Eleven years of data on the Jefferson Scale of Empathy – medical student version: Japanese norm data and tentative cutoff scores - BMC Medical Education - BMC Medical Education

Background

More and much studies analyse aesculapian students’ empathy utilizing the Jefferson Scale of Empathy (JSE). However, nary norm information oregon cutoff scores of the JSE for Japanese aesculapian students are available. This survey truthful explored Japanese norm information and tentative cutoff scores for the Japanese translation of the JSE-medical pupil mentation (JSE-S) utilizing 11 years of information obtained from matriculants from a aesculapian schoolhouse successful Japan.

Methods

Participants were 1,216 students (836 men and 380 women) who matriculated astatine a aesculapian schoolhouse successful Japan from 2011 to 2021. The JSE-S questionnaire was administered to participants anterior to the commencement of the program. Data were summarized utilizing descriptive statistic and statistical tests were performed to amusement the norm information and tentative cutoff scores for antheral and pistillate students separately.

Results

The people distributions of the JSE-S were moderately skewed and leptokurtic for the full sample, with indices -0.75 and 4.78, respectively. The mean people (standard deviation) for each participants was 110.8 (11.8). Women had a importantly higher mean people (112.6) than men (110.0; p < 0.01). The effect size estimation of sex quality was 0.22, indicating a tiny effect size. The debased and precocious cutoff scores for men were ≤ 91 and ≥ 126, respectively, and the corresponding scores for women were ≤ 97 and ≥ 128, respectively.

Conclusions

This survey provides JSE-S norm information and tentative cutoff scores for Japanese aesculapian schoolhouse matriculants, which would beryllium adjuvant successful identifying those who whitethorn request further grooming to heighten their empathy.

Empathy tin beryllium described arsenic the competence of a doc to recognize their patient’s situation, perspective, and feelings; to pass this knowing and corroborate its accuracy; and to enactment connected that knowing with the diligent successful a adjuvant (therapeutic) mode [1]. Empathy has been described arsenic an indispensable constituent of wide doc competence [2]. Previous studies show the effectiveness of doc empathy successful narration to affirmative diligent outcomes among diabetic patients [3, 4]. Moreover, studies besides amusement accrued diligent enablement [5] and diligent restitution [6]. Medical students’ empathy has besides been reported to beryllium associated with their objective competence [7, 8].

To date, galore studies person investigated the level of empathy among aesculapian students successful assorted countries [9,10,11,12,13,14,15,16,17]. Although aesculapian students’ empathy whitethorn summation oregon alteration during their education, their levels of empathy successful the archetypal twelvemonth of aesculapian schoolhouse person shown a inclination to beryllium higher successful Western countries (e.g., the United States [US] and the United Kingdom) than successful Asian countries (e.g., India, South Korea, and Japan) [18]. The determinants of wherefore pupil empathy varies according to geographical regions stay unknown. To research the factors of geographical differences successful empathy among aesculapian students, internationally comparable norm information from antithetic countries oregon regions are required.

Norm information and cutoff scores of first-year aesculapian students’ empathy successful the US [19] and Spain [20] person already been reported utilizing the Jefferson Scale of Empathy (JSE). The JSE is simply a validated psychometric instrumentality specifically developed to measurement empathy successful the discourse of diligent attraction among healthcare nonrecreational practitioners and students. It has been wide utilized for antithetic healthcare nonrecreational practitioners and students, translated into 56 languages/dialects, and utilized successful astatine slightest 85 antithetic countries [21]. A elaborate statement of the JSE is disposable elsewhere [22, 23].

Study plan and participants

This descriptive cross-sectional survey utilized information from the aesculapian schoolhouse of Okayama University successful Japan, from April 2011 to April 2021.

Study participants included 1,216 students (836 men and 380 women) who matriculated astatine the aesculapian schoolhouse of Okayama University successful Japan from the world years of 2011 to 2021, and who responded to the survey astatine the opening of their aesculapian schoolhouse acquisition (representing a 97.5% effect rate).

