Jefferson Scale of Physician Empathy (JSPE)

1. Abstract

The Jefferson Scale of Physician Empathy (JSPE), developed by Mohammadreza Hojat and colleagues at Thomas Jefferson University’s Sidney Kimmel Medical College, stands as the premier psychometric instrument specifically designed to operationalize and evaluate empathy within the context of clinical medical education and healthcare practice. Recognizing that general psychological measures of empathy emphasize affective contagion and emotional resonance—qualities that can precipitate clinical burnout and impair objective therapeutic decision-making—the JSPE defines clinical empathy predominantly as a multidimensional cognitive attribute. This construct encapsulates the healthcare provider’s capacity to comprehend a patient’s internal perspective, experiences, and concerns, coupled with the capability to communicate this understanding back to the patient in a therapeutic manner. The instrument comprises 20 items evaluated on a 7-point Likert response scale ranging from 1 (Strongly Disagree) to 7 (Strongly Agree), generating theoretical global scores between 20 and 140. Half of the inventory (10 items) is positively scored, while the remaining 10 items are reverse-worded to counteract acquiescence response bias. Extensive empirical testing across diverse cultural, linguistic, and professional cohorts corroborates a stable three-factor structural architecture comprising Perspective Taking, Compassionate Care, and Standing in the Patient’s Shoes. The scale exhibits robust psychometric integrity, typically yielding internal consistency values (Cronbach’s alpha) between .78 and .89 across medical student, resident, and practicing physician populations. Three specialized target-group adaptations exist: the Health Care Professionals version (HP-version), the Medical Students version (S-version), and the Health Professions Students version (HPS-version). The scale demonstrates profound predictive and convergent validity, correlating positively with clinical competence assessments, ratings of patient satisfaction, objective structured clinical examinations (OSCE), and lower levels of physician burnout.

2. Keywords

Jefferson Scale of Physician Empathy, JSPE, clinical empathy, physician-patient relations, medical education, perspective taking, compassionate care, psychometrics, scale validation, clinical competence, healthcare communication, medical student empathy

3. Authors

The Jefferson Scale of Physician Empathy was conceived, developed, and standardized under the auspices of the Center for Research in Medical Education and Health Care (CRMEHC) at the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania, USA. The multidisciplinary investigative team comprises the following key scholars:

• Mohammadreza Hojat, Ph.D. — Research Professor of Psychiatry and Human Behavior, Director of the Jefferson Longitudinal Study of Medical Education, Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University. Principal investigator and primary architect of the JSPE theoretical and psychometric framework.
• Salvatore Mangione, M.D. — Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Sidney Kimmel Medical College at Thomas Jefferson University. Clinical lead exploring the integration of physical diagnosis, medical humanities, and clinical communication skills.
• Thomas J. Nasca, M.D., MACP — Professor of Medicine and former Dean of Jefferson Medical College; Chief Executive Officer of the Accreditation Council for Graduate Medical Education (ACGME).
• Michael J. Cohen, M.D. — Research Associate and Clinical Educator, Center for Research in Medical Education and Health Care, Thomas Jefferson University.
• Joseph S. Gonnella, M.D. — Distinguished Professor of Medicine, Dean Emeritus of Jefferson Medical College, and Founder/Director of the Center for Research in Medical Education and Health Care. Seminal researcher on longitudinal medical student performance and physician competency.
• James B. Erdmann, Ph.D. — Professor of Medical Education and former Associate Dean for Academic Affairs, Sidney Kimmel Medical College at Thomas Jefferson University.
• Michael Magee, M.D. — Senior Fellow in Health Policy, Center for Research in Medical Education and Health Care, Thomas Jefferson University.

Institutional Contact for Research Licensing: Center for Research in Medical Education and Health Care (CRMEHC), Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, Suite 119, Philadelphia, PA 19107, USA. Official Web Resource: Jefferson Scale of Empathy Institutional Portal.

