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Empathy in medical students of Córdoba, Argentina

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Introduction: Physicians' empathy is an advantage for a better patient care and resolution of disease, and is considered a relevant part of professional training. Objective: To measure the level of empathy and its components in medical students of the city of Córdoba, Argentina. Methods: This was an exploratory, cross-sectional study. The Jefferson Scale of Physician Empathy was administered, in its Spanish version for health sciences students (version S), validated in Mexico and Chile, and culturally adapted to Argentina based on experts' opinion. A two-factor analysis of variance (model III) was used to assess mean differences between sexes and school years, and the interaction between these factors. Results: 306/497 students from first through fifth year assessed in November 2016. The sample was stratified by school year and sex. Significant differences were observed in overall empathy and in compassionate care in both factors. These differences increased over the years (higher among fifth year students and lower among first year ones), and women showed higher values than men in terms of empathy and compassionate care. Conclusion: Overall empathy, and the compassionate care component specifically, increased from first through fifth year (and were higher among women compared to men), which evidenced the progressive development of the affective component of empathy. The percentage of development of overall empathy and the cognitive components showed little progression.
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Arch Argent Pediatr 2019;117(2):81-86 / 81
Empathy in medical students of Córdoba,
Argentina
a. School of
Health Sciences,
Universidad
Católica de
Córdoba, Argentina.
b. School of Health
Sciences,
Universidad de
Atacama, Copiapó,
Region III, Chile.
E-mail address:
María J. Ulloque:
Magister: mjulloque@
yahoo.com.ar
Funding:
Universidad Católica
de Córdoba, Argentina,
Research Secretariat,
project code:
80020150200082CC.
Conflict of interest:
None.
Received: 12-19-2017
Accepted: 8-15-2018
ABSTRACT
Introduction. Physicians’ empathy is an
advantage for a better patient care and resolution
of disease, and is considered a relevant part of
professional training.
Objective. To measure the level of empathy and
its components in medical students of the city
of Córdoba, Argentina.
Methods. This was an exploratory, cross-sectional
study. The Jeerson Scale of Physician Empathy
was administered, in its Spanish version for
health sciences students (version S), validated
in Mexico and Chile, and culturally adapted to
Argentina based on experts’ opinion. A two-
factor analysis of variance (model III) was used to
assess mean dierences between sexes and school
years, and the interaction between these factors.
Results. 306/497 students from rst through
fth year assessed in November 2016. The
sample was stratied by school year and sex.
Signicant dierences were observed in overall
empathy and in compassionate care in both
factors. These dierences increased over the
years (higher among fth year students and
lower among rst year ones), and women showed
higher values than men in terms of empathy and
compassionate care.
Conclusion. Overall empathy, and the
compassionate care component specically,
increased from rst through fth year (and were
higher among women compared to men), which
evidenced the progressive development of the
aective component of empathy. The percentage
of development of overall empathy and the
cognitive components showed little progression.
Key words: professional training, medicine, students,
empathy.
http://dx.doi.org/10.5546/aap.2019.eng.81
To cite: Ulloque MJ, Villalba S, Varela de Villalba T,
Fantini A, et al. Empathy in medical students of
Córdoba, Argentina. Arch Argent Pediatr 2019;117(2):81-
86.
INTRODUCTION
Empathy has been described as the
synthesis of two core components:1
cognitive empathy, which is the
ability to understand the experience
and feelings of other people and the
capability to observe and understand
the world from another person’s
perspective, and emotional empathy,
which relates the affective aspect to
the ability to share the experiences of
others.2,3 The contribution of social
determinants to both individual and
collective health has been gaining
relevance in medical training
programs, together with students’
involvement in the care of vulnerable
populations. Empathy is recognized
as a manner of binding students and
patients together, but there is still
scarce evidence on how to help students
develop such skill in favor of these
populations.4
At present, numerous factors have
an effect on health care providers’
practice: the economic crisis, excessive
technicality, and bureaucracy,
which account for the deterioration
in empathy, integrity, solidarity,
altruism or confidentiality.5 Published
studies have demonstrated the
advantages of physicians’ empathetic
manner for a better patient care6,7 and,
when the patient-doctor relationship
is positive, there are more possibilities
of disease resolution or maintenance
of health status; therefore, this
is an essential element in medical
practice.7,8 It is worth noting the
importance of developing empathy
in pediatrics because it contributes
to a more favorable doctor-patient-
family relationship and, therefore, an
improved health care, thus playing an
María J. Ulloque, Magistera, Silvina Villalba, M.D.a, Teresa Varela de Villalba, M.D.a,
Adrián Fantini, Medical Specialista, Susana Quinteros, Medical Specialista and
Víctor Díaz-Narváez, PhD.b
Original article
82 / Arch Argent Pediatr 2019;117(2):81-86 / Original article
active role in a pediatric patient’s health care and
recovery.9
Medical students’ empathy, and its
components, have been assessed in different
countries of Europe, Asia, Latin America and also
in the United States of America;1,2,4,6,7,10-16 however,
no studies have been published on how they
work in medical students attending Argentine
universities.
The objective of this study was to measure the
level of empathy and its components in medical
students of the city of Córdoba, Argentina.
