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      Empathy in Chinese eight-year medical program students: differences by school year, educational stage, and future career preference

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          Abstract

          Backgroud

          To examine the psychometric properties of a Chinese translation of the Jefferson Scale of Empathy (Student-version, JSE-S), and to study differences in empathy scores among eight-year undergraduate medical students across gender, year of study, and future career preference.

          Methods

          The JSE-S was administered to 442 participants from December 2016 to July 2017, who were all first- to seventh-year students on an eight-year medical education course at Fudan University. Factor analysis was used to examine the underlying components of the Chinese version of the JSE-S. The data analyses comprised a t-test and analyses of variance.

          Results

          Factor analysis confirmed four components: perspective taking, compassionate care, ability to stand in patient’s shoes, and difficulties in adopting patient’s perspective. The lowest empathy score was found in the seventh-year students (99.5), while a decline was found across school years. Students in clinical training (sixth/seventh year) had lower empathy than students in premedical study (first/second year), basic medicine (third/fourth year), and clinical medicine (fifth year). Statistically significant differences in empathy mean scores were found in respect of future career preference but not gender. Students who preferred not to become doctors had lower empathy than students who preferred to become doctors, who were undecided, and who did not specify.

          Conclusions

          The findings support the construct validity and reliability of the Chinese version of the JSE-S for medical students. The study also revealed the features of empathy in eight-year program students, and provided a reliable reference to design interventions to cultivate empathy among Chinese medical students.

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          Most cited references27

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          Characterizing changes in student empathy throughout medical school.

           Empathy is important in the physician-patient relationship. Prior studies suggest that medical student empathy declines with clinical training.  We examined the trend of empathy longitudinally; determined differences in empathy according to gender and medical specialty preferences; and determined empathy and career preference differences among students admitted through different medical school admission pathways.  The data for this study were collected using a longitudinal cohort design and included 2652 observations nested within 1162 individuals. Participants were medical students at a university-based medical school surveyed yearly from 2007 through 2010. Empathy was measured by the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a validated, 20-item self-administered questionnaire. Predictors of JSPE-S scores included gender, age, anticipated financial debt upon graduation and future career interest.  Empathy scores of students in preclinical years were higher than in clinical years. Gender was a significant predictor of empathy, with women having higher empathy scores than men. Students preferring technology-oriented specialties had lower empathy scores. When career preference was controlled, higher levels of debt were significantly associated with greater empathy. Students with high baseline empathy decreased less than students with low baseline empathy during medical school. Students in traditional four-year medical school programs had higher baseline empathy than those in early pathway programs.  Self-reported empathy for patients, a possibly critical factor in high-quality patient-centered care, wanes as students advance in clinical training, particularly among those entering technology-oriented specialties. In the era of new health care policy and primary care shortages, our research may have implications for the medical education system and admission policy.
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            Empathy in senior year and first year medical students: a cross-sectional study

            Background The importance of fostering the development of empathy in undergraduate students is continuously emphasized in international recommendations for medical education. Paradoxically, some studies in the North-American context using self-reported measures have found that empathy declines during undergraduate medical training. Empathy is also known to be gender dependent- (highest for female medical students) and related to specialty preference - (higher in patient-oriented than technology-oriented specialties). This factor has not been studied in Portuguese medical schools. Methods This is a cross-sectional study of undergraduate medical students on self-rated measures of empathy collected at entrance and at the conclusion of the medical degree, and on the association of empathy measures with gender and specialty preferences in one medical school in Portugal. Empathy was assessed using the Portuguese adaptation of the Jefferson Scale of Physician Empathy-students version (JSPE-spv) among three cohorts of undergraduate medical students in the first (N = 356) and last (N = 120) year. The construct validity of JSPE-spv was cross-validated with Principal Component Analysis and Confirmatory Factor Analysis. Reliability was assessed using Cronbach' Alpha. Global JSPE-spv score differences were examined by year of medical school, gender and specialty preferences (people-oriented vs technology-oriented specialties). Results The empathy scores of students in the final year were higher as compared to first year students (F (1,387) = 19.33, p < .001, ɳ2 p = 0.48; π = 0.99). Female students had higher empathy scores than male students (F (1,387) = 8.82, p < .01, ɳ 2 p = 0.23; π = 0.84). Significant differences in empathy were not found between the students who prefer people-oriented specialties compared to those who favor the technology-oriented specialties (F (1,387) = 2.44, p = .12, ɳ 2 p = 0.06; π = 0.06). Conclusions This cross-sectional study in one medical school in Portugal showed that the empathy measures of senior year students were higher than the scores of freshmen. A longitudinal cohort study is needed to test variations in students' empathy measures throughout medical school.
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              Perception of empathy in the therapeutic encounter: effects on the common cold.

              To evaluate the effects of patient-practitioner interaction on the severity and duration of the common cold. We conducted a randomized controlled trial of 719 patients with new cold onset. Participants were randomized to three groups: no patient-practitioner interaction, "standard" interaction or an "enhanced" interaction. Cold severity was assessed twice daily. Patients randomized to practitioner visits used the Consultation and Relational Empathy (CARE) measure to rate clinician empathy. Interleukin-8 (IL-8) and neutrophil counts were obtained from nasal wash at baseline and 48 h later. Patients' perceptions of the clinical encounter were associated with reduced cold severity and duration. Encounters rated perfect on the CARE score had reduced severity (perfect: 223, sub-perfect: 271, p=0.04) and duration (perfect: 5.89 days, sub-perfect: 7.00 days, p=0.003). CARE scores were also associated with a more significant change in IL-8 (perfect: mean IL-8 change 1586, sub-perfect: 72, p=0.02) and neutrophil count (perfect: 49, sub-perfect: 12, p=0.09). When patients perceive clinicians as empathetic, rating them perfect on the CARE tool, the severity, duration and objective measures (IL-8 and neutrophils) of the common cold significantly change. This study helps us to understand the importance of the perception of empathy in a therapeutic encounter. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Contributors
                lidongju@shmu.edu.cn
                huimingxu@sina.com
                14301050233@fudan.edu.cn
                slma@fudan.edu.cn
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                22 October 2018
                22 October 2018
                2018
                : 18
                : 241
                Affiliations
                [1 ]ISNI 0000 0001 0125 2443, GRID grid.8547.e, Experimental Teaching Center of Basic Medicine,School of Basic Medical Sciences, , Fudan University, ; Shanghai, China
                [2 ]Shimen Second Road Community Health Service Center, Jing-An District, Shanghai, China
                [3 ]ISNI 0000 0001 0125 2443, GRID grid.8547.e, Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, , Fudan University, ; Shanghai, China
                Author information
                http://orcid.org/0000-0002-2014-025X
                Article
                1348
                10.1186/s12909-018-1348-2
                6198363
                30348197
                c7e2698a-9650-4142-9a26-1e253582a5eb
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 January 2018
                : 12 October 2018
                Funding
                Funded by: Jing'an District Health Bureau
                Award ID: JWRC2014G24
                Funded by: FundRef http://dx.doi.org/10.13039/501100003347, Fudan University;
                Award ID: 2018A015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Education
                empathy,chinese eight-year medical students,jefferson scale of empathy
                Education
                empathy, chinese eight-year medical students, jefferson scale of empathy

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