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Tomorrow’s doctors and dentists in Malaysia: empathic or indifferent?

Muneer Gohar Gohar Babar, Syed Shahzad Hasan, Lee Ping Lim, Phei June Lim, Nik Mohd Mazuan Nik Mohd Rosdy, Siti Fauzza Binti Ahmad


Objectives: This study compared the empathic behaviour of first year to final year dental and medical students in Malaysia and explored whether academic training of dental and medical students increases their subjective empathic tendencies.

Methods: This cross-sectional study was carried out among 1020 first year to final year (fifth-year) undergraduate medical and dental students using a validated, self-administered Jefferson Scale of Empathy-Health Care Provider Student Version (JSE-HPS) questionnaire. The data were collected from first year to final year (fifth-year) students enrolled in Bachelor of Medicine/Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS) degree programs at 2 government-funded universities and one private university.

Results: Dental students had a significantly higher total mean empathy score than medical students (84.11 versus 81.96, p < 0.05). However, medical students had a narrow actual score range (59.35 - 133.35) than dental (22.05 - 133.35) students. Males (Medical: 82.57, Dental: 84.97) and students of Malay origin (Medical: 82.52, Dental: 85.11) were more empathic than females and students of other ethnic origins. The results also indicate that third-year medical students (mean: 82.95) and fourth-year dental students (mean: 86.36) were more empathic than students in other professional years.

Conclusions: We recommend the use of some form of active training and assessment to assist in the development of empathy in medical and dental students. Medical and dental schools should place more emphasis on teaching empathic communication.


Dental-students; medical-students; empathy; indifferent; JSE-HPS; Malaysia

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Babar, M., Omar, H., Lim, L., Khan, S., Mitha, S., Ahmad, S.F.B. & Hasan, S.S. (2013). An assessment of dental students’ empathy levels in Malaysia. International Journal of Medical Education 4, 223-229.

Hojat, M. (2007). Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes. pp. 1-283. New York: Springer.

Hemmerdinger, J.M., Stoddart, S.D.R. & Lilford, R.J. (2007). A systematic review of tests of empathy in medicine. BMC Medical Education 7 (1) 24.

Hojat, M., Mangione, S. & Nasca, T. (2001). The Jefferson Scale of Physician Empathy: development and preliminary psychometric data. Educational and Psychological Measurement 61 (2) 349-365.

Coulehan, J.L., Platt, F.W., Egener, B., Frankel, R., Lin, C.T., Lown, B. & Salazar, W.H. (2001 ). “Let me see if I have this right... ”: Words that help build empathy. Annals of Internal Medicine 135 (3) 221-227.

Spiro, H. (2009). Commentary: The practice of empathy. Academic Medicine 84 (9) 1177-1179.

Hojat, M., Louis, M. & Daniel, Z. (2011). The Jefferson Scale of Empathy (JSE): An update. Population Health 24 (2) 5.

Di Blasi, Z., Harkness, E., Ernst, E., Georgiou, A. & Kleijnen, J. (2001). Influence of context effects on health outcomes: a systematic review. Lancet 357 (9258) 757-762.

Stewart, M.A. (1995). Effective physician-patient communication and health outcomes: a review. Canadian Medical Association Journal 152 (9) 1423-1433.

Stewart, M., Brown, J.B., Donner, A., McWhinney, I.R., Oates, J., Weston, W.W. & Jordan, J. (2000). The impact of patient-centered care on outcomes. Journal of Family Practice 49 (9) 796-804.

Griffin, S., Kinmonth, A. & Veltman, M. (2004). Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Annals of Family Medicine 2 (6) 595-608.

Nightingale, S.D., Yarnold, P.R. & Greenberg, M.S. (1991). Sympathy, empathy, and physician resource utilization. Journal of General Internal Medicine 6 (5) 420-423.

Brownell, A. K. & Côté, L. (2001). Senior residents’ views on the meaning of professionalism and how they learn about it. Academic Medicine 76 (7) 734-737.

