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PubMed2002

Empathy in medical students as related to academic performance, clinical competence and gender.

CONTEXT: Empathy is a major component of a satisfactory doctor-patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools. OBJECTIVES: We designed this study to test two hypotheses: firstly, that medical students with higher empathy scores would obtain higher ratings of clinical competence in core clinical clerkships; and secondly, that women would obtain higher empathy scores than men. MATERIALS AND SUBJECTS: A 20-item empathy scale developed by the authors (Jefferson Scale of Physician Empathy) was completed by 371 third-year medical students (198 men, 173 women). METHODS: Associations between empathy scores and ratings of clinical competence in six core clerkships, gender, and performance on objective examinations were studied by using t-test, analysis of variance, chi-square and correlation coefficients. RESULTS: Both research hypotheses were confirmed. Empathy scores were associated with ratings of clinical competence and gender, but not with performance in objective examinations such as the Medical College Admission Test (MCAT), and Steps 1 and 2 of the US Medical Licensing Examinations (USMLE). CONCLUSIONS: Empathy scores are associated with ratings of clinical competence and gender. The operational measure of empathy used in this study provides opportunities to further examine educational and clinical correlates of empathy, as well as stability and changes in empathy at different stages of undergraduate and graduate medical education.

Analysis of Variance↗

PubMed1985

Empathy and psychoanalytic technique.

I have attempted to review the major psychoanalytic contributions to our understanding of empathy within the psychoanalytic situation. In doing so, I have discussed the relation between empathy and identification, reviewed aspects of the metapsychology of analytic comprehension, and have described the role of the analyst's evenly hovering attention in empathic responsiveness, as noted by several analytic investigators of empathy. The interrelations between empathy and countertransference have been described, and neutrality issues as they relate to empathy have been noted. Certain themes around the development of empathy have been grouped together and critically examined. The work of Kohut with regard to empathy has been discussed in relation to earlier psychoanalytic contributions of which it is an outgrowth and expansion. The changes in meaning and emphasis of empathic processes in Kohut's works have been described and critically reviewed. Empathy in its popular usage refers to the capacity of one person to communicatively partake, in a limited way, in the experience of another. In its differentiation from sympathy and pity, its noncritical or value-neutral character is emphasized. This description of empathy indicates its relevance to psychoanalytic technique, which shares many similar characteristics. Empathy is a general or superordinate term for many more specific aspects of the sensitive interpersonal interactions in the intimacy of relationships like the psychoanalytic one. Attempts to assign a particular psychoanalytic technical meaning to empathy or build clinical and developmental theory around empathy are limited by the multiple referents and generality of the concept. Empathy as a term has its place as descriptive of the analyst's emotional relatedness to the patient. It does not refer to any specific psychoanalytic technical intervention or theoretical construct; rather, it describes in a general way the sensitive, tactful, and experience-near way in which the analyst approaches the inner life of his patients.

Affect↗

PubMed2003

Victim empathy, social self-esteem, and psychopathy in rapists.

The purpose of the present study was to compare the responses of 27 incarcerated rapists and 27 incarcerated nonsexual offenders using the Rapist Empathy Measure (targeting victim specific empathy deficits) and to examine the relationship between empathy with self-esteem and psychopathy for both groups. The Social Self-Esteem Inventory was used as a measure of perceived social competence and the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) was used as a measure of psychopathy. All participants completed the two self-report questionnaires on empathy and self-esteem; in addition, the rapists were required to complete an extra section of the empathy measure that assessed their empathic responses to their own victims. Demographic information and psychopathy scores were obtained by reviewing institutional files. When psychopathy scores were not available, subjects participated in a semi-structured interview and were scored on the Psychopathy Checklist-Revised by the researcher. Rapists demonstrated more empathy than the nonsexual offenders toward women in general and the same degree of empathy as the nonsexual offenders toward a woman who had been a victim of a sexual assault by another male. Of particular importance were the within-group comparisons across victim type for the rapists which revealed significant empathy deficits toward their own victim(s). Interestingly, no differences were found between the rapists and nonsexual offenders in terms of self-esteem and psychopathy, and neither self-esteem nor psychopathy significantly predicted empathy for either group. It was concluded from the present study that rapists may suppress empathy primarily toward their own victim rather than suffer from a generalized empathy deficit. It is suggested that empathy deficits in rapists might better be construed as cognitive distortions specific to their victims and should be addressed in that manner in treatment.

