ABSTRACT
Objectives
Empathy has been an essential competency in the clinical training of dental students and plays an important role in building relationship with patients. It has been found that gender and age may influence these empathetic responses; however, the findings vary across the literature. This study aims to investigate if age, gender and type of undergraduate dental training have a dependent relationship with the level of empathy.
Methods
The participants' empathy levels were measured using the Jefferson Scale of Empathy for Health Professional Students and reported as a total score. The data were analysed using an independent t‐test to compare the means of age and gender with level of empathy. An ANOVA test was used to evaluate the mean difference between dental science, dental hygiene and dental nursing students and their level of empathy.
Results
Most of the 57 participants were females (82%). Only 10 males participated and were all members of the dental science. The male students had a higher mean empathy level (110.6) than their female peers (109) (p = 0.733); participants aged 19–23 years had a lower mean (108) empathy level than their peers aged 24 and older (114) (p = 0.113); discipline empathy levels in dental science and dental hygiene were similar (111), with a lower mean level in dental nursing (106) (p = 0.233).
Conclusion
The study did not demonstrate a statistically significant difference between age, gender or discipline of undergraduate training with level of empathy. However, the results showed that age and gender have some influential relationship and should be investigated further to guide development of the educational curriculum in dental undergraduate training.
Keywords: age, dental, empathy, gender
1. Introduction
Empathy has attracted considerable interest in recent years and has been widely discussed in the scientific literature. It has been reported to account for improved patient–clinician relationship, increased adherence to treatment recommendations and improved clinical outcomes in patient care [1, 2]. For this reason, empathy is an essential element in the healthcare profession and an important aspect in health care education and patient care [3, 4]. In a general context, empathy is regarded as a psychological phenomenon that implies the ability to understand another person's feelings and to communicate that understanding with compassion [5]. As a multidimensional concept, it includes both cognitive and emotional domains [4]. When considering empathy in the context of healthcare, empathy is recognised mainly as a cognitive element that entails an understanding of the concerns, experiences and perspectives of the patient and an ability to communicate this understanding back to the patient [6]. Sympathy is another term for emotional or affective empathy, and in contrast to the cognitive element mainly accounts for emotional characteristics that engaged intense feelings [7]. It is important to distinguish the differences between these two domains. An excess of sympathy can impede neutrality and hinder clinical decisions, diagnosing and/or treatment outcomes [8]. From a clinician perspective, it can also lead to an emotional overinvolvement in patients [9] that may cause burnout and exhaustion [10]. Several instruments are available to examine empathy levels. However, only the Jefferson Scale of Empathy (JSE) is specifically oriented at clinical students and includes assessment of the cognitive domain [10].
There are other views on understanding the concept of empathy. From the social perspective, empathy is considered to be a binding force that attracts people to help each other and prevents them from hurting others [5]. More recent studies also looking at the neurosciences suggest that empathy is a mirror neuron system in the brain that enables us to wear the ‘mental shoes’ of others [11].
Other factors like age and gender might also influence empathetic responses. Some studies claim that female dental students express more empathy than their male peers [12, 13]. There are many hypotheses on why females may be more empathetic. One of the hypotheses is that the empathy level is associated with gender difference as a result of an activation of the right inferior frontal cortex in females when compared with males where there were no activations [14]. There could also be a historical difference, where females, as the primary caretakers, evolved to be sensitive to the nonverbal expressions of their children [14].
Several studies have explored the relationship between age and empathy, although the findings varied, the trend seems to be consistent with reports of higher levels of empathy in older age groups indicating that an older cohort is more empathetic than their younger peers [15, 16, 17, 18].
There are also a number of studies that compared different undergraduate disciplines with levels of empathy [17, 18, 19]. However, the results are not consistent and vary between disciplines [17, 18, 19].
Given these inconsistent findings, the current study aimed to investigate if age, gender, and type of undergraduate dental training have a dependent relationship with the level of empathy in undergraduate dental students using the Jefferson Clinical Empathy Scale.
