A Cross-Sectional Study on Empathy and its Associated Factors among Medical Students of Bangalore Medical College and Research Institute, Bangalore

Introduction

The word empathy is derived from Greek word ‘empatheia’, meaning affection or passion with a quality of suffering.¹ Empathy was defined by Hojat et al., as ‘a predominant cognitive attribute that involves an understanding of the patient’s experiences, perspectives and concerns, combined with the capacity to communicate understanding and also an intention to help’.² Empathic communication helps in the development of trust and openness between a healthcare provider and patient. It also results in a precise diagnosis and greater accordance to treatment. Both sympathy and empathy involves sharing but sympathy involves sharing emotions with the patients while the concept of empathy lies in cognitive understanding.³

Empathy among doctors vary depending on their personality. Medical students who plan to pursue people-oriented specializations such as internal medicine, family medicine, psychiatry and pediatrics should have higher empathy levels than those who choose to pursue technology-oriented specialties such as radiology, surgery and anesthesiology.⁴ The medical undergraduate students with more empathy will do better in clinical competence than in academic competence. Empathy in undergraduate medical students is determined by various factors, i.e., age, gender, year of undergraduate medical education, specialty choice, family background, culture, burn out, quality of life, personality trait, emotional intelligence, and mental health.

One of the major tasks of medical education is to maintain and increase empathy in undergraduate medical students towards patients. Empathic communication with patient and patient’s relatives may help to avoid doctor–patient miscommunications leading to violence. Thus, it is vital to assess empathy of doctors and its associated factors right from the starting of their medical education. The present study intended to assess empathy and various associated factors among medical students of Bangalore Medical College and Research Institute, Bangalore.

Materials and Methods

It was a cross sectional study undertaken based on Jefferson Scale of Empathy-Student version (JSE-S) questionnaire⁵ to assess the empathy and its associated factors among undergraduate medical students of Bangalore Medical College and Research Institute, Bangalore. Considering the mean empathy score of 96.01±14 reported by Anirban Chatterjee et al.,⁶ the following formula was used to calculate the sample size:

n = Z_a/2 ² σ² /d²

• Where Z_a/2 = Standard table value for 95% confidence interval = 1.96

• σ = The mean empathy score among medical students = 96.01

• d = absolute precision= 15%

 n = Z_a/2² σ² /d²

= 3.84 × (96.01)²/(15)²

= 35396.81 / 225

= 157.31

Final sample size calculated was 157.31, which was rounded off to 180.

Samples were collected by simple random sampling method.

The study was conducted among undergraduate students of first, second, third and fourth year MBBS. The students were briefly explained about the nature of study, and an online survey with digital consent was circulated among medical students. A total of 1000 undergraduate students study at Bangalore Medical College, with 250 students in each batch. From each year, students were selected by simple random sampling and the numbers were selected using a random number generator. A total of 180 students completed the survey after giving informed consent.

Inclusion criteria

All students aged 18 years and above, and willing to participate in the study.

Exclusion criteria

Students who were not present at the time of survey and those not willing to participate in the study.

The questionnaire included mainly two sections. The first section included pre-tested, semi-structured questionnaire which included questions related to sociodemographic characteristics of the participants. The questionnaire also included questions related to preferred career choice. Future choice of career was categorized into people-oriented, technology-oriented, and undecided. The second section included Jefferson Scale of Empathy-Student version (JSE-S). JSE-S is a self-administered, self-perceived inventory, which is a customized version for the students. This questionnaire consisted of 20 items, with a seven-point Likert scale for responses, with 1 being ‘strongly disagreed’ and 7 being ‘strongly agreed’ for positively phrased items and 1 being ‘strongly agreed’ and 7 being ‘strongly disagreed’ for negatively phrased items. Question numbers 1, 2, 7, 9, 10, 12, 15, 16, 19 and 20 were negatively phrased questions. It was classified into three subscales, including perspective-taking, compassionate, and walking in the patient’s shoes. All the 180 students completed the pretested semi-structured questionnaire and JSE-S.

