for a significant amount of additional variance in both IRI and PPOS-8-IT components above and beyond gender. Emotion dysregulation was positively associated with Personal Distress (βs from .135 to .250, ps ≤ .007), whereas Empathic Concern, Perspective Taking, and the PC components were negatively predicted by emotion regulation difficulties (βs from -.131 to -.309, ps ≤ .005). Female students showed higher levels of all empathy and PC measures than males (ts from -3.49 to -5.54, ps ≤ 001) except for Perspective Taking. Tailored educational approaches that provide medical students with emotion regulation strategies implemented along the pre-clinical curriculum may sustain empathy and PC and equip students to appropriately and functionally face the emotional and interpersonal aspects of the clinical internship experience.

Does nonviolent communication education improve empathy in French medical students?

OBJECTIVES

To evaluate the impact of nonviolent communication (NVC) training on five aspects of medical students' empathy skills using implicit and explicit measures.

METHODS

312 third-year French medical students were randomly allocated to an intervention group (n = 123) or a control group (n = 189). The intervention group received 2.5 days of NVC training. For each group, empathy-related skills were measured implicitly using three cognitive tests (Visuo-Spatial Perspective Taking, Privileged Knowledge, Empathy for Pain evaluation) and explicitly using two self-rating questionnaires (Jefferson Scale of Physician Empathy, Empathy Quotient). Both groups completed tests and questionnaires before (pre-test) and three months after training (post-test). Responses were collected via online software, and data were analyzed using paired linear mixed models and Bayes Factors.

RESULTS

We found a significant increase in the Jefferson  Scale of Physician Empathy (JSPE) score between pre- and post-tests in the intervention group compared to the control group (linear mixed models: 0.95 points [0.17, 1.73], t₍₁₅₈₎ = 2.39, p < 0.05), and an expected gender effect whereby females had higher JSPE scores (1.57 points [0.72, 2.42], t₍₂₆₂₎ = -3.62, p < 0.001). There was no interaction between these two factors.

CONCLUSIONS

Our results show that brief training in nonviolent communication improves subjective empathy three months after training. These results are promising for the long-term effectiveness of NVC training on medical students' empathy and call for the introduction of NVC training in medical school. Further studies should investigate whether longer training will produce larger and longer-lasting benefits.

A National Survey on the characteristics of Iranian General Practitioners and Their Preferred Specialty: A Need to Transition toward Preventive Medicine

Background:

The shortage and unbalanced distribution of physicians has adverse effects on the provision of equitable services at all levels of health care and especially at the prevention and primary care levels. The choice of specialty can seriously change the structure and composition of the physician workforce. Therefore, this study aimed to investigate the relationship between background characteristics of Iranian general practitioners' (GPs) and their preferred specialty fields.

Methods:

In this mixed-method study, first, 12 medical doctors participated in a nominal group technique to determine the most important background characteristics that affect GPs' preferences for specialty selection. In the second phase, we conducted a survey among 680 GPs in six provinces from different geographic regions. We gathered data using a researcher-made checklist and analyzed them using an adjusted multivariate regression.

Results:

The adjusted analysis showed that being female, being married, being in an older age group, having children, graduation from universities located in the provincial centers, and decision for living and practicing in the less-populated areas were significantly associated with the Iranian GPs' preferences for non-surgical specialties.

Conclusions:

This study provided evidence that could inform national health workforce policy-makers to avoid unbalanced distribution of physicians and accordingly to ensure the provision of equitable services at all levels of healthcare and especially at the primary care level. Other effective factors on the selection of specialty should be evaluated at the national level using specific surveys and econometrics studies such as discrete selection experiment to move toward preventive medicine.

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.

Comparison of empathy with patients between first-year and last-year medical students of Tehran University of Medical Sciences

PURPOSE

This study was conducted to assess the developmental factors of empathy among medical students of Tehran University of Medical Sciences (TUMS).

METHODS

To assess the empathy levels, 42 first-year and an equal number of last-year medical students were randomly selected. They answered a questionnaire including the medical student version of the Jefferson Scale, demographic, and some related variables. Statistical analyses were performed using the Chi-square test, T-test, univariate, and multivariate regressions.