Adult↗

PubMed2004

Gender differences in empathy in parents at high- and low-risk of child physical abuse.

OBJECTIVES: The present research was designed to study empathy in high-risk parents for child physical abuse. The main objective was to study if high-risk mothers and fathers, compared to low-risk mothers and fathers, presented more Personal distress, less Perspective-taking, less Empathic concern and a deficit in dispositional empathy toward their partner and children. METHOD: Based on their scores on the Abuse Scale of the CAP Inventory [J.S. Milner, The Child Abuse Potential Inventory: Manual, 2nd ed., Psytec Corporation, Webster, NC], 19 (9 fathers and 10 mothers) high- and 26 (12 fathers and 14 mothers) low-risk parents for child physical abuse were selected from a total sample of 331 parents of the Spanish general population. Both groups were statistically matched on sociodemographic variables. The Interpersonal Reactivity Index (IRI) [Catalog of Selected Documents in Psychology 10 (1980) 85] and the Parent/Partner Empathy Scale (PPES) [N.D. Feshbach, N. Caskey, A new scale for measuring parent empathy and partner empathy: factorial structure, correlates and clinical discrimination, 1985] were used to assess dispositional empathy. RESULTS: An interaction between risk status and gender for "Personal distress" and "Perspective-taking" was found. High-risk mothers for child physical abuse showed more "Personal distress" than low-risk mothers and low-risk fathers. High-risk fathers for child physical abuse showed less "Perspective-taking" than low-risk mothers and low-risk fathers. No difference between both groups was found for the IRI "Empathic concern" dimension. Moreover, high-risk, compared to low-risk, parents showed lower scores both on the "Empathy toward the partner" and on the "Empathy toward the child" dimensions of the PPES. No interaction between risk status and gender was found for the PPES dimensions. CONCLUSIONS: Findings of the present study supported the hypothesis that high-risk parents for child physical abuse show a deficit both in general empathy and in empathy toward their family members. Moreover, findings suggested the existence of a different pattern of deficits in empathy for high-risk fathers and high-risk mothers.

Adult↗

PubMed1988

Five studies testing two new egoistic alternatives to the empathy-altruism hypothesis.

The empathy-altruism hypothesis claims that prosocial motivation associated with feeling empathy for a person in need is directed toward the ultimate goal of benefiting that person, not toward some subtle form of self-benefit. We explored two new egoistic alternatives to this hypothesis. The empathy-specific reward hypothesis proposes that the prosocial motivation associated with empathy is directed toward the goal of obtaining social or self-rewards (i.e., praise, honor, and pride). The empathy-specific punishment hypothesis proposes that this motivation is directed toward the goal of avoiding social or self-punishments (i.e., censure, guilt, and shame). Study 1 provided an initial test of the empathy-specific reward hypothesis. Studies 2 through 4 used three procedures to test the empathy-specific punishment hypothesis. In Study 5, a Stroop procedure was used to assess the role of reward-relevant, punishment-relevant, and victim-relevant cognitions in mediating the empathy-helping relationship. Results of these five studies did not support either the empathy-specific reward or the empathy-specific punishment hypothesis. Instead, results of each supported the empathy-altruism hypothesis. Evidence that empathic emotion evokes altruistic motivation continues to mount.

Adult↗

PubMed2004

An empirical study of decline in empathy in medical school.

