The effect of Humanitude care methodology on improving empathy: a six-year longitudinal study of medical students in Japan.

BACKGROUND: Empathy, which involves understanding another person's experiences and concerns, is an important component for developing physicians' overall competence. This longitudinal study was designed to test the hypothesis that medical students' empathy can be enhanced and sustained by Humanitude Care Methodology, which focuses on perception, emotion and speech. METHODS: This six-year longitudinal observational study examined 115 students who entered Okayama University Medical School in 2013. The study participants were exposed to two empathy-enhancing programs: (1) a communication skills training program (involving medical interviews) and (2) a Humanitude training program aimed at enhancing their empathy. They completed the Jefferson Scale of Empathy (JSE) seven times: when they entered medical school, before participation in the first program (medical interview), immediately after the first program, before the second program (Humanitude exercise), immediately after the second program, and in the 5th and 6th year (last year) of medical school. A total of 79 students (69% of the cohort) completed all seven test administrations of the JSE. RESULTS: The mean JSE scores improved significantly after participation in the medical interview program (p < 0.01) and the Humanitude training program (p = 0.001). However, neither program showed a sustained effect. CONCLUSIONS: The Humanitude training program as well as medical interview training program, had significant short-term positive effects for improving empathy among medical students. Additional reinforcements may be necessary for a long-term sustained effect.

Preparing for the MD: How Long, at What Cost, and With What Outcomes?

PURPOSE: To assess educational and professional outcomes of an accelerated combined bachelor of science-doctor of medicine (BS-MD) program using data collected from 1968 through 2018. METHOD: Participants of this longitudinal study included 2,235 students who entered medical school between 1968 and 2014: 1,134 in the accelerated program and 1,101 in the regular curriculum (control group)-matched by year of entrance to medical school, gender, and Medical College Admission Test (MCAT) scores. Outcome measures included performance on medical licensing examinations, academic progress, satisfaction with medical school, educational debt, first-year residency program directors' ratings on clinical competence, specialty choice, board certification, and faculty appointments. RESULTS: The authors found no practically important differences between students in the accelerated program and those in the control group on licensing examination performance, academic progress, specialty choice, board certification, and faculty appointments. Accelerated students had lower mean educational debt (P < .01, effect sizes = 0.81 and 0.45 for, respectively, their baccalaureate debt and medical school debt), lower satisfaction with their second year of medical school (P < .01, effect size = 0.21), and lower global satisfaction with their medical school education (P < .01, effect size = 0.35). Residency program directors' ratings in 6 postgraduate competency areas showed no practically important differences between the students in the accelerated program and those in the control group. The proportion of Asian students was higher among program participants (P < .01, effect size = 0.43). CONCLUSIONS: Students in the accelerated program earned BS and MD degrees at a faster pace and pursued careers that were comparable to students in a matched control who were in a regular MD program. Findings indicate that shortening the length of medical education does not compromise educational and professional outcomes.

Can communication skills training improve empathy? A six-year longitudinal study of medical students in Japan.

BACKGROUND: Empathy is an important component of overall clinical competence; thus, enhancing empathy in medical education is essential for quality patient care. AIM: This longitudinal study was designed to address the following questions: 1. Can a targeted educational program in communication skills training enhance empathy in medical students? and 2. Can such a program have a sustained effect? METHODS: Study participants included 116 students who entered Okayama University Medical School in 2011. Students participated in a communication skills training program aimed to enhance their empathy, and completed the Jefferson Scale of Empathy (JSE) five times: at the beginning of medical school, prior to participation in the program, immediately after the program, and in last years of medical school. A total of 69 students, representing 59% of the cohort, completed the JSE in all five test administrations. RESULTS: Students' total scores on the JSE and its two factors (Perspective Taking and Compassionate Care) increased significantly (p < 0.001) after participation in the communication skills training program. However, the program did not have a sustained effect. CONCLUSIONS: Targeted educational programs to enhance empathy in medical students can have a significant effect; however, additional reinforcements may be needed for a sustained effect.

