Comparative cross-sectional study among 131 first year and 106 final year (fifth year) medical students was conducted in Jimma University, Ethiopia on academic year 2010/11. Jimma University is found in Jimma city located 350
km southwest of Addis Ababa, Ethiopia. There were about 1000 medical students in total, the number of first-year students being around 210 and final year students around 150. Assuming small to medium effect sizes (Cohen’s d
0.4) and a power of 80%, a sample size of 100 students per group was envisaged. In the end, 131 first year and 106 final year medical students were included in the study. The study subjects were selected using simple random sampling technique from the list of the students.
Two different self administered survey instruments were used to measure the students’ empathy. The Balanced Emotional Empathy Scale (BEES) was used for the measurement of “heart-reading”, i.e. emotional empathy [32
]. The BEES is an instrument consisting of 15 positively and 15 negatively worded items that measure emotional responses to fictive situations and particular life events (examples of the items include: “Unhappy movie endings haunt me for hours afterward, I cannot feel much sorrow for those who are responsible for their own misery”). The coefficient alpha internal consistency of the BEES is 0.87. The questions attempt to probe the extent to which the respondent is able to feel the other’s suffering or take pleasure in their happiness. Study subjects report the degree of their agreement or disagreement for each of the 30 items using a 9-point Likert-scale. A higher total score represents a higher level of emotional empathy. The stated norm provided in the Manual for the BEES is 45
As gaze perception plays a crucial role in the ability to reason about others’ intentions and feelings [33
], the Reading the Mind in the Eyes test (RME-R test) was used to evaluate “mind-reading”, i.e. cognitive empathy. The RME-R test consists of 36 photographs depicting just the eye regions. A rectangular area of approximately 5
2 in. delineated the eye region, encompassing the entire width of the face from midway up the nose to right above the brow. Four mental states accompanying each stimulus (one target word and three foils) were presented at each corner of the high resolution photograph. To reduce linguistic difficulties, the test had appended a detailed glossary where all adjectives were explained using synonyms and example sentences. A typical mean score is in the range 22–30. A mean score over 30 indicates a very accurate at decoding a person’s facial expressions around the eyes. A score under 22 indicates a very low score of RME-R test [34
Socio-demographic characteristics included questions about gender, age, year of education, ethnicity, country of birth, migration background, the people with whom the students grew up (mother/father/both/other), number of siblings, position (birth order) within siblings (eldest/sandwich/youngest), major life events during childhood (divorce/illness/death of parents), place of residence (at home with relatives/moved out), socio-economic status of parents, religion, active membership in a religious community, number of close relationships, involvement in online social networks like facebook, daily internet use, interest in a medical specialization (specialization with continuity of patient care such as internal medicine, psychiatry and pediatrics versus specialization with less interpersonal contact such as surgery, radiology and pathology) and a question about students’ personal experience with psychiatric or psychotherapeutic treatment.
To deal with missing values in the self-rating scale BEES, imputation by the individual mean of the observed items was applied separately for the positively and the negatively worded items, in case the respective number of missing values did not exceed 5 (i.e. 33%). Otherwise the questionnaire was treated as insufficient and was excluded from the analyses. In the RME-R test, missing answers were treated as “the participant did not recognize the emotion”. However, if more than the half of the RME-R questionnaire was empty, this was interpreted as insufficient motivation to complete the test, which was therefore excluded from the analyses. Apart from descriptive statistics, t-test for empathy and RME-R scores were performed to check for mean difference between the two groups of students. Pearson correlations between the BEES and the RME-R were also calculated. A linear regression was computed between the empathy scores and socio-demographic and other background characteristics using the enter method. A significance level of 5% was used. All analyses were performed using SPSS version 16.
Ethical approval for the study was granted by the Ethics Review Board of Jimma University, college of public health and Medical Sciences. After a brief explanation of the study, a written consent was obtained from each participant.