Instrument

There are presently 3 versions of the JSE: (1) An “HP” mentation for physicians and practitioners of each healthcare professions, (2) an “S” mentation for aesculapian students, and (3) an “HPS” mentation for students successful each healthcare professions different than medicine. These 3 versions are each precise akin successful context, with lone flimsy differences successful a fewer words utilized to set the instrumentality for its people colonisation [19, 27]. In the contiguous study, we utilized the Japanese translation of the “S” mentation (JSE-S). The details of the JSE-S person been described antecedently [11, 19]. Moreover, the validity and reliability of the Japanese translation of the JSE-S person been confirmed [17].

The JSE questionnaire is comprised of 20 question items. Each point is answered connected a 7-point Likert-type standard from 7 = “strongly agree” to 1 = “strongly disagree.” The S-version, for example, includes questions specified arsenic “Physicians’ knowing of the affectional presumption of their patients, arsenic good arsenic that of their families, is 1 important constituent of the physician–patient relationship.”

Procedure

Prior to the archetypal people of the aesculapian program, which is provided conscionable aft introduction into aesculapian schoolhouse each year, we explained the survey to the students, orally and successful writing, and asked them to participate. We ensured that they were alert that information was voluntary, that their responses would beryllium kept strictly confidential, that their answers would not impact their world record, and that the information mightiness beryllium utilized arsenic aggregated information for statistical analysis. A hard transcript of the JSE-S questionnaire was distributed to each pupil entering classes of 2011–2019; for the 2020 and 2021 classes, it was administered online. Students who consented to enactment successful the survey filled retired and submitted the questionnaire.

This survey protocol was approved by the morals committee of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University infirmary (Approval No. 826 and Ken 2207–024).

Statistical analysis

Submitted questionnaires with missing accusation connected much than 4 items (of the 20) were considered incomplete and excluded from the analysis. If 4 oregon less items were missing, each missing worth was replaced with the mean people calculated from the completed items [22, 28]. Previous studies person required a minimum JSE people of 50 [22], truthful questionnaires with a full people of little than 50 were marked arsenic invalid and excluded from this study. However, this was lone a negligible amount, arsenic lone 2 participants scored little than 50 connected our questionnaire (< 0.3%).

For examination with erstwhile studies, we summarized the information utilizing descriptive statistic and performed the pursuing statistical tests [19]. First, we summarized the information of the JSE-S scores with descriptive statistics, which included frequency, mean, modular deviation (SD), median, range, skewness, and kurtosis indices crossed matriculation years. We besides calculated the Cronbach’s α coefficient—an scale of interior consistency and reliability of the JSE-S crossed matriculation years. Second, we performed an investigation of variance (ANOVA) to analyse the differences successful the mean JSE-S scores crossed matriculation years. Third, we utilized the χ² trial to find whether the organisation of sex among the participants was akin crossed matriculation years. Fourth, we examined the quality successful the mean JSE-S scores betwixt antheral and pistillate students utilizing a two-tailed Student’s t-test. We besides calculated Cohen’s d arsenic an estimation of effect size. The effect size d values of 0.8, 0.5, and 0.2 were considered large, medium, and tiny effect sizes, respectively [29].

Finally, we determined cutoff scores to place debased oregon precocious scores. Low and precocious scores were defined arsenic points beneath the 7th percentile and supra the 93rd percentile, respectively, arsenic indicated by a erstwhile survey [19]. As sex differences successful the JSE-S person been reported [7, 25, 30], we determined the cutoff scores separately for men and women, from their respective people distributions.

Two-sided p-values beneath 0.05 were considered statistically significant. The information were analyzed utilizing Stata SE 17.0 for Windows (Stata Corp, College Station, Texas, USA).

The participants included successful the analyses were 1,216 students (836 men and 380 women), and the wide effect complaint was 97.5% (men 97.1% and women 98.4%).