RESULT

The study population consisted of 51 (60.7 %) men and 33 (39.3 %) women with a mean (SD) age of 22.24 (4.10) years. The Jefferson score was 110.19 ± 13.61 and 103.52 ± 20.00 in first- and last-year medical students, respectively. Moreover, medical students who completely passed at least one of the considered empathy courses of the TUMS curriculum had higher empathy scores compared to their counterparts (109.83 ± 15.54 vs. 103.68 ± 19.02). There was no significant association between empathy and gender, self-experience of illness, marital status, family history of chronic disease, and parents' education (all P-values > 0.05). After adjusting for the effects of confounders, the empathy scores were significantly associated with the academic year level (p = 0.04), level of interest in medicine (p = 0.001), and passing the empathy courses (p = 0.04).

CONCLUSIONS

The data provided from a top Iranian medical school indicated that the academic year level, level of interest in medicine, and passing the empathy courses were significantly associated with the empathy level. Further studies are recommended.

Differences in personality related determinants of empathetic sensibility in female and male students of medicine

The issues of personality and its relations with the level of empathetic sensibility of medical doctors are broadly discussed in the literature. The aim of this study was an assessment of personality related predictors of empathy indicators in female and male students of medicine with consideration of gender differences. Methods applied were Empathic Sensitiveness Scale (ESS) and Personality Inventory (NEO-PI-R). The study included 153 participants, who were students of the fifth year of medical studies. Students filled in questionnaires during workshops in clinical psychological skills. Participation in the study was voluntary and anonymous. The statistical analysis was performed using Statistica 13 PL and PS IMAGO PRO (SPSS). Linear regression analysis with the interaction component was performed to explore the relationship between personality factors and gender and their interaction with the variable dependent level of empathy. The analysis showed that Extraversion, Openness and Agreeableness are associated with the level of Empathic Concern. Neuroticism, Extraversion, Agreeableness and Conscientiousness are associated with the level of Personal Distress. Extraversion, Openness, Agreeableness and Conscientiousness are associated with the level of Perspective-taking. The regression analysis with the interactive component showed that there is no relationship between gender and the level of empathy, therefore the interactions were insignificant. Empathetic sensibility is related to personality dimensions of the students of medicine. Although there has been no interaction among chief personality dimensions, empathy indicators and gender, detailed analysis of personality dimensions’ components has shown differences between men and women.

Personality traits are associated with cognitive empathy in medical students but not with its evolution and interventions to improve it

OBJECTIVE

Cognitive empathy might decrease during medical school. Factors associated with its evolution remain poorly understood, as well as whether such factors could moderate the effect of an intervention to preserve cognitive empathy. The aim was to explore the associations between personality traits and both cognitive empathy at baseline and its changes at follow-up. The possible effect of an intervention depended upon personality traits was also examined.

METHODS

The cohort consisted of fourth year medical students and the associations between personality traits, using the Short Big Five Inventory, and cognitive empathy changes at 3-month, using the Jefferson Scale of Empathy-Student version (JSE-S), were examined. A randomization in two groups (Balint groups versus no intervention) allowed examining whether the effect of the intervention depended upon personality traits. Linear regressions were adjusted for gender, anticipated specialty choice, parental education, living status, financial insecurity, randomization group and baseline JSE-S.

RESULTS

The cohort included 311 participants from October 2015 to December 2016 at Paris Diderot and Paris Descartes University. At follow-up, there was a JSE-S total score increase of 1.22(SD:9.10) in the intervention group, compared to a decrease of 1.64(SD:10.74) in the other group. Baseline JSE-S was positively associated with Extraversion and Conscientiousness and negatively with Neuroticism. In contrast, we found no associations between baseline personality traits and JSE-S change. There were no interactions between personality traits and randomization group.

CONCLUSION

Although personality might be linked with cognitive empathy, medical students may benefit from strategies designed for improving cognitive empathy regardless of their personality.

