Jefferson Scale of Physician Empathy (JSPE)

Abstract

The Jefferson Scale of Physician Empathy (JSPE) is a self-report instrument specifically designed to measure empathy in physicians and medical students. Developed by Mohammadreza Hojat and colleagues, the scale operationalizes empathy as a cognitive attribute that involves the ability to understand the patient’s experiences, concerns, and perspectives, alongside the capacity to communicate this understanding. The JSPE consists of 20 items rated on a 7-point Likert scale. It is widely used internationally to assess the impact of medical education programs on affective competencies and to evaluate empathy levels across various stages of professional development in healthcare.

The instrument has been adapted into several versions, including those tailored for medical students (S-version), practicing health professionals (HP-version), and health professions students (HPS-version), ensuring its applicability across the spectrum of healthcare training and practice. Its rigorous psychometrics have made it a standard tool for quantifying this crucial component of the physician-patient relationship.

Keywords

Empathy, Physician Empathy, Health Professions, Medical Education, Patient Care, Assessment, Psychometrics, Cognitive Empathy, JSPE

Authors

Hojat, Mohammadreza, Mangione, Salvatore, Nasca, Thomas J., Gonnella, Joseph S., Erdmann, J.B., Cohen, M. J., Magee, M.

Purpose

The primary purpose of the JSPE is to reliably and validly measure the level of empathy exhibited by physicians, residents, and students in medicine and related health professions. It serves as a tool for evaluating educational outcomes, specifically assessing the effectiveness of curricula designed to enhance interpersonal skills and compassionate care.

By focusing on the cognitive aspects of empathy—the capacity for perspective-taking and understanding—the scale helps institutions track changes in this attribute over time, identify areas where training may be lacking, and ensure that future healthcare providers are equipped with the necessary interpersonal skills for effective patient management.

Construct

The JSPE measures cognitive empathy, which is defined as the ability to understand the patient’s internal experiences, feelings, and viewpoints, rather than affective or emotional empathy (which involves sharing or feeling the patient’s distress). This cognitive approach is considered crucial for professional medical practice, as it allows the physician to integrate the patient’s personal context into clinical decision-making without succumbing to emotional burnout.

The scale assumes that empathy is a measurable and teachable attribute that is essential for achieving positive patient outcomes and maintaining a strong physician-patient relationship. The items reflect attitudes toward the importance of understanding nonverbal cues, considering the patient’s emotional status, and viewing care from the patient’s perspective.

Validity

Extensive research has established the validity of the JSPE across diverse cultural and professional settings. Content validity was ensured during development by basing items on input from experts and literature review concerning the role of empathy in clinical practice. Construct validity has been supported through confirmatory factor analysis (CFA) and correlations with related psychological constructs, such as the Interpersonal Reactivity Index (IRI).

Furthermore, studies have shown evidence of criterion validity, demonstrating that JSPE scores correlate positively with measures of clinical competence, academic performance (in some cohorts), and patient satisfaction. The scale’s ability to differentiate between various professional groups and career stages further supports its utility in measuring the targeted construct.

Reliability

The JSPE exhibits strong internal consistency reliability across numerous studies involving different populations (students, residents, and practicing physicians). The Cronbach’s alpha coefficients for the total score typically range from 0.75 to 0.90, indicating high reliability. This level of internal consistency confirms that the scale items measure a consistent underlying construct of empathy.

Test-retest reliability has also been generally favorable, suggesting that the JSPE provides stable measurements of an individual’s empathic orientation over reasonable time intervals, making it suitable for longitudinal studies in medical education.

Factor Analysis

Initial factor analysis studies (Hojat et al., 2001) using exploratory and confirmatory techniques generally suggested a multi-dimensional structure, supporting the theoretical complexity of empathy in a clinical setting. While the exact number of factors can vary slightly depending on the population and language version, the scale often reveals three primary factors:

• Perspective Taking (the ability to adopt the patient’s viewpoint).
• Compassionate Care (the tendency to treat patients with kindness and consideration).
• “Standing in the Patient’s Shoes” (a direct measure of imaginative perspective-taking).

Although the JSPE is often scored and interpreted as a single, overall measure of empathy for clinical and educational assessment purposes, its underlying factor structure confirms its theoretical grounding in cognitive and behavioral aspects of professional care.

Instrument

Test Type: Self-administered questionnaire/rating scale

Format: 20 items rated on a 7-point Likert scale, ranging from 1 (Strongly Disagree) to 7 (Strongly Agree). Several items are reverse-scored (R).

Language Available: Available in numerous languages, having been validated globally (e.g., Iranian, Spanish, Japanese, Chinese, Turkish, etc.).

Population Group: Physicians, medical students, residents, and various health professions (nursing, pharmacy, dentistry, etc.).