Descriptive statistics, including the frequency, mean, SD, median, people range, skewness, and kurtosis indices of the JSE-S by matriculation year, are presented successful Table 1. The mean people (SD) for each participants was 110.8 (11.8); mean scores varied from a debased of 108.4 (13.8) for the matriculants of 2014 to a precocious of 112.5 (11.6) for the matriculants of 2011. The ANOVA revealed nary statistically important differences successful the mean scores crossed matriculation years (p = 0.16). The skewness scale was antagonistic for the full illustration (-0.75) and for each matriculation twelvemonth (range: -2.17 [for matriculants of 2021] to -0.17 [for matriculants of 2018]). The kurtosis for the full illustration was 4.78 (range: 2.39 [for matriculants of 2020] to 9.54 [for matriculants of 2021]). The Cronbach’s α coefficient for the full illustration was 0.81 (range: 0.75 [for matriculants of 2012, 2017, and 2018] to 0.87 [for matriculants of 2021]).

Table 2 shows the organisation of the participants by matriculation twelvemonth and sex arsenic good arsenic the sex differences successful the JSE-S mean scores by matriculation year. The proportionality of men was higher crossed each matriculation years. However, the sex creation differed crossed matriculation years (p = 0.007). Women consistently tended to get higher scores than men, but successful the matriculation twelvemonth of 2012; however, determination were nary important differences successful the mean people betwixt men and women successful immoderate of the matriculation years. For each participants, women had a importantly higher mean people (112.6) than men (110.0), owing to the ample illustration size (p = 0.0004). The effect size estimates of the mean people differences betwixt men and women varied according to matriculation twelvemonth (range: -0.10 [for matriculants of 2012] to 0.42 [for matriculants of 2013]). For each participants, the effect size estimation of sex quality was 0.22, indicating a tiny effect size.

The frequence distributions of JSE-S scores and percentile ranks for men, women, and the afloat illustration are shown successful Table 3. The mean (SD) and median for each participants were 110.8 (11.8) and 111, respectively. The debased and precocious cutoff scores for men were ≤ 91 and ≥ 126, respectively, and the corresponding scores for women were ≤ 97 and ≥ 128, respectively.

The contiguous survey aimed to find the norm information and tentative cutoff scores for the JSE-S instrumentality among Japanese aesculapian students, utilizing information of 11 years obtained from a aesculapian schoolhouse successful Japan. The reported norm information person imaginable implications for aesculapian acquisition successful comparing the idiosyncratic JSE-S scores to find their comparative percentile ranks. For example, the JSE-S people of a antheral aesculapian pupil that falls betwixt 121 and 125 would spot him successful the apical 80‒91 percentile comparative to the people of different antheral aesculapian pupil whose JSE-S people falls betwixt 111 and 115, frankincense placing him successful the 50‒63 percentile.

Comparison with erstwhile studies

Here, we sermon our findings connected norm information and tentative cutoff scores for the JSE-S among aesculapian schoolhouse matriculants successful Japan, compared to erstwhile studies conducted successful the US (N = 2,637) [19] and Spain (N = 893) [20] for first-year aesculapian students. First, we compared our findings with those of the American study, incorporating 11 years’ data, from 2002 to 2012 [19]. The mean JSE-S scores for this survey were higher than those of Japan by astir 2 and 4 points for men and women, respectively. Several factors whitethorn lend to this difference. First, the property astatine introduction to aesculapian schoolhouse is higher successful the US. According to a survey reporting the characteristics of matriculants successful aesculapian schools successful the US, much than 98% of matriculants betwixt 2001 and 2015 were 21 years aged oregon older astatine the clip of introduction [31]. The mean property of the US study’s participants was 23.4 years aged [19]. In Japan successful caller years, astir 85% of matriculants successful aesculapian schools are younger than 21 years astatine the clip of matriculation [32]. Most Japanese students participate aesculapian schoolhouse instantly oregon wrong a fewer years of completing precocious school.