A thematic network for factors affecting the choice of specialty education by medical students: a scoping study in low-and middle-income countries

BACKGROUND

Medical specialty selection is a complex phenomenon that can affect the performance of health systems, community health, and physicians' lives. It is essential to identify the key factors influencing the choice of specialty for evidence-based policymaking. This scoping review aimed to provide a comprehensive map of evidence regarding the factors influencing the choice of specialty by medical students (MS) in low-and middle-income countries (LMICs) and also to determine knowledge gaps.

METHODS

We carried out a systematic search on six online databases from January 2000 to May 2020. We used a five-step scoping review method proposed by Arksey and O'Malley. We synthesized the data using a quantitative content analysis approach. Then, we developed a thematic network as a conceptual map for a better understanding of the concept.

RESULTS

The analysis led to the development of five main themes, including personal determinants, life fulfillment aspects, influential career aspects, educational determinants, and interpersonal effects. Moreover, the most frequent sub-themes were specific personal factors, controllable lifestyle, quality of working life, and future working conditions.

CONCLUSION

This review provided evidence on the factors influencing the choice of specialties. In order to support physician workforce policy with more precise evidence, it is necessary to explore the weight and ranking of these factors based on the socioeconomic contexts of the countries. This study also indicated that factors such as ethical values, various aspects of medical philosophy, and immigration tendencies are areas for further investigations.

Attitudes toward people with dementia among communication science and disorders students

The purpose of this study was to: 1) explore attitudes among Communication Sciences and Disorders (CSD) students toward people with dementia, 2) investigate factors that might be associated with the expressed attitudes, and 3) suggest a means for promoting positive attitudes among CSD students. 94 CSD students completed a three-section online survey via Qualtrics. First, participants provided demographic information in three categories: person, courses, and experiences. Second, they completed a 25-item quiz on aging and dementia. Finally, each participant submitted responses to the Scale of Attitude toward People with Dementia. A stepwise regression analysis revealed two factors that best predicted positive attitudes of participants toward people with dementia. The first factor was having completed more courses on gerontology and/or dementia and the second factor was having found the courses beneficial for their future career as speech-language pathologists. The findings of this study imply that providing CSD students with more courses in gerontology and/or dementia may foster more positive attitudes toward people with dementia. These findings indicate that maximum benefit may be achieved by designing courses on gerontology and dementia that include professional practice-oriented activities and assessments.

The Development of Empathy and Associated Factors during Medical Education: A Longitudinal Study

PURPOSE

In this longitudinal study, we investigated the development of empathy during medical education and assessed potential predictors of empathy at different time points in the course of medical studies.

METHODS

In our longitudinal study, starting in 2011, we surveyed medical students at Lübeck Medical School, Germany at the beginning of their course of study and after 2, 4, and 6 years (t0-t3) using standard instruments for empathy (Jefferson Scale of Empathy, Student Version, JSE-S), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), stress (Perceived Medical School Stress scale), and behavior and experience patterns (Arbeitsbezogene Verhaltens- und Erlebensmuster [Work-related Behavior and Experience Patterns]).

RESULTS

A total of 43 students completed all surveys. The cross-sectional samples for the different survey time points comprised between n = 220 and 658 students. We observed a slight, but statistically significant, increase of empathy scores from t0 to t3 (t(43) = -3.09, P < .01). Across all analyses, a preference for a people-oriented specialty was associated with a higher JSE-S sum score, as well as being female, whereas we saw a negative association between HADS depression and JSE-S scores.

CONCLUSION

In our study, empathy scores were shown to be relatively stable during medical education with a tendency to increase. In line with previous research, individuals preferring a people-oriented specialty and women showed higher empathy scores.

Validation of a Modified Jefferson Scale of Empathy for Observers to Assess Trainees

OBJECTIVE

"Demonstrate insight and understanding into emotion" is a competency amenable to simulation-based assessment. The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) has validity evidence for patients to assess provider empathy. A version adapted for a third-party observers does not exist. Our aim was to modify the JSPPPE and use recorded standardized encounters to obtain validity evidence.

METHODS

This cross-sectional study used video and data collected from 2 pediatric residencies. In 2018, 4 raters reviewed 24 videos of 12 interns communicating with standardized patients (SP) in 2 encounters and completed a modified JSPPE for observers (JSEO). Reliability between raters was established using Intraclass Correlations (ICC). JSEO mean scores were correlated to Essential Elements of Communication (EEC), JSPPPE, and faculty composite interpersonal communication (IC) scores using Spearman Rank.