CONTEXT: It has been reported that medical students become more cynical as they progress through medical school. This can lead to a decline in empathy. Empirical research to address this issue is scarce because the definition of empathy lacks clarity, and a tool to measure empathy specifically in medical students and doctors has been unavailable. OBJECTIVE: To examine changes in empathy among medical students as they progress through medical school. MATERIALS AND SUBJECTS: A newly developed scale (Jefferson Scale of Physician Empathy [JSPE], with 20 Likert-type items) was administered to 125 medical students at the beginning (pretest) and end (post-test) of Year 3 of medical school. This scale was specifically developed for measuring empathy in patient care situations and has acceptable psychometric properties. METHODS: In this prospective longitudinal study, the changes in pretest/post-test empathy scores were examined by using t-test for repeated measure design; the effect size estimates were also calculated. RESULTS: Statistically significant declines were observed in 5 items (P < 0.01) and the total sores of the JSPE (P < 0.05) between the 2 test administrations. CONCLUSIONS: Although the decline in empathy was not clinically important for all of the statistically significant findings, the downward trend suggests that empathy could be amenable to change during medical school. Further research is needed to identify factors that contribute to changes in empathy and to examine whether targeted educational programmes can help to retain, reinforce and cultivate empathy among medical students for improving clinical outcomes.

Clinical Competence↗

PubMed2006

Educating for empathy. A review.

OBJECTIVE: Empathy in the medical setting is appreciation of the patient's emotions and expression of that awareness to the patient. Named as an essential learning objective by the American Association of Medical Colleges, empathy is believed to significantly influence patient satisfaction, adherence to medical recommendations, clinical outcomes, and professional satisfaction. The objective of this study was to identify effective strategies to enhance empathy in undergraduate medical students. DATA SOURCES: We searched PubMed for studies that address the effectiveness of strategies for teaching empathy to medical students. We identified 13 peer-reviewed, English language, qualitative and quantitative studies reporting primary data on interventions that aim to foster empathy in undergraduate medical students, using Medical Subject Heading terms education, medical, undergraduate or student, medical crossed with empathy. RESULTS: These studies indicate that empathy may be amenable to positive change with a range of interventional strategies. Communication skill workshops addressing the behavioral dimension of empathy show greatest quantitative impact on participants. However, current studies are challenged by varying definitions of empathy, small sample sizes, lack of adequate control groups, and variation among existing empathy measurement instruments. CONCLUSION: Given the methodological limitations of the available studies, and uncertainty about which dimensions of empathy should be addressed, larger studies using validated measurement tools are recommended.

Communication↗

PubMed1990

A cognitive/affective empathy training program as a function of ego development in aggressive adolescent females.

This study investigated the effects of an affective/cognitive empathy training program on level of empathy in 24 aggressive adolescent females in a residential treatment center. In addition, the relationship between empathy and level of ego development was explored. Empathy was defined as a psychological construct regulated by both cognitive and affective components, interacting in a systemic manner to produce emotional understanding. Subjects were pretested on measures of affective empathy, cognitive empathy, and Loevinger's scale of ego development. High and low scores on the measures of ego development were defined by a median split. Following random assignment to groups, experimental subjects were exposed to four 1.5-hour training sessions directed at increasing levels of affective and cognitive empathy. Posttests revealed significant positive relationships between ego development and both measures of empathy. Training significantly increased levels of affective empathy, while increases in cognitive empathy were unremarkable. There was no difference between high and low ego development scorers in their ability to profit from training. The hypothesized systemic relationship between affective and cognitive empathy was also supported by the findings.

Adolescent↗

PubMed2005

Responding to the emotions of others: dissociating forms of empathy through the study of typical and psychiatric populations.

Empathy is a lay term that is becoming increasingly viewed as a unitary function within the field of cognitive neuroscience. In this paper, a selective review of the empathy literature is provided. It is argued from this literature that empathy is not a unitary system but rather a loose collection of partially dissociable neurocognitive systems. In particular, three main divisions can be made: cognitive empathy (or Theory of Mind), motor empathy, and emotional empathy. The two main psychiatric disorders associated with empathic dysfunction are considered: autism and psychopathy. It is argued that individuals with autism show difficulties with cognitive and motor empathy but less clear difficulties with respect to emotional empathy. In contrast, individuals with psychopathy show clear difficulties with a specific form of emotional empathy but no indications of impairment with cognitive and motor empathy.

Affect↗

PubMedDate not supplied

Empathy in general practice consultations: a qualitative analysis.

