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Empathy in Medical Education and Patient Care

Hojat, Mohammadreza PhD; Mangione, Salvatore MD; Gonnella, Joseph S. MD; Nasca, Thomas MD; Veloski, J. Jon MS; Kane, Gregory MD

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Dr. Hojat is research professor of psychiatry and human behavior, Dr. Mangione is associate professor of medicine, Dr. Gonnella is distinguished professor of medicine and director, Center for Research in Medical Education and Health Care, Dr. Nasca is dean and senior vice president, Mr. Veloski is chief, Medical Education Division, and Dr. Kane is clinical associate profesor of medicine; all are at Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.

We read with interest the report on empathy among medical students by Newton and colleagues.1 The scale used in that study, Mehrabian's Balanced Emotional Empathy Scale,2 was developed for the general population, and it may not capture the concept of empathetic care that is specific to health care situations. Recently, we developed the 20-item Jefferson Scale of Physician Empathy,3 which is specifically related to the patient—physician relationship and supported by psychometric evidence using data from medical students, nurses, medical residents, and practicing physicians.3

We administered the Jefferson Scale of Physician Empathy to a sample of physicians (n = 704) affiliated with the Jefferson Health Care System in an ongoing study. The results will be reported at a later time. Preliminary analyses indicate some differences on empathy scores among groups of physicians. For example, we found that the 462 physicians in “people-oriented” specialties (e.g., primary care specialties, obstetrics and gynecology, emergency medicine, psychiatry, medical subspecialties) obtained a significantly higher average score on the physician's empathy scale (mean = 121.0, SD = 11.6) than did their counterparts in “technology-oriented” specialties (e.g., anesthesiology, pathology, radiology, orthopedic surgery, urology, surgery and surgical subspecialties) (mean = 117.2, SD = 12.1; t(702) = 4.03, p < .001). The difference in scores remained unchanged when the effect of physicians' gender was controlled (adjusted F(1,683) = 15.5, p < .001). Our findings support what Newton and colleagues' found1 regarding a higher average emotional empathy score for students who planned to pursue core specialties (e.g., family medicine, pediatrics) versus those who planned to pursue non-core specialties (e.g., radiology, pathology). Also, our preliminary findings are consistent with the previous report that physicians in people-oriented specialties tend to value interpersonal relationships (social values) more than do their counterparts in technology-oriented specialties.4

While the cross-sectional comparison of medical students' empathy scores that Newton and colleagues1 report is informative, we are undertaking a prospective longitudinal study by following the same cohort of students at different stages of medical education to investigate changes in their empathy as they advance through medical school and residency training.

Training of empathetic physicians has always been a concern of medical education. With the rise of technology-based diagnosis that limits the opportunity for patient—physician interaction and the waning of bedside interaction straining the patient—physician relationship, it is timely and important to continue studying the influence of medical education in the development of empathy among medical students and physicians.

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1. Newton BW, Savidge MA, Barber L, et al. Differences in medical students' empathy. Acad Med. 2000;75:1215.

2. Mehrabian A. Manual of the Balanced Emotional Empathy Scale (BEES). 1996. (Available from Albert Mehrabian, 1130 Alta Mesa Road, Monterey, CA 93940).

3. Hojat M, Mangione S, Nasca TJ, et al. The Jefferson Scale of Physician Empathy: development and preliminary psychometric data. Educ Psychol Meas. 2001;61:349–65.

4. Hojat M, Brigham TP, Gotheil E, Xu G, Glaser K, Veloski JJ. Medical students' values and their careers a quarter century later. Psychol Rep. 1998;82:547–59.

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