4. Purpose

The clinical interview constitutes the single most frequent diagnostic and therapeutic intervention enacted throughout a physician’s career. Despite its centrality, historical medical education paradigms frequently prioritized biomedical data acquisition and diagnostic algorithms at the expense of relational, communicative, and humanistic proficiencies. Prior to the early 2000s, clinical educators lacked a psychometrically sound, domain-specific evaluation tool capable of quantifying empathy exclusively within the unique constraints of health professional-patient encounters. General psychological instruments such as Davis’s Interpersonal Reactivity Index (IRI) or the Hogan Empathy Scale captured overarching psychosocial predispositions, but their items frequently conformed to social, casual, or non-hierarchical peer contexts, failing to reflect the asymmetrical power dynamics, institutional time pressures, emotional distress, and ethical boundaries characteristic of clinical care.

The primary purpose of the Jefferson Scale of Physician Empathy is to provide medical educators, clinical researchers, healthcare administrators, and social scientists with a targeted, self-administered measurement tool that explicitly reflects the operational definition of empathy in medicine. From a theoretical standpoint, Hojat and colleagues established the JSPE to decouple clinical empathy from raw sympathy or emotional identification. Whereas broad affective sympathy involves sharing a patient’s personal distress—a mechanism that can cloud diagnostic objectivity, induce compassion fatigue, and catalyze burnout—cognitive empathy centers upon understanding the patient’s condition, feelings, and perspectives, and translating this insight into tailored clinical communication.

In academic medical centers, the JSPE serves several distinct clinical and educational applications:

• Curricular Evaluation and Longitudinal Tracking: The scale enables medical schools to gauge systemic trends across four years of undergraduate training. Longitudinal studies utilizing the JSPE have critically documented the phenomenon of “empathy erosion,” where medical students experience a statistically significant drop in empathy during their third year, coinciding with the onset of demanding clinical clerkships.
• Educational Intervention Assessment: Academic institutions utilize the JSPE as a pre-test and post-test metric to evaluate the efficacy of pedagogical interventions designed to enhance humanism, such as patient-centered interviewing seminars, reflective narrative medicine workshops, perspective-taking simulations, and medical humanities electives.
• Correlational Outcomes Research: Clinicians and health systems utilize the JSPE to investigate links between provider empathy scores and tangible health outcomes. Empirical investigations demonstrate that higher physician JSPE scores correlate with superior glycemic control in diabetic patients, improved lipid profiles, shortened acute illness duration, lower postoperative complication rates, enhanced patient treatment adherence, and dramatically lower rates of medical malpractice litigation.
• Specialty Preference and Personality Studies: The instrument facilitates the exploration of individual differences among clinicians, shedding light on the psychological profiles of practitioners pursuing “people-oriented” specialties (e.g., family medicine, general internal medicine, pediatrics, psychiatry) versus “procedure-oriented” specialties (e.g., surgery, radiology, pathology, anesthesiology).

5. Psychological Construct

The core construct operationalized by the Jefferson Scale of Physician Empathy is clinical empathy. In their conceptual framework, Hojat and colleagues define clinical empathy as: “a predominantly cognitive attribute that involves an understanding of the patient’s experiences, concerns, and perspectives, combined with a capacity to communicate this understanding and an intention to help.” This construct is fundamentally demarcated into three complementary psychometric subscales, or empirical dimensions:

1. Perspective Taking

Perspective Taking represents the foundational cognitive pillar of the JSPE, accounting for the highest proportion of variance in factor-analytic studies. It captures the clinician’s conscious, intellectual effort to mentally view clinical circumstances through the cognitive and emotional lens of the patient. Rather than experiencing emotional contagion, a clinician scoring high on Perspective Taking deliberately maps the patient’s internal worldview, values, and psychological background. This cognitive stance prevents the physician from dismissing subjective symptoms as irrational or non-compliant. Items addressing this dimension explore whether the practitioner actively decodes nonverbal cues, values body language as equal to verbal output, and works systematically to comprehend the psychological status of both patients and their families. For instance, Item 2 (“I try to understand what is going on in my patients’ minds by paying attention to their nonverbal cues and body language”) directly indexes the active, observational diagnostic behaviors that drive clinical perspective taking.