AIMS: Empathy is an important basis of all provider-patient interaction, including general practice. Little has been known about the details of how general practitioners express empathy to their patients. In the present study, it was a main aim to carry out a detailed qualitative study of actual sequences through which empathy was achieved, by focusing on the form, function, and categorisation of such sequences. METHODS: The study drew on the qualitative method of conversation analysis. Transcriptions of 77 British general-practitioner-patient interactions were analysed in detail in order to identify and characterise sequences in which empathy was achieved. RESULTS: Four types of empathy were identified, described, and analysed: cognitive empathy, affective empathy, sharing empathy, and nurturant empathy. Although sequences involving empathy typically were brief and occurred relatively rarely, the analyses demonstrated that the sequences often concerned matters of great importance to the interactants. CONCLUSIONS: The study underlined the need to focus also on phenomena that occur relatively rarely in consultations. For this purpose, the method of conversation analysis was a useful tool.

Adolescent↗

PubMed2004

The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences.

Empathy is an essential part of normal social functioning, yet there are precious few instruments for measuring individual differences in this domain. In this article we review psychological theories of empathy and its measurement. Previous instruments that purport to measure this have not always focused purely on empathy. We report a new self-report questionnaire, the Empathy Quotient (EQ), for use with adults of normal intelligence. It contains 40 empathy items and 20 filler/control items. On each empathy item a person can score 2, 1, or 0, so the EQ has a maximum score of 80 and a minimum of zero. In Study 1 we employed the EQ with n = 90 adults (65 males, 25 females) with Asperger Syndrome (AS) or high-functioning autism (HFA), who are reported clinically to have difficulties in empathy. The adults with AS/HFA scored significantly lower on the EQ than n = 90 (65 males, 25 females) age-matched controls. Of the adults with AS/HFA, 81% scored equal to or fewer than 30 points out of 80, compared with only 12% of controls. In Study 2 we carried out a study of n = 197 adults from a general population, to test for previously reported sex differences (female superiority) in empathy. This confirmed that women scored significantly higher than men. The EQ reveals both a sex difference in empathy in the general population and an empathy deficit in AS/HFA.

Adolescent↗

PubMed2005

A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow Homoeopathic Hospital.

OBJECTIVE: To relate prospectively initial consultation characteristics-length, empathy, and patient enablement- with perceived health changes in patients going to the Glasgow Homoeopathic Hospital (GHH). METHODS: Consecutive outpatients completed the Consultation and Relational Empathy (CARE) measure and the Patient Enablement Instrument (PEI) immediately after their first consultations, again at 3 months, and the PEI also at 12 months. The Short Form-12 was completed immediately before and the Measure Yourself Medical Outcome (MYMOP) Profile during the first consultation, and both were repeated at 3 and 12 months. Perceived changes in main complaint and well-being were assessed using the Glasgow Homoeopathic Outcome Scale (GHHOS). RESULTS: Empathy score at first consultation was highly predictive of ongoing empathy score at 3 months (Spearman's rho, 0.572, p < 0.0001). Empathy scores at first consultation also correlated significantly with enablement score at first consultation (rho, 0.325, p < 0.0001) and overall enablement at 12 months (rho, 0.281; p < 0.05). Controlling for the number of subsequent consultations, initial empathy scores were also predictive of change in main complaint, and general well-being, at 3 months (rho, 0.225, 0.213 respectively; p < 0.05). Enablement score at first consultation also predicted overall enablement at 3 months (rho, 0.255; p < 0.05) and 12 months (rho, 0.282; p < 0.05). Initial enablement predicted GHOSS well-being score at 3 months after controlling for number of consultations (rho, 0.279; p < 0.05). Both empathy and enablement at 3 months predicted overall enablement at 12 months (rho, 0.327; p < 0.01 and rho, 0.577; p < 0.0001, respectively). Empathy at 3 months was not significantly related to GHHOS scores at 12 months, whereas enablement scores at 3 months were highly predictive of both GHHOS main complaint and well-being scores at 12 months (rho, 0.459 and 0.507, respectively; p < 0.0001). Empathy and enablement scores did not correlate significantly with changes in SF-12 and MYMOP scores at any of the time points. The length of the first consultation was related to initial and subsequent CARE scores, overall enablement, and GHHOS scores at 3 and 12 months. CONCLUSIONS: Empathy is crucial for enablement, which, in turn, is strongly related to perceived change in main complaint and well-being. The length of time the clinician spends with a patient at initial consultation appears to be an important factor in these complex relationships among process and outcome.