POPULATION AND METHODS
This was an exploratory, cross-sectional
study conducted in the context of the Helsinki
guidelines. The population was made up of
students from the first through fifth year of the
school of Medicine of Universidad Católica de
Córdoba (UCC), Argentina. Data were collected
in June 2016. The Jefferson Scale of Physician
Empathy (JSPE) was administered, in the Spanish
version for medical students (version S), which
had been validated in Mexico and Chile,17,18 and
culturally adapted to Argentina based on experts’
opinion,19 which had also been used in the study
by Díaz et al.6 In addition to the construct of
overall empathy (E), its three components
or domains were analyzed: compassionate
care (CC), perspective taking (PT), and ability
to stand in someone else’s shoes (ASSES). The
scale was administered confidentially (neutral
operator), once participants had signed the
informed consent. Students’ comprehension of
the culturally adapted scale was pilot-tested.
Data were tested for normality (Kolmogorov-
Smirnov) and homoscedasticity (Levene). The
internal reliability of data was measured using
the total Cronbach’s alpha and this statistics’
values as each element was removed (questions),
an intraclass correlation coefficient, Hotelling’s T2
distribution, and Tukey’s test of non-additivity
were estimated. The mean and standard
deviation were also estimated. A two-factor
analysis of variance (ANOVA) (model III) was
done to establish mean differences between
sexes and school years, and the interaction
between these two factors. Data were described
using single arithmetic diagrams and processed
with the SPSS 22.0® statistical software. The
percentage of development (PD) was considered
the quotient between two magnitudes: a) the
effective difference between the scores observed
in fifth year students minus the score observed
in first year students (D1) compared to b) the
possible difference between the highest empathy
value permitted by the scale (140) in relation
to the effective empathy value among first
year students (D2): PD = D1/D2. The PD is an
indicator that shows the extent of progression
in empathy levels that may be observed in
cross-sectional and longitudinal studies. The
significance level was established at α ≤ 0.05 and
β ≤ 0.20 in all cases.
RESULTS
The population was made up of 497 medical
students; a sample of 306 was analyzed (61.57 %
of the total). The sample stratified by school
year was as follows: first year = 49, second
year = 40, third year = 95, fourth year = 46, and
fifth year = 76. In terms of sex, the sample was
distributed into 195 female students and 111 male
students. The total student population was not
analyzed because a) they were absent or late
for class (125 students) on the day the scale was
administered, b) the instruments were not fully
completed (36 students); or c) they did not agree to
participate voluntarily (30 students). The scale was
not administered to students who were absent to
prevent any potential answer contamination. The
results of the mean and standard deviation of the
study outcome measures and the sample size for
each level and combination of the two factors that
were analyzed for overall empathy and each of its
components are shown in Table 1.
The Kolmogorov-Smirnov test and the
Levene test were not significant (p > 0.05);
data were distributed normally and showed
homoscedasticity. Cronbach’s alpha values
were satisfactory (non-typified = 0.766;
typified = 0.789), and this suggested that
data displayed internal reliability. The total
Cronbach’s alpha value, if an element (question)
was removed, ranged between 0.744 and 0.777;
and it was inferred that the test showed a high
reliability, regardless of the removal of any
element. The intraclass correlation coefficient
was 0.766 (F = 4.27, p = 0.001), which confirmed
that data were adequately reliable. Hotelling’s T2
test (F = 114.3, p = 0.001) and Tukey’s test of non-
additivity (F = 10.32, p = 0.001) allowed to infer,
in the first case, that the mean values of questions
differed from one another. This demonstrated that
not all questions provided the same value to the
overall mean (5.64) and showed variability among
the answers of the scale. In the second case, it was
inferred that data showed no additive effect (it
Empathy in medical students of Córdoba, Argentina
/ 83
required a sample increase); the methods used for
analysis proved to be adequate.
Table 2 shows the ANOVA results applied
to empathy and each of its components. It was
observed that, for E, the school year (SY) factor
was significant (F = 2.73, p = 0.029); the highest
value was observed in fifth year and the lowest
one, in second year (Table 1, Figure 1.a); the Eta-
squared (0.036) and the observed power (0.752)
were satisfactory; the sex (S) factor showed
highly significant differences (F = 8.05, p = 0.005)
and the mean value was higher among women
than men (Table 1); the Eta-squared value was
0.026 and the power, 0.807, and both values
were satisfactory. For the CC component,
significant differences were observed in the SY
factor (F = 2.45, p = 0.045); the highest value was
recorded in fifth year students and the lowest one,
in first year students; the Eta-squared (0.032) and
the observed power (0.788) were satisfactory. In
Table 1. Estimation of scores for overall empathy (and each of its components) by school year and sex
SD: standard deviation.
