




































 

Sadia Shah 2 

 

©Advance Educational Institute & Research Centre                                                 Annals of Psychophysiology 

www.aeirc-edu.com                                                                                                       Volume 2, December 2015 

 

ISSN 2412-3188 
 

Original Article 

Empathy Levels among Medical Students: A Psycho-Social Analysis 

Sadia Shah1, Muhammad Muneeb2 & Aatir H.Rajput2 

1-Liaquat University of Medical & Health Sciences, Jamshoro 

2-Lumhs Research Forum 

Corresponding Author: drsadiashah@outlook.com 

Abstract 

Empathy is an important component in a doctor-patient relationship.  It is an objective and relatively a stable 

constitutional trait. The apprehension among educationalists that clinical training may have an adversative effect on 

medical trainees and student empathy levels, holds truth as indicated by the existing literature. Long work/study hours 

and sleep deprivation may be the potential reasons believed to contribute to empathy decline. The aim of the study 

was to determine the changes in the empathy levels among the students, during their medical school years. The 

opinions and observations of medical students were recorded and interpreted hoping to determine the main reasons 

behind the changing empathy levels (if present).  A psycho- social cross-sectional analysis of medical students’ 

empathy levels was conducted at Liaquat University of Medical and Health Sciences Jamshoro. A 20 item JSPE-S 

(Jefferson Scale of Physician Empathy–Student Version) self-administered structured questionnaire including 7- point 

Likert scale was used to evaluate empathy levels among students. Convenient sampling procedure was used. A total 

of 300 students were approached during their class timings at lecture halls. A prior verbal informed consent was taken 

and those who agreed were included in the study. The duration of study was from May, 2014 to August, 2014. Data 

analysis was done via SPSS 16.0.41% (n=123) out of 300 participants were male while 59% (n=177) were females. 

The mean empathy value of first year students (91.29) was greater than that of final year students (84.53). E.S value 

i.e. effect size value comes out to be 0.5, which is moderately significant. Study concluded that the students at LUMHS 

have the least empathy score in comparison to the standard values. This decline in the empathy levels explains the 

change of social behavior of the students across their medical school years. It is related to the hectic and difficult time 

period of their studies, their personal experience with the patients, realization of the difficulties and challenges in 

seeking medical services. 

Keywords 

Empathy, Medical students, Liaquat University 

Introduction 

Empathy is a psychological term which shouldn’t be 

confused with sympathy. Empathy is an objective and 

relatively a stable constitutional trait in contrast to 

sympathy, which is an irregular, non-objective and a 

non-critical sentiment (Helena, 2014; Lt: Col. R., 

2014). Empathy refers to the insightful awareness of 

an individual to the emotions, feelings and conduct of 

someone else. It is all about showing warmth, 

recognition and compassion for the people (Areeb, 

2013; Sandara, 2014) .Empathy is considered as an 

extremely important component in a doctor-patient 

relationship that involves careful and active listening 

to the patients, in order to identify, distinguish and 

understand their problems, show concern about their 

feelings, and passing on this comprehension. This 

understanding allows the patient to feel respected and 

comfortable and can trust the doctor give an 

appropriate data or history (M. Rahimi, 2010; Deleing, 

2013). Empathy is as important and crucial for the 

medical students as it is for the physicians. The 

apprehension among educationalists that clinical 

training may have an adversative effect on medical 

trainees and student empathy levels, holds truth as 

indicated by the existing literature. Empathy should be 

flourished and can be developed among the medical 

undergraduates during their stay in the medical 

schools (Kataoka, 2009; Hojat, 2009). The aim of the 

current study is to measure empathy levels amongst 

medical students in the first and the final year of their 

medical curriculum and to check weather this existing 

phenomenon holds truth in ours locality. 

Methodology 

This cross-sectional quantitative study was conducted 

at Liaquat University of Medical and Health Sciences, 

Jamshoro from May, 2014 to August, 2014.  A total 

number of 300 students (including 123 males and 177 

females) from First and Final year MBBS were 

enrolled after taking an informed consent. Students 

were chosen by simple random sampling and were 

approached during their class timings in lecture halls, 

ward classes and practical labs. Students were advised 

not to identify themselves in any manner except age, 

gender and medical study year. Every 3rd student in a 

row was requested to be indulged in the research 

procedure. A pre-formed structured questionnaire 

(including Student version of Jefferson Scale of 

Physician Empathy) was used to get knowledge about 

students’ name, age, gender, educational status, 

frequency of interaction with people, their 

classification as emotional or practical, and time given 

to medical practice daily. The student version (S-

version) of JSPE (Jefferson Scale of Physician 

Empathy) was used in the study, in its original 

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Sadia Shah 3 

 

©Advance Educational Institute & Research Centre                                                 Annals of Psychophysiology 

www.aeirc-edu.com                                                                                                       Volume 2, December 2015 

 

ISSN 2412-3188 
 

language (English) and format which took 

approximately 5–7 minutes to get completed. JSPE is 

a self-administered inventory, containing 20 items. 

Negative and Positive items were equally phrased. 