Age Group: Adults (typically 18+), generally those enrolled in or practicing within the healthcare field.

Population Details: Specific versions include the S-version (Medical students), HP-version (Health Professions practitioners), and HPS-version (Health Professions students).

Test Methodology: Summation of scores across all 20 items (with reversed items appropriately adjusted) to yield a total empathy score. Higher scores indicate greater levels of physician empathy.

Keywords

JSPE, Perspective Taking, Compassionate Care, Clinical Competence, Health Professional Training, Self-Report Scale, Psychometric Properties

Authors

Author ORCID Identifier: Information not provided in the source content.

Affiliation Email addresses: Information not provided in the source content.

Correspondence Address: Correspondence is typically handled through Thomas Jefferson University (Philadelphia, PA), where the scale was developed.

Permissions & Fee and Test Year

The JSPE was initially developed and published with preliminary psychometric data in 2001. Permissions for use, scoring instructions, and available language versions are managed by the authors through Thomas Jefferson University. Users are typically required to obtain permission for academic or clinical use, though the fee structure varies based on the scope of the project.

The official instrument can be found at the Jefferson website: http://www.jefferson.edu/university/skmc/research/research-medical-education/jefferson-scale-of-empathy.html

The original PDF containing information about emotional health outcome measures is available here: http://www.ircimh.org/local/uploads/content/files/Emotional%20Health%20Outcome%20Measures%202014_4_29kk(1).pdf

Reference’s

• Hojat, M., Mangione, S., Nasca, T. J., Cohen, M. J., Gonnella, J. S., Erdmann, J.B. … & Magee, M. (2001). The Jefferson Scale of Physician Empathy: development and preliminary psychometric data. Educational and Psychological Measurement, 61(2), 349-365.
• Hojat, M., Gonnello, J. S., Magione, S., Nasca, T. J., Velosk, J., & Erdman, J. B. (2002). Empathy in medical students as related to academic performance. Clinical competence and Gender. Medical Education, 36: 522-527.
• Kane, Gregory C., Gotto, Joanne L., Mangione, Salvatore., West, Susan., and Hojat, M. (2007). Jefferson Scale of Patient’s Perceptions of Physician Empathy: Preliminary Psychometric Data. Croat Med J, 48(1): 81–86.
• Shariat, S. V., Eshtad, E., & Ansari, S. (2010). Empathy and its correlated in Iranian physician: A preliminary psychometric study of the Jeferson Scale of Physician Empathy. Medical Teacher, 32:417-421.
• Williams, Brett., Brown, Ted., Boyle, Malcolm., and Dousek, Simon., (2013). Psychometric testing of the Jefferson Scale of Empathy Health Profession Students’ version with Australian paramedic students. Nursing and Health Sciences, 15: 45–50
• Hojat, Mohammadreza ., Mangionea, Salvatore., Kanea, Gregory C. & Gonnella, Joseph S. (2015). Relationships between scores of the Jefferson Scale of Physician Empathy (JSPE) and the Interpersonal Reactivity Index (IRI). Medical Teacher, 27; 625-628.

Items of the Jefferson Scale of Physician Empathy (JSPE)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. An important component of the relationship with my patients is my understanding of the emotional status of the patients and their families.
2. I try to understand what is going on in my patients’ minds by paying attention to their nonverbal cues and body language.
3. I believe that empathy is an important therapeutic factor in medical treatment.
4. Empathy is a therapeutic skill without which my success as a physician would be limited.
5. My understanding of my patients’ feelings gives them a sense of validation that is therapeutic in its own right.
6. My patients feel better when I understand their feelings.
7. I consider understanding my patients’ body language as important as verbal communication in physician-patient relationships.
8. I try to imagine myself in my patients’ shoes when providing care to them.
9. I have a good sense of humor, which I think contributes to a better clinical outcome.
10. I try to think like my patients in order to render better care.
11. Patients’ illnesses can be cured only by medical treatment; therefore, affectional ties to my patients cannot have a significant place in this endeavor. (R)
12. Attentiveness to my patients’ personal experiences is irrelevant to treatment effectiveness. (R)
13. I try not to pay attention to my patients’ emotions in interviewing and history taking. (R)
14. I believe that emotion has no place in the treatment of medical illness. (R)
15. I do not allow myself to be touched by intense emotional relationships among my patients and their family members. (R)
16. My understanding of how my patients and their families feel is an irrelevant factor in medical treatment. (R)
17. I do not enjoy reading nonmedical literature or experiencing the arts. (R)
18. I consider asking patients about what is happening in their lives an unimportant factor in understanding their physical complaints. (R)
19. It is difficult for me to view things from my patients’ perspectives. (R)
20. Because people are different, it is almost impossible for me to see things from my patients’ perspectives. (R)