|Year : 2018 | Volume
| Issue : 4 | Page : 183-188
Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school
Mainul Haque1, Bidyadhar Sa2, Md Anwarul Azim Majumder3, Md Zakirul Islam4, Nur Syamirah Aishah Binti Othman1, Siti Nur Najihah Binti Lutfi1, Golam Mohammad Kibria1, Abdus Salam5, Mohd Hafizi Ismail1, Shahidah Leong Abdullah1
1 Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
2 The Centre for Medical Sciences Education, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies, Trinidad and Tobago
3 Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados, West Indies, Barbados
4 The Department of Pharmacology, Eastern Medical College, Comilla, Kabila, Dhaka-Chittagong Highway, Burichang 3520, Bangladesh
5 Medical Education and Quality Assurance, Asia Metropolitan University, No.6, Jalan Lembah Bandar Seri Alam, 81750 Johor Bahru, Malaysia
|Date of Web Publication||24-Dec-2018|
Dr. Mainul Haque
The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Empathy is one of the cardinal components for physician–patient relationships, optimal outcomes in patient care, improved patient satisfaction, greater adherence to therapy, and lower malpractice liability. It is also considered an essential quality for health-care professionals to practice medicine. The aim of the present study was to assess the empathy level of medical students of Universiti Pertahanan Nasional Malaysia (UPNM) National Defense University of Malaysia, Kuala Lumpur, Malaysia. Methods: This was a cross-sectional study conducted in 2017 which recruited medical students of UPNM. The Empathy Quotient, a self-reported questionnaire, was utilized for data collection. The total empathy score of the questionnaire is 80. Results: Majority of the respondents were male (60.9%), year-V students (26.6%), Malay (70.5%), and cadet officer (69.6%). The overall mean score achieved by the respondents was 36.76 ± 9.18, and 74.4% of the respondents scored more than 30. The empathy scores of the students were significantly affected by the gender (t = 2.371; df = 205; P < 0.05), year of study (F = 2.553; df = 4/202; P < 0.05), and examination grades (F = 3.488; df = 2/204; P < 0.05). The findings showed that female students are more empathetic than their male counterparts. Further, the post hoc Tukey test analysis revealed that Year-V students are more empathetic than their junior counterparts and students who got highest grade are more empathetic. Conclusions: To improve the empathy level of the UPNM medical students, appropriate educational strategies and interventions should be designed and implemented in the curriculum to inculcate, maintain, and enhance empathy.
| Abstract in French|| |
Arrière-plan: L'empathie est l'un des éléments essentiels dans les relations médecin-patient, des résultats optimaux en matière de soins aux patients, d'une meilleure satisfaction des patients, d'une plus grande observance du traitement et d'une réduction de la responsabilité en cas de faute professionnelle. La pratique de la médecine est également considérée comme une qualité essentielle pour les professionnels de la santé. Le but de l'étude actuelle était d'évaluer le niveau d'empathie des étudiants en médecine de l' Université Pertahanan Nasional Malaysia (UPNM) Université de défense nationale de Malaisie, Kuala Lumpur, Malaisie. Méthodes: Il s'agissait d'une étude transversale menée en 2017 qui recrutait des étudiants en médecine de l'UPNM. Le quotient d'empathie, un questionnaire auto-déclaré, a été utilisé pour la collecte de données. Le score total d'empathie du questionnaire est de 80. Résultats: La majorité des répondants étaient des hommes (60,9%) et des étudiants de la cinquième année (26,6%), officier malais (70,5%) et officier cadet (69,6%). Le score moyen global obtenu par les répondants était de 36,76 ± 9,18 et 74,4% des répondants ont obtenu plus de 30 points. Les scores d'empathie des élèves étaient significativement affectés par le sexe (t = 2,371; df = 205; p < 0.05, année d'étude (F = 2,553; df = 4/202; P <0,05) et notes d'examen (F = 3,4488; df = 2/204; P <0,05). Les résultats ont montré que les étudiantes sont plus empathiques que leurs homologues masculins. En outre, l'analyse post-hoc de Tukey a révélé que les élèves de la cinquième année sont plus empathiques que leurs camarades juniors et que les élèves ayant obtenu la meilleure note sont plus empathiques. Conclusions: Pour améliorer le niveau d'empathie des étudiants en médecine de l'UPNM, des stratégies et des interventions éducatives appropriées devraient être conçues et mises en œuvre dans le programme pour inculquer, maintenir et renforcer l'empathie.
