Empathy and its Correlates among Undergraduate Medical Students at a Medical College in India

  • Tumul Nandan Veer Chandra Singh Garhwali Government Institute of Medical Science andResearch, Srinagar, Uttarakhand, India,
  • Rudresh Negi All India Institute of MedicalSciences, Bhopal, Madhya Pradesh, India
  • Dibyanshu Singh All India Institute of MedicalSciences, Bhopal, Madhya Pradesh, India
  • Amit Kumar Mehto Veer Chandra Singh GarhwaliGovernment Institute of Medical Science and Research, Srinagar, Uttarakhand, India
Keywords: Empathy,, Medical students,, Choice of specialty

Abstract

Introduction: Empathy is a highly desirable professional trait, since empathic communication skills promote patient satisfaction,
establish trust, reduce anxiety, increase adherence to treatment regimens, improve health outcomes, as well as decreasing the
likelihood of malpractice suits. It is beneficial to the physician as well, cognitively defined empathy can lead to personal growth,
career satisfaction resulting from the optimal clinical outcomes.
Purpose: The purpose of the study was to assess empathy level of medical students and its correlates.
Methodology: A cross-sectional observational study was conducted among undergraduate medical students of Veer Chandra
Singh Garhwali Government Institute of Medical Science and Research, Srinagar, Uttarakhand, with a survey tool employing
Jefferson Scale of Physician Empathy (JSE-S). JSE-S comprising certain details such as age, gender, year of medical school,
specialty of choice, and an inventory of 20 questions half of which are negatively phrased. The students recorded their response
on a scale of 1 of the 7, provided on a Likert scale in response to each item (1 = strongly disagree and 7 = strongly agree).
Scale is reversed (that is, 1 = strongly agree and 7 = strongly disagree) for the negatively phrased items.
Results: The mean empathy score among males was 103.4 (standard deviation [SD] – 17.33), and among females, it was
109.4 (SD – 15.37). In our study, this difference was found to statistically significant. A majority of students reported having
made the decision to enter the medical profession on their own accord, n = 355 (68.5%). For the rest, it was either their family
member’s decision or a combined decision, n = 66, 12.7% and n = 97, 18.7%, respectively. A majority of students, n = 360,
69.5%, preferred to join a medical specialty involving direct patient contact.
Conclusion: The empathy score varied with gender, with a higher mean score for females. It was also more for those satisfied
with their career choice compared to those who were unsatisfied. Semester wise, there was no increasing or decreasing pattern
of scores and was found to be variable. An impetus for empathy was provided with the introduction of foundation course for
medical students where life skills education is being imparted.

Author Biographies

Tumul Nandan, Veer Chandra Singh Garhwali Government Institute of Medical Science andResearch, Srinagar, Uttarakhand, India,

Senior Demonstrator, Department of Community Medicine

Rudresh Negi, All India Institute of MedicalSciences, Bhopal, Madhya Pradesh, India

Senior Resident, Department of Community and Family Medicine

Dibyanshu Singh, All India Institute of MedicalSciences, Bhopal, Madhya Pradesh, India

Senior Resident, Department of Community and Family Medicine

Amit Kumar Mehto, Veer Chandra Singh GarhwaliGovernment Institute of Medical Science and Research, Srinagar, Uttarakhand, India