Hojat, M., Gonnella, J.S., Nasca, T.J., Mangione, S., Vergare, M. & Magee, M. (2002). Physician empathy: Definition, components, measurement, and relationship to gender and specialty. American Journal of Psychiatry 159 (9) 1563-1569.

Yarascavitch, C., Regehr, G., Hodges, B. & Haas, D.A. (2009). Changes in dental student empathy during training. Journal of Dental Education 73 (4) 509-517.

Beckman, H. & Frankel, R. (2003). Training practitioners to communicate effectively in cancer care: it is the relationship that counts. Patient Education and Counseling 50 (1) 85-89.

Neumann, M., Wirtz, M. & Bollschweiler, E. (2008). Psychometric evaluation of the German version of the "Consultation and Relational Empathy" (CARE) measure at the example of cancer patients. Psychotherapie 58 (1) 5-15.

Larson, E.B. & Yao, X. (2005). Clinical empathy as emotional labor in the patient-physician relationship. Journal of the American Medical Association 293 (9) 1100-1106.

Halpern, J. (2001). From detached concern to empathy: humanizing medical practice. New York: Oxford University Press.

Irving, P. & Dickson, D. (2004). Empathy: towards a conceptual framework for health professionals. International Journal of Health Care 17 (4) 212-220.

Neumann, M., Wirtz, M., Bollschweiler, E., Mercer, S.W., Warm, M., Wolf, J. & Pfaff, H. (2007). Determinants and patient-reported long-term outcomes of physician empathy in oncology: A structural equation modelling approach. Patient Education and Counseling 69 (1-3) 63-75.

Kim, S.S., Kaplowitz, S. & Johnston, M.V. (2004). The Effects of Physician Empathy on Patient Satisfaction and Complicance. Evaluation & the Health Professions 27 (3) 237-251.

Price, S., Mercer, S.W. & MacPherson, H. (2006). Practitioner empathy, patient enablement and health outcomes: A prospective study of acupuncture patients. Patient Education and Counseling 63 (1-2) 239-245.

Levinson, W., Gorawara-Bhat, R. & Lamb, J. (2000). A study of patient clues and physician responses in primary care and surgical settings. Journal of the American Medical Association 284 (8) 1021-1027.

MacPherson, H., Mercer, S.W., Scullion, T. & Thomas, K.J. (2003). Empathy, enablement, and outcome: an exploratory study on acupuncture patients’ perceptions. Journal of Alternative and Complementary Medicine 9 (6) 869-876.

Bikker, A.P., Mercer, S.W. & Reilly, D. (2005). A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow Homoeopathic Hospital. Journal of Alternative and Complementary Medicine 11 (4) 591-600.

Kataoka, H.U., Koide, N., Ochi, K., Hojat, M. & Gonnella, J.S. (2009). Measurement of empathy among Japanese medical students: psychometrics and score differences by gender and level of medical education. Academic Medicine 84 (9) 1192-1197.

Spencer, J. (2004). Decline in empathy in medical education: how can we stop the rot? Medical Education 38 (9) 916-918.

Thomas, M.R., Dyrbye, L.N., Huntington, J.L., Lawson, K.L., Novotny, P.J., Sloan, J.A. & Shanafelt, T.D. (2007). How do distress and well-being relate to medical student empathy? A multicenter study. Journal of General Internal Medicine 22 (2) 177-183.

Schouten, B.C., Eijkman, M.A.J. & Hoogstraten, J. (2003). Dentists’ and patients’ communicative behaviour and their satisfaction with the dental encounter. Community Dental Health 20 (1) 11-15.

Corah, N.L., O’Shea, R.M., Bissell, G.D., Thines, T.J. & Mendola, P. (1988). The dentist-patient relationship: perceived dentist behaviors that reduce patient anxiety and increase satisfaction. Journal of the American Dental Association 116 (1) 73-76.

Kenny, D. (1995). Determinants of patient satisfaction with the medical consultation. Psychology and Health 10 (5) 427-437.