Second, matriculants successful the US person a wide inheritance successful their undergraduate majors, including humanities, arts, and societal sciences [33, 34]. A erstwhile survey demonstrates that first-year osteopathic aesculapian students successful the US who had majored successful “Social and Behavioral Sciences” and “Arts and Humanities” had higher mean scores of JSE-S than those with a inheritance successful “Chemical and Physical Sciences” [30]. In addition, they person much acquisition earlier entering aesculapian school, specified arsenic pursuing different career, engaging successful household obligations, oregon planetary travel, living, and moving experiences [35, 36]. Most matriculants successful Japan, however, participate aesculapian schoolhouse straight from precocious school, with chemistry and carnal sciences courses, with the objection of those who whitethorn person failed their entranceway exam astatine their archetypal attempt. It is imaginable that first-year Japanese students had not yet cultivated empathy, having conscionable been freed from the terrible effort of passing the highly competitory entranceway examination. Thus, matriculants successful the US were apt to beryllium much mature personally, with much experiences and vulnerability to situations that would foster empathy. This whitethorn beryllium the crushed for the uncovering of the baseline mean people of the JSE-S being higher among American students than among Japanese students.

The benignant of survey administration—that is, hard transcript questionnaire for the matriculants of 2011–2019 oregon online questionnaire for the matriculants of 2020–2021—did not impact JSE-S scores (data not shown). This effect is accordant with that of the US [19].

Next, we compared our findings with those of a Spanish survey conducted successful 8 aesculapian schools successful Madrid successful 2019 [20]. The mean JSE scores successful Spain were higher than those successful Japan by astir 7 and 8 points for men and women, respectively. The participants successful the Spanish survey were first-year aesculapian students who had not yet been successful interaction with patients, and the mean property erstwhile the survey was conducted was 18.9 years; this is akin to our study. Differences successful effect rates and successful the JSE mentation utilized for the survey could beryllium factors causing the quality successful mean scores betwixt Spain and Japan. The effect rates of Spanish and Japanese studies were 59.7 and 97.5%, respectively. While astir Japanese students responded to the questionnaire, Spanish students who had comparatively precocious empathy mightiness person selectively responded, starring to higher mean scores among Spanish participants.

The JSE mentation utilized successful the Spanish survey was the HP mentation for physicians and practitioners of each healthcare professions, alternatively of the S-version for aesculapian students. The JSE was primitively developed to measurement aesculapian students’ predisposition oregon attitudes toward doc empathy successful patient-care situations; that is, the S-version. Thereafter, the HP mentation was developed to measurement empathy among practicing physicians and different healthcare professionals. Although the 2 versions are precise akin successful context, the wording of the HP mentation was modified somewhat for immoderate items, to marque them much applicable to caregivers’ empathic behavior, than to empathic predisposition oregon attitudes among physicians. For example, the pursuing appeared successful the S-version: “Because radical are different, it is hard for physicians to spot things from their patients’ perspectives.” In the HP version, this point was revised to work arsenic follows: “Because radical are different, it is hard for maine to spot things from my patients’ perspectives” [37]. It is imaginable that the respondents to the S-version were scored much strictly, arsenic this mentation refers to the empathy of a doc successful general, not the empathy of the respondents themselves. This mightiness person contributed to the little mean people of the Japanese students who utilized the JSE-S version, compared with the Spanish students who utilized the HP version.

Cultural traits whitethorn besides beryllium important factors that impact empathy. A erstwhile survey investigating the quality successful mean JSE-S scores successful narration to contention and ethnicity among American osteopathic aesculapian students showed that Asian students had little mean scores than White/Caucasian oregon Hispanic/Latino/Spanish students [30]. In general, Japanese radical thin to pass with others successful a mode that is calm, ambiguous, humble, and censoring of themselves [38]. It is apt that galore Japanese patients hesitate to explicit their idiosyncratic feelings oregon emotions to others, including aesculapian staff. These culture-specific characteristics mightiness person resulted successful differences successful empathy scores betwixt the Japanese and American oregon Spanish students. These differences whitethorn besides originate from the differences betwixt concepts of aesculapian professionalism successful Japanese and Western culture. One nonfiction [39] suggests that the Bushido, a Japanese codification of idiosyncratic behaviour originating from past samurai warriors, whitethorn power the behaviors of modern Japanese doctors. The Bushido contains concepts that disagree from the doc charters utilized successful Western aesculapian societies, specified arsenic autonomy of the individual, sex roles, and ethical conception. However, these assumptions necessitate further probe successful aboriginal research.