RESULTS

The mean ICC for all 4 raters was 0.573 (0.376-0.755). When ICC was calculated for pairs of raters, Rater 1 was an outlier. ICCs for mean scores for pairs among the 3 remaining raters was 0.81 to 0.84. Mean JSEO scores from the four raters correlated with the JSPPPE (rho = 0.45, P = .03) and IC (rho = 0.68, P < .001), but not the EEC (rho = 0.345, P = .1).

CONCLUSIONS

We found validity evidence for the use of a modified JSPPPE for an observer to assess empathy in a recorded encounter with a SP. This may be useful as medical educators shift toward competency-based tracking. The brevity of this tool and potential assessment using video are also appealing.

Empathy, well-being, and mental health: do gender differences diminish by the end of medical school?

This study aims to investigate if medical students demonstrate differences related to gender in terms of empathy, burnout, tolerance, openness to spirituality, well-being, and mental health, and to examine whether these differences vary across levels of medical training. A cross-sectional study was conducted in the first semester of 2015 in a Brazilian medical school. The following were evaluated: quality of life (WHOQOL-Bref), burnout (Oldenburg), mental health (DASS-21), empathy (Empathy Inventory and ESWIM), and tolerance, well-being, and openness to spirituality (ESWIM). We investigated how these outcomes varied in terms of gender, stage of medical training, and its interaction using a two-way MANOVA. A total of 776 students were included and important differences were observed. As medical training advanced, the differences between genders that were present during students' initial years (greater empathy, worse quality of life, and worse mental health among women) tended to become nonsignificant during the clerkship years. In addition, a significant interaction between stage and gender was found for ESWIM Wellness; WHOQOL; DASS Anxiety and DASS Stress. These results may denote a shortcoming in the way medical schools approach gender differences. Educators should consider these findings when restructuring curricula to respect gender differences, thus fostering their respective potentials.

Relationship between level of empathy during residency training and perception of professionalism climate

BACKGROUND

Empathy is one of the vital personality attributes for all physicians. It is essential for establishing general interpersonal relationships among doctors and patients. Unfortunately, there is evidence for the decline of physician's empathy during the clinical training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment.

OBJECTIVE

This study examines the relationship between empathy level and perception of climate of professionalism among residents.

METHOD

The study participants included 70 residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital in Karachi, Pakistan. Two self-administered internet based surveys - Jefferson Scale of Physician Empathy (JSPE) and "Professionalism Climate Instrument"(PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation.

RESULTS

The overall response rate was 81.4% with mean empathy level of 103 ± 13. The internal consistency of each scale measured by Cronbach's coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106 + 8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (r_s = 0.56, p = 0.64).

CONCLUSION

The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism.

The distribution of Ohio's Certificates to Recommend: who will "prescribe" medical marijuana?

Background

Under Ohio Medical Marijuana Control Program rules, Ohio physicians that recommend medical marijuana (MMJ) to patients must possess a Certificate to Recommend (CTR) from the State Medical Board. Although a pre-program state survey indicated that more than a quarter of Ohio physicians were likely to recommend MMJ, only 473 physicians obtained CTRs in the first year of the program, amounting to just 1.39% of the physician workforce. The purpose of this study is to evaluate demographic factors that influence a physician’s decision to obtain the CTR.

Method

Using physician demographic data extracted from Ohio’s databases of medical licensees and CTR holders, as well as the American Medical Association Physician Masterfile, prevalence ratios for CTR holders were calculated for specialty, medical degree (Doctor of Medicine, MD, vs. Doctor of Osteopathy, DO), age and gender. A multivariate model was implemented to generate adjusted prevalence ratios (aPRs) reflecting the independent effects of specialty, degree, and age. To assess temporal variations in CTR acquisition, per-specialty CTR counts were also plotted as a function of program month.