Hojat, M. (2009). Ten approaches for enhancing empathy in health and human services cultures. Journal of Health and Human Services Administration 31 (4) 412-450.

Nunes, P., Williams, S., Sa, B. & Stevenson, K. (2011). A study of empathy decline in students from five health disciplines during their first year of training. International Journal of Medical Education 2, 12-17.

Chen, D., Lew, R., Hershman, W. & Orlander, J. (2007). A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine 22 (10) 1434-1438.

Hojat, M., Mangione, S., Nasca, T.J., Rattner, S., Erdmann, J.B., Gonnella, J.S. & Magee, M. (2004). An empirical study of decline in empathy in medical school. Medical Education 38 (9) 934-941.

Hojat, M., Vergare, M.J., Maxwell, K., Brainard, G., Herrine, S.K., Isenberg, G.A., Veloski, J. & Gonnella, J.S. (2009). The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Academic Medicine 84 (9) 1182-1191.

Sherman, J.J. & Cramer, A. (2005). Measurement of changes in empathy during dental school. Journal of Dental Education 69 (3) 338-345.

Boyle, M., Williams, B., Brown, T., Molloy, A., McKenna, L., Molloy, L. & Lewis, B. (2010). Levels of empathy in undergraduate health science students. The Internet Journal of Medical Education 1 (1) 1-7.

Magalhães, E., Salgueira, A.P., Costa, P. & Costa, M.J. (2011). Empathy in senior year and first year medical students: a cross-sectional study. BMC Medical Education 11, 52.

Gallop, R., Lancee, W.J. & Garfinkel, P.E. (1990). The empathic process and its mediators. A heuristic model. Journal of Nervous and Mental Disease 178 (10) 649-654.

Davis, M.H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology 44 (1) 113-126.

Hogan, R. (1969). Development of an Empathy Scale. Journal of Consulting and Clinical Psychology 33 (3) 307-316.

Mehrabian, A. & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality 40 (4) 525-543.

Beattie, A., Durham, J., Harvey, J., Steele, J. & McHanwell, S. (2012). Does empathy change in first-year dental students? European Journal of Dental Education 16 (1) e111-116.

Spreng, R.N., McKinnon, M.C., Mar, R.A. & Levine, B. (2009). The Toronto Empathy Questionnaire: scale development and initial validation of a factor-analytic solution to multiple empathy measures. Journal of Personality Assessment 91 (1) 62-71.

Hojat, M. & Gonnella, J.S. (2015). Eleven years of data on the jefferson scale of empathy-medical student version (JSE-S): Proxy norm data and tentative cutoff scores. Medical Principles and Practice 24 (4) 344-350.

Fjortoft, N., Van Winkle, L.J. & Hojat, M. (2011). Measuring empathy in pharmacy students. American Journal of Pharmaceutical Education 75 (6) 109.

Di Lillo, M., Cicchetti, A., Lo Scalzo, A., Taroni, F. & Hojat, M. (2009). The Jefferson Scale of Physician Empathy: preliminary psychometrics and group comparisons in Italian physicians. Academic Medicine 84 (9) 1198-1202.

Jabarifar, S-E., Khalifesoltani, F., Nilchian, F. & Yosefi, A. (2012). Empathy levels in undergraduate and postgraduate dental students in Isfahan Faculty of Dentistry in 2011. Journal of Isfahan Dental School 7 (5) 753-762.

Fields, S.K., Mahan, P., Tillman, P., Harris, J., Maxwell, K. & Hojat, M. (2011). Measuring empathy in healthcare profession students using the Jefferson Scale of Physician Empathy: health provider-student version. Journal of Interprofessional Care 25, 287-293.

Hemmerdinger, J.M., Stoddart, S.D.R. & Lilford, R.J. (2007). A systematic review of tests of empathy in medicine. BMC Medical Education 7 (1) 24.