School Sex Empathy Compassionate Perspective Ability to stand in n
year care taking someone else’s shoes
Mean SD Mean SD Mean SD Mean SD
First Female 111.63 8.650 42.26 4.667 58.69 6.328 10.69 2.938 35
Male 106.71 11.678 39.21 6.542 57.79 5.309 9.71 2.840 14
Total 110.22 9.745 41.39 5.381 58.43 6.014 10.41 2.915 49
Second Female 110.62 10.265 41.65 5.051 57.77 6.901 11.19 2.638 26
Male 107.93 13.135 41.21 4.995 55.29 8.713 11.43 3.413 14
Total 109.68 11.258 41.50 4.972 56.90 7.568 11.28 2.891 40
Third Female 115.27 9.216 43.97 4.980 59.86 6.278 11.44 3.143 66
Male 108.38 10.818 40.41 5.852 57.79 8.028 10.17 3.413 29
Total 113.17 10.187 42.88 5.483 59.23 6.883 11.05 3.263 95
Fourth Female 114.31 16.323 43.62 7.514 60.41 8.588 10.28 2.750 29
Male 114.29 10.815 43.00 6.364 60.29 4.767 11.00 3.221 17
Total 114.30 14.400 43.39 7.044 60.37 7.347 10.54 2.919 46
Fifth Female 117.77 9.097 44.85 3.964 61.56 5.734 11.36 2.951 39
Male 111.86 14.281 42.51 6.569 58.65 8.908 10.70 3.439 37
Total 114.89 12.192 43.71 5.482 60.14 7.543 11.04 3.193 76
Total Female 114.35 10.755 43.48 5.274 59.79 6.701 11.08 2.950 195
Male 110.18 12.516 41.46 6.198 58.14 7.738 10.58 3.307 111
Total 112.84 11.581 42.75 5.700 59.20 7.127 10.90 3.089 306
Table 2. Results of the relationship of overall empathy and each of its components by school year and sex
Overall empathy F (p) Eta-squared Power
SY 2.73 0.029 0.036 0.752
S 8.05 0.005 0.026 0.807
SY*S 0.777 0.541 0.010 0.249
Compassionate care
SY 2.45 0.045 0.032 0.788
S 7.91 0.005 0.026 0.801
SY*S 0.796 0.529 0.011 0.254
Perspective taking
SY 2.097 0.081 0.028 0.620
S 3.553 0.060 0.012 0.468
SY*S 0.336 0.854 0.005 0.126
Standing in someone else’s shoes
SY 0.758 0.554 0.010 0.243
S 0.966 0.326 0.003 0.165
SY*S 0.926 0.449 0.012 0.293
(p) Probability of making a type I error.
* Symbol for the interaction between SY and S.
SY: school year; S: sex.
84 / Arch Argent Pediatr 2019;117(2):81-86 / Original article
relation to S, highly significant differences were
observed (F = 7.91, p = 0.005), and the highest
value was recorded in women (Table 1, Figure 1.b).
For the PT component, the ANOVA showed no
significant differences in any of the factors or
the interaction; therefore, no differences were
observed between men and women and among
the school years (Table 1, Figure 1.c). Lastly, the
situation for the ASSES component was similar
to that of the component analyzed above (Table 1,
Figure 1.d). Results observed here should be
interpreted with caution, especially when the Eta-
squared and the power values were not entirely
satisfactory.
The PD of E in first year students was
estimated to be 30.83 (140-109.17): the difference
in empathy between fifth and first year students
(114.82-100.17) was 5.65 points; this means that
only 18.33 % of the total possible development
potential was covered.
The PD of the CC component in first year
students was estimated to be 5.29 (49-43.71): the
difference in empathy between fifth and first
year students (43.71-41.39) was 2.32 points; this
means that only 43.86 % of the total possible
development potential was covered.
The development potential of the PT
component was observed to be 9.86 points (70-
60.14): the difference between first and fifth year
students (60.14-58.43) was 1.71 points; as a result,
the development potential of this component was
17.34 %. Lastly, it was observed that for the ASSES
component, the development potential was 9.96
(21-11.04); therefore, the percentage of coverage of
the total development potential was 0.63 %.
Figure 1 (1.a-1.d) is a graphic representation
of the mean values for the SY and S factors.
Empathy and CC increase with school years, and
differences in such development are observed
between both sexes. Certainly, such behavior is
analyzed based on the fact that there are statistical
differences between sexes in terms of E and CC.
DISCUSSION
The results of this study show that women
had higher E and CC levels than men (significant
differences) and only had absolute value
differences in relation to the PT and ASSES
components. The higher levels observed in the
CC component, which is related to emotional
empathy, indicate that students have a
compassionate basis. Other studies conducted
in different courses from several universities
and Latin American countries also showed such
contrast between sexes in favor of women.6,10,17,20-23
Likewise, the study by Varela et al.19 found such
difference in dental students from Latin American
universities.
In addition, empathy progressed along school
years. These results were consistent with those
Figure 1. Distribution of overall empathy and each of its components in the school year and sex factors
Empathy in medical students of Córdoba, Argentina
/ 85
suffering first hand, not in theory– since they
start their academic program, both in individual
and family/group settings, which allows them to
develop an emotional connection.
Cognitive components (PT and ASSES)
showed low values and scarce PD coverage levels.