Adolescent↗

PubMed2005

Patterns of cognitive and emotional empathy in frontotemporal lobar degeneration.

OBJECTIVE: To examine the relationship between empathy and cognition in frontotemporal lobar degeneration (FTLD). BACKGROUND: Theoretical models suggest empathy has multiple cognitive and affective subcomponents, and recent studies suggest that performance on specific cognitive tests may predict empathy. Qualitative behavioral studies of patients with FTLD suggest empathy loss may occur directly as a result of damage to frontal and temporal structures. METHOD: First-degree relatives used the Interpersonal Reactivity Index (IRI), a measure of cognitive and emotional empathy, to rate 18 patients with frontotemporal dementia (FTD), 19 patients with semantic dementia (SD), 16 patients with Alzheimer disease (AD), and 10 age-matched healthy control subjects (NC). Subjects also underwent cognitive testing. RESULTS: Both FTD and SD groups showed significantly lower levels of empathy than either ADs or NCs. SDs showed disruption of both emotional and cognitive empathy, whereas FTDs showed only disruption of cognitive empathy. Regressions controlling for general cognitive impairment showed 32% of the variance in Perspective Taking score was predicted by Category Fluency (P < 0.001), and 25% of the variance in Fantasy score was accounted for by Phonemic Fluency (P < 0.001). CONCLUSIONS: Although cognitive empathy is at least partly reliant on frontal structures, the emotional components of empathy are likely mediated by structures in the temporal lobes.

Aged↗

PubMed1977

Measuring medical students' empathy: a validation study.

The aim of this study was to validate the empathy scale (Hogan, 1969) for use in the context of medical education in Australia. Empathy Scale scores of students in their first clinical year at Monash University were correlated with patient ratings, self ratings, and peer ratings of empathy. Inter-rater and intra-rater reliability were assessed. Correlations were also obtained between Empathy Scale scores and course marks in psychiatry. Of the empathy ratings only those by peers correlated significantly with Empathy Scale scores (r = 0-45, P less than 0-05, n = 29). Empathy Scale scores were unrelated to academic performance. In a separate part of the study, not connected to the establishing of criterion-related validity, Empathy Scale scores of the medical student group were found to be significantly higher (t=4-44, df = 52, P less than 0-001) than the scores of psychiatric patients with a diagnosis of "personality disorder". This study provides some support for the Empathy Scale as a measure of interpersonal effectiveness, but has not established it as a valid measure of empathy in a clinical setting.

Adult↗

PubMed1997

Nurse-expressed empathy, patient outcomes, and development of a middle-range theory.

PURPOSE: To demonstrate how a middle-range theory was developed and tested through research that examined relationships between nurse-expressed empathy and two patient outcomes: patient-perceived empathy and patient distress. SIGNIFICANCE: Nurse-patient relationships are the basis for all nursing care and empathy is an important aspect of these relationships. Research is needed, however, to determine the patient outcomes that are related to the empathy of nurses. ORGANIZING FRAMEWORK: Orlando's (1961, 1972) nursing model. SCOPE: 140 subjects, 70 staff RNs and 70 patients from hospital medical-surgical acute care units. Each nurse-subject completed two measures of nurse-expressed empathy and each patient-subject completed a measure of perceived empathy and two measures of distress. FINDINGS: Negative relationships were found between nurse-expressed empathy and patient distress (r = -.71, p < .001), and between patient-perceived empathy and patient distress (r = -.71, p < .001). A moderate positive relationship was found between nurse-expressed empathy and patient-perceived empathy (r = .35 to .47, p < .05). CONCLUSIONS: A model can be tested when propositions theoretically linked to the model are empirically tested. This study's findings demonstrated support for relationships proposed in Orlando's model.

