|Year : 2017 | Volume
| Issue : 2 | Page : 162-165
Assessment of empathy among clinical dental students in a teaching dental institution in Telangana State, India
V Siva Kalyan1, S Manjula2, T Madhavi Padma1, K. V. N. R. Pratap1, P Vineela1, Surya Chandra Varma1
1 Department of Public Health Dentistry, Mamata Dental College, Khammam, Telangana, India
2 Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
|Date of Web Publication||13-Jun-2017|
V Siva Kalyan
Department of Public Health Dentistry, Mamata Dental College, Khammam, Telangana
Source of Support: None, Conflict of Interest: None
Introduction: The understanding of patient's view is considered as an important component in doctor–patient relationship. The health-care provider with an empathetic understanding may perceive patient's need as more reasonable and thus therapeutic. Aim: To assess empathy among clinical dental students in a teaching dental institution. Materials and Methods: A cross-sectional study was conducted among clinical dental students during the period between June 2016 and July 2016 in a teaching dental institution in Khammam town. Jefferson Scale of Empathy-Health Care Provider Student version was used to assess empathy among the students in this study. Gender differences were analyzed using t-test, and one-way ANOVA was used for comparison of empathy scores across year of study. P< 0.05 was considered statistically significant. Results: A total of 364 students participated in the study with a mean age of 22.76 ± 2.4 years. Males exhibited more empathy (86.54 ± 7) compared to females. The mean empathy level was found to be highest for the postgraduates (85.92 ± 6.5) followed by 3rd year students (P = 0.0943). Conclusion: There is a need to train these students not only from technical point of view but also in “life skills” such as communication, interpersonal relationship and empathy.
Keywords: Dental, education, empathy, India, students
|How to cite this article:|
Kalyan V S, Manjula S, Padma T M, Pratap K, Vineela P, Varma SC. Assessment of empathy among clinical dental students in a teaching dental institution in Telangana State, India. J Indian Assoc Public Health Dent 2017;15:162-5
|How to cite this URL:|
Kalyan V S, Manjula S, Padma T M, Pratap K, Vineela P, Varma SC. Assessment of empathy among clinical dental students in a teaching dental institution in Telangana State, India. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2019 Sep 22];15:162-5. Available from: http://www.jiaphd.org/text.asp?2017/15/2/162/207913
| Introduction|| |
Empathy is considered as one of the cornerstones in the field of medicine. Empathy plays a vital role in physician–patient therapeutic relationship , because health-care provider with an empathetic attitude/understanding may perceive patients need as reasonable. Although the health-care education is offering an intangible knowledge regarding acquiring standard technical skills, training in offering a compassionate care to the patient is limited. Both the Association of American Medical Colleges  and the American Dental Education Association  listed empathy as one of the most important objectives of clinical training.
Empathy has two domains, cognitive and affective. The cognitive domain allows us to understand another person's inner experiences and view the outside world from other person's point of view. The affective domain allows us to enter or join the experience of another person. In context of patient care, a distinction should be made between sympathy and empathy as they are often mistaken as same since both involves sharing. Sympathy if excess interferes with the diagnosis and treatment as sympathetic physicians share their emotions with their patients. In contrast, empathy has no bonding as it is a state of separateness and sharing though in abundance will add to crucial element of healing as it is considered as a basic component of all therapeutic relationship.
The research has revealed that physician anointed with empathetic style during patient's communication has improved treatment outcomes such as increased compliance with medical advice and a speedy recovery  and a cutback in doctor shopping. In a similar way, dentist with empathetic nature had exhibited similar trends such as decrease in dental fear, adherence to orthodontic treatment, and increased cooperation with pediatric patients.,
Clinical dental students interact with their patients at a proximity and empathy is a factor that improves dentist–patient relationship. The literature cites that vital interactions among people require that they are equipped to construe each other's point of view and this tendency to capture another person's condition is empathy, an essential concept in numerous theories of social behavior. However, there is wealth of literature assessing empathy levels of medical students, lacunae exist in research regarding dental students. In particular, only few ,,, studies were conducted with regard to Indian scenario. With this background, a cross-sectional questionnaire-based study was conducted among clinical dental students to assess their empathy. The objectives of the study were to assess whether empathy differs between males and females and between years of study.
| Materials and Methods|| |
The study was conducted between June 1, 2016, and July 31, 2016. This study received ethical clearance from the Institutional Ethics Research Committee that was designed for all the clinical dental students (undergraduates and postgraduates) pursuing dental education in Khammam town.
The questionnaire was pilot tested and the Cronbach's alpha has found to be good (0.8164). The questionnaire [Table 1] consisted of two parts (Part I and II). Part I consisted of questions related to demographics of the participants. Part II consists of Jefferson Scale of Empathy Health Care Provider Student's Version  which consists of 20 items which were answered as 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Out of these 20 questions, 10 were positively worded questions and 10 were negatively worded questions. The negatively worded questions were reverse scored. The total scale ranged from 20 to 140 where greater the score, greater is the empathetic tendency.
|Table 1: Jefferson Scale of Empathy Health Care Provider Student's Version|
Click here to view
Before the start of study, the exact difference between the words “sympathy” and “empathy” was explained to the students and they were invited to participate promising confidentiality. The questionnaire was distributed to 3rd and 4th year students in the classroom and to postgraduates and interns during their clinical postings when they were not attending patients and collected after completion.