Empathy is the result of subjects’ ontogenetic
and evolutionary development in interaction
with their environment; therefore, there may be
specific factors that encompass and modulate
empathy in interaction with each subject’s specific
ontogenetic factors, given that several factors
have been observed to affect the determination
of an empathic response.16 It will be necessary
to further look into these factors in order to
complete an empathic diagnosis and the behavior
of empathy levels in relation to sex and school
year. Calzadilla-Nuñez et al.16 proposed that the
diagnosis process will help to identify whether
overall empathy or any of its components are
under development, have stopped or simply
deteriorated, and this may guide the training
response strategy so as to improve empathy
levels. In the end, these results provide
information that will allow to establish specific
strategies aimed at promoting the development of
empathy during students’ professional training.
CONCLUSIONS
Overall empathy, and the CC component
specifically, increased from the first through
fifth year of school (and it was higher among
women compared to men), which evidenced
the progressive development of the affective
component of empathy. The development
potential of overall empathy and cognitive
components showed little progression. n
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... (5,6,7) A pesar de la importancia de este atributo en la relación profesional kinesiólogo y paciente, la enseñanza de la empatía en las universidades chilenas no está formalizada en sus currículos. (8) Por otra parte, existe la tendencia a realizar "intervenciones empáticas" sin un diagnóstico previo del comportamiento de este atributo en los estudiantes que permita visualizar el comportamiento de la empatía. ...
... Para algunos autores una intervención de este tipo, implica una modificación de todo el currículo para que sea positiva y, sobre todo, permanente, sobre la empatía en el estudiante. (2,5,6,8) Como consecuencia, antes de la realización de una intervención, es necesario precisar un diagnóstico capaz de determinar cuáles son las características específicas del comportamiento empático para intervenir en correspondencia con la realidad encontrada. Pese a su relevancia, la investigación en empatía en estudiantes de kinesiología es limitada, (7,8,9) especialmente en Chile. ...
... (2,5,6,8) Como consecuencia, antes de la realización de una intervención, es necesario precisar un diagnóstico capaz de determinar cuáles son las características específicas del comportamiento empático para intervenir en correspondencia con la realidad encontrada. Pese a su relevancia, la investigación en empatía en estudiantes de kinesiología es limitada, (7,8,9) especialmente en Chile. (6) El objetivo del estudio fue determinar los niveles de empatía en estudiantes de kinesiología considerando los factores género y curso de la Facultad de Ciencias de la Salud, Universidad de Atacama (Chile) en noviembre 2018. ...
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Introduction: empathy is an important concept in the interaction between the Kinesiologist and the patient. Objective: to determine the levels of empathy in students of Kinesiology considering the variables course and gender from the School of Health Sciences, University of Atacama (Chile) in November 2018. Methods: exploratory and cross-sectional study. A sample of 191 students was included in the study. The Jefferson's Empathy scale was used. The median, quartile 1 and 3, inter-quartile difference and confidence interval of the median were estimated. The possible differences regarding empathy were studied using nonparametric tests (Mood Median). Results: there were differences in empathy in the course variable. Empathy was not different concerning gender variable. Conclusions: levels of empathy, along with the levels of interest showed differences between courses and there are no differentiation concerning empathy between genders.
... Despite these differences in subscales, from a theoretical point of view, empathy should be considered a system with three elements: CC, PA and Wips. Therefore, empathy is based on the interaction among these elements, an existence characterized mainly by active, positive correlation, and any alteration of their natural relationship (for example, the decrease or absence of positive correlation of an element, such as Wips in our case), may alter the system itself; consequently it cannot function as before or change into another type of system (1,(25)(26) . In others words, empathy is a dialectical synthesis of cognitive (PA and Wips) and affective (CC) attributes. ...
... This is a significant challenge, as it implies profound changes in structure of teaching curricula and its own dynamics right up to the level of empathic teacher training. Many researchers have analyzed studies of interventions for developing empathy in nursing students, concluding that in general, the effect of these interventions on levels of empathy was small to moderate (25)(26)34) . ...
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Objective To evaluate the psychometric properties of the Jefferson Medical Empathy Scale, Spanish version (JSE-S), its factorial structure, reliability, and the presence of invariance between genders in the behavior of empathy levels among Chilean nursing students. Method Instrumental research design. The JSE-S was applied to 1,320 nursing students. A confirmatory factor analysis was used. An invariance study between genders was carried out. Descriptive statistics were estimated. Between genders, Student’s T distribution was applied alongside a homoscedasticity analysis. The level of significance was α ≤ 0.05. Results The confirmatory factor analysis determined the existence of three dimensions in the matrix. The statistical results of the invariance tests were significant, and allowed comparison between genders. Differences were found between mean empathy values, as well as in some of its dimensions between genders. Conclusion The factor structure of empathy data and its dimensions is in correspondence with the underlying three-dimensional model. There are differences in empathy levels and their dimensions between genders, with the exception of the compassionate care dimension, which was distributed similarly. Women were more empathetic than men.
... Bogotá, Colombia, vol. 18 (2): 1-16, mayo-agosto de 2020 piloto (35 estudiantes escogidos al azar en cada facultad de medicina) (20)(21)(22). Este trabajo fue aprobado por el Comité de Ética de la Investigación en cada universidad examinada. ...