Results

The best-represented specialties among CTR holders were Family Medicine (29.11%), Internal Medicine and its subspecialties (22.57%), and Anesthesiology (9.07%). Expressed as an adjusted per-specialty prevalence ratio in reference to Family Medicine, the dominant specialty was Physical Medicine and Rehabilitation (aPR 2.08, 95% CI 1.34–3.24), with the lowest measurable prevalence ratios found in Pediatrics (aPR 0.17, 95% CI 0.10–0.30) and Surgery (aPR 0.33, 95% CI 0.22–0.50). DOs were more likely to obtain CTRs than MDs (aPR 1.72, 95% CI 1.39–2.15). The mean age of CTR holders was 54.03 +/− 11.43, vs. 51.13 +/− 13.38 for non-CTR holders (p < .0001). Although gender could not be included in the multivariate model, males were more likely than females to obtain a CTR (PR 1.54, 95%CI 1.26–1.89). A plot of per-month CTR acquisition by specialty demonstrated a fairly consistent specialty distribution of CTRs in the first year, as well as variations in overall CTR acquisition that may correspond to program-operational events.

Conclusion

Specialty, type of medical degree, and age all correlate independently with the likelihood of registering to recommend medical marijuana in Ohio. Specialty distribution of CTRs remained fairly consistent in the program’s first year, although overall CTR acquisition may be sensitive to program-operational events such as delays in dispensary opening or product availability.

Communicative and Social Skills among Medical Students in Spain: A Descriptive Analysis

Effective risk communication in public health requires the development of social skills such as active listening and empathy. Communicative and social skills were evaluated in third-year medical students (n = 917) using the Active Listening Test and the Test of Cognitive and Affective Empathy. The results obtained revealed that our participants had equal or better-than-norm communication skills. Women scored higher in active listening whereas men scored higher on the General Empathy Scale. The students who preferred a clinical specialty obtained higher scores in active listening and empathetic abilities, as compared to students who chose a surgical specialty. In conclusion, the medical students who participated in the study exhibited good communicative and social skills. An association was observed between gender and specialty preference, and empathy and active listening skills.

Revisiting the trajectory of medical students' empathy, and impact of gender, specialty preferences and nationality: a systematic review

BACKGROUND

Empathy allows a physician to understand the patient's situation and feelings and respond appropriately. Consequently, empathy gives rise to better diagnostics and clinical outcomes. This systematic review investigates the level of empathy among medical students across the number of educational years and how this level relates to gender, specialty preferences, and nationality.

METHOD

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the authors conducted a systematic search of studies published between February 2010 and March 2019 investigating the level of empathy among medical students. The databases PubMed, EMBASE, and PsycINFO were searched. Studies employing quantitative methodologies and published in English or Scandinavian language and examining medical students exclusively were included.

RESULTS

Thirty studies were included of which 24 had a cross-sectional and 6 a longitudinal study design. In 14 studies, significantly lower levels of empathy were reported by increase in the number of educational years. The remaining 16 studies identified both higher, mixed and unchanged levels. In 18 out of 27 studies it was reported that females had higher empathy scores than males. Only three out of nine studies found an association between empathy scores and specialty preferences. Nine out of 30 studies reported a propensity towards lower mean empathy scores in non-Western compared to Western countries.

CONCLUSION

The results revealed equivocal findings concerning how the empathy level among medical students develops among medical students across numbers of educational years and how empathy levels are associated with gender, specialty preferences, and nationality. Future research might benefit from focusing on how students' empathy is displayed in clinical settings, e.g. in clinical encounters with patients, peers and other health professionals.

Exploration of empathy in Cyprus nursing and health care students: A mixed method study

Developing professionals who are perceptive to the needs of patients and can respond by expressing empathetic behavior is one of the aims of health care education. The aim of this study was to explore the level of empathy in health care students through a mixed method. The quantitative approach included the use of the Jefferson Scale of Empathy and the qualitative a focus group approach to further deepen into the descriptive results. 869 health care students (RR=81%) participated in the study and the level of empathy ranged from 42 to 139 with a mean score of 100.6 (20-140 scale). Significant statistical differences were found between the disciplines (F=8.6, p-value<0.001) and gender (p-value<0.001) with nursing students and women scoring the higher levels. Two focus groups of ten participants each were conducted with 3^rd and 4^th year nursing students. Four themes were derived from the analysis of these data a) empathy as an imperative component of care b) contact with the clinical reality c) the influence of family and choice of studies d) gender stereotypes. There is a lack of mixed methodologies in the empathy research and this study provided the opportunity of a better understanding of the health care students' views.