2. Compassionate Care

The second essential dimension, Compassionate Care (often referred to in early psychometric papers as the clinician’s valuation of emotional engagement and therapeutic humanism), addresses the physician’s recognition that emotional dynamics, affectional rapport, and humanistic warmth constitute potent therapeutic agents rather than extraneous noise. This dimension is heavily saturated with reverse-worded items designed to identify emotional detachment, detached cynicism, or an excessively reductionist, strictly biomedical orientation toward healing. Clinicians who reject humanistic connection frequently endorse beliefs that illness is entirely mechanistic and that emotional relationships have no legitimate role in medicine. Items such as Item 11 (“Patients’ illnesses can be cured only by medical treatment; therefore, affectional ties to my patients cannot have a significant place in this endeavor”) and Item 14 (“I believe that emotion has no place in the treatment of medical illness”) gauge the degree to which a provider embraces or denigrates the emotional, psychosocial, and affective realities inherent to healing.

3. Standing in the Patient’s Shoes

The third dimension, labeled Standing in the Patient’s Shoes (or Walking in the Patient’s Shoes), represents the clinician’s direct subjective appraisal of how readily they can place themselves in the personal shoes of their patients. Unlike the broader cognitive mapping measured by Perspective Taking, this dimension specifically evaluates internal perceived difficulty, barriers, and cognitive resistance related to inter-individual differences. Healthcare providers operate under immense temporal, educational, and socio-economic gradients compared to their patients. Clinicians scoring poorly on this subscale report a profound sense of alienation or perceived impossibility when attempting to empathize with patients from disparate walks of life, cultures, or demographic groups. Core items exemplifying this dimension include Item 19 (“It is difficult for me to view things from my patients’ perspectives”) and Item 20 (“Because people are different, it is almost impossible for me to see things from my patients’ perspectives”).

6. Theoretical Framework

The theoretical architecture of the JSPE bridges classical cognitive psychology, social-cognitive neuroscience, psychodynamics, and humanistic psychotherapeutic models, synthesizing them into a coherent medical-education framework.

Cognitive vs. Affective Empathy Dichotomy

The most foundational theoretical postulate advanced by Carl Rogers, and adapted to clinical medicine by Hojat (2007), is the strict differentiation between empathy and sympathy. Classical psychological theories (e.g., Hoffman, Davis, Eisenberg) delineate empathy along dual tracks: affective empathy (mirroring, shared visceral emotions, visceral distress, emotional contagion) and cognitive empathy (intellectual comprehension, mentalizing, theory of mind). In medical practice, excessive unmitigated affective empathy leads to emotional exhaustion, personal distress, and objective diagnostic impairment. If an oncologist actively mirrors the agony, despair, and grief of every terminal patient, the physiological load activates chronic sympathetic nervous system arousal, precipitating clinical depression and professional burnout. Conversely, cognitive empathy utilizes cortical pathways—primarily localized within the medial prefrontal cortex, temporal-parietal junction, and superior temporal sulcus—to comprehend the emotional state without personal co-suffering. The JSPE theoretical model posits that cognitive empathy acts as a protective buffer, enhancing patient satisfaction and diagnostic yield while mitigating provider burnout.

The Biopsychosocial Model

The JSPE explicitly operationalizes George Engel’s Biopsychosocial Model of health and illness. Traditional 19th- and 20th-century Flexnerian medicine operated largely within a reductionist biomedical paradigm, conceptualizing the human organism as an organic machine vulnerable to structural breakdowns and pathogen invasions. Under this framework, subjective human experience was dismissed as secondary epiphenomena. Engel asserted that biological anomalies interact with psychological states and social contexts to govern the clinical presentation, course, and resolution of disease. The JSPE incorporates this model by evaluating whether physicians respect personal experiences, socio-cultural contexts, and emotional narratives as clinically decisive diagnostic and therapeutic information.

