|Year : 2014 | Volume
| Issue : 2 | Page : 69-73
|Standing in patients' shoes — survey on empathy among dental students in India
S Prabhu1, V Shiva Kumar2, S Sam Prasanth3, Shreya Kishore3
1 Department of Public Health Dentistry, Chettinad Dental College and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India
2 Department of Periodontia, Chettinad Dental College and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India
3 Intern, Chettinad Dental College and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India
Click here for correspondence address and email
|Date of Web Publication||9-Jan-2015|
| Abstract|| |
Background: Empathy is fundamental to the health care provider-patient relationship. The present study was conducted with the aim to assess the level of Empathy among Indian Dental Students and the objectives of the study are to assess any difference in the level of empathy across gender and year of study.
Materials and Methods: Cross sectional descriptive study, employing convenience sampling method was conducted to assess the level of empathy using a validated, self-administered questionnaire Jefferson Scale of Empathy, Health Care Provider Student version (JSE-HPS) in this study. Independent samples t-test and one way ANOVA was used for comparison of empathy scores across gender and year of study.
Results: A total of 406 dental students and Interns participated in the present study; the mean empathy score among the dental students was 82.76 ± 8.59. Mean empathy score of male students (83.99 ± 8.711) is greater than female students (82.37 ± 8.54) and there is a significant difference in empathy score among years of study (P < 0.05).
Conclusion: Mean empathy score among Indian Dental Students is lesser than those reported in other studies. Empathy should be given importance in dental curriculum to improve dentist-patient relationship, thereby improving the treatment outcomes.
Keywords: Dental students, empathy, Jefferson Scale of Empathy
|How to cite this article:|
Prabhu S, Kumar V S, Prasanth S S, Kishore S. Standing in patients' shoes — survey on empathy among dental students in India. J Educ Ethics Dent 2014;4:69-73
|How to cite this URL:|
Prabhu S, Kumar V S, Prasanth S S, Kishore S. Standing in patients' shoes — survey on empathy among dental students in India. J Educ Ethics Dent [serial online] 2014 [cited 2021 Apr 11];4:69-73. Available from: https://www.jeed.in/text.asp?2014/4/2/69/148990
| Introduction|| |
Empathy is fundamental to the health care provider-patient relationship.  In terms of patient care, empathy is defined as a cognitive attribute that involves an ability to understand the patient's experiences, pain, suffering and perspective combined with a capability to communicate this understanding and intention to help.  Pederson (2009) defined empathy succinctly as the "appropriate understanding of the patient".  The concept of empathy in health care fields is diverse, but most likened to ideas of compassion, thoughtfulness, attentiveness and caring, all of which culminate in a desirable type of "chair side manner" that generates understanding and produces positive rapport with patients. It is considered essential to the notion of patient-centred care: To what degree can a patient's best interests be served if the caregivers know relatively little about the patient's world, values or interests. 
Medical research has shown that the use of a "warm, empathic style" by physicians during communications with patients is associated with improved treatment outcomes  such as increased compliance with medical recommendations, , decreased pain  and reduced recovery time, , as well as increased patient satisfaction ,, and decreased medical litigation. , The role of empathy in the dentist-patient relationship has received less attention.  Demonstration of empathy by dentists has been correlated with decreased dental fear, ,, increased compliance with orthodontic treatment,  improved treatment success and cooperation in paediatric patients, , improved treatment outcomes in myofacial pain,  and increased patient satisfaction. ,
One of the challenges in measuring empathy among health care professionals is the abundant descriptions of empathy from the various domains of psychology ,, and neuroscience.  The gold standard for assessment of empathy and interpersonal skills is behavioural observation by trained observers to ascertain use of skills. However, this can be only costly and time-consuming.  Jefferson Scale of Physician Empathy (JSPE-HPS) has been validated in a variety of dental settings; , however there is a lack of studies among the Indian Dental students to assess their level of empathy, hence the present study was conducted with the aim to assess the level of Empathy among Indian Dental Students and the objectives of the study are to assess any difference in the level of empathy across gender and year of study.