Data were entered in MS Excel and analyzed using SPSS version 22. Mean score of empathy was calculated. Percentages and frequencies were calculated according to students’ age and gender. Standard deviation (SD) was calculated for continuous variables. Comparisons of the empathy scores were conducted using t-test and one-way analysis of variance (ANOVA). p <0.05 was considered as statistically significant.

Results

A total of 180 undergraduate medical students took part in the study which included 75 (41.6%) male and 105 (58.3%) female students. Among them, 45 (25%) were first-year students, 41 (22.8%) were from second year, 48 (26.7%) were third years, 46 (25.5%) were from fourth year. The mean age was 20.29±3.25 years (Mean ± SD; Range: 18 to 23 years).

The mean ± SD empathy score of all students was 95.52±6.32 (range: 20-140). Highest empathy was observed among first year students while the lowest empathy was observed among fourth year students (p = 0.004), and the difference was statistically significant. Female students showed higher empathy levels compared to male students (p = 0.002). Similarly, those who preferred pursuing people-oriented specialties in future showed significantly higher mean empathy score compared to others (p=0.012). The place of stay, age, whose decision it was for the student to enroll in MBBS were not significantly associated with empathy scores. Mean empathy scores of the students based on gender, year of education and career choice are tabulated in Table 1, 2, 3, respectively. Mean empathy score of the students based on year of education is depicted in Figure 1.

The JSE-S was classified into three: perspective taking, compassionate care, and walking in the shoes of the patients. Perspective taking was higher in women and third year students. Compassionate care was higher in women, first year students, and students with people oriented career choices. The mean score of walking in patient’s shoes was higher in women, final year students, and students with people-oriented career choices.

Discussion

In the present study, the level of empathy among medical students was found to be 95.52±6.32. In the study conducted by Anirban Chatterjee et al.,⁶ the mean empathy score reported was 98.11±12.31 and in the study conducted by Kulkarni Meenal Vinay et al.,³ the mean empathy score was 99.25±13.81.

The mean ± SD of the age of participants was 20.29±3.25 years. There was a slight female preponderance (58.3%). Female undergraduate medical students were more empathetic than the male students which was similar to the reports of studies conducted by Anirban Chatterjee et al.,⁶ Kulkarni Meenal Vinay et al.,³ Lt Col R. Shashikumar et al.,⁴ Bijit Biswas et al. ⁷ Year of education was also an important determinant of empathy score. A trend of progressive reduction in empathy levels with years of medical education in medical college as seen in this study was observed in other similar studies. The relation of empathy scores and preferred choice of specialty was significant as reported in other similar studies. There was no decline or increase in the mean empathy scores based on age, place of stay, whose decision it was for that student to enroll in MBBS course.

Conclusion

Empathy levels of undergraduate medical students in our study were low compared to similar studies conducted in various other parts of India. Empathy declined with increasing years of education. Gender and future career choice were important determinants of empathy score.

Medicine is a job field where empathy is very important, as this field at its core, is to serve humanity and those suffering in the society. It is thus important to pay attention to nurture medical students to have empathy rather than lose it under the stress of academic performance. The medical curriculum should give more focus to the promotion of empathy and other humanistic values among the undergraduate medical students. This would enable them to serve humanity better in the future.

Recommendations

Empathy among medical students is a research subject that has received limited attention. The declining empathy levels among medical students is of concern and studies to identify the cause should be conducted. Various workshops regarding this should be conducted to maintain and increase empathy levels among students.

Limitations of the study

• Medical student’s future specialty choice showed significant correlation with their empathy score. The findings were merely based on their current specialty choice, which may change with their progress in medical education.

• The current study was cross sectional and has not evaluated the longitudinal perspective of the problem. It was done as a single-time evaluation and the participants were not followed up. Longitudinal study design assessing empathy across semesters could probably better report empathy erosion rather than a cross-sectional study design.

• The current study was done at a single center. Multi-centric studies including private medical institutions would yield better results and provide an opportunity for comparison.

• There may be other specific, vital determinants of empathy, such as psychological morbidities, which we did not examine.

Acknowledgement

We would like to first acknowledge Director cum Dean of Bangalore Medical College & Research Institute, Bengaluru for permitting us to take up the study among undergraduates. We would also like to express our gratitude towards all the study participants.

Conflict on interest

None