Mots-clés: Empathie, notes d'examen, Malaisie, étudiants en médecine, année d'études
Keywords: Empathy, examination grades, Malaysia, undergraduate medical students, year of study
|How to cite this article:|
Haque M, Sa B, Majumder MA, Islam MZ, Othman NS, Lutfi SN, Kibria GM, Salam A, Ismail MH, Abdullah SL. Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school. Ann Afr Med 2018;17:183-8
|How to cite this URL:|
Haque M, Sa B, Majumder MA, Islam MZ, Othman NS, Lutfi SN, Kibria GM, Salam A, Ismail MH, Abdullah SL. Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school. Ann Afr Med [serial online] 2018 [cited 2019 Dec 7];17:183-8. Available from: http://www.annalsafrmed.org/text.asp?2018/17/4/183/248395
| Introduction|| |
Empathy is one of the cardinal components for physician–patient relationships, optimal outcomes in patient care, and is often considered an important quality for health-care professionals.,, Sir William Osler, a Canadian physician and the father of modern medicine, stated that “the physician needs a clear head and a kind heart; his work is arduous and complex, requiring the exercise of the very highest faculties of the mind, while constantly appealing to the emotions and finer feelings.” Furthermore, he pronounced “be careful, when you get into practice, to cultivate equally well your hearts and your heads.”
Medicine at its essential is a human service profession. Medical and health care is principally driven by physician- and disease-centered approach for the last few hundred years. Over the years of the commencement of the patient-centered tactic, physicians began to incorporate the patients' perception as one of the treatment outcomes.,, By and large, a patient-centered approach is linked to an improved understanding of the medical problems., The patient-centered approach has been marked as “the physician tries to enter the patient's world, to see the illness through the patient's eyes.” Nourishing humanistic values in general increases and augments interpersonal expertise and empathy precisely considered as dominant, important proficiency for professional practice, and identified as the most influential element of clinical practice, although it is often disregarded by practitioners.,, In terms of patient care, empathy is defined as “a cognitive attribute that involves an ability to understand the patient's pain, suffering, and perspective combined with a capability to communicate this understanding and an intention to help.” In general, empathy has been defined concisely as the proper conjecture of the patient. Research studies have made known that “warm, empathic style” by physicians during interacting and talking with patients is linked with better quality treatment outcomes, such as augmented compliance with medical commendations,, lessened pain, reduced recovery time, as well as amplified patient satisfaction,,, increased patients' empowerment, enhanced patients' perception of their social support network,, and declined medical legal process., Furthermore, Professor Teresa Hellín has described that “to attend those who suffer, a physician must possess not only the scientific knowledge and technical abilities but also an understanding of human nature. The patient is not just a group of symptoms, damaged organs, and altered emotions. The patient is a human being, at the same time worried and hopeful, who is searching for relief, help, and trust. The importance of an intimate relationship between patient and physician can never be overstated because in most cases an accurate diagnosis, as well as an effective treatment, relies directly on the quality of this relationship.” Clinician empathy is a strategic skill to interact and communicate with patients, and hence, develops and ensures patient-centered care; a wide-ranging line of action for clinical work that has emerged in the previous 20 years plus time and that lead to formulating and encompassed in many codes of conduct and guiding principles adopted and implemented by medical schools around the world.,,
Multiple research studies reported that empathy level is declining during medical school education and that one's attributes related to empathy, such as humanitarianism, enthusiasm, and idealism, also decreased.,,,,,,,, There are several studies conducted regarding empathy among Malaysian medical students.,,, Thus far, no data are available regarding empathy level among medical students of Universiti Pertahanan Nasional Malaysia (UPNM), National Defense University of Malaysia. The aim of the present study was to assess the empathy level of medical students of UPNM.
| Materials and Methods|| |
This was a cross-sectional study.
The study populations were medical students of the UPNM, Kuala Lumpur, Malaysia.
Data were collected between February and April 2017.
Sampling method and sample size
Universal sampling method was adopted.
