James B. Erdmann

An empirical study of decline in empathy in medical school

Context  It has been reported that medical students become more cynical as they progress through medical school. This can lead to a decline in empathy. Empirical research to address this issue is scarce because the definition of empathy lacks clarity, and a tool to measure empathy specifically in medical students and doctors has been unavailable.

The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data

The present study was designed to develop a brief instrument to measure empathy in health care providers in patient care situations. Three groups participated in the study: Group 1 consisted of 55 physicians, Group 2 was 41 internal medicine residents, and Group 3 was composed of 193 third-year medical students. A 90-item preliminary version of the Empathy scale was developed based on a review of the literature and distributed to Group 1 for feedback. After pilot testing, a revised and shortened 45-item version of the instrument was distributed to Groups 2 and 3. A final version of the Jefferson Scale of Physician Empathy containing 20 items based on statistical analyses was constructed. Psychometric findings provided support for the construct validity, criterion-related validity (convergent and discriminant), and internal consistency reliability (coefficient alpha) of the scale scores.

Empathy in medical students as related to academic performance, clinical competence and gender

Context  Empathy is a major component of a satisfactory doctor–patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools.

Medical students' cognitive appraisal of stressful life events as related to personality, physical well-being, and academic performance: a longitudinal study ☆

Abstract This longitudinal study was designed to test three hypotheses that medical students who can cope better with adversity would: (1) have a more positive personality profile, (2) report less physical illnesses, (3) perform better academically. Total participants were 2114 medical students at Jefferson Medical College who completed a set of psychosocial questionnaires, and were prospectively followed up during medical school education and beyond. Participants reported on a five-point scale their appraisal of five stressors (death or health deterioration of a family member, personal illness, financial, and academic problems). Students who experienced the stressors (n=1446, 68% of total participants) were divided into three groups (Resilient, Intermediate, Frail) based on their appraisal of the stressors. The three groups were compared on a set of personality scales (e.g. general anxiety, depression, test anxiety, neuroticism, loneliness, self-esteem and extraversion), physical well-being factors (e.g. chronic health, eating/drinking/smoking, agitation symptoms, somatic symptoms, and global sickness), and academic performance indicators in medical school (e.g. grade point averages, class rank, and medical licensing examinations), and ratings of clinical competence in postgraduate medical training. Hypotheses 1 and 2 were confirmed, and hypothesis 3 was partially confirmed. Implications for developing coping skills, stress management strategies, and student counseling are discussed.

Reliability and Validity of the Jefferson Scale of Empathy in Undergraduate Nursing Students

Evidence has been reported in support of the reliability and validity of the Jefferson Scale of Physician Empathy (JSPE) when used with physicians, medical students, and nurses. This study examined the psychometrics of a modified version of the scale in undergraduate nursing students. The modified version of the JSPE was administered to 333 nursing students at different levels of training. Three underlying constructs, that is, “Perspective Taking,” “Compassionate Care,” and “Standing in Patient’s Shoes” emerged from the factor analysis of the scale that were consistent with the conceptual framework of empathy, thus supporting the construct validity of the scale. The coefficient alpha was .77. Scores of the empathy scale were significantly correlated with the scores of the Jefferson Scale of Attitudes toward Physician–Nurse Collaboration (r = .38,p < .001). Women scored higher than men, and those with more clinical experiences scored higher than others. It was concluded that the empathy scale used in this study is a psychometrically sound instrument for measuring empathy in undergraduate nursing students.

The predictive validity of three versions of the MCAT in relation to performance in medical school, residency, and licensing examinations: a longitudinal study of 36 classes of Jefferson Medical College.

Purpose The Medical College Admission Test (MCAT) has undergone several revisions for content and validity since its inception. With another comprehensive review pending, this study examines changes in the predictive validity of the MCATs three recent versions. Method Study participants were 7,859 matriculants in 36 classes entering Jefferson Medical College between 1970 and 2005; 1,728 took the pre-1978 version of the MCAT; 3,032 took the 1978–1991 version, and 3,099 took the post-1991 version. MCAT subtest scores were the predictors, and performance in medical school, attrition, scores on the medical licensing examinations, and ratings of clinical competence in the first year of residency were the criterion measures. Results No significant improvement in validity coefficients was observed for performance in medical school or residency. Validity coefficients for all three versions of the MCAT in predicting Part I/Step 1 remained stable (in the mid-0.40s, P < .01). A systematic decline was observed in the validity coefficients of the MCAT versions in predicting Part II/Step 2. It started at 0.47 for the pre-1978 version, decreased to between 0.42 and 0.40 for the 1978–1991 versions, and to 0.37 for the post-1991 version. Validity coefficients for the MCAT versions in predicting Part III/Step 3 remained near 0.30. These were generally larger for women than men. Conclusions Although the findings support the short- and long-term predictive validity of the MCAT, opportunities to strengthen it remain. Subsequent revisions should increase the tests ability to predict performance on United States Medical Licensing Examination Step 2 and must minimize the differential validity for gender.

What have we learned, and where do we go from here?

No abstract available.

Personality assessments and outcomes in medical education and the practice of medicine: AMEE Guide No. 79

In a paradigm of physician performance we propose that both “cognitive” and “noncognitive” components contribute to the performance of physicians-in-training and in-practice. Our review of the relevant literature indicates that personality, as an important factor of the “noncognitive” component, plays a significant role in academic and professional performances. We describe findings on 14 selected personality instruments in predicting academic and professional performances. We question the contention that personality can be validly and reliably assessed from admission interviews, letters of recommendation, essays, and personal statements. Based on conceptual relevance and currently available empirical evidence, we propose that personality attributes such as conscientiousness and empathy should be considered among the measures of choice for the assessment of pertinent aspects of personality in academic and professional performance. Further exploration is needed to search for additional personality attributes pertinent to medical education and patient care. Implications for career counseling, assessments of professional development and medical education outcomes, and potential use as supplementary information for admission decisions are discussed.

An empirical study of the predictive validity of number grades in medical school using 3 decades of longitudinal data: implications for a grading system

Context  It is important to establish the predictive validity of medical school grades. The strength of predictive validity and the ability to identify at‐risk students in medical schools depends upon assessment systems such as number grades, pass/fail (P/F) or honours/pass/fail (H/P/F) systems.

Is the glass half full or half empty? A reexamination of the associations between assessment measures during medical school and clinical competence after graduation

The purpose of this study was to investigate the associations between performances during medical school and in the first year of residency. It was hypothesized that the strength of such associations is a function of several variables, including similarities of the measured concepts, the formats of the assessments, the time interval between the assessments, performance levels, and specialty areas. The total sample consisted of 2,368 graduates of Jefferson Medical College between 1980 through 1990. The performance measures in medical school were grades on objective examinations in basic and clinical sciences, global ratings of clinical competence in junior core clerkships, and scores on the Part I and Part II examinations of the National Board of Medical Examiners (NBME). The postgraduate performance measures were scores on the Part III NBME examination, postgraduate competence ratings, and board certification. The ratings of postgraduate clinical competence (available for 73% of graduates) were made by residency directors at the end of the first year of residency in the areas of data-gathering and processing skills, interpersonal skills and attitudes, and socioeconomic aspects of patient care. Results supported the research hypotheses. It was found that the associations varied for different measures, at different levels of performance, and in different specialties. The authors conclude that the glass is “half full” regarding the associations between assessment measures before and after graduation from medical school.