Cultura, ensino e aprendizagem da empatia na educação médica: scoping review

Este estudo teve o objetivo de identificar, na literatura, como a empatia é influenciada pelos diferentes fatores culturais no contexto de ensino e aprendizagem em saúde. Realizado por meio de scoping review , conforme a proposta de Joanna Briggs Institute (JBI), a busca foi realizada nas bases de dados PubMed, Lilacs, Scopus e Web of Science e executada entre o período de dezembro de 2017 a janeiro de 2018. Observou-se, pelas pesquisas, que os estudantes ocidentais têm maior nível de empatia quando comparados aos estudantes orientais. Além disso, há diferença na empatia entre diferentes etnias, raças, sexo e religião. Sua avaliação dá-se por meio de diferentes instrumentos. Assim, entre os fatores que influenciam a empatia, identificou-se a cultura como sendo um deles. São necessários novos estudos a fim de compreender da melhor forma a empatia entre as diversas profissões da saúde.

Differences and changes in the empathy of Korean medical students according to gender and vocational aptitude, before and after clerkship

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.

Empathy, burnout, life satisfaction, correlations and associated socio-demographic factors among Chinese undergraduate medical students: an exploratory cross-sectional study

BACKGROUND

Medical education is widely known to be a demanding process that may cause various mental health problems, such as burnout, which can lead to lowered levels of life satisfaction among medical students. Research shows that empathy is negatively correlated with burnout, but there are few studies on the relationship among empathy, burnout and life satisfaction in medical students. The objective of the present study is to explore the correlations of empathy and burnout with life satisfaction and the associated socio-demographic factors among Chinese undergraduate medical students.

METHODS

In this cross-sectional study, 1271 undergraduate medical students (age 19.42 ± 1.34 years, 36% male) from 1st to 4th grades completed questionnaires including the Interpersonal Reactivity Index Chinese version (IRI-C), the Maslach Burnout Inventory Modified Chinese version (MBI-MC), the Satisfaction With Life Scale (SWLS) and socio-demographic characteristics. Statistical analyses included Student's t-test, one-way ANOVA, post hoc Bonferroni tests, hierarchical linear regression analysis and general linear model-univariate full factorial model.

RESULTS

Over four academic years, medical students' empathy levels declined, but their burnout levels almost plateaued and their life satisfaction levels witnessed an initial fall before a rebound. Empathy was correlated with students' age and grade, and burnout was associated with students' maternal education. Significant differences in life satisfaction were detected with regard to medical students' age, academic year, the number of children in the family, place of residence and parents' educational levels.

CONCLUSIONS

Empathy explained 0.6% of the variance in life satisfaction in contrast to 13.7% of the variance explained by burnout in life satisfaction. Although empathy did not have a main effect on life satisfaction, there was an interaction effect of empathy and burnout on life satisfaction among students of high and low empathy and burnout levels. Students with high levels of empathy and low levels of burnout were most satisfied with life. Medical institutions and related authorities need to find effective measures to enhance students' empathy levels and reduce burnout to improve their life satisfaction.

Is empathy change in medical school geo-socioculturally influenced?

CONTEXT

There is convincing evidence that physician empathy leads to better patient care. As a result, there has been considerable research interest in investigating how empathy changes during undergraduate medical studies. Early (generally North American) studies raised concerns that medical training causes a decline in empathy. More recent studies (conducted around the world) have begun to suggest that either a slight increase or decrease in empathy occurs during undergraduate medical training, which has led some to argue that empathy changes indiscriminately (with no discernible pattern). This paper explores whether there is evidence to suggest that empathy changes indiscriminately or with a discernible geo-sociocultural pattern during undergraduate medical training.