Assistant Professor, Department of Community Medicine

References

1. Butow PN, Maclean M, Dunn SM, Tattersall MH, Boyer MJ. The dynamics
of change: Cancer patients’ preferences for information, involvement and
support. Ann Oncol 1997;8:857-63.
2. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physicianpatient
communication; the relationship with malpractice claims among
primary care physicians and surgeons. J Am Med Assoc 1997;277:553-9.
3. Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B.
Effectiveness of interventions to improve patient compliance a metaanalysis.
Med Care 1998;36:1138-61.
4. Brownell AKW, Côté L. Senior residents’ views on the meaning of
professionalism and how they learn about it. Acad Med 2001;76:734-7.
5. Canale S Del, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, et al. The
relationship between physician empathy and disease complications: An
empirical study of primary care physicians and their diabetic patients in
Parma, Italy. Acad Med 2012;87:1243-9.
6. Glaser KM, Markham FW, Adler HM, McManus PR, Hojat M.
Relationships between scores on the Jefferson Scale of physician empathy,
patient perceptions of physician empathy, and humanistic approaches to
patient care: A validity study. Med Sci Monit 2007;13:CR291-4.
7. Hojat M. Empathy in patient care: Antecedents, development, measurement,
and outcomes. In: Empathy in Patient Care: Antecedents, Development,
Measurement, and Outcomes. New York: Springer; 2007. p. 1-283.
8. Hojat M. Empathy in health professions education and patient care. In:
Empathy in Health Professions Education and Patient Care. Berlin: Springer
International Publishing; 2016. p. 1-450.
9. Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA,
et al. The devil is in the third year: A longitudinal study of erosion of
empathy in medical school. Acad Med 2009;84:1182-91.
10. Sinclair S, Beamer K, Hack TF, McClement S, Bouchal SR, Chochinov HM,
et al. Sympathy, empathy, and compassion: A grounded theory study of
palliative care patients’ understandings, experiences, and preferences.
Palliat Med 2017;31:437-47.
11. Halpern J. What is clinical empathy? Gen Intern Med 2003;18:670-4.
12. Newton BW. Walking a fine line: Is it possible to remain an empathic
physician and have a hardened heart? Front Hum Neurosci 2013;7:233.
13. Emotional and Cognitive Empathy in First-Year Medical Students; 2020.
Available from: https://www.hindawi.com/journals/isrn/2013/801530. [last
accessed on 2020 Aug 07].
14. Hojat M, Mangione S, Nasca TJ, Cohen MJ, Gonnella JS, Erdmann JB, et al.
The jefferson scale of physician empathy: Development and preliminary
psychometric data. Educ Psychol Meas 2001;61:349-65.
15. Sng G, Tung J, Ping YS, Lee SS, Win MT, Hooi SC, et al. Complex and
novel determinants of empathy change in medical students. Korean J Med
Educ 2016;28:67-78.
16. Santos MA, Grosseman S, Morelli TC, Giuliano IC, Erdmann TR. Empathy
differences by gender and specialty preference in medical students: A study
in Brazil. Int J Med Educ 2016;7:149-53.
17. Bertram K, Randazzo J, Alabi N, Levenson J, Doucette JT, Barbosa P. Strong
correlations between empathy, emotional intelligence, and personality traits
among podiatric medical students: A cross-sectional study. Educ Heal
Chang Learn Pract 2016;29:186-94.
18. Park KH, Kim DH, Kim SK, Yi YH, Jeong JH, Chae J, et al. The
relationships between empathy, stress and social support among medical
students. Int J Med Educ 2015;6:103-8.
19. Empathy in Undergraduate Medical Students of Bangladesh: Psychometric
Analysis and Differences by Gender, Academic Year, and Specialty
Preferences; 2020. Available from: https://www.hindawi.com/journals/
isrn/2014/375439. [Last accessed on 2020 Aug 08].
20. Rahimi-Madiseh M, Tavakol M, Dennick R, Nasiri J. Empathy in Iranian
medical students: A preliminary psychometric analysis and differences by
gender and year of medical school. Med Teach 2010;32(11):e471-8.
21. Shashikumar R, Chaudhary R, Ryali VS, Bhat PS, Srivastava K, Prakash J,
