Empathy in Iranian medical students: Measurement model of the Jefferson Scale of Empathy

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Practice points

Factor structure of the Persian version of JSE (s-version) fits with the proposed model by the developers JSE seems to measure the same attributes regardless of the differences of samples Female students have higher scores of empathy than male students Empathy score decreases with increase in the years of education of medical students in both large and small universities Cultural factors does not seem to affect the underlying attributes of empathy

Table 1.  Mean and standard deviation of empathy score in each of the three factors of JSE in male and female Iranian students

Subscales	Female		Male
	Mean	(SD)	Mean	(SD)
Perspective taking	52.49	(9.10)	49.59	(10.06)
Compassionate care	42.15	(6.79)	41.27	(7.56)
Standing in the patient's shoes	8.1	(2.59)	8.07	(2.67)

Table 2.  Mean scores of JSE in Iranian medical students in different stages of training and in large and small universities

	Number	All of the sample	Large universities	Small universities
		Mean (SD)	Mean (SD)	Mean (SD)
Preclinical students	423	105.5 (13.2)	106 (13.3)	101.6 (11.7)
Clinical trainees	471	99.7 (14.6)	98.8 (13.2)	100 (15.4)
Interns	207	96.8 (15.1)	100.3 (16.2)	95.3 (14.4)
Total	1101	101.4 (14.5)	103.2 (14)	98.9 (14.9)

Table 3.  Parameter estimates from CFA of the three-factor oblique model (N = 1187)

Items	FL Hojat	FL	R^2	SE of FL	US	TPE
Factor 1: Perspective taking
Physicians’ understanding of the emotional status of their patients, as well as that of their families is one important component of the physician-patient relationship (16)	0.70	0.62	0.38	0.04	−2.36	22.35
Physicians should try to understand what is going on in their patients’ minds by paying attention to their non-verbal cues and body language (13)	0.62	0.51	0.26	0.05	−2.47	16.83
I believe that empathy is an important therapeutic factor in medical treatment (20)	0.60	0.64	0.41	0.04	−5.60	23.94
Empathy is a therapeutic skill without which the physician's success is limited (15)	0.58	0.64	0.41	0.04	−4.19	24.07
Patients value a physician's understanding of their feelings which is therapeutic in its own right (10)	0.58	0.58	0.34	0.04	−5.00	21.27
Patients feel better when their physicians understand their feelings (2)	0.50	0.49	0.24	0.03	–11.61	16.71
Understanding body language is as important as verbal communication in physician-patient relationships (4)	0.48	0.50	0.25	0.04	−5.89	16.66
Physicians should try to stand in their patients’ shoes when providing care to them (9)	0.46	0.54	0.29	0.05	−1.87	18.64
A physician's sense of humor contributes to a better clinical outcome (5)	0.45	0.44	0.19	0.04	−4.25	14.97
Physicians should try to think like their patients in order to render better care (17)	0.46	0.35	0.12	0.06	0.98	10.90
Factor 2: Compassionate care
Patients’ illnesses can be cured only by medical or surgical treatment; therefore, physicians’ emotional ties with their patients do not have a significant influence in medical or surgical treatment (11)	0.60	0.70	0.49	0.04	−7.34	26.47
Attentiveness to patients’ personal experiences does not influence treatment outcomes (8)	0.59	0.28	0.08	0.06	−3.69	8.21
Attention to patients’ emotions is not important in history taking (7)	0.545	0.59	0.35	0.04	−8.73	20.77
I believe that emotion has no place in the treatment of medical illness (14)	0.50	0.69	0.48	0.04	−7.34	25.03
Physicians should not allow themselves to be influenced by strong personal bonds between their patients and their family members (18)	0.44	0.06	0.004	0.06	4.98	−1.79
Physicians’ understanding of their patients’ feelings and the feelings of their patients’ families does not influence medical or surgical treatment (1)	0.43	0.36	0.13	0.05	−6.55	11.55
I do not enjoy reading nonmedical literature or experiencing the arts (19)	0.37	0.40	0.16	0.05	–11.38	12.13
Asking patients about what is happening in their personal lives is not helpful in understanding their physical complaints (12)	0.37	0.53	0.28	0.05	−4.35	17.01
Factor 3: Standing in the patient's shoes
It is difficult for a physician to view things from patients’ perspectives (3)	0.74	0.65	0.42	0.17	−0.35	6.08
Because people are different, it is difficult to see things from patients’ perspectives (6)	0.66	0.55	0.30	0.15	0.08	6.11

Notes: All parameter estimates were significant at p < 0.05. FL Hojat: Factor loadings for items as reported by Hojat et al. (2002b); FL: factor loadings for items; R²: coefficient of determination of parameter estimation for items; SE: standard error; US: Test of univariate normality for linear transformed skewness of items; TPE: t-value for parameter estimation.

Table 4.  Goodness-of-fit indexes for CFA of JSE in Iranian medical students

Model	NNFI	RMR	RMSEA	CFI	AGFI	GFI	χ^2 a	χ^2 b	df	χ^2/df
M1	0.89	0.17	0.07	0.90	0.87	0.89	1181.95	840.93	171	4.95
M2	0.03	0.34	0.07	0.13	0.89	0.91	9269.82	1010.11	170	5.94
M3	0.95	0.12	0.05	0.95	0.92	0.94	663.10	597.02	167	3.57

Notes: ^a Satorra–Bentler.

^bCorrected for non-normality.

Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: Definition, components, measurement, and relationship to gender and specialty. Amer J Psychiatry 2002b; 159: 1563–1569

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