... L a población estuvo compuesta por los estudiantes pertenecientes a los cursos primero a sexto año de la carrera de medicina de la um (20) y de primero a quinto año académico en la uees (21) y en la ucc (22). La estimación de las medias, la desviación estándar y el tamaño de la muestra en cada año de estudio y en cada universidad examinada se muestran en la tabla 1. Tabla 1. Resultados de la estimación de la media y la desviación estándar en empatía y sus componentes en la um, en la uees y la ucc componentes cuidado con compasión (cc), toma de perspectiva del paciente (tpp) y habilidad para entender a otros (heo) se presentan en la figura 1. En la E se encontró que la curva de la um (figura 1a) no responde exactamente al modelo de declinación (2): comenzó desde el segundo año de estudio y, posteriormente, del cuarto en adelante, se manifestó una tendencia al incremento de la empatía sin superar el nivel inicial de primer año. ...
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Introducción: algunos autores plantean que la empatia en los estudiantes de medicina sufre un proceso de declinación a partir del tercer año de estudios, y otros han encontrado que ello no se da. El objetivo del presente estudio es verificar la coexistencia de varios modelos de comportamiento empático. Materiales y métodos: trabajo exploratorio y transversal. Se aplicó la escala de empatia para estudiantes de medicina (EEJM-S) en tres facultades de medicina de Colombia, El Salvador y Argentina, entre 2018 y 2019. Los valores de las medias de cada año de estudio se sometieron a pruebas de regresión con datos previamente estandarizados. Se realizaron un análisis de varianza (Anova), para comprobar si el coeficiente de la ecuación era diferente de cero, y un Anova secuencial, para determinar el tipo de curva. Resultados: la distribución de las medias, a través de los años de estudio, presentó diversos tipos de curvas de regresión entre las diferentes universidades en la empatia, asi como en cada uno de sus componentes. Conclusión: se comprobó la presencia de tipos diferentes de comportamiento empático (diferentes curvas de regresión) de las medias de los años de estudio entre las distintas facultades estudiadas, y la hipótesis de trabajo planteada resultó verdadera.
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Objetivo: Verificar que la estructura factorial de los datos observados estén en correspondencia con la estructura factorial teórica de la empatia. Estimar y comparar los niveles de empatía en las especialidades médicas evaluadas. Materiales y métodos: Estudio realizado en el cantón de Cuenca (Ecuador) en 2019. Diseño descriptivo y transversal. La muestra estuvo constituida por 223 médicos que trabajaban en el sector público, quienes respondieron voluntariamente la Escala de Empatia Médica de Jefferson. Variables dependientes: niveles de empatia y sus dimensiones. Independientes: género, nivel de atención y especialidad. Se estimó la normalidad y homocedasticidad, Análisis Factorial Confirmatorio, Invarianza entre grupos, análisis de varianza trifactorial y de un factor, t-Student y d de Cohen. El nivel de significación fue a< .05. Resultados: Se observa una adecuada consistencia interna, se confirma el modelo de tres dimensiones del instrumento original. No existen diferencias entre los géneros (p> .05), pero sí entre los tipos de atención y entre las especialidades (p< .05). Los datos observados tienen la estructura factorial teórica asociada al instrumento empleado en la medición de la empatía. Conclusión: El análisis multigrupo permite asumir invarianza factorial de la empatía entre los géneros, sin que se logre especificar un modelo según tipos de atención al paciente. Los niveles de empatía global fueron mayores en la atención primaria en relación con la hospitalaria y mayor en las especialidades de Pediatría y Medicina Familiar (unidas).
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Introduction: Empathy is an important trait in the training of medical students, as it has been shown that it improves the doctor-patient relationship. Objective: To evaluate the decline of empathy levels and possible sex differences in undergraduate medical students from the Universidad Central del Este, Dominican Republic. Materials and methods: Exploratory cross-sectional study. A Spanish version of the Jefferson Scale of Empathy for Medical Students (S-version) Scale was administered in September 2018 to 1 144 1st-year to 5th-year medical students (887 women and 257 men). Data reliability was verified using the Cronbach's alpha and the intraclass correlation coefficient (ICC). A generalized linear equation model (Type III) was applied to analyze data and the Wald chi-squared test was used to determine differences in overall empathy levels and the mean scores obtained in each of its three components based on the year of medical training and sex. Results: Cronbach's alpha was satisfactory (0.839), and the ICC was 0.834 (F=5.68; p=0.005). The variability of the estimated curves in relation to empathic behavior by course (year of medical training) and sex was observed using linear and non-linear regression equations: Wald x²=115.6, p=0.0001 between courses; and Wald x2 =12.85, p=0.001 between men and women. Conclusions: Sex differences were observed regarding empathy levels in the study population. Moreover, a decline in empathy levels (overall empathy and Compassionate Care component in men and Walking in the Patient's Shoes component in men and women) was also observed as students progressed in their medical training. The behavior of these data raises questions regarding the need to determine the factors causing these differences and the decline in empathy levels.