Predicting risk of hospitalisation: a retrospective population-based analysis in a paediatric population in Emilia-Romagna, Italy.

OBJECTIVES: Develop predictive models for a paediatric population that provide information for paediatricians and health authorities to identify children at risk of hospitalisation for conditions that may be impacted through improved patient care. DESIGN: Retrospective healthcare utilisation analysis with multivariable logistic regression models. DATA: Demographic information linked with utilisation of health services in the years 2006-2014 was used to predict risk of hospitalisation or death in 2015 using a longitudinal administrative database of 527 458 children aged 1-13 years residing in the Regione Emilia-Romagna (RER), Italy, in 2014. OUTCOME MEASURES: Models designed to predict risk of hospitalisation or death in 2015 for problems that are potentially avoidable were developed and evaluated using the C-statistic, for calibration to assess performance across levels of predicted risk, and in terms of their sensitivity, specificity and positive predictive value. RESULTS: Of the 527 458 children residing in RER in 2014, 6391 children (1.21%) were hospitalised for selected conditions or died in 2015. 49 486 children (9.4%) of the population were classified in the 'At Higher Risk' group using a threshold of predicted risk >2.5%. The observed risk of hospitalisation (5%) for the 'At Higher Risk' group was more than four times higher than the overall population. We observed a C-statistic of 0.78 indicating good model performance. The model was well calibrated across categories of predicted risk. CONCLUSIONS: It is feasible to develop a population-based model using a longitudinal administrative database that identifies the risk of hospitalisation for a paediatric population. The results of this model, along with profiles of children identified as high risk, are being provided to the paediatricians and other healthcare professionals providing care to this population to aid in planning for care management and interventions that may reduce their patients' likelihood of a preventable, high-cost hospitalisation.

Patient Perceptions of Clinician's Empathy: Measurement and Psychometrics.

The prominence of reciprocal understanding in patient-doctor empathic engagement implies that patient perception of clinician's empathy has an important role in the assessment of the patient-clinician relationship. In response to a need for an assessment tool to measure patient's views of clinician empathy, we developed a brief (5-item) instrument, the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). This review article reports evidence in support of the validity and reliability of the JSPPPE.

What Matters More About the Interpersonal Reactivity Index and the Jefferson Scale of Empathy? Their Underlying Constructs or Their Relationships With Pertinent Measures of Clinical Competence and Patient Outcomes?

In their study published in this issue of Academic Medicine, Costa and colleagues confirmed the underlying constructs of the Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy (JSE) in medical students. The authors of this Commentary propose that in comparing two instruments that both purport to measure empathy, researchers or test users must pay close attention to the target populations, the conceptualizations of empathy, and the validity evidence in relation to pertinent criterion measures. The Commentary's authors draw attention to the fact that the IRI was developed for administration to the general population, whereas the JSE was developed specifically for administration to students and practitioners of health professions. Also, the author of the IRI conceptualized empathy as a combination of cognitive and emotional attributes, whereas the authors of the JSE defined empathy as a predominantly cognitive attribute. These differences are reflected in the content of the items, which determines the underlying constructs of the two instruments. The Commentary authors suggest that any empathy-measuring instrument in the context of health professions education and patient care requires the crucial evidence of significant relationships with indicators of clinical competence and positive patient outcomes. Such validity evidence is readily available for the JSE, and the Commentary authors recommend that researchers make efforts to provide pertinent validity support for any other instrument measuring empathy in health professionals-in-training and in-practice.

Eleven Years of Data on the Jefferson Scale of Empathy-Medical Student Version (JSE-S): Proxy Norm Data and Tentative Cutoff Scores.