| Materials and Methods|| |
A cross sectional descriptive study, employing convenience sampling method was conducted among the students and interns of Chettinad Dental College and Research Institute, Kelambakkam to assess their level of empathy using a validated, self-administered questionnaire Jefferson Scale of Empathy, Health Care Provider Student version (JSE-HPS) in this study.  The instrument consists of 20 items answered on 7-point likert scale which are scored from 1 (strongly disagree) to 7 (strongly agree). The questionnaire consists of the following questions:
(1) My understanding of how my patients and their families feel do not influence medical or surgical treatment,
(2) I believe that emotion has no place in the treatment of medical illness,
(3) My patients value my understanding of their feelings, which is therapeutic in its own right,
(4) Empathy is a therapeutic skill without which success in treatment is limited,
(5) I believe that empathy is an important therapeutic factor in medical or surgical treatment,
(6) My patients feel better when I understand their feelings,
(7) Patients' illnesses can be cured only by medical or surgical treatment; therefore, emotional ties to my patients do not have a significant influence on medical or surgical outcomes,
(8) An important component of the relationship with my patients is my understanding of their emotional status, as well as that of their families,
(9) I do not allow myself to be influenced by strong personal bonds between my patients and their family members,
(10) Attentiveness to my patients' personal experiences does not influence treatment outcome,
(11) I try to think like my patients in order to render better care,
(12) I consider understanding my patients' body language as important as verbal communication in caregiver-patient relationships,
(13) I try to understand what is going on in my patients' minds by paying attention to their nonverbal cues and body language,
(14) I try to imagine myself in my patients' shoes when providing care to them,
(15) I try not to pay attention to my patients' emotions in history taking or in asking about their physical health,
(16) It is difficult for me to view things from my patients' perspectives,
(17) I have a good sense of humour, which I think contributes to a better clinical outcome,
(18) Because people are different, it is difficult for me to see things from my patients' perspectives,
(19) Asking patients about what is happening in their personal lives is not helpful in understanding their physical complaints and
(20) I do not enjoy reading nonmedical literature and the arts.
Among the 20 questions, 10 negatively worded items in the scale were reverse scored they are Question No - 1, 2, 7, 9, 10, 12, 15, 16, 19 and 20. The total score ranges from 20-140; a higher score indicates a behavioural tendency favouring empathic engagement in patient care. ,,,
The sample size required for the present study was estimated to be (N = 158) dental students based on the study conducted by Sherman et al (2005).  Prior to the start of the study approval has been obtained from the college authorities and explanation was given to all the dental students regarding the study and informed consent was obtained from the students who are willing to participate in the study, students who were not willing to participate in the study were excluded.
Self - administered Questionnaires were distributed to the students, Data collection was done for a period 15 days, from 16 th Jan 2014 to 30th Jan 2014 and the students were asked to go through the statements carefully and are asked to 'tick' the appropriate answer of their choice. The filled questionnaires were collected by placing a collection box in the department of Public Health Dentistry during the aforementioned time period.
Collected forms filled with responses were entered in Microsoft Excel - 2010 and then subjected to statistical analysis using SPSS (Version 17). Frequency tables were computed and Independent samples t-test is used for the comparison of mean empathy score across gender and between clinical and non-clinical dental students. One way ANOVA with Tukey's Post-Hoc test was used for the comparison of the difference in Empathy scores across all the years of study.
| Results|| |
A total of 406 dental students and interns participated in the present study; response rate was 81.2% (406/500). [Figure 1] depicts the distribution of study subjects according to the year of study and gender among the 89 study subjects from first year 28 (31.5%) were male and 61 (68.5%) were female, among the 100 study subjects from second year 22 (22%) were male and 78 (78%) were female, among the 72 study subjects from third year 18 (25%) were male and 54 (75%) were female, among the 76 study subjects from final year 13 (17.1%) were male and 63 (82.9%) were female and among the 69 interns 16 (23.2%) were male and 53 (76.8%) were female, In all the years of study the proportion of female students is found to higher than male students.
[Table 1] depicts the mean empathy level across gender based on the year of study, Independent samples t-test showed that the difference in the mean empathy level was found to be statistically significant across gender among the first year students (P < 0.05) and there is no difference in the mean empathy level across gender among the students from the other years of study.
|Figure 1: Distribution of study subjects according to year of study and gender|
Click here to view
[Table 2] depicts the comparison of mean empathy level across non-clinical year (first year and second year) vs. Clinical year (third year, final year and Interns) students. Independent samples t-test showed that there is no difference in their level of empathy between non-clinical and clinical year students.