METHODS

Literature that investigated change in empathy during undergraduate medical training was reviewed. Cross-sectional and longitudinal studies were tabulated separately according to their respective geographical locations. The tabulated results were analysed to investigate whether empathy changed similarly or differently within different geographical locations.

RESULTS

The studies reviewed indicate similar patterns of empathy change within approximate geo-sociocultural clusters. Whereas US studies predominantly show small but significant decreases in empathy, Far Eastern studies mostly show small but significant increases in empathy as undergraduates progress through the medical course.

CONCLUSIONS

These results suggest that change in empathy during undergraduate medical education is not as indiscriminate (patternless) as once thought. Additionally, these results support the notion that empathy is a locally construed global construct.

Understanding compassion for people with dementia in medical and nursing students

BACKGROUND

Compassion is an essential component of good quality care. Compassion towards people with dementia in health systems is often suboptimal, which can have negative impacts on clinical outcomes and patient experience. Attitudes are formed early in training and the literature on healthcare student compassion towards those with dementia is limited. This study aimed to understand how undergraduate medical and nursing students understand compassion towards people with dementia and factors influencing the delivery of compassionate care.

METHODS

Nine individual in-depth interviews and two focus groups were undertaken with 23 medical and nursing students. A topic guide was developed, and transcripts were analysed using thematic analysis.

RESULTS

The analysis identified three themes which students used to define compassion: (i) connection, (ii) care, and (iii) respect. Three factors were identified as being either facilitators or barriers to delivering compassionate care to people with dementia: (i) patient factors, (ii) student factors, and (iii) connection. Patient factors related to the presence of behaviours which might be challenging to manage. Student factors included student exposure to dementia, as well as student knowledge and skills. Connection focussed on whether there was an awareness and understanding of the person behind the diagnosis.

CONCLUSION

Undergraduate healthcare students are the future workforce for patients with dementia, and understanding how compassion develops within them is important. We found medical and nursing students had a broad understanding of compassion, and identified factors influence their compassion towards people with dementia. These novel data can be used to shape healthcare education programmes aimed at improving dementia care.

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.

Venus and Mars on the benches of the faculty: Influence of gender on mental health and behavior of medical students. Results from the BOURBON national study

Medical student wellness has emerged as an important issue in medical education.

OBJECTIVE

To evaluate the gender influence on psychiatric and/or psychological follow-up, psychotropic and illicit drug consumption, addictive behaviors, quality of life and motives for consumption in a large multicentric national sample of medical students.

METHODS

Medical students of the 35 French Medicine faculties were recruited through mailing lists and social networks between December 2016 and May 2017 and fulfilled Internet anonymized questionnaires.

RESULTS

Overall, 10,985 medical students were included in the present study (mean age 21.8 years, 9640 (87.8%) women). Compared to men, women were found to smoke tobacco and cannabis less frequently (aOR = 0.8 [0.7-0.9], p < 0.0001 and aOR = 0.3 [0.3-0.4], p < 0.0001 respectively), to have lower rate of alcohol use disorders (aOR = 0.7 [0.6-0.7], p < 0.0001). Men were also found to consume more frequently ecstasy, cocaine, mushrooms, amphetamine, LSD, codeine and ketamine (all p < 0.0001) for pleasure and novelty seeking, group effect, but also alleviating anxiety, sedative and stimulant effect and stress before exam (all p < 0.001) while women were more frequently followed-up by a psychiatrist and/or a psychologist (aOR = 2.0 [1.7-2.3],p < 0.0001), consumed more frequently anxiolytics (aOR = 1.6[1.3-1.9], p < 0.0001) and antidepressants (aOR = 1.4[1.1-1.9], p = 0.01), reported lower rates of physical and mental quality of life in all subscores (all p < 0.0001). They were more frequently exposed to sexual assault (aOR = 4.1 [2.5-6.9], p < 0.0001) and domestic violence (aOR = 1.6[1.1-2.5], p = 0.02) while men were more frequently exposed to physical assault (aOR = 0.4[0.4-0.5], p < 0.0001) during their medical studies.