Theory of Mind and Narrative Medicine

From a developmental and cognitive perspective, the JSPE relies on the construct of Theory of Mind (ToM)—the human capacity to impute mental states, intentions, desires, and beliefs to self and others. In clinical encounters, this manifests as Narrative Medicine (as formulated by Rita Charon), wherein the physician possesses the competence to recognize, absorb, interpret, and be moved by the stories of illness. Items evaluating the clinician’s engagement with the arts and literature (e.g., Item 17: “I do not enjoy reading nonmedical literature or experiencing the arts”) stem from the theoretical stance that narrative exposure strengthens cognitive mentalizing, expands emotional literacy, and develops the cognitive scaffolding necessary to interpret multifaceted patient histories.

7. Validity

The validity of the Jefferson Scale of Physician Empathy has been exhaustively investigated across dozens of multinational investigations involving tens of thousands of medical students, residents, and licensed medical practitioners. The empirical evidence demonstrates robust construct, convergent, discriminant, and predictive validity.

Construct and Factorial Validity

In the seminal validation study conducted by Hojat et al. (2001) across 704 medical students and physicians, exploratory and confirmatory factor analyses supported the theoretical construct of clinical empathy. Factor structures confirmed three primary dimensions accounting for substantial proportions of common variance, with the primary factor—Perspective Taking—consistently emerging as the central axis of clinical empathy. Cross-cultural adaptations across Italian, Spanish, Persian, Japanese, Korean, French, Portuguese, and Australian health professional cohorts have consistently reproduced this overarching latent construct, demonstrating structural stability across diverse cultural contexts.

Convergent Validity

Convergent validity has been established by correlating JSPE scores with standardized, psychometrically validated measures of empathy, personality, and interpersonal functioning:

• Interpersonal Reactivity Index (IRI): Hojat et al. (2005) demonstrated that JSPE scores correlate moderately to strongly with the Perspective Taking subscale of the IRI (r = .40 to .45, p < .001) and the Empathic Concern subscale (r = .41, p < .001). Crucially, confirming theoretical expectations, the JSPE exhibited near-zero or non-significant correlations with the IRI’s Personal Distress subscale (r = -.06 to .04), empirically validating the conceptual divergence between cognitive clinical empathy and unhelpful affective distress.
• Warmth and Gregariousness: On personality inventories such as the NEO-PI-R and the California Psychological Inventory (CPI), the JSPE correlates positively with Agreeableness, Openness to Experience, Warmth, and Sociability.
• Emotional Intelligence: High positive correlations (r = .50 to .62) have been repeatedly documented between the JSPE and validated emotional intelligence instruments (e.g., the Mayer-Salovey-Caruso Emotional Intelligence Test [MSCEIT] and the Schutte Self-Report Emotional Intelligence Test).

Discriminant Validity

Discriminant validity is supported by the absence of significant correlations between JSPE scores and constructs theoretically irrelevant to empathy, such as analytical intelligence, visual-spatial reasoning, medical knowledge acquisition tests (e.g., USMLE Step 1 scores), and generalized test-taking anxiety. Furthermore, the JSPE discriminates between clinical specialties: longitudinal data consistently show that matriculating residents pursuing people-oriented specialties (e.g., internal medicine, pediatrics, psychiatry) achieve significantly higher baseline JSPE scores than peers entering procedure-oriented disciplines (e.g., orthopedic surgery, anesthesiology, radiology, pathology).

Criterion and Predictive Validity

The predictive power of the JSPE relative to actual clinical and patient outcomes represents one of its strongest psychometric assets:

• Clinical Competence Evaluations: Hojat et al. (2002) found that third-year medical students with top-quartile JSPE scores achieved significantly higher core clinical clerkship ratings and Objective Structured Clinical Examination (OSCE) communication performance scores than bottom-quartile peers.
• Direct Patient Outcomes: In a landmark study involving 242 primary care physicians and over 20,000 diabetic patients in central Italy (Del Canale et al., 2012), physicians with high JSPE scores had significantly fewer patients experiencing acute metabolic complications (ketoacidosis, hyperosmolar state, coma) requiring hospitalization compared to low-scoring physicians (odds ratio = 0.59), confirming that clinical empathy directly improves patient outcomes.