[Table 3] depicts the mean empathy level of the study subjects across the year of study, mean empathy level for the second year students was highest 85.00 ± 7.99 (mean ± SD) and the empathy level was the least for third year students 81.08 ± 7.11 (mean ± SD). One way ANOVA test showed that the difference in mean empathy level across the year of study was statistically significant (P < 0.05).
|Table 2: Comparison of mean empathy level across nonclinical vs. clinical year students|
Click here to view
[Table 4] depicts the comparison of mean empathy score among the years of study among dental students using Tukey's post hoc test. Mean difference in empathy score was found to be significant between first year vs. second year students and between second year vs. third year students (P < 0.05).
| Discussion|| |
The present cross-sectional descriptive study employing convenience sampling method was conducted with the aim to assess the empathy level among Indian dental students, the mean empathy score among the dental students was 82.76 ± 8.59 (mean ± SD) and the results of the present study are in accordance with the studies conducted by Sherman et al (2005).  The mean empathy score in this study is much lower than the average empathy scores of 103-117 reported by previous studies among medical , and dental students  using S-version and HP-version of JSE. This difference in empathy level could be a result of their different cultural values, religious beliefs or traditions.  It has been reported earlier that cultural differences, ethnicity, religious beliefs, and sex stereotyping may lead to empathy score disparity  and can also influence empathic engagement during clinical encounters. 
Comparison of mean empathy score across gender showed that the male students had a comparatively higher empathy score than female dental students the results of the present study are in accordance with the previous studies by Sherman et al.  Grace et al.  This can be attributed to the higher proportion of female students compared to male students in the present study, there has been a demographic shift in the selection of dental degree course and recent trends had shown that dentistry is commonly chosen by female students than male dental students.
Comparison of empathy scores across years of study showed significant difference in the empathy level among dental students with the second year students and the interns having the higher score compared to other years of study, this is attributed to the exposure of second year dental students to the medical field which makes them feel much about the patients' pain and there is gradual decline in empathy level from second year to final year , and there is again an increase in level of empathy among the interns which is attributed to the responsibilities given for the interns towards patient care and their urge to start their clinical practice which makes them "Standing in Patients' shoes" a necessity for a successful dental practice.
The limitations of the present study are difference in gender distribution and empathy is recorded on the cross-sectional basis, as a result it cannot give information on change in empathy during the dental curriculum and the students responded to the survey based on their experience in the previous years in the dental school.
| Conclusion|| |
The present study shows that there is a low empathy level among dental students when compared to other studies and the empathy level of male students was higher than the female students. It is necessary to inculcate the role of empathy in dentist-patient relationship among the dental students by modification of dental curriculum for improving dentist-patient relationship; further longitudinal studies are required to assess the change in empathy level during dental the dental school training.
| References|| |
Spiro H. Commentary: The practice of empathy. Acad Med 2009;84:1177-9.
Jefferson scale of Empathy (JSPE). Center for research in medical education and health care (CRMEHC). [Last cited on 2013 July]; Available from: http://www.jefferson.edu/jmc/crmehc/jse.html.
Pederson R. Empirical research on empathy in medicine - A critical review. Patient Educ Couns 2009;76:307-22.
More ES, Milligan MA. The empathic practitioner: Empathy, gender and medicine. New Brunswick, NJ: Rutgers University Press; 1994.
Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: A systematic review. Lancet 2001;357:757-62.
Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: Three decades of research - A comprehensive review. J Clin Pharm Ther 2001;26:331-42.
Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof 2004;27:237-51.
Berk SN, Moore ME, Resnick JH. Psychosocial factors as mediators of acupuncture therapy. J Consult Clin Psychol 1977;45:612-9.
Olsson B, Olsson B, Tibblin G. Effect of patients' expectations on recovery from acute tonsillitis. Fam Pract 1989;6:188-92.
Thomas MR, Dyrbye LN, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, et al
. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med 2007;22:177-83.
Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract 1991;32:175-81.
Donovan JL. Patient decision-making: The missing ingredient in compliance research. Int J Technol Assess Health Care 1995;11:44355.
Levinson W. Physician-patient communication: A key to malpractice prevention. JAMA 1994;272:1619-20.
Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice: Lessons from plaintiff depositions. Arch Intern Med 1994;154:1365-70.
Schouten BC, Eijkman MA, Hoogstraten J. Dentists and patients communicative behavior. Community Dent Health 2003;20:11-5.
Kleinkne RA, Klepac RK, Alexande LD. Origins and characteristics of fear of dentistry. J Am Dent Assoc 1973;86:842-8.
