The Jefferson Scale of Physician Empathy: Further Psychometric Data and Differences by Gender and Specialty at Item Level

Researchers agree that empathy has a positive role in clinical outcomes and in improving interpersonal relationships, but they are divided on its definition and components. In the context of health care, we define empathy as ‘‘a cognitive (as opposed to affective) attribute that involves an understanding of the inner experiences and perspectives of the patient, combined with a capability to communicate this understanding to the patient.’’ With the exception of the affective domain, this definition is similar to the conceptualization of empathy by Feighny and colleagues. The key feature of empathy, according to our definition, is understanding, rather than affective involvement with patients’ experiences. The affective domain is a key component of sympathy, rather than empathy. The Association of American Medical College’s Medical School Objectives Project (MSOP) lists empathy among the educational objectives by emphasizing that medical schools should strive to educate altruistic physicians who are ‘‘compassionate and empathetic in caring for patients’’ and who can understand a patient’s perspective by demonstration of empathy. Medical educators concede that empathy is a significant factor in patient care that must be cultivated during medical education and can be assessed at admission to medical school. Likewise, empathy is an important component of ‘‘professionalism’’ in medical practice. Yet, empirical research on empathy among medical students and physicians is scarce. One reason for this dearth of empirical research is the absence of a psychometrically sound and specific research instrument. A few empathy scales for the general population exist that we previously described but to the best of our knowledge there is no psychometrically sound tool available for measuring empathy among medical students and physicians. There is a need for an operational measure of empathy for medical students and physicians. Such a measure can be used to evaluate the effectiveness of educational interventions aimed at promoting empathy. In response to this need, we developed the Jefferson Scale of Physician Empathy. In our previous studies with students, we found that total empathy scores were significantly associated with clinical competence ratings in medical school, but not with licensing examination scores. A significant overlap between empathy and clinical competence constitutes key validity evidence for the empathy scale. In another study, we noticed a significant decline in mean empathy scores during the third year of medical school. Such a decline was also observed among internal medicine residents, but it did not reach the conventional level of statistical significance. Overall, we found that female students and physicians scored higher in empathy than males. In our studies with physicians, we noted that physicians in ‘‘patient-oriented’’ specialties obtained a significantly higher average empathy score than those in ‘‘technology-oriented’’ specialties. Psychiatrists obtained the highest mean empathy score and anesthesiologists, orthopedists, neurosurgeons, and radiologists received the lowest. Although we found no significant difference in the total empathy scores between physicians and nurses, the two groups differed significantly on some items. Some of these findings that were consistent with our expectations can be considered as evidence in support of the validity of the empathy scale. This study was designed to further examine the psychometric properties of the Jefferson Scale of Physician Empathy, and to investigate differences on individual items between men and women and between physicians in specialty areas defined as ‘‘people-oriented’’ and ‘‘technology-oriented.’’