OBJECTIVE: This study was designed to provide typical descriptive statistics, score distributions and percentile ranks of the Jefferson Scale of Empathy-Medical Student version (JSE-S) of male and female medical school matriculants to serve as proxy norm data and tentative cutoff scores. SUBJECTS AND METHODS: The participants were 2,637 students (1,336 women and 1,301 men) who matriculated at Sidney Kimmel (formerly Jefferson) Medical College between 2002 and 2012, and completed the JSE at the beginning of medical school. Information extracted from descriptive statistics, score distributions and percentile ranks for male and female matriculants were used to develop proxy norm data and tentative cutoff scores. RESULTS: The score distributions of the JSE tended to be moderately skewed and platykurtic. Women obtained a significantly higher mean score (116.2 ± 9.7) than men (112.3 ± 10.8) on the JSE-S (t2,635 = 9.9, p < 0.01). It was suggested that percentile ranks can be used as proxy norm data. The tentative cutoff score to identify low scorers was ≤ 95 for men and ≤ 100 for women. CONCLUSIONS: Our findings provide norm data and cutoff scores for admission decisions under certain conditions and for identifying students in need of enhancing their empathy.

Predicting risk of hospitalisation or death: a retrospective population-based analysis.

OBJECTIVES: Develop predictive models using an administrative healthcare database that provide information for Patient-Centred Medical Homes to proactively identify patients at risk of hospitalisation for conditions that may be impacted through improved patient care. DESIGN: Retrospective healthcare utilisation analysis with multivariate logistic regression models. DATA: A population-based longitudinal database of residents served by the Emilia-Romagna, Italy, health service in the years 2004-2012 including demographic information and utilisation of health services by 3,726,380 people aged ≥18 years. OUTCOME MEASURES: Models designed to predict risk of hospitalisation or death in 2012 for problems that are potentially avoidable were developed and evaluated using the area under the receiver operating curve C-statistic, in terms of their sensitivity, specificity and positive predictive value, and for calibration to assess performance across levels of predicted risk. RESULTS: Among the 3,726,380 adult residents of Emilia-Romagna at the end of 2011, 449,163 (12.1%) were hospitalised in 2012; 4.2% were hospitalised for the selected conditions or died in 2012 (3.6% hospitalised, 1.3% died). The C-statistic for predicting 2012 outcomes was 0.856. The model was well calibrated across categories of predicted risk. For those patients in the highest predicted risk decile group, the average predicted risk was 23.9% and the actual prevalence of hospitalisation or death was 24.2%. CONCLUSIONS: We have developed a population-based model using a longitudinal administrative database that identifies the risk of hospitalisation for residents of the Emilia-Romagna region with a level of performance as high as, or higher than, similar models. The results of this model, along with profiles of patients identified as high risk are being provided to the physicians and other healthcare professionals associated with the Patient Centred Medical Homes to aid in planning for care management and interventions that may reduce their patients' likelihood of a preventable, high-cost hospitalisation.

Personality assessments and outcomes in medical education and the practice of medicine: AMEE Guide No. 79.

In a paradigm of physician performance we propose that both "cognitive" and "noncognitive" components contribute to the performance of physicians-in-training and in-practice. Our review of the relevant literature indicates that personality, as an important factor of the "noncognitive" component, plays a significant role in academic and professional performances. We describe findings on 14 selected personality instruments in predicting academic and professional performances. We question the contention that personality can be validly and reliably assessed from admission interviews, letters of recommendation, essays, and personal statements. Based on conceptual relevance and currently available empirical evidence, we propose that personality attributes such as conscientiousness and empathy should be considered among the measures of choice for the assessment of pertinent aspects of personality in academic and professional performance. Further exploration is needed to search for additional personality attributes pertinent to medical education and patient care. Implications for career counseling, assessments of professional development and medical education outcomes, and potential use as supplementary information for admission decisions are discussed.

Psychometrics of the scale of attitudes toward physician-pharmacist collaboration: a study with medical students.