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Altought compassionate care is an important factor in health care, remains an unmet need in patients. The studies have been carried out in Anglo-Saxon countries with cultural environments and health systems that are very different from Spanish-speaking contexts. The aim of this study to understand the conceptual, evaluation and clinical application nuances of compassion and compassionate care in Spanish-speaking health care settings, through a systematic review. A search of the scientific literature was carried out following the PRISMA guidelines in ProQuest Central, PubMed and Web Of Science, resulting in 295 studies, of which 27 were selected, based on the following inclusion criteria: the article studied or analyzed the construct of compassion in healthcare setting and the participants were Spanish speakers or the authors spoke of the construct in Spanish. Two blinded evaluators performed the study selection process using the Covidence tool. The agreement between evaluators was in all cases satisfactory. Different definitions of the construct have been identified, that they generally share: the recognition of suffering and the attempt to alleviate it. There are few studies that focus solely on the analysis of compassion, since other concepts appear that are associated with it, such as empathy and self-compassion. Further research is needed to obtain a better and greater understanding of compassionate care adapted to the perceptions of patients and health professionals in different socio-cultural contexts. In this way, instruments that measure compassionate care can be better developed and adjusted, and interventions aimed at promoting compassion can be properly assessed.
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Objectives Empathy education is very important for medical students. There is little research on the influence of early clinical practice on the development of empathy and other aspects of professionalism in medical students. The aim of this study was to compare the self-reported empathy levels of first-year and second-year undergraduate medical students before and after their early clinical contact curriculum. Setting The study was conducted at the Shanghai University of Medicine & Health Sciences, Shanghai, China. Participants A total of 257 undergraduate medical students participated in the study. The 154 first-year students were studying in 10 community-based teaching hospitals, and the 103 second-year students were studying in 3 university-affiliated hospitals. Primary and secondary outcome measures Primary measures: the Jefferson Scale of Empathy—Student version (JSE-S) was compared between students of different sexes and in different academic years before their early clinical contact course. Secondary measures: comparisons were made after they finished the curriculum 3 weeks later. Results A total of 219 of 257 students responded (85.21% response rate), and 214 answers could be analysed (135 first-year and 79 second-year students; 120 female and 94 male individuals). No significant differences in the empathy scores before early clinical contact were observed between students of different sexes and in different academic years. After early clinical contact, the mean JSE-S score of the participants was significantly higher than the mean score at the beginning of the curriculum. Conclusions Empathy-focused training during early clinical contact can improve the empathetic capacity of undergraduate medical students. Fostering empathetic attitudes among undergraduate medical students is necessary for the early stage of their medical education. Further research is needed on the long-term effects of empathy-focused education in entry-level medical students.
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Aim To determine and compare levels of empathy and its dimensions in Polish and Croatian dental students. Methods Fourth‐ and fifth‐year dental students (N = 193) at the University of Rijeka and University of Silesia, completed questionnaires to determine levels of overall empathy and its dimensions: compassionate care (CC), perspective taking (PT), and ability to stand in someone else’s shoes (ASSES). Total empathy and its dimensions were analysed depending on the country of origin, year of study, and gender of the participants. The HPS‐Version of the Jefferson Scale of Physician Empathy was used to conduct the research. Statistical analysis was performed using the Mann‐Whitney U test. Results The analysis showed no significant differences in total empathy level between Polish and Croatian students (p=0.838). However, separate analysis of empathy items showed significant differences between the two groups. Croatian students obtained significantly higher average PT values (p=0.021), while Polish students had significantly higher CC scores (p<0.001). Analysis of Croatian respondents revealed significantly higher ASSES scores in the fourth‐ and fifth‐year students (p=0.047). Analysis in the Polish group demonstrated an increase in PT scores from the fourth to the fifth year of study (p=0.008). Conclusion Croatian students scored higher on items associated with cognitive empathy, while Polish students displayed higher values in the aspect of emotional empathy. The present results demonstrated an increase in cognitive empathy level in Polish students; while in their Croatian colleagues, the level of cognitive empathy decreased with the progression of the academic program.
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A successful health care provider may be described as a clinician capable of establishing a comprehensive diagnosis including identifying related risk factors. However, an equally important quality a clinician should possess is the ability to understand the experiences and feelings of others to allow better communication for better outcomes. It is likely that faculty empathy levels influence students' ability to demonstrate this attribute. The aim of this study was to assess the levels of empathy of dental faculty members relative to dental students at the Universidad San Sebastian in Chile. Using a cross-sectional design of survey-collected data collected with the Jefferson Scale of Empathy, the authors compared the perceptions of the dental faculty involved in teaching fourth- and fifth-year dental students (n=116) to the perceptions of basic and preclinical students (n=346) and clinical students (n=189). The data were collected in 2016-17. The results showed that the mean faculty scores were higher than that of the students in compassionate care (90.1%) and perspective adoption (89.7%); however, for putting oneself in the other's shoes, the faculty had a lower score (57.8%) than the clinical students (58.2%). Future investigations are needed to understand the impact of faculty empathy scores on students and whether pedagogical interventions can increase empathy scores.
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INTRODUCTION: Empathy erosion may be defined as a sudden decline in the levels of empathy that occurs as of the third year of medical school and continues until the fifth year. According to some authors, this process is normal during medical training and may be considered a model of empathic behavior. The objective of this study was to verify whether empathy erosion is a general phenomenon in the schools of medicine included in the study and its relation to gender.
