Development of a metacognitive effort construct of empathy during clinical training: a longitudinal study of the factor structure of the Jefferson Scale of Empathy

Stansfield, R. Brent; Schwartz, Alan; O’Brien, Celia Laird; Dekhtyar, Michael; Dunham, Lisette; Quirk, Mark E.

doi:10.1007/s10459-015-9605-1

Cited by 46 publications

(64 citation statements)

References 29 publications

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“…Although this study is unique in that it provides an in‐depth, longitudinal assessment of several component processes of empathy, both self‐reported and behavioural, across a large number of students and multiple time‐points, it has some limitations. First, the sample size is small compared with those of recent work that has examined changes in empathy over time during medical training as assessed by the JSPE, as well as its factor validity . However, this sample size is comparable with those in much of the other longitudinal research on changes in empathy over the course of medical school, and this is the first study, to the present authors’ knowledge, to assess and compare empathy changes in medical students as assessed by the JSPE, or empathy in the context of the physician–patient interaction, and by a more general measure of students’ capacity for empathy, the QCAE, along with measures designed to assess the behavioural manifestation of this capacity.…”

Section: Discussionmentioning

confidence: 85%

“…First, the sample size is small compared with those of recent work that has examined changes in empathy over time during medical training as assessed by the JSPE, as well as its factor validity. 13 However, this sample size is comparable with those in much of the other longitudinal research on changes in empathy over the course of medical school, 10,14 and this is the first study, to the present authors' knowledge, to assess and compare empathy changes in medical students as assessed by the JSPE, or empathy in the context of the physician-patient interaction, and by a more general measure of students' capacity for empathy, the QCAE, along with measures designed to assess the behavioural manifestation of this capacity. Additionally, there may be potential bias as a result of the self-selection of participants in that patterns of change may be different in students who did not volunteer for the study.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is not clear how reliable this decline is . Recent work failed to find changes in empathy during medical school or found declines in only some aspects of empathy and none in others . There is some evidence for increases in behavioural aspects of empathy .…”

Section: Introductionmentioning

confidence: 98%

“…11 Recent work failed to find changes in empathy during medical school 12 or found declines in only some aspects of empathy and none in others. 13 There is some evidence for increases in behavioural aspects of empathy. 14 This suggests that empathy changes during medical training may be more complex than can be represented by an overall decline.…”

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confidence: 99%

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The complexity of empathy during medical school training: evidence for positive changes

2017

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Background Empathy is an essential aspect of clinical care, associated with improved patient satisfaction, increased adherence to treatment, and fewer malpractice complaints. Previous studies suggest that empathy declines during medical training. However, this past research relied on a single narrowly operationalized self-report measure of empathy. As empathy is a complex socio-emotional construct, it is critical to assess changes across its distinct components using multiple measures, to better understand how medical training influences empathy. Methods In a longitudinal design, medical students completed a series of self-report and behavioral measures twice a year during the first three years of their study (2012 – 2015). These included the previously used Jefferson Scale of Physician Empathy (JSE), designed to assess empathy in the clinical context, the Questionnaire of Cognitive and Affective Empathy (QCAE), designed to assess overall empathy and its main components, and behavioral measures of sensitivity to others’ pain and understanding of other’s emotions, both important aspects of empathy. Employing multiple measures allowed for a more complete assessment of medical students’ empathy and related processes. Results Replicating previous work, students’ empathy assessed by the JSE decreased over training. However, on the QCAE, aspects of students empathy, specifically overall cognitive empathy and it’s subcomponent perspective-taking and the emotion contagion subcomponent of affective empathy improved while the remaining subcomponents stayed stable. Students also exhibited comparable growth in their understanding of others’ emotions and increased sensitivity for others’ pain during medical school. Conclusions Changes in empathy during medical school cannot be simply characterized as an overall decline. Indeed, aspects of empathy thought to be valuable in positive patient physician interactions improve during training. Overall, this study points to the importance of assessing the distinct components of empathy using multiple forms of measurement in order to better understand the mechanisms involved in empathy changes in medical practice.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

mentioning

confidence: 99%

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The complexity of empathy during medical school training: evidence for positive changes

2017

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“…In a large scale exploratory and confirmatory factor analytic study with allopathic medical students (Stansfield et al 2016), a 3-factor model was confirmed as an acceptable fit for the preclinical years, but a 4-factor model emerged as a better fit for the clinical years of medical school education. Similarly, the 3-factor structure was also confirmed in medical students from two Spanish medical schools (Ferreira-Valente et al 2016), and in Turkish medical students (Bilgel and Ozcakir 2017).…”

Section: Resultsmentioning

confidence: 99%

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

Hojat

DeSantis

Shannon³

et al. 2018

Adv in Health Sci Educ

180

174

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

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Clarifying changes in student empathy throughout medical school: a scoping review

Ferreira-Valente

Monteiro

Barbosa³

et al. 2016

Adv in Health Sci Educ

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Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.

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Development of a metacognitive effort construct of empathy during clinical training: a longitudinal study of the factor structure of the Jefferson Scale of Empathy

Cited by 46 publications

References 29 publications

The complexity of empathy during medical school training: evidence for positive changes

The complexity of empathy during medical school training: evidence for positive changes

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

Clarifying changes in student empathy throughout medical school: a scoping review

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