BACKGROUND: Despite the emphasis placed on interdisciplinary education and interprofessional collaboration between physicians and pharmacologists, no psychometrically sound instrument is available to measure attitudes toward collaborative relationships. AIM: This study was designed to examine psychometrics of an instrument for measuring attitudes toward physician-pharmacist collaborative relationships for administration to students in medical and pharmacy schools and to physicians and pharmacists. METHODS: The Scale of Attitudes Toward Physician-Pharmacist Collaboration was completed by 210 students at Jefferson Medical College. Factor analysis and correlational methods were used to examine psychometrics of the instrument. RESULTS: Consistent with the conceptual framework of interprofessional collaboration, three underlying constructs, namely "responsibility and accountability;" "shared authority;" and "interdisciplinary education" emerged from the factor analysis of the instrument providing support for its construct validity. The reliability coefficient alpha for the instrument was 0.90. The instrument's criterion-related validity coefficient with scores of a validated instrument (Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration) was 0.70. CONCLUSIONS: Findings provide support for the validity and reliability of the instrument for medical students. The instrument has the potential to be used for the evaluation of interdisciplinary education in medical and pharmacy schools, and for the evaluation of patient outcomes resulting from collaborative physician-pharmacist relationships.

The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy.

PURPOSE: To test the hypothesis that scores of a validated measure of physician empathy are associated with clinical outcomes for patients with diabetes mellitus. METHOD: This retrospective correlational study included 20,961 patients with type 1 or type 2 diabetes mellitus from a population of 284,298 adult patients in the Local Health Authority, Parma, Italy, enrolled with one of 242 primary care physicians for the entire year of 2009. Participating physicians' Jefferson Scale of Empathy scores were compared with occurrence of acute metabolic complications (hyperosmolar state, diabetic ketoacidosis, coma) in diabetes patients hospitalized in 2009. RESULTS: Patients of physicians with high empathy scores, compared with patients of physicians with moderate and low empathy scores, had a significantly lower rate of acute metabolic complications (4.0, 7.1, and 6.5 per 1,000 patients, respectively, P < .05). Logistic regression analysis showed physicians' empathy scores were associated with acute metabolic complications: odds ratio (OR) = 0.59 (95% confidence interval [CI], 0.37-0.95, contrasting physicians with high and low empathy scores). Patients' age (≥69 years) also contributed to the prediction of acute metabolic complications: OR = 1.7 (95% CI, 1.2-1.4). Physicians' gender and age, patients' gender, type of practice (solo, association), geographical location of practice (mountain, hills, plain), and length of time the patient had been enrolled with the physician were not associated with acute metabolic complications. CONCLUSIONS: These results suggest that physician empathy is significantly associated with clinical outcome for patients with diabetes mellitus and should be considered an important component of clinical competence.

Measurement and correlates of empathy among female Japanese physicians.

BACKGROUND: The measurement of empathy is important in the assessment of physician competence and patient outcomes. The prevailing view is that female physicians have higher empathy scores compared with male physicians. In Japan, the number of female physicians has increased rapidly in the past ten years. In this study, we focused on female Japanese physicians and addressed factors that were associated with their empathic engagement in patient care. METHODS: The Jefferson Scale of Empathy (JSE) was translated into Japanese by using the back-translation procedure, and was administered to 285 female Japanese physicians. We designed this study to examine the psychometrics of the JSE and group differences among female Japanese physicians. RESULTS: The item-total score correlations of the JSE were all positive and statistically significant, ranging from .20 to .54, with a median of .41. The Cronbach's coefficient alpha was .81. Female physicians who were practicing in "people-oriented" specialties obtained a significantly higher mean empathy score than their counterparts in "procedure-" or "technology-oriented" specialties. In addition, physicians who reported living with their parents in an extended family or living close to their parents, scored higher on the JSE than those who were living alone or in a nuclear family. CONCLUSIONS: Our results provide support for the measurement property and reliability of the JSE in a sample of female Japanese physicians. The observed group differences associated with specialties and living arrangement may have implications for sustaining empathy. In addition, recognizing these factors that reinforce physicians' empathy may help physicians to avoid career burnout.

The Jefferson Scale of Physician Empathy: a preliminary psychometric study and group comparisons in Korean physicians.