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Purpose: As medical education curricula increasingly acknowledge the contributions of the social determinants of health to individual health, new methods of engaging students in the care of vulnerable groups are needed. Empathy is one way to connect students with patients, but little is known about how to nurture students' empathy on behalf of populations. This study examined the relationship between individual and social empathy as groundwork for cultivating students' empathy for vulnerable groups. Method: In 2014-2015, first-year medical students completed the Social Empathy Index at the start and end of a two-semester population health course, and they completed a reflective writing assignment exploring the challenges of caring for vulnerable patients. Pre- and posttest mean survey scores were compared, and reflective writing assignments were analyzed for themes concerning social empathy. Results: Data from 130 students were analyzed. Scores for the contextual understanding of systemic barriers domain increased significantly. There was a trend toward increased cumulative social empathy scores that did not reach statistical significance. Students' essays revealed three themes relating to individual empathy as the foundation for social empathy; civic and moral obligations; and the role of institutional practices in caring for vulnerable groups. Conclusions: This study extends understanding of empathy beyond care for the individual to include care for vulnerable groups. Thus, social empathy may function as a valuable concept in developing curricula to support students' commitment to care for the underserved. Educators first need to address the many barriers students cited that impede both individual and social empathy.
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Objetivo. Comparar la orientacion empatica entre estudiantes de Medicina de tres facultades de Medicina de Colombia y una de Republica Dominicana. Material y metodos. Se midio la orientacion empatica de los estudiantes de Medicina mediante la escala de empatia medica de Jefferson, en la version en espanol para estudiantes (version S) validada en Mexico y Chile, y adaptada culturalmente a Colombia y Republica Dominicana. Los datos se compararon mediante un analisis de varianza trifactorial (modelo III) y por un analisis discriminante. Resultados. No se encontraron diferencias de orientacion empatica entre los cursos ni entre los sexos, pero si entre las facultades de Medicina consideradas como una unidad en cada uno de los paises estudiados. Conclusiones. Los niveles de orientacion empatica tienden a disminuir a medida que los cursos avanzan. Este hecho se produce en estudiantes de ambos sexos y en todas las facultades analizadas.(AU) Objective. To compare empathic orientation among medical students from three schools of medicine in Colombia and one in the Dominican Republic. Material and Methods. Empathic orientation of medical students was measured using the Jefferson Scale of Physician Empathy (JSPE), Spanish version for students (the "S" version) validated in Mexico and Chile, and culturally adapted to Colombia and the Dominican Republic. Data were compared using a three-factor analysis of variance (model III) and a discriminant analysis. Results. No differences in empathic orientation were observed among courses and between sexes, but differences were found in schools of medicine considered as a unit in each studied country. Conclusions. Empathic orientation levels tend to reduce as courses advance. This was observed in both male and female students and in all schools analyzed.(AU)
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Introduction: The development of empathy in medical students, which is essential for therapeutic effectiveness and improved patient outcomes, is not well understood. The objective of this study is to determine whether there are differences between levels of the “compassionate care” component of empathy among four medical schools in Colombia and the Dominican Republic. Subjets and methods: The sample consisted of medical students. This exploratory and cross-section study measured empathy levels by using the Spanish version of the Jefferson Scale of Physicians. Levels of empathy were studied and compared by a three-factor analysis of variance, Tukey multiple comparison test and discriminant analysis of the matrix components. Results: Differences in levels of empathy of the “compassionate care” component between universities, courses and gender were found. Conclusions: Variability in the values of the levels of the “compassionate care” component of empathy were observed among the factors: university, course and gender. The observed variability between and within the university populations studied cannot be explained, which can be attributed to other unknown factors that influence empathy levels.
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Professionalism is rarely taught formally. It is learned by osmosis through the hidden curriculum: a set of attitudes that each one of us transmits unconsciously to students, medical residents, and colleagues. All of us are a model or counter-model of professionalism through a series of values that have been the pillars of our profession since Hippocrates. Values that do not seem to be strong enough to pass our time. There are specific factors of the 21st century such as the financial crisis, the highly technical nature of medicine, bureaucratisation or trivialisation of the medical process that could explain, but not justify, the decline in the values of our profession: Empathy, integrity, solidarity, the altruism, or confidentiality. That is why, from the Bioethics Committee of the Spanish Paediatrics Association we establish the need to revive professionalism. Building and maintaining the values of our profession by training scientifically competent paediatricians, as well as being excellent from an ethical point of view, is part of our responsibility. Copyright © 2016. Publicado por Elsevier España, S.L.U.