Techniques of data collection
The Empathy Quotient (EQ), a self-reported questionnaire, was utilized for the data collection. The total score of empathy of the questionnaire is 80. Each item scores 1 point if the respondent records the empathic behavior mildly or 2 points if the respondent records the behavior strongly. A cutoff point equal to or fewer than 30 points is used to separate the group of students. This questionnaire is a straightforward score because it does not depend on any interpretation. The necessary permission was obtained from the Department of Psychiatry, Autism Research Centre (ARC), the University of Cambridge, UK (http://www.autismresearchcentre.com/arc_tests). The questionnaire was pretested and validated with 25 medical students (5 from each year) who did not participate in the primary study. The Cronbach's alpha was calculated as 0.551 and convergent validity as −0.008–0.533. For convergent validity, most of the items correlated moderately to excellent to their own domain (P < 0.05).
Data analysis and interpretation
Collected data were treated with t-test and one-way ANOVA (F-test) followed by post hoc Turkey test analysis with SPSS version 24 (IBM Corporation, Armonk, NY, USA).
This research was approved by the Centre for Research and Innovation Management, UPNM, Kuala Lumpur, Malaysia (Code of Research: UPNM/2016/SF/SKK/03, Memo No: UPNM [PPPI] 16.01/06/019 , December 22, 2016). The study population had been explained about the objectives of the study and informed written consent was obtained before questionnaires were distributed. Additionally, it was also informed that the data later will be utilized for publication. The students also ensured that the study participation is totally voluntary and anonymous and the information would be confidential.
| Results|| |
The details of sociodemographic profiles and the empathy scores of the respondents are depicted in [Table 1]. All 207 students responded to the questionnaire. Majority of the respondents were male (60.9%), Year-V students (26.6%), Malay (70.5%), and cadet officer (69.6%). The overall mean score achieved by the respondents was 36.76 ± 9.18 (range: minimum 15 and maximum 63) and 74.4% of the respondents scored more than 30.
|Table 1: Sociodemographic profiles and the empathy scores of the respondents|
Click here to view
The empathy scores of the students were significantly affected (t = 2.371; df = 205; P < 0.05) by the gender, i.e., female students are more empathetic than their male counterparts. F-test showed a significant effect of year of study (F = 2.553; df 4/202; P < 0.05) and exam grades (F = 3.488; df 2/204; P < 0.05) on empathy scores. Further, the post hoc Tukey test analysis for the year of study revealed that Year-V students differ significantly with Year-I to Year-IV students (P < 0.05), which indicates that Year-V are more empathetic than their junior counterparts. The post hoc Tukey test analysis for the exam grades was found to be significantly different between empathy scores of those students who got Grade A and Grade C (P < 0.05), which indicated that those who got the highest grade are more empathetic.
| Discussion|| |
This EQ questionnaire possessed Cronbach's alpha of 0.80 which can be considered as a good reliability index for local context. The overall empathy score (36.76 ± 9.18) of the respondents in this study was low when compared with that of an earlier study we conducted in Bangladesh with dental students (39.4 ± 8.7) using the EQ questionnaire. A recent study conducted among medical students from the Faculty of Medicine, University of Lleida in Spain also showed higher empathy scores (50) using similar instrument. Our study showed that female students score slightly but significantly higher on the EQ than their male counterparts. This supports a series of earlier studies reporting female superiority on empathy scales in medical schools in Malaysia, and around the world.,,,,, However, studies using the two most popularly used instruments in empathy research and medical education context, the Jefferson Scale of Physician Empathy (JSPE),,,,,,,,,,,, and the Interpersonal Reactivity Index, showed mixed results in correlating the levels of empathy with gender. In the present study, 18.4% of males and 7.2% of females scored equal to or fewer than 30 points (cutoff score), which is much higher than Baron-Cohen et al's. study which reported the development of the EQ questionnaire (14% and 4%, respectively). In comparison to Baron-Cohen et al's. study, fewer students in the present study scored in the “super-empathic range” (i.e., equal to or more than 62 points, 7.7% vs. 1.5%).
Most of the studies in the literature suggested that empathy diminishes after the 3rd year of medical school.,,,,,,, This research found that Year-V students had significantly higher levels of empathy than junior class students. One meta-analysis on the empathy levels of medical students, interns, and residents analyzed studies and showed significant decreases in empathy level when the respondents' progress to complete their studies. However, most of the longitudinal studies found no changes in the empathy scores over time. In a recent study, empathy scores in JSPE and EQ did not change and medical students were found to maintain empathy scores. Appropriate educational interventions can be designed and implemented to inculcate, maintain, and enhance empathy in undergraduate medical students. The inventions included patient narrative and creative arts, writing, drama, communication skills' training, problem-based learning, interprofessional skills' training, patient interviews, experiential learning, and empathy-focused training.