BACKGROUND: Empathy is an important element of professionalism in medicine. Thus, evaluation and enhancement empathy in physicians is important, regardless of geographical boundaries. AIM: This study was designed to evaluate the psychometrics of a Korean version of the Jefferson Scale of Physician Empathy (JSPE) among Korean physicians. METHODS: The Korean version of JSPE was completed by 229 physicians in Korea. RESULTS: Item-total score correlations were all positive and statistically significant. Cronbach's coefficient alpha was 0.84. The mean score was 98.2 (SD = 12.0), which was lower than that reported for American and Italian physicians. The emerged factor structure of the translated version was somewhat similar to that reported for American physicians, although the order was different. Significant differences in the mean empathy scores were observed between men and women and among physicians in different specialties. CONCLUSION: Our findings provide evidence in support of reliability and construct validity of the Korean version of JSPE for assessing empathy among Korean physicians. The disparity between Korean physicians and physicians from other countries may be explained by differences in the culture of medical education and medical practice. It suggests an exploration of cross-cultural differences in physician empathy.

A brief instrument to measure patients' overall satisfaction with primary care physicians.

BACKGROUND AND OBJECTIVES: A brief and psychometrically sound scale to measure patients' overall satisfaction with their primary care physicians would be useful in studies where a longer instrument is impractical. The purpose of this study was to develop and examine the psychometrics of a brief instrument to measure patients' overall satisfaction with their primary care physicians. METHODS: Research participants included 535 outpatients (between 18--75 years old, 66% female) who completed a mailed survey that included 10 items for measuring overall satisfaction with their primary care physician who was named on the survey. Patients were also asked about their perceptions of physician empathy, preventive tests recommended by the physician (colonoscopy, mammogram, and prostate-specific antigen (PSA) for age and gender appropriate patients) and demographic information. RESULTS: Factor analysis of the patient satisfaction items resulted in one prominent component. Corrected item-total score correlations of the patient satisfaction scale ranged from 0.85 to 0.96; correlation between patient satisfaction scores and patient perception of physician empathy was 0.93, and correlation with recommending the physician to family and friends was 0.92. Criterion-related validity coefficients were mostly in the 0.80s and 0.90s. Patient satisfaction scores were significantly higher for those whose physicians recommended preventive tests (colonoscopy, mammogram, and PSA-compliance rates >.80). Cronbach's coefficient alpha for patient satisfaction scale was 0.98. CONCLUSIONS: Empirical evidence supported the validity and reliability of a brief patient satisfaction scale that has utility in the assessments of educational programs aimed at improving patient satisfaction, medical services, and patient outcomes in primary care settings.

Empathic and sympathetic orientations toward patient care: conceptualization, measurement, and psychometrics.

PURPOSE: To develop instruments for measuring empathic and sympathetic orientations in patient care and to provide evidence in support of their psychometrics. METHOD: Third-year medical students at Jefferson Medical College responded to four clinical vignettes in 2010. For each vignette, students indicated the extent of their agreement with an empathic response (conveying their understanding of patients' concerns) and with a sympathetic response (sharing patients' feelings). The authors calculated, based on students' responses to the clinical vignettes, two measures of empathic and sympathetic orientation. Students also completed the Jefferson Scale of Empathy (JSE) and the Interpersonal Reactivity Index (IRI). RESULTS: Of the 258 students in the class, 201 (78%) responded to all four vignettes and completed the JSE and IRI. The authors confirmed construct validity of the measures of empathic and sympathetic orientation through factor analysis. The empathic orientation was significantly associated with the measure of empathy (as measured by the JSE) but not with measures of sympathy (as measured by specific scales of the IRI). Conversely, sympathetic orientation was significantly associated with measures of sympathy. Thus, these results support the validity of the empathic and sympathetic orientation measures as assessed by four clinical vignettes. Coefficient alphas for the two measures were, respectively, 0.79 and 0.84. CONCLUSIONS: The validated measures of empathic and sympathetic orientation provide research opportunities to enhance the understanding of the contributions of empathy and sympathy to physicians' competence and patient outcomes.