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Objetivo: Evaluar el nivel de orientación empática en alumnos de la Facultad de Odontología de la Universidad de Concepción, Chile. Material y Métodos: Se realizó un estudio observacional descriptivo transversal. Participaron 341 alumnos de un universo de 402 correspondientes a los niveles 1º, 2º, 3º, 4º y 5º de la Facultad de Odontología de la Universidad de Concepción (Chile) en 2012, a quienes se les aplicó la Escala de Empatía Médica de Jefferson (EEMJ). Para el análisis de los datos obtenidos se realizó la prueba de normalidad de Shapiro-Wilks y la prueba de homo-cedasticidad de Levene. Posteriormente se estimaron los estadígrafos descriptivos en todos los factores estudiados, y finalmente la comparación de las medias se realizó mediante un Análisis de Varianza Bifactorial y una prueba de comparación múltiple de Duncan. Resultados: Los puntajes obtenidos en la (EEMJ) son significativamente mayores en tercer año que en segundo año de la carrera. Las mujeres presentaron puntuaciones más altas que los hombres, en los distintos niveles estudiados. Esta diferencia se acentúa mucho más en quinto año. Conclusiones: Los estudiantes de odontología de los niveles 3º, 4º y 5º de la Universidad de Concepción presentan un alto nivel de orientación empática. Las mujeres presentan mayor nivel de orientación empática que los hombres.
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Objetivo: determinar la orientación empática en estudiantes de odontología. Metodología: es una investigación no experimental, descriptiva, de corte transversal y ex post facto causa-efecto. La población estuvo constituida por 284 estudiantes de la carrera de odontología de la Universidad Central del Este (República Dominicana) y la muestra se conformó con 239 sujetos, quienes cursaban los niveles 1º, 2º, 3º, 4º y 5º (Años), durante 2012. Se utilizó la Escala de Empatía Médica de Jefferson (EEMJ), versión S, adaptada culturalmente para la República Dominicana. Resultados: se analizaron las variables año y género. Se encontró que el factor año fue altamente significativo (p0,05), lo cual indica que existen diferencias entre los años estudiados, pero no entre los géneros. Conclusiones: es necesario realizar estudios que favorezcan la observación de las variables estudiadas y compararlas con modificaciones hechas a nivel de los programas académicos y mallas curriculares
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p class="p1"> Antecedentes. La empatía es un importante atributo que los estudiantes de medicina deben tener y ha sido poco estudiado en América Latina. Objetivo. Determinar el nivel de orientación empática de los estudiantes de medicina de las universidades Libre, seccional Barranquilla, y San Martín, sede Puerto Colombia, Barranquilla. Materiales y métodos. La orientación empática de los estudiantes se midió mediante la aplicación de la Escala de Empatía Médica de Jefferson en español, diseñada para estudiantes — versión S — , validada en otros países de Latinoamérica y adaptada culturalmente a Colombia. La comparación de los datos se realizó mediante análisis de varianza bifactorial — Modelo III — . Resultados. El nivel de orientación empática de los estudiantes tiene valores bajos, ubicados por encima del valor central del rango de la escala, 20 a140. Las diferencias entre las puntuaciones, según cursos y género, no fueron estadísticamente significativas al comparar los promedios de las sumatorias del puntaje de los estudiantes; sin embargo, se observó, un comportamiento diferente según el género entre las universidades: el femenino tuvo valores de orientación empática mejores que el masculino en la Universidad San Martín, mientras que en la Universidad Libre sucedió, relativamente, lo contrario. La comparación de las respuestas permitió observar que existen diferencias entre ellas. Conclusiones. Los resultados de este estudio no explican la contradicción encontrada en relación a las diferencias de género y cursos entre universidades; sin embargo, estos resultados son consistentes con otros trabajos, especialmente realizados en Latinoamérica, que muestran variabilidad de la respuesta empática en estudiantes de medicina. Las diferencias entre las universidades no pueden atribuirse a causas psicológicas solamente, sino a la presencia de otros factores que también influyen en la respuesta empática.</p
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A pressing issue in paediatric education is to improve Patient-Paediatrician and Family relationships (PPFR). This paper highlights the following aspects: promoting the connection between paediatricians and Patient/Family organizations; improving the information system, from the moment of the first contact with the family: eliminating barriers to allow parents to accompany admitted children at all times; and encouraging parents to play a more active role in their children’s in-patient care. Hospitalization should be as short as possible. Hospital schools should be established, and those already existing should be improved, given their important psychological and educational role. PPFR must be improved at all levels of paediatric education, stressing its importance at undergraduate level, exploring the subject in detail in postgraduate training, and performing periodic concept reviews in continuing education. However, PPFR can be impaired as a result of staff shortages or insufficient diagnostic and therapeutic means. A motivated health team contributes to promote a truly humanistic climate for the patient and family. Efficient organization is essential, since lack of time, repeated delays or defective archives may undermine the best intentions. In the teamwork setting, the staff in charge of the patient must be appointed promptly and must take responsibility for providing information. Patient’s age (toddler, children or adolescent), the relationship of the family member (parent, grand-parent, or other), and the social, cultural and religious background are all variables that should be taken into account. The media have a great impact: newspapers, radio, television and Internet may have an unwanted effect if the family receives incomplete or incorrect information. Staff should be aware of the dangers of this media information. To achieve appropriate PPFR in these changing times, the paediatrician’s professional and human profile needs to bear in mind the variability of family structures, the rapid maturity of the young, the problems posed by the bureaucracy of the health system and city lifestyle. All these factors add to the complexity of the task and may induce anxiety, thus impeding a satisfactory PPFR.