2. Methods
2.1. Study Design and Setting
This study looked at the baseline empathy level data gathered as part of a larger study that assessed an educational intervention to improve empathy levels in dental undergraduate students and was carried out in 2021. The Dental School Research Ethics Committee of Trinity College Dublin granted ethical approval for this study in February 2021 (DSREC2021‐06). The study is reported using the STROBE cross‐sectional reporting guidelines [20]. A convenient sample was used to gather quantitative data to test the hypothesis that the independent variables such as age, gender and the type of undergraduate discipline have a dependent relationship with the levels of empathy.
2.2. Study Participants
A convenient sample of dental undergraduate students in the Dublin Dental University Hospital, Trinity College Dublin was utilised (n = 57). The sample included 2nd‐year dental nursing, 2nd‐year dental hygiene and 4th‐year dental science students. The participants were informed about what was involved in the study. All data were managed confidentially with relevant EU and Irish legislation on privacy adhered to. The participants were invited to complete an anonymous online survey.
2.3. Data Collection
The participants completed a questionnaire on socio‐economic parameters, including age, gender and the type of undergraduate course. The main body of the questionnaire contained questions from The Jefferson Scale of Empathy for Health Professionals Student Version (HPS‐version). The HPS‐version is composed of a battery of tools including the Interpersonal Reactivity Index (IRI), the NEO Personality Inventory‐Revised (NEO‐PI‐R) together with the Faith in People Scale [4] and validated using a Delphi technique [1, 10]. It included 20 Likert‐type item instrument with a 7‐point scale, ranging from 1 = strongly disagree to 7 = strongly agree, which are reported descriptively to obtain the participant's preferences or degree of agreement with the given statements. The instrument covered three factors: the first 10 items covered perspective taking, that is, ‘view of patients perspective’ and ‘emotions in patient care’ and are positively worded, the next 8 items covered compassionate care, that is, ‘understanding patient's experiences' and the last 2 items covered walking in patient's shoes that is, ‘thinking like the patient’ and are negatively worded which are reversely scored and records the emotional elements of empathy. On completion, the questionnaire can be scored with a minimum of 20 and a maximum of 140 points [1].
2.4. Statistical Analyses
The independent t‐test was used to assess and compare the means of the unrelated groups: age and gender on the same continuous with the dependent variable which was level of empathy. An ANOVA test was used to compare the means between the dental science, dental hygiene, and dental nursing students and their level of empathy. Data were expressed as mean and standard deviation of summative scale scores. The values of p < 0.05 were considered statistically significant. Statistical analysis was performed using the SPSS 26 statistical software.
3. Results
The response rate in this study was 92%. In total, fifty‐seven students studying in 2nd‐year dental nursing (n = 16), 2nd‐year dental hygiene (n = 9) and 4th‐year dental science (n = 32) completed the questionnaire. Table 1 shows that the sample was representative with respect to gender of which 47/57 were females and 10/57 were males. All students in the dental hygiene and dental nursing groups were females and there were 22 females and 10 males in the dental science group. Table 2 provides the age, gender and disciplines data of the three groups. The total JSE score for the female participants ranged between 84 and 126 (mean 109). The total JSE for the male participants ranged between 95 and 135 (mean 110.6). The difference was not statistical significance between gender and total JSE score (p = 0.733).
TABLE 1.
Undergraduate course and gender distribution.
| Female | Male | |
|---|---|---|
| Dental science | 22 | 10 |
| Dental hygiene | 9 | 0 |
| Dental nurse | 16 | 0 |
| Per cent (%) | 82.5 | 17.5 |
TABLE 2.
