Evaluation of the educational effectiveness of patient narratives and discussion of experiences of care in the Irish Healthcare System using the Jefferson Scale of Empathy in a final year medicine cohort

Background Empathy is essential for high quality care but is difficult to define and measure. The Jefferson Scale of Empathy (JSE) is a validated instrument “to measure empathetic qualities”. We designed a learning intervention to promote empathy using a “patient narrative” approach and measured empathy in final year students using the JSE in a cross sectional study 2 months before graduation. AIM To measure empathy in final year students and to evaluate the effectiveness of a patient centered “Care Seminar” on this using the JSE METHOD The seminar was designed by a multidisciplinary educational team as a 3-hour patient centered discussion of experiences of care with student interaction. All students in final year were asked to complete an online version of the JSE (Student version). Statistical comparison of scores investigated the role of various factors on JSE scores. Other evaluation included detailed follow up feedback. Statistical comparisons were made using the method of Bonferroni (SPPS) for the following variables i. UEM 5, UEM6 and GEM Programmes ii. Gender iii. Previous healthcare work iv. Care seminar attendance v. Age vi. GPA Results 92 of 180 final year students completed the questionnaire which has a maximum score of 140. 53 had attended a Care Seminar at the time of completion, 39 had not. Empathy scores were normally distributed [mean 113, sd=10], lower than reported scores in other populations. No statistical difference in JSE scores was found for any variable tested. Score analysis from the subscale “perspective taking” revealed an unexpected fall in scores for attenders. DISCUSSION & CONCLUSIONS This study is a cross sectional observational study and this instrument does not uncover any association between JSE measured empathy and any variable studied, at odds with accepted gender variation (women score more highly than men). This finding has prompted a full validation study of the JSE in the UCD medical student population. We consider that we are thus are unable to draw conclusions about the efficacy of the “Care Seminar” measured by the JSE, but note that feedback via other methods was strongly positive from participants. Falls (ns) in scores on ‘perspective taking’ questions in seminar attenders may indicate that these offered “too much perspective” or may reflect the instrument itself. We acknowledge that the JSE was neither designed or validated for subscale analysis of this sort and conclude that measuring the educational effectiveness of a ‘patient narrative” intervention to engender empathy may require a more nuanced instrument responsive to a greater awareness and deepening understanding of the patient’s perspective irrespective of how ‘difficult’ that perspective taking might be, as reported on the JSE.