The collected information was subjected to statistical analysis. The normality of data was assessed by Kolmogorov–Smirnov one-sample test. Parametric tests were applied since the data followed a normal distribution. Both t-test and one-way ANOVA were used to test the significance difference. P< 0.05 was considered statistically significant.
| Results|| |
A total of 364 students participated in the study with a mean age of 22.76 ± 2.4 years. The majority (82.6%) of them were female. Among the participants, most of them were from 4th year (28.3%). The mean empathy score between males and females where males exhibited more empathy (86.54 ± 7) compared to females was found to be statistically significant. The mean empathy level was found to be highest for the postgraduates (85.92 ± 6.5) followed by 3rd year students. The difference in the mean empathy score across the year of study was not statistically significant [Table 2].
|Table 2: Mean empathy scores of respondents by gender and years of study|
Click here to view
| Discussion|| |
The cultivation of humanistic values and enhancing interpersonal skills and empathy in particular are of great importance in any human service; dental profession is no exception. In this era of informatics, and technology where human interactions and perceptions are often overlooked, still empathy is an important aspect to ponder upon as it is one of the most valuable traits of physician which patients look up to. It has been cited in the literature that it increases referral, enhances efficiency, and decreases burnout from the doctor's point of view.,,,
For all the above-mentioned reasons, empathy has gained its importance and interest in health professionals in recent times and has led to much research in different disciplines including dentistry. In the present study, an attempt is made to assess empathy levels among clinical undergraduate students (3rd, 4th year, and Interns) and postgraduates as these students interact with patients in the clinical postings.
The total mean empathy score in the present study (84.80 ± 6.36) was more in comparison to other studies conducted elsewhere ,,, and in contrast studies , reported more empathy levels among dental students compared to our study. The difference in empathy levels can be attributed to cultural, religious, and traditions as reported. The differences in mean empathy score can also be “incidental” that what the scale actually measures is the result of intricate process which is in addition, based on ontogeny constructed from students young age till they mature. Moreover, in the Indian scenario, the admission system into medical school is based on marks obtained in the entrance examination and no emphasis is laid on overall development before the admittance into medical school. Even in the curriculum, there is no exposure to humanity subjects such as economy, literature, and philosophy.
In the present study, males scored higher in comparison to females similar to studies reported to literature., In contrast, majority of studies ,,,,, reported that females score higher than males. Empathy is a natural human emotion, gender differences may be due to their genetic differences and differences in socialization, and empathy is merely based on motivation rather than capability.
The empathy when assessed across the years of study, postgraduate students scored higher compared to undergraduates in our study. A study  reported that postgraduates scored least. The probable reason why postgraduates scored higher can be attributed to invariable patient exposure and habitual examination that fabricates a professional attitude, which increases patients' cooperation. As the study was conducted in a teaching health-care institution, majority of patients visiting the hospital/institution for treatment are underprivileged and students mostly rely on proper patient interactions and excellent clinical experience.
Among the undergraduate students, a decrease in empathy was observed as the years progressed, i.e., 3rd year students scored highest followed by 4th year students and interns scored the least, similar to study conducted in Bangalore  and Rajasthan. The results were in contrast to studies , conducted in Kelambakkam and Chennai where interns scored higher. Third year students come in contact with the patient on the dental chair for the first time and the feeling of doctor in them might have led to more empathy. In 4th year students, the factors related to academics such as more subjects  (compared to 3rd year students) and clinical quota completion might have led to decline in empathy as compared to 3rd year counterparts. Stress and burnout must also have contributed to decline in empathy, which need to be assessed.
In the present study, interns scored the lowest. When we look into the actual meaning of internship which explains it as “an opportunity offered by an employer to potential employees, called interns, to work at a firm for a fixed and limited period. Interns are usually undergraduate students. Most internships last for any length of time between 1 week and 12 months,” makes them concentrate more on exclusive learning of technical skills rather than “life skills”. These students are more in a hurry to complete their 1-year program to be addressed as doctors by the society can be considered as a reason for interns scoring least. Moreover, vigorous training undergone in 3rd and 4th year makes them more relaxed. More reasons are to be discovered. Finally, as we receive students with varying degrees of empathetic attitude, the need arises to take up the task of crafting this trait in all educational models  and appropriate training is required in this regard, as it helps in illustrating poise and preserving the individuality of the patient.