et al. Cross sectional assessment of empathy among undergraduates from a
medical college. Med J Armed Forces India 2014;70:179-85.
22. Khademalhosseini M, Khademalhosseini Z, Mahmoodian F. Comparison
of empathy score among medical students in both basic and clinical levels.
J Adv Med Educ Prof 2014;2:88-91.
23. Benabbas R. Empathy in Iranian medical students: A comparison by age,
gender, academic performance and specialty preferences. Med J Islam
Repub Iran 2016;30:439.
24. Chatterjee A, Ravikumar R, Singh S, Chauhan PS, Goel M. Clinical
empathy in medical students in India measured using the jefferson scale of
empathy-student version. J Educ Eval Health Prof 2017;14:33.
25. Hasan S, Al-Sharqawi N, Dashti F, Abdulaziz M, Abdullah A, Shukkur M,
et al. Level of empathy among medical students in Kuwait University,
Kuwait. Med Princ Pract 2013;22:385-9.
26. Magalhães E, Salgueira AP, Costa P, Costa MJ. Empathy in senior year
and first year medical students: A cross-sectional study. BMC Med Educ
2011;11:52.
27. Vallabh K. Psychometrics of the student version of the Jefferson scale of
physician Empathy (JSPE-S) in final-year medical students in Johannesburg
in 2008. S Afr J Bioeth Law 2011;4:63-8.
28. Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C,
et al. Empathy decline and its reasons: A systematic review of studies with
medical students and residents. Acad Med 2011;86:996-1009.
29. Roff S. Reconsidering the “decline” of medical student empathy as reported
in studies using the Jefferson scale of physician empathy-student version
(JSPE-S). Med Teach 2015;37:783-6.
30. Medical Council of India. Attitude, Ethics and Communication AETCOM.
New Delhi: Medical Council of India; 2018.
31. Competency Based Undergraduate Curriculum for the Indian Medical
Graduate. New Delhi: Medical Council of India; 2019.
32. Association of American Medical Colleges. Available from: https://www.
aamc.org. [Last accessed on 2020 Aug 07].
33. Cooke M, Irby DM, Sullivan W, Ludmerer KM. Medical education:
American medical education 100 years after the flexner report. N Engl J
Med 2006;355:1339-44.
34. Norcini JJ, McKinley DW. Assessment methods in medical education.
Teach Teach Educ 2007;23:239-50.
35. Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M.
Physician empathy: Definition, components, measurement, and relationship
to gender and specialty. Am J Psychiatry 2002;159:1563-9.
36. Biswas B, Haldar A, Dasgupta A, Mallick N, Karmakar A. An
epidemiological study on empathy and its correlates: A cross-sectional
assessment among medical students of a government medical college of
India. Indian J Psychol Med 2018;40:364-9.
37. Narang R, Mittal L, Saha S, Aggarwal V, Sood P, Mehra S. Empathy among
dental students: A systematic review of literature. J Indian Soc Pedod Prev
Dent 2019;37:316-26.
38. Rajput S, Puranik M, Shanbhag N, Kumar A. Factors affecting empathy
among indian dentists. Indian J Dent Res 2020;31:14-21.
39. Jefferson Scale of Empathy. Available from: https://www.jefferson.
edu/academics/colleges-schools-institutes/skmc/research/researchmedical-
education/jefferson-scale-of-empathy.html. [Last accessed on
2020 Aug 08].
40. Hojat M, DeSantis J, Shannon SC, Mortensen LH, Speicher MR, Bragan L,
et al. The Jefferson scale of empathy: A nationwide study of measurement
properties, underlying components, latent variable structure, and national
norms in medical students. Adv Heal Sci Educ 2018;23:899-920.
41. Newton BW, Barber L, Clardy J, Cleveland E, OʼSullivan P. Is there
hardening of the heart during medical school? Acad Med 2008;83:244-9.
42. Christov-Moore L, Simpson EA, Coudé G, Grigaityte K, Iacoboni M,
Ferrari PF. Empathy: Gender effects in brain and behavior. Neurosci
Biobehav Rev 2014;46:604-27.
43. Pantovic M, Dunjic-Kostic B, Gligoric M, Lačković M, Damjanovic A,
Ivković M. Empathy predicting career choice in future physicians. Engrami.
2015;37:37-48
Published
2021-10-01
Section
Original Articles