This study also found that exam grades and level of empathy of medical students were significantly different who got Grade A and Grade C (P < 0.05), i.e., those who got the highest grade are more empathetic. The finding is supported by previous studies that showed a positive correlation between academic performance and clinical competence and empathy scores., However, studies found opposite findings – students from higher grade levels had lower scores than those from the lower grade levels., This issue needs further investigation using larger sample in multicenter settings.
This was a cross-sectional study with its own inherent limitations. The research sample was collected from only one public medical school of Kuala Lumpur, Malaysia. In addition, the study participants lead a restricted and disciplined military life. Hence, the study findings should be generalized with caution. Further studies are required on a longitudinal basis to explore various aspects of involving students of multiple medical institutions.
| Conclusion|| |
This study concluded that EQ questionnaire is found to have good reliability index for local context. We found low EQ scores among UPNM medical students in comparison to other studies conducted with the same questionnaire. In order to inculcate, maintain, and enhance the empathy level of the UPNM medical students, appropriate educational strategies and interventions should be designed and implemented in the undergraduate medical curriculum.
The authors appreciate all those students who participated in this study and thank our friends who are actively exchanging ideas and thoughts in completing the study. The authors are much grateful to the Department of Psychiatry, ARC, University of Cambridge, UK, for their kind consent to conduct this study. The authors also would like to thank Dr Poulasti Kumar Patel PhD (French), Adjunct Professor of French, Gangadhar Meher University, Sambalpur, Odisha, India for translating the abstract to French.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Riess H. Empathy in medicine – a neurobiological perspective. JAMA 2010;304:1604-5.
Hojat M. Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes. New York: Springer; 2007.
Boyle MJ, Williams B, Brown T, Molloy A, McKenna L, Molloy L, et al
. Levels of empathy in undergraduate health science students. J Med Educ 2010;1:1-8.
Osler W. Teaching and thinking. In: Osler W. Aequanimitas, editor. With Other Addresses to Medical Students, Nurses and Practitioners of Medicine. London, UK: HK Lewis; 1906. p. 121-36.
Osler W. Address to the students of the Albany Medical College. Albany Med Ann 1899;20:307-9.
Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, et al.
The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med 2009;84:1182-91.
Conti AA, Gensini GF. Doctor-patient communication: A historical overview. Minerva Med 2008;99:411-5.
Laine C, Davidoff F. Patient-centered medicine. A professional evolution. JAMA 1996;275:152-6.
Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med 2011;9:100-3.
Saha S, Beach MC. The impact of patient-centered communication on patients' decision making and evaluations of physicians: A randomized study using video vignettes. Patient Educ Couns 2011;84:386-92.
King A, Hoppe RB. “Best practice” for patient-centered communication: A narrative review. J Grad Med Educ 2013;5:385-93.
McWhinney I. The need for a transformed clinical method. In: Stewart M, Roter D, editors. Communicating with Medical Patients. London: Sage; 1989.
Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: A systematic review. Br J Gen Pract 2013;63:e76-84.
Kelley JM, Kraft-Todd G, Schapira L, Kossowsky J, Riess H. The influence of the patient-clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2014;9:e94207.
Pedersen R. Empathy: A wolf in sheep's clothing? Med Health Care Philos 2008;11:325-35.
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.
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;11:443-55.
Street RL Jr., Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns 2009;74:295-301.
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.
Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997;277:553-9.
Hellín T. The physician-patient relationship: Recent developments and changes. Haemophilia 2002;8:450-4.
Australian Medical Council. Good Medical Practice: A Code of Conduct for Doctors in Australia. Kingston, ACT: Australian Medical Council; 2009.
Brown J. How clinical communication has become a core part of medical education in the UK. Med Educ 2008;42:271-8.
Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med 2007;22:1434-8.
Chen DC, Pahilan ME, Orlander JD. Comparing a self-administered measure of empathy with observed behavior among medical students. J Gen Intern Med 2010;25:200-2.
Hegazi I, Wilson I. Maintaining empathy in medical school: It is possible. Med Teach 2013;35:1002-8.
Hojat M, Mangione S, Nasca TJ, Rattner S, Erdmann JB, Gonnella JS, et al.
An empirical study of decline in empathy in medical school. Med Educ 2004;38:934-41.