Total JSE scores by age, gender and discipline.
| Total count | JSE mean | SD | |
|---|---|---|---|
| Gender | |||
| Female | 47 | 109.4043 | 9.87896 |
| Male | 10 | 110.6000 | 10.69995 |
| Age | |||
| 18–23 | 43 | 108.1628 | 10.18620 |
| > 23 | 9 | 114.1111 | 9.27961 |
| Discipline | |||
| Dental science | 32 | 111.0000 | 9.37051 |
| Dental hygiene | 9 | 111.1111 | 11.55903 |
| Dental nursing | 16 | 106.0000 | 9.83192 |
The age of the participants in this study varied from 19 to 33. For the purpose of data analyses, students were grouped as young or mature students [21] and divided respectively: group 1 was aged between 19 and 23 (young) and group 2 was aged 24 years and older (mature students). Of the participants that provided their age (n = 52) 9 were mature students. Further analyses of the age groups are presented in Table 2; the total JSE score in the group 1 participants ranged between 84 and 135 (mean 108). The total JSE score in the group 2 participants ranged between 99 and 125 (mean 114); there was no statistical significance between the age groups and total JSE score (p = 0.113). The analyses demonstrated that in both dental science and dental hygiene the mean total JSE score was 111, and in dental nursing mean total JSE score was 106; however, the difference between disciplines and total JSE score was not statistically significant (p = 0.233) (Table 2).
4. Discussion
This study intended to measure if age, gender and undergraduate type of training had a dependent relationship with the level of empathy in undergraduate dental students. The findings suggested that there was no statistically significant relationship between these parameters and level of empathy.
Concerning the literature, female dental students were generally reported more empathetic than males [12, 15, 22]. Some researchers explained that this gender difference could be as a result of evolution either of biological nature or female humanistic qualities as a caretaker [14, 23]. However, this relationship could not be confirmed in this study. The mean empathy level score in females was slightly lower than in males, although this difference was not statistically significant. This is in line with Barbar et al. (2013) who also did not find that females were significantly more empathetic than males [16]. It can be speculated that our finding could be due to the fact that all the males were from one discipline, 4th‐year dental science. Additionally, there is some evidence that supports a causation relationship with discipline year; for example, Torres‐Martínez et al. [12] found in their study that from the third year of studies, empathy levels in the dental science discipline increased and stayed constant [12]. All of the dental hygiene and dental nursing students in our study were only in their 2nd year.
No statistically significant difference between younger (aged 19–23) and more mature students (aged > 24) were revealed; however, the younger age group had lower mean empathy levels than the older age group. This overall trend was also evident in the literature and confirmed with other studies stating that empathy level increases with ageing [18, 24]. However, one study by Aggarwal et al. [15] found a statistically significant higher level of empathy in 20–24‐year‐old students compared to those aged > 25. This could be due to the fact that postgraduate students were included in the same cohort for analyses in that study. There were also other factors that could have influenced the relationship between empathy and age such as experience and additional training.
In relation to the comparison of empathy levels between disciplines, a higher mean score of empathy was recorded in the dental science and dental hygiene disciplines, although the difference in empathy levels in between the disciplines including dental nursing did not reach statistical significance. The small difference noted could be due to the differences in the course structure and clinical placements while in training. Interestingly, this difference within healthcare disciplines is well documented and varies between the training courses, of those assessed empathy levels are generally reported to be lower in paramedics [17, 18, 19]. However, there is a dearth of studies that compare dental disciplines with other health care professions therefore making it difficult to make any comparison. Nunes et al. [18] reported that the level of empathy in dentistry was the second highest after the nursing discipline. There are no previously reported studies of empathy levels among dental science, dental hygiene and dental nursing students using the JSE‐HPS version; therefore, making it difficult to standardise their empathy scores and compare with other disciplines.
4.1. Limitations
This study has a few limitations that may affect the findings overall. First, the sample did not include a sufficient number of participants to reach a statistically significant effect. Second, this study was completed late in the academic year during a very busy exam schedule. Last, the cohort also came from different disciplines with different level of training and duration of the training; for example, exposure to a clinical placement and hours might have a plausible explanation to why dental nursing students had lowest levels of empathy.
4.2. Recommendations
As empathy is an important skill in the context of clinical practice, understanding this relationship could potentially guide the development of the undergraduate curriculum to ensure empathetic skills are enhanced and sustained throughout the training.
Therefore, the authors recommend that further research is initiated to explore if age, gender and disciplines are influential factors on the level of empathy in the undergraduate dental cohort. Examining larger sample from a range of educational institutions could help to confirm or reject the dependent relationship between empathy level and age, gender and disciplines.
Additionally, the authors recommend that school administrators should take into account the importance of empathy training in educational institutions for the future benefits and well‐being of newly graduated clinicians and their sustainability in the profession.
5. Conclusion
The study did not demonstrate a statistically significant difference between age, gender or discipline of undergraduate training with level of empathy.
However, the results showed that age and gender have some influential relationship and should be investigated further to guide the development of dental undergraduate curriculum and training.
6. Clinical Relevance
6.1. Scientific Rationale for Study
Empathy has an important role not only in humanistic relationship, but also as an essential competency in clinical training.
6.2. Principal Findings
The findings suggest that age, gender and discipline might have an influence on the empathy levels of dental undergraduate students.
6.3. Practical Implications
These findings can be used to inform development of the educational curriculum for dental undergraduates, to ensure the enhancement and sustainability of the empathy training in the dental cohort.
Author Contributions
Sviatlana Anishchuk conceived the ideas; collected the data; analysed the data. Sviatlana Anishchuk and Aidan Seery undertook the writing.
Ethics Statement
Ethical approval was gained and approved by the Research Ethics Committee, Dublin Dental University Hospital, Trinity College Dublin.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
We would also like to thank all participants for their assistance and time dedicated to this study.
Funding: The authors received no specific funding for this work.
Data Availability Statement
The authors have nothing to report.
References
- 1. Hojat M., Mangione S., Nasca T., et al., “The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data,” Educational and Psychological Measurement 61, no. 2 (2001): 349–365, 10.1177/00131640121971158. [DOI] [Google Scholar]
- 2. Del Canale S., Louis D., Maio V., et al., “The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients in Parma, Italy,” Academic Medicine 87, no. 9 (2012): 1243–1249. [DOI] [PubMed] [Google Scholar]
- 3. Veloski J. and Hojat M., “Measuring Specific Elements of Professionalism: Empathy, Teamwork, and Lifelong Learning,” in Measuring Medical Professionalism, ed. Stern D. (Oxford: Oxford University Press, 2006), 117–145. [Google Scholar]
- 4. Hojat M., Erdmann J., and Gonnella J., “Personality Assessments and Outcomes in Medical Education and Practice of Medicine: AMEE Guide No. 79,” Medical Teacher 35 (2013): e1267–e1301. [DOI] [PubMed] [Google Scholar]
- 5. Decety J. and Jackson P., “The Functional Architecture of Human Empathy,” Behavioral and Cognitive Neuroscience Reviews 3 (2004): 71–100. [DOI] [PubMed] [Google Scholar]
- 6. Ten H. M., “Approaches for Enhancing Empathy in Health and Human Services Cultures,” Journal of Health and Human Services Administration 31 (2009): 412–450. [PubMed] [Google Scholar]
- 7. Hojat M., Spandorfer J., Louis D., and Gonnella J., “Empathic and Sympathetic Orientations Toward Patient Care: Conceptualization, Measurement, and Psychometrics,” Academic Medicine 86 (2011): 989–995. [DOI] [PubMed] [Google Scholar]
- 8. Hojat M., Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes (New York: Springer, 2007). [Google Scholar]
- 9. Hojat M. and LaNoue M., “Exploration and Confirmation of the Latent Variable Structure of the Jefferson Scale of Empathy,” International Journal of Medical Education 5 (2014): 73–81, 10.5116/ijme.533f.0c41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Hojat M., Vergare M., Isenberg G., Cohen M., and Spandorfer J., “Underlying Construct of Empathy, Optimism, and Burnout in Medical Students,” International Journal of Medical Education 6 (2015): 12–16, 10.5116/ijme.54c3.60cd. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Vittorio G. M., “Mirror Neurons, Embodied Simulation, and the Neural Basis of Social Identification,” Psychoanalytic Dialogues 19, no. 5 (2009): 519–536, 10.1080/10481880903231910. [DOI] [Google Scholar]
- 12. Torres‐Martínez P., Barrios‐Penna C., Fonseca‐Molina J., Díaz‐Narváez V. P., and González‐Cruz S., “Levels of Empathy in Dental Students at Universidad San Sebastián in Concepción, Chile,” Revista de la Facultad de Medicina 65, no. 2 (2017): 219–225, 10.15446/revfacmed.v64n2.61444. [DOI] [Google Scholar]
- 13. Hsieh N., Herzig K., Gansky S., Danley D., and Gerbert B., “Changing dentists' Knowledge, Attitudes and Behavior Regarding Domestic Violence Through an Interactive Multimedia Tutorial,” Journal of the American Dental Association 137, no. 5 (2006): 596–603, 10.14219/jada.archive.2006.0254. [DOI] [PubMed] [Google Scholar]
- 14. Schulte‐Rüther M., Markowitsch H., Shah N., Fink G., and Piefke M., “Gender Differences in Brain Networks Supporting Empathy,” NeuroImage 42 (2008): 393–403. [DOI] [PubMed] [Google Scholar]
- 15. Aggarwal V., Garg R., Goyal N., et al., “Exploring the Missing Link—Empathy Among Dental Students: An Institutional Cross‐Sectional Survey,” Dental Research Journal 13, no. 5 (2016): 419–423, 10.4103/1735-3327.192279. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Babar M., Omar H., Lim L. P., et al., “An Assessment of Dental students' Empathy Levels in Malaysia,” International Journal of Medical Education 4 (2013): 223–229, 10.5116/ijme.5259.4513. [DOI] [Google Scholar]
- 17. Williams B., Brown T., Boyle M., McKenna L., Palermo C., and Etherington J., “Levels of Empathy in Undergraduate Emergency Health, Nursing, and Midwifery Students: A Longitudinal Study,” Advances in Medical Education and Practice 5 (2014): 299–306, 10.2147/AMEP.S66681. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Nunes P., Williams S., Sa B., and Stevenson K., “A Study of Empathy Decline in Students From Five Health Disciplines During Their First Year of Training,” International Journal of Medical Education 2 (2011): 12–17, 10.5116/ijme.4d47.ddb0. [DOI] [Google Scholar]
- 19. Boyle M., Williams B., Brown T., et al., “Levels of Empathy in Undergraduate Health Science Students,” Internet Journal of Medical Education 1 (2009): 1–4, 10.5580/1b15. [DOI] [Google Scholar]
- 20. von Elm E., Altman D. G., Egger M., Pocock S. J., Gøtzsche P. C., and Vandenbroucke J. P., “The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies,” International Journal of Surgery 12 (2014): 1495–1499.25046131 [Google Scholar]
- 21. “Citizens Information.” Updated 2022, accessed February 20, 2023, https://www.citizensinformation.ie/en/education/third‐level‐education/applying‐to‐college/third‐level‐courses‐for‐mature‐students/#:~:text=Generally%2C%20you%20are%20considered%20to,are%20aged%2023%20or%20over.
- 22. Sherman J. and Cramer A., “Measurement of Changes in Empathy During Dental School,” Journal of Dental Education 69, no. 3 (2005): 338–345, 10.1002/j.0022-0337.2005.69.3.tb03920.x. [DOI] [PubMed] [Google Scholar]
- 23. Christov‐Moore L., Simpson E., Coudé G., Grigaityte K., Iacoboni M., and Ferrari P., “Empathy: Gender Effects in Brain and Behavior,” Neuroscience and Biobehavoural Review 46, no. Pt 4 (2014): 604–627, 10.1016/j.neubiorev.2014.09.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Fields S., Mahan P., Tillman P., Harris J., Maxwell K., and Hojat M., “Measuring Empathy in Healthcare Profession Students Using the Jefferson Scale of Physician Empathy: Health Provider—Student Version,” Journal of Interprofessional Care 25, no. 4 (2011): 287–293, 10.3109/13561820.2011.566648. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The authors have nothing to report.