Hsiao, C.Y., Tsai, Y.F. & Kao, Y.C. (2013). Psychometric properties of a Chinese version of the Jefferson Scale of Empathy-Health Profession Students. Journal of Psychiatric and Mental Health Nursing 20 (10) 866-873.

Feighny, K., Arnold, L., Monaco, M., Munro, S. & Earl, B. (1999). In pursuit of empathy and its relationship to physician communication skills: multidimensional empathy training for medical students. Annals of Behavioral Science and Medical Education 5, 13-21.

Edwards, M.T. & Zimet, C.N. (1976). Problems and concerns among medical students-1975. Journal of Medical Education 51, 619-625.

Kay, J. (1990). Traumatic Deidealization and the Future of Medicine. Journal of the American Medical Association 263 (4) 572.

Skeff, K. & Mutha, S. (1998). Role models - guiding the future of medicine. New England Journal of Medicine 339 (27) 2015-2017.

Wright, S., Kern, D. & Kolodner, K. (1998). Attributes of excellent attending-physician role models. New England Journal of Medicine 339 (27) 1986-1993.

Kramer, D., Ber, R. & Moore, M. (1987). Impact of workshop on students’ and physicians’ rejecting behaviors in patient interviews. Journal of Medical Education 62 (11) 904-910.

Diseker, R. & Michielutte, R. (1981). An analysis of empathy in medical students before and following clinical experience. Academic Medicine 56 (12) 1004-1010.

DiLalla, L.F., Hull, S.K. & Dorsey, J.K. (2004). Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teaching and Learning in Medicine 16 (2) 165-170.

Stratton, T.D., Saunders, J.A. & Elam, C.L. (2008). Changes in medical students’ emotional intelligence: An exploratory study. Teaching and Learning in Medicine 20 (3) 279-284.

Bellini, L.M. (2002). Variation of Mood and Empathy During Internship. Journal of the American Medical Association 287 (23) 3143-3146.

Bellini, L.M. & Shea, J.A. (2005). Mood Change and Empathy Decline Persist during Three Years of Internal Medicine Training. Academic Medicine 80 (2) 164-167.

West, C.P., Huschka, M.M., Novotny, P.J., Sloan, J.A., Kolars, J.C., Habermann, T.M. & Shanafelt, T.D. (2006). Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. Journal of the American Medical Association 296 (9) 1071-1078.

Roh, M., Hahm, B., Lee, D. & Suh, D. (2010). Evaluation of empathy among Korean medical students: a cross-sectional study using the Korean Version of the Jefferson Scale of Physician Empathy. Teaching and Learning in Medicine 22 (3) 167-171.

Yarascavitch, C., Regehr, G., Hodges, B. & Haas, D.A. (2009). Changes in dental student empathy during training. Journal of Dental Education 73 (4) 509-517.

Decety, J., Smith, K.E., Norman, G.J. & Halpern, J. (2014). A social neuroscience perspective on clinical empathy. World Psychiatry 13 (3) 233-237.

Markham, B. (1979). Can a behavioural science course change medical students’ attitudes? Journal of Psychiatric Education 3, 44-54.

Bonvicini, K.A., Perlin, M.J., Bylund, C.L., Carroll, G., Rouse, R.A. & Goldstein, M.G. (2009). Impact of communication training on physician expression of empathy in patient encounters. Patient Education and Counseling 75 (1) 3-10.

Wilkes, M., Milgrom, E. & Hoffman, J.R. (2002). Towards more empathic medical students: A medical student hospitalization experience. Medical Education 36 (6) 528-533.

Austin, E.J., Evans, P., Magnus, B. & O’Hanlon, K. (2007). A preliminary study of empathy, emotional intelligence and examination performance in MBChB students. Medical Education 41 (7) 684-689.

Vallabh, K. (2011). Psychometrics of the student version of the Jefferson Scale of Physician Empathy (JSPE-S) in final-year medical students in Johannesburg in 2008. South African Journal of Bioethics and Law 4 (2) 63-68.



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