Hojat M. Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm 2009;31:412-50.
Nunes P, Williams S, Sa B, Stevenson K. A study of empathy decline in students from five health disciplines during their first year of training. Int J Med Educ 2011;2:12-7.
Lim BT, Moriarty H, Huthwaite M, Gray L, Pullon S, Gallagher P, et al.
How well do medical students rate and communicate clinical empathy? Med Teach 2013;35:e946-51.
Youssef FF, Nunes P, Sa B, Williams S. An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean. Int J Med Educ 2014;5:185-92.
Williams B, Sadasivan S, Kadirvelu A. Malaysian medical students' self-reported empathy: A cross-sectional comparative study. Med J Malaysia 2015;70:76-80.
Williams B, Sadasivan S, Kadirvelu A, Olaussen A. Empathy levels among first year Malaysian medical students: An observational study. Adv Med Educ Pract 2014;5:149-56.
Babar MG, Hasan SS, Lim LP, Lim PJ, Rosdy NM, Binti Ahmad SF. Tomorrow's doctors and dentists in Malaysia: Empathic or indifferent? Eur J Pers Cent Health 2017;5:25-212.
Haque M, Lutfi SN, Othman NS, Lugova H, Abdullah SL. Empathy level among the medical students of National Defence University of Malaysia consuming Toronto empathy scale. Acta Med Int 2018;5:24-30. [Full text]
Baron-Cohen S, Wheelwright S. The empathy quotient: An investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. J Autism Dev Disord 2004;34:163-75.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.
Faruque M, Haque M, Islam S, Shihab SF, Asmara HS. Empathy level among dental students of Bangladesh utilizing the Cambridge behavior scale. J Glob Pharm Tech 2017;9:34-40.
Guilera T, Batalla I, Soler-González J. Empathy and specialty preference in medical students. Follow-up study and feedback. Educ Med 2017. [doi.org/10.1016/j.edumed. 2017.07.017].
Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M, et al.
Physician empathy: Definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry 2002;159:1563-9.
Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach 2012;34:305-11.
Quince TA, Parker RA, Wood DF, Benson JA. Stability of empathy among undergraduate medical students: A longitudinal study at one UK medical school. BMC Med Educ 2011;11:90.
Hasan S, Al-Sharqawi N, Dashti F, AbdulAziz M, Abdullah A, Shukkur M, et al.
Level of empathy among medical students in Kuwait University, Kuwait. Med Princ Pract 2013;22:385-9.
Neumann M, Scheffer C, Tauschel D, Lutz G, Wirtz M, Edelhäuser F, et al.
Physician empathy: Definition, outcome-relevance and its measurement in patient care and medical education. GMS Z Med Ausbild 2012;29:Doc11.
Di Lillo M, Cicchetti A, Lo Scalzo A, Taroni F, Hojat M. The Jefferson scale of physician empathy: Preliminary psychometrics and group comparisons in Italian physicians. Acad Med 2009;84:1198-202.
Kataoka HU, Koide N, Hojat M, Gonnella JS. Measurement and correlates of empathy among female Japanese physicians. BMC Med Educ 2012;12:48.
Tavakol S, Dennick R, Tavakol M. Psychometric properties and confirmatory factor analysis of the Jefferson scale of physician empathy. BMC Med Educ 2011;11:54.
Magalhães E, Salgueira AP, Costa P, Costa MJ. Empathy in senior year and first year medical students: A cross-sectional study. BMC Med Educ 2011;11:52.
Suh DH, Hong JS, Lee DH, Gonnella JS, Hojat M. The Jefferson Scale Of Physician Empathy: A preliminary psychometric study and group comparisons in Korean physicians. Med Teach 2012;34:e464-8.
Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al.
Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med 2011;86:996-1009.
Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: An updated, systematic review. Acad Med 2013;88:1171-7.
Hojat M, Gonnella JS, Nasca TJ, Mangione S, Veloksi JJ, Magee M, et al.
The Jefferson scale of physician empathy: Further psychometric data and differences by gender and specialty at item level. Acad Med 2002;77:S58-60.
Hojat M, Gonnella JS, Mangione S, Nasca TJ, Veloski JJ, Erdmann JB, et al.
Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ 2002;36:522-7.
Park KH, Roh H, Suh DH, Hojat M. Empathy in Korean medical students: Findings from a nationwide survey. Med Teach 2015;37:943-8.