Strengths and limitations

The advantages of our survey see its comparatively ample illustration size, utilizing 11 years of data, and its precocious effect rates, which enables the proviso of norm information and tentative cutoff scores of the JSE-S by sex among Japanese aesculapian students. Several erstwhile studies show that the mean scores of aesculapian students’ empathy increases aft acquisition programs/interventions. However, determination are constricted studies investigating acquisition effectiveness according to the level of empathy. Still, a survey successful the US reported that students’ empathy scores were little successful objective years than successful preclinical years, and that the alteration successful empathy was smaller successful students with precocious baseline empathy than those with debased baseline empathy [40]. In contrast, our preliminary information bespeak that the effectiveness of professional/educational programs successful enhancing students’ empathy tends to beryllium higher successful students with mean baseline empathy than successful students with debased oregon precocious baseline empathy. Thus, determining norm information and cutoff scores would let america to measure acquisition effects and plan acquisition programs and methods according to the levels of students’ empathy.

Our survey has immoderate limitations arsenic well. First, the information were collected astatine a azygous institution, which could impact the generalizability of the findings. However, the aesculapian schoolhouse of the assemblage successful this survey is emblematic of nationalist aesculapian schools successful Japan successful presumption of the mean property astatine matriculation and the sex organisation of matriculants. The proportionality of pistillate students successful the aesculapian schoolhouse of this assemblage and that of each nationalist aesculapian schools successful Japan betwixt 2011 and 2021 was astir the same: 31.3 and 33.2%, respectively [41]. When applying to this aesculapian school, students look precocious levels of contention comparative to different aesculapian schools successful Japan, but these are not highly high. Of each 82 aesculapian schools successful Japan (national, public, and private), Okayama University is typically ranked successful the apical 15. Alongside their preparatory studies for the entranceway examination, galore students besides person acquisition successful extra-curricular activities, specified arsenic nine and unpaid activities. Therefore, the information of this survey tin beryllium considered typical of each nationalist aesculapian schools successful Japan.

Second, we were lone capable to comparison our results with 2 erstwhile studies, which, similar ours, investigated the cutoff scores of first-year aesculapian students and separated them by gender. We could not see immoderate different studies owed to the unavailability of comparable measures.

Third, we were not capable to see the students’ property and acquisition arsenic variables successful the analyses owed to the unavailability of these data. Empathy whitethorn beryllium influenced by students’ property and acquisition earlier entering aesculapian school. However, arsenic astir Japanese students participate aesculapian schoolhouse instantly aft oregon wrong a fewer years of completing precocious school, we judge that these variables would not substantially power the results.

Forth, successful a aboriginal study, we request to corroborate the validity and practicality of the cutoff scores reported successful this survey by comparing high-scoring (above the apical JSE-S cutoff score) and low-scoring (below the bottommost cutoff score) students connected measures of objective competence to analyse whether differences successful objective competence ratings contiguous arsenic expected.

Analysis of variance

Jefferson Scale of Empathy

JSE-medical pupil version

Standard deviation

The United States

References

Authors and Affiliations

1. Center for Diversity and Inclusion, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama-Shi, Okayama, 700-8558, Japan

   Hitomi U. Kataoka, Akiko Tokinobu & Chikako Fujii

2. Division of Kidney, Diabetes and Endocrine Diseases, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama-Shi, Okayama, 700-8558, Japan

   Mayu Watanabe

3. Department of General Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-Cho, Kita-Ku, Okayama-Shi, Okayama, 700-8558, Japan

   Mikako Obika

Contributions

HUK designed the survey protocols. HUK, CF, MW and MO collected the data. AT analyzed the data. HUK and AT prepared the manuscript. All the authors work and approved the last manuscript.

Corresponding author

Correspondence to Hitomi U. Kataoka.

Ethics support and consent to participate

This survey was conducted successful accordance with the World Medical Association Declaration of Helsinki guidelines. The survey protocol was approved by the morals committee of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University infirmary (Approval No. 826 and Ken 2207–024). The authors confirmed that each the methods were carried retired successful accordance with the applicable guidelines and regulations. Informed consent was obtained from each participants.

Consent for publication

Not applicable.

Competing interests

The authors state that they person nary competing interests.

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