Corah NL, Oshea RM, Bissell GD, Thines TJ, Mendola P. The dentist-patient relationship: Perceived dentist behaviors that reduce patient anxiety and increase satisfaction. J Am Dent Assoc 1988;116:73-6.
Kulich KR, Berggren U, Hallberg LRM. A qualitative analysis of patient-centered dentistry in consultations with dental phobic patients. J Health Commun 2003;8:171-87.
Sinha PK, Nanda RS, McNeil DW. Perceived orthodontist behaviors that predict patient satisfaction, orthodontist-patient relationship, and patient adherence in orthodontic treatment. Am J Orthod Dentofacial Orthop 1996;110:370-7.
Weinstein P, Getz T, Ratener P, Domoto P. Dentists' responses to fear-related and nonfear-related behaviors in children. J Am Dent Assoc 1982;104:38-40.
Sarnat H, Arad P, Hanauer D, Shohami E. Communication strategies used during pediatric dental treatment: A pilot study. Pediatr Dent 2001;23:337-42.
Laskin DM, Greene CS. Influence of doctor-patient relationship on placebo therapy for patients with myofascial pain-dysfunction (mpd) syndrome. J Am Dent Assoc 1972;85:892-4.
Schouten BC, Eijkman MA, Hoogstraten J. Dentists' and patients' communicative behaviour and their satisfaction with the dental encounter. Community Dent Health 2003;20:11-5.
Allport G. Pattern and growth in personality. New York: Holt, Rinehardt & Winston; 1961.
Rogers CR. Empathic: An unappreciated way of being. Couns Psychol 1975;5:2-10.
Batson C, Coke J. Empathy: A source of altruistic motivation for helping. In: Rushton J, Sorrento R, editors. Altruism and helping behaviour: Social, personality, and developmental perspectives. Boston: McGraw-Hill; 1981. p. 282-316.
Eisenberg N, Strayer J. Empathy and its development. Cambridge, UK: Cambridge University Press; 1987.
Decety J, Jackson PL. The functional architecture of human empathy. Behav Cognit Neurosci Rev 2004;3:71-100.
Sherman JJ, Adam Cramer BS. Measurement of Changes in Empathy During Dental School. Journal of Dental Education. J Dent Educ 2005;69:338-45.
Muneer GB, Hanan O, Lee PL, Khan SA, Mitha S, Ahmed SF, et al
. An assessment of dental students empathy levels in Malaysia. Int J Med Educ 2013;4:223-9.
Fields SK, Mahan P, Tillman P, Harris J, Maxwell K, Hojat M. Measuring empathy in healthcare professions using Jefferson Scale of physician empathy: Health provider-student version. J Interprof Care 2011;25:287-93.
Boyle MJ, Williams B, Brown T, Molly A, McKenna L, Molly L, et al
. Level of empathy in undergraduate health science students. Int J Med Educ 2010;1:1.
Chen D, Lew R, Hershman W, Orlander J. A Cross-sectional measurement of medical student empathy. J Gen Intern Med 2007;22:1434-8.
Fjortoft N, Van Winkle LJ, Hojat M. Measuring empathy in pharmacy students. Am J Pharm Educ 2011;75:109.
Kataoka HU, Koide N, Ochi K, Hojat MR, Gonnella JS. Measurement of empathy among Japanese medical students: Psychometrics and score differences by gender and level of medical education. Acad Med 2009;84:1192-7.
Beattie A, Durham J, Harvey J, Steele J, McHanwell S. Does empathy change in first-year dental students? Eur J Dent Educ 2012;16:e111-6.
Vallabh K. Psychometrics of the student version of the Jefferson Scale of Physician Empathy (JSPE-S) in final-year medical students in Johannesburg in 2008. S Afr J Bioeth Law 2001;4:1.
Spencer J. Decline in empathy in medical education: How can we stop the rot? Editorials. Med Educ 2004;38:916-20.
Rose G, Frankel N, Kerr W. Empathic and socio-metric status among young teenagers. J Genet Psychol1956;89:277-8.
Dr. S Prabhu
Department of Public Health Dentistry, Chettinad Dental College and Research Institute, Rajiv Gandhi Salai, Kelambakkam, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]
| Article Access Statistics|
| Viewed||2897 |
| Printed||54 |
| Emailed||0 |
| PDF Downloaded||483 |
| Comments ||[Add] |