Limitations and Future Research
The research sample restricted to single-dental institution; hence, generalization should be done with prudence though empathy is not taught as a part of curriculum. Research should also focus involving students of other dental institutions. Further studies are required on a longitudinal basis to explore various aspects such as family background, interest in joining the dental course, and discipline selected in postgraduation. There is a need to conduct studies following a single cohort from the time of admission until leaving the institution.
| Conclusion|| |
The present study reveals that there is difference in mean empathy scores when compared to other studies conducted elsewhere. Males scored higher compared to females and postgraduate students scored higher compared to undergraduates. Based on results of the present study, there is a need to train competent professionals not only from technical point of view but also in “life skills” such as communication, interpersonal relationship, and empathy.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
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.
Mercer SW, Maxwell M, Heaney D, Watt GC. The consultation and relational empathy (CARE) measure: Development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract 2004;21:699-705.
Wiltshire AD, Ross MW, Brimlow DL. Empathic communication between dental professionals and persons living with HIV and AIDS. J Dent Educ 2002;66:86-93.
Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med 2003;15:88-92.
Barbosa P, Raymond G, Zlotnick C, Wilk J, Toomey R 3rd
, Mitchell J 3rd
. Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students. Educ Health (Abingdon) 2013;26:9-14.
Babar MG, Omar H, Lim LP, Khan SA, Mitha S, Siti Ahmad FB, et al.
An assessment of dental students' empathy levels in Malaysia. Int J Med Educ 2013;4:223-9.
Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: Definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry 2002;159:1563-9.
Wispe L. The distinction between sympathy and empathy: To call forth a concept, a word is needed. J Pers Soc Psychol 1986;50:314-21.
Bolognini S. Empathy and 'empathism'. Int J Psychoanal 1997;78(Pt 2):279-93.
Yarascavitch C, Regehr G, Hodges B, Haas DA. Changes in dental student empathy during training. J Dent Educ 2009;73:509-17.
Swaminath G. Doctor-patient communication: Patient perception. Indian J Psychiatry 2007;49:150-3.
] [Full text]
Kleinknecht RA, Klepac RK, Alexander LD. Origins and characteristics of fear of dentistry. J Am Dent Assoc 1973;86:842-8.
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.
Díaz-Narváez VP, Gutierrez-Ventura F, de Villalba TV, Salcedo-Rioja M, Calzadilla-Nunez A, Hamdan-Rodriguiz M. Empathy levels of dentistry students in Peru and Argentina Health 2015;7:1268.
Johnson JA, Cheek JM, Smither R. The structure of empathy. J Pers Soc Psychol 1983;45:1299.
Prabhu S, Kumar VS, Prasanth SS, Kishore S. Standing in patients' shoes – Survey on empathy among dental students in India. J Educ Ethics Dent 2014;4:69-73. [Full text]
Pradeep RK, Pavithra HD, Thenmozhi S. Empathy levels among dental students in India. J Curr Res 2016;8:33418-20.
Datta G, Vanishree N, Nayak SS, Bullappa D, Naveen N, Lakshmikantha R, et al
. Measuring empathy towards patients among dental under graduate students of Bangalore city – A cross sectional study. J Med Public Health 2016;6:113-6.
Aggarwal VP, Garg R, Goyal N, Kaur P, Singhal S, Singla N, et al.
Exploring the missing link – Empathy among dental students: An institutional cross-sectional survey. Dent Res J (Isfahan) 2016;13:419-23.
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.
Zinn W. The empathic physician. Arch Intern Med 1993;153:306-12.
Vedsted P, Heje HN. Association between patients' recommendation of their GP and their evaluation of the GP. Scand J Prim Health Care 2008;26:228-34.
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.
Anfossi M, Numico G. Empathy in the doctor-patient relationship. J Clin Oncol 2004;22:2258-9.
Sherman JJ, Cramer A. Measurement of changes in empathy during dental school. J Dent Educ 2005;69:338-45.
Vinay KM, Swanand P. Assessment of empathy among undergraduate medical students. J Educ Technol Health Sci 2016;3:23-7.
Shashikumar R, Chaudhary R, Ryali VS, Bhat PS, Srivastava K, Prakash J, et al.
Cross sectional assessment of empathy among undergraduates from a medical college. Med J Armed Forces India 2014;70:179-85.
Eisenberg N, Lennon R. Sex differences in empathy and related capacities. Psychol Bull 1983;94:100-31.
Spiro H. Commentary: The practice of empathy. Acad Med 2009;84:1177-9.
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.
Klein KJ, Hodges SD. Gender differences, motivation, and empathic accuracy: When it pays to understand. Pers Soc Psychol Bull 2001;27:720-30.
Bangash AS, Ali NF, Shehzad AH, Haqqi S. Maintenance of empathy levels among first and final year medical students: A cross sectional study. F1000Res 2013;2:157.
Vera C. Empathetic orientation in dentistry students from Latin America. Literature review. J Oral Res 2014;3:123-7.
Kadanakuppe S. Effective communication and empathy skills in dentistry for better dentist-patient relationships. J Dent Probl Solut 2015;2:58-9.
[Table 1], [Table 2]