8. Reliability

The psychometric evaluation of the JSPE has demonstrated high internal consistency and temporal stability across diverse health professional populations and international clinical environments.

Internal Consistency

In the original normative sample of medical students and physicians (Hojat et al., 2001, 2002), the inventory demonstrated an overall Cronbach’s alpha coefficient of .89 for physicians and .87 for medical students. Subsequent psychometric evaluations of the Health Professions version (HP-version) and Health Professions Students version (HPS-version) yield comparable reliability indices across diverse disciplines:

• Physicians and Medical Residents: Cronbach’s alpha typically ranges between .81 and .89.
• Medical Students (S-Version): Alpha coefficients consistently fall between .78 and .88 across all four years of medical training.
• Nursing and Allied Health Professionals: In validation studies with Australian paramedic students (Williams et al., 2013) and registered nurses (Ward et al., 2012), alpha coefficients were reported at .78 and .85, respectively.
• Item-Total Correlations: Point-biserial item-total correlations across the 20 items range from .30 to .64, well above the psychometric threshold of .20, indicating that each item contributes constructively to the shared latent construct without redundant duplication.

Test-Retest Temporal Stability

The temporal stability of the JSPE over defined retest intervals reflects an instrument measuring an enduring cognitive-behavioral trait rather than a transient affective state. Over a short-term interval of 2 to 4 months, test-retest reliability coefficients among medical students have demonstrated stability indices ranging from r = .65 to .75 (p < .001). Over a full 12-month academic duration, test-retest coefficients remain stable at r = .58 to .69, capturing meaningful programmatic curricular shifts (such as third-year empathy erosion) while preserving stable individual rank-order scoring.

9. Factor Analysis

Extensive factor-analytic evaluations employing both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) have solidified the multidimensional structure of the JSPE.

Exploratory Factor Analysis (EFA)

In early development, principal axis factoring and principal component analysis utilizing orthogonal (Varimax) and oblique (Promax) rotations across multi-institutional cohorts consistently identified a three-factor solution based on Kaiser’s eigenvalue-greater-than-one criterion and Cattell’s scree plot inspection. The three factors collectively explain between 35% and 48% of the total variance across clinical cohorts:

• Factor 1: Perspective Taking (10 items). Accounting for the largest portion of explained variance (typically 25% to 32%), this factor contains predominantly positively worded items (e.g., Items 1, 2, 3, 4, 5, 6, 7, 8, 9, 10). Factor loadings for these items are strong, generally spanning .45 to .74.
• Factor 2: Compassionate Care (8 items). Accounting for 7% to 10% of total variance, this factor is primarily composed of reverse-scored items reflecting emotional avoidance, detached clinical attitudes, and skepticism regarding the value of human connection in medicine (e.g., Items 11, 12, 13, 14, 15, 16, 17, 18). Factor loadings typically range between .42 and .70.
• Factor 3: Standing in the Patient’s Shoes (2 items). Accounting for 4% to 6% of total variance, this factor focuses exclusively on the perceived cognitive impossibility of adopting another person’s perspective due to inter-individual differences (Items 19 and 20). Item loadings on this distinct dyad frequently exceed .65.

Confirmatory Factor Analysis (CFA) and Goodness-of-Fit

Subsequent contemporary structural equation modeling (SEM) and CFA across multinational cohorts have compared unidimensional, two-factor, three-factor, and higher-order bi-factor models. The three-factor correlated model consistently achieves superior goodness-of-fit indices:

• Root Mean Square Error of Approximation (RMSEA): Values consistently range between .042 and .058, well within the conventional < .06 standard for excellent model fit.
• Comparative Fit Index (CFI): Values consistently span .92 to .96.
• Tucker-Lewis Index (TLI): Estimates fall between .91 and .95.
• Standardized Root Mean Square Residual (SRMR): Typically documented between .038 and .049.

While some researchers advocate for a bi-factor formulation where a broad, general “Clinical Empathy” factor accounts for overarching variance alongside specific sub-dimensions, the correlated three-factor structural model remains the international clