Investigating the relation between self-assessment and patients' assessments of physicians-in-training empathy: a multicentric, observational, cross-sectional study in three teaching hospitals in Brazil

BMJ Open. 2019 Jun 25;9(6):e029356. doi: 10.1136/bmjopen-2019-029356.


Objectives: This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training.

Design: A multicentric, observational, cross-sectional study.

Setting: This study was conducted in three public teaching hospitals in Brazil.

Participants: From the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females.

Primary and secondary outcome measures: Physicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE).

Results: This study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p<0.01) between the JSPPPE score and the JSE compassionate care subscore. CARE and JSPPPE scales proved to be valid and reliable instruments.

Conclusions: Physicians-in-training self-assessments of empathy differ from patient assessments. Knowledge about empathy derived from self-assessment studies probably does not capture the perspective of the patients, who are key stakeholders in patient-centred care. Future research on the development of physician empathy or on outcomes of educational interventions to foster empathy should include patient perspectives.

Keywords: education; empathy; internship and residency; medical; patients.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Brazil
  • Cross-Sectional Studies
  • Empathy*
  • Female
  • Hospitals, Teaching
  • Humans
  • Internship and Residency*
  • Male
  • Middle Aged
  • Patients / psychology
  • Physician-Patient Relations
  • Self-Assessment*
  • Students, Medical / psychology*
  • Young Adult