Each item was answered on a seven-point Likert-type 

scale, ranging from 1 (strongly disagree) to 7 (strongly 

agree). For negative items, scoring is reversed (1= 

strongly agree to 7= strongly disagree). The total score 

was obtained by the sum of all items (scores can range 

from 20 to 140).  Higher values indicate higher level 

of empathy. The JSPE was originally developed in 

2001 to measure medical students’ attitudes about 

physician empathy in a patient-care situation. Items 

included in the scale were derived from an extensive 

review literature followed by studies with groups of 

physicians, medical students and residents. (Hojat et 

al. 2001; Hojat et al. 2002c). The scale has been 

validated and found to be reliable in USA, Mexico and 

Japan (Hojat et al. 2001; Alcorta-Garza et al. 2005; 

Kataoka et al. 2009). All the responses to the JPSE-S 

by the medical students were coded and analyzed 

using SPPS version 16.00. For categorical data, 

percentages and frequencies was used. For numeric 

data, mean and standard deviation was used. An 

independent E.S value i.e. the effect size value was 

applied to assess the clinical and statistical difference 

between the empathy levels. (Mean Empathy score of 

final year – Mean Empathy score of 1st year)/St. 

Deviation of 1st year score. 

Results 

Of the 330 questionnaires distributed, 91% i.e. n=300 

questionnaires were responded completely and 

included in the study. There were 41% (123) males and 

59% (177) females. 147 (49%) respondents were from 

First year whereas, 153 (51%) respondents from Final 

year.  

 

Figure 1 Showing gender distribution of respondents. 

59% of the sample was consisted of female population 

while males were 41% of the sample. 

A comparative analysis reveals that the mean empathy 

score for the first year students is 91.29 which is 

significantly greater than that of the final year 

students, i.e. 84.53. Though, final year students did not 

have a higher level of empathy than their first year 

counterparts, but the difference in the Standard 

Deviation was not statistically significant. While the 

E.S value i.e. the effect size value, comes out to be 0.5, 

which shows that the clinical and statistical difference 

between the empathy levels, which is moderately 

significant. (E.S= Mean Empathy score of final year – 

Mean Empathy score of 1st year/St. deviation of 1st 

year score).  

Figure 2; representing educational status of 

respondents. There were 49% first year students while 

59% of the sample was from final year 

 

Figure: 3 shows a decline in Mean Empathy Score i.e. 

91.29 from first year to 84.53 in final year. 

FIRST 

YEAR

49%

FINAL 

YEAR

51%

91.29

84.53

80

82

84

86

88

90

92

First Year Final Year

Mean Empathy Score

MALES

41%

FEMALES

59%

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Sadia Shah 4 

 

©Advance Educational Institute & Research Centre                                                 Annals of Psychophysiology 

www.aeirc-edu.com                                                                                                       Volume 2, December 2015 

 

ISSN 2412-3188 
 

 

Table: 1. the background demographic of empathy 

mean scores (n=300) 

Discussion  

The results revealed that empathy among the medical 

students’ builds up during the first year of medical 

education, however it starts to come down after the 

clinical exposure begins and remains down through 

the final year of medical school. The variation in 

JSPE-S score is as incredible as 6.76 between the first 

year and final year students. The study, albeit cross-

sectional, is reliable with past studies, recommending 

that empathy diminishes after the clinical exposure in 

the medical school. Different stressful aspects of 

medical training for example long working hours, lack 

of sleep, depending on technology for diagnosis, 

shorter hospitalizations of patient and limited bedside 

interactions may contribute to diminish empathy 

levels (Rose, 2006; Benbassat, 2004). Another 

alternate conceivable clarification for the observed 

decrease in the empathy levels may be cultural 

assimilation or acculturation phenomenon (Kay, 

1990). Medical students encounter an extensive range 

of emotions and feelings and may struggle to keep up 

their empathy levels (Kramer, 1989). The results also 

show that the overall empathy of students at LUMHS 

is less than the international standard. Bangladesh 

(mean = 110.41), China (mean = 109.60), Japan (mean 

= 104.3), Kuwait (mean = 104.6), Iran (mean = 105.1) 

and American medical students (mean=115). The 

possible explanation for this is the overwhelming 

clinical exposure in our settings which probably train 

the minds of students in such a way that their empathy 

levels starts to come down and they start thinking more 

professionally and practically rather emotionally 

(Marcus, 1999; Branch, 1993).  

Conclusion 

The study concluded that there are differences in 

empathy among the different classes and that empathy 

declines with increased clinical training in the medical 

school.  Empathy serves as a key factor in establishing 

a good doctor-patient relationship. It is thus essential 

that empathy should be nurtured in medical students 

rather than swept away with time and clinical 

exposure, so that the upcoming physicians can serve 

their patients in the best possible way.  

Limitations 

There were several limitations to the study. Due to 

cross-sectional nature of the study, only the empathy 

levels among first year and final year students could 

be examined. It would be of interest to measure how 

empathy varies with each year throughout the five 

years of medical school using a prospective 

longitudinal study design. Secondly, the candidates 

own self-perception influences his/her choices while 

filling out the questionnaire and this may vary from 

the actual behavior that is implemented in their 

everyday interactions.  

Recommendations 

It would be profitable to do a prospective study where 

the students under study are emulated every year from 

the first year until graduation, to give a genuine 

representation of progress in empathy levels.  In spite 

of the fact that the study is constrained to our medical 

university, we feel that our results could be summed 

up to restorative universities that have a customary 

structure like our own.  

References 

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D01:10.1371/journal.pone 0094133  

DEMOGRAPHIC 

VARIABLES 

No. MEAN/S.D 

First Year 147 91.29/13.2 

Final Year 153 84.53/12.4 

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Sadia Shah 5 

 

©Advance Educational Institute & Research Centre                                                 Annals of Psychophysiology 

www.aeirc-edu.com                                                                                                       Volume 2, December 2015 

 

ISSN 2412-3188 
 

 Kataoka MU, Koide.N, Ochi.K, Hojat M. Acad 

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 Deleing Wen, Xiao Dan Ma, Hong he Li; , published 

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education, BMC Med edu.2013 13:130 

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