Attitude to Health↗

PubMed2002

Physician empathy: definition, components, measurement, and relationship to gender and specialty.

OBJECTIVE: There is a dearth of empirical research on physician empathy despite its mediating role in patient-physician relationships and clinical outcomes. This study was designed to investigate the components of physician empathy, its measurement properties, and group differences in empathy scores. METHOD: A revised version of the Jefferson Scale of Physician Empathy (with 20 Likert-type items) was mailed to 1,007 physicians affiliated with the Jefferson Health System in the greater Philadelphia region; 704 (70%) responded. Construct validity, reliability of the empathy scale, and the differences on mean empathy scores by physicians' gender and specialty were examined. RESULTS: Three meaningful factors emerged (perspective taking, compassionate care, and standing in the patient's shoes) to provide support for the construct validity of the empathy scale that was also found to be internally consistent with relatively stable scores over time. Women scored higher than men to a degree that was nearly significant. With control for gender, psychiatrists scored a mean empathy rating that was significantly higher than that of physicians specializing in anesthesiology, orthopedic surgery, neurosurgery, radiology, cardiovascular surgery, obstetrics and gynecology, and general surgery. No significant difference was observed on empathy scores among physicians specializing in psychiatry, internal medicine, pediatrics, emergency medicine, and family medicine. CONCLUSIONS: Empathy is a multidimensional concept that varies among physicians and can be measured with a psychometrically sound tool. Implications for specialty selection and career counseling are discussed.

Adult↗

PubMed1981

Empathy: its nature and limitations.

Empathy is usually regarded as an irreducible inborn capacity, operative from birth, for knowing the inner experience of another person without necessarily perceiving cues from that person about his thoughts or feelings. Merging of the type characteristic of early infant-mother symbiosis has often been considered the origin and basic component of empathy. However, merging is an illusory experience which cannot function as an active mechanism in the perceptual process, and the psychological structures needed for certain kinds of empathy do not commence development until eighteen months of age. The mechanism of empathy has also been ascribed to vaguely defined variants of identification. This is not a settled issue, but the idea is not compatible with a recent rigorous effort to define identification. The author offers a different theory of empathy, according to which empathy is a capacity that evolves with neuropsychological maturation and interpersonal interactions in the course of individual development. Empathy depends on sensory perception of behavioral cues from the object about his inner state. The empathizer compares these behavioral cues with one or more kinds of referent in this own mind which could be expressed by similar behavior. He then infers that the inner experience of the object qualitatively matches that associated with his referent. Limitations in the accuracy and scope of empathy are threefold: patients may limit or distort the expression of behavioral cues about their state of mind; referents available in the mind of the empathizer may be inadequate; and the inferential process is inherently uncertain. As a result, knowledge of another person's thoughts and feelings which can be acquired through empathy is limited. The theoretical understanding of empathy offered in this paper implies ways for improving empathic accuracy, especially by means of applying two or more kinds of referents to the same set of perceived cues.

Cues↗

PubMed1997

[The relationship between maternal role attainment during pregnancy and empathy].

The purpose of this study was to describe the relationship between maternal role attainment during pregnancy and empathy. Sixty-seven pregnant women were asked to complete the Japanese version of the Interpersonal Reactivity Index to measure their empathy, and were subsequently divided into a high-empathy group consisting of 13 subjects, and a low-empathy group consisting of 9 subjects. Data was collected from the 12th through the 30th gestational week by means of a semi-structured interview which was based on Rubin's conseptual model of maternal role attainment. The following results were obtained. 1. Eight subjects of the high-empathy group and 2 of the low-empathy group were judged to have reached the Introjection-projection-rejection phase. 2. High-empathy group subjects displayed Mimicry more of ten, had partners near them during Role-play, began Fantasy earlier, and expected more changes in themselves through Grief-work than low-empathy group subjects. 3. High-empathy group subjects were more prepared for the maternal role before conception, came in contact with people that served as a role model more often during pregnancy, and formed Binding-in earlier than low-empathy group subjects.

Empathy↗