CONCLUSIONS

Medical students are mostly women. While men and women are both exposed to professional and personal stress with differences, men are more frequently involved in addictive behavior and psychoactive substance consumption while women are mostly followed-up by psychiatrist and/or psychologist and psychotropic drug consumers, with more impaired self-reported mental and physical quality of life scores. These results should orientate future health strategies for the prevention of later mental illness onset and stress at work in hospital.

An Epidemiological Study on Empathy and its Correlates: A Cross-sectional Assessment among Medical Students of a Government Medical College of India

BACKGROUND

Empathy is a desirable quality in every clinician. It is a crucial determinant of patient-physician communication and relation. There are very few existent Indian studies on empathy of medical students and its correlates.

AIM

The aim of the study was to assess empathy level of medical students and its correlates.

METHODOLOGY

It was a cross-sectional, hospital-based, analytical observational study conducted from July to November 2017. In total, 249 undergraduate medical students of a medical college of Kolkata were interviewed with a structured schedule. The schedule comprised of the sociodemographic questionnaire, career satisfaction, future career choice, and Jefferson Scale of Empathy.

RESULTS

The mean empathy score was 98.5 ± 12.5. Third-semester students had higher empathy scores (102.4 ± 12.4) compared to fifth (97.2 ± 12.9) and seventh semester (95.0 ± 10.9) students. The difference between the mean scores of different semesters was statistically significant. Female students were more empathic than male students. In the multivariable linear regression model, sex, semester, residence, career satisfaction, future career choice, and current place of living were significant predictors of empathy scores.

CONCLUSION

Empathy level of medical students of our study was quite low compared to other studies conducted outside India. Empathy eroded with semester, which supports earlier pieces of evidence in this regard.

Novel Approaches To Undergraduate Oncology Education

With the increasing incidence of cancer and related survival, junior doctors are more commonly involved the management of oncology patients. A comprehensive oncology curriculum has been developed and adopted across medi-cal schools in Australia. However, it was not designed to inform how medical students should be taught, and whether curriculum content translates to knowledge and competency can depend on its implementation. We have conducted a literature review of PubMed, Embase and Cochrane databases to identify and summarise the evidence for novel approaches to delivering the undergraduate oncology curriculum. Numerous effective approaches have been developed across areas of prevention, clinical examination through simulation, the multidisciplinary team, psycho-oncology, palliative care and even research. There is growing focus on a holistic and multidisciplinary approach to cancer education although direct clinical exposure and interactions with cancer patients is still crucial. Medical schools may also have an under-recognised role in promoting positive health behaviour if their graduates are to convey these preventative measures to their patients. Application of such methods relies upon clinicians and medical educators to consider the practicability and relevance of specific implementation in their local context.

Are alexithymia and empathy predicting factors of the resilience of medical residents in France?

OBJECTIVES

To explore resilience, resilience predicting factors and resilience distribution in French medical residents.

METHODS

A cross-sectional study was conducted in which general practice residents (n = 380) were asked to answer the Jefferson Scale of Physician Empathy, the Connor-Davidson Resilience Scale, and the Toronto Alexithymia Scale. One hundred thirty-seven (137) responses were collected. The scores of the different scales have been calculated. The score differences were examined using the Student's t-test or analysis of variance. The correlations were estimated using the Pearson correlation coefficient. The relationships between scores were analysed by multiple linear regression. The heterogeneity of the sample was examined by non-hierarchical cluster analysis.

RESULTS

Resilience and empathy were positively correlated (r(135) = .36, p< .001). Alexithymia was negatively correlated with resilience, r(135) = -.40,p<.001, and empathy, r(135) = -.38, p<.001. Resilience was influenced by alexithymia, b = -.284, p = .001, empathy, b= .255, p = .002, gender (female < male), b = -.231, p = .002 and year of formation, β= .157, p = .036. Two clusters of residents were characterized. They differed by their empathy and resilience profiles and by alexithymia trait.

CONCLUSIONS

Alexithymia, empathy, gender and year of formation correspond to predicting factors of resilience. This suggests that the resilience of vulnerable residents can be enhanced by increasing their empathy and by reducing their alexithymia. Thus, teaching teams could sustain their students' well-being through educational programs aiming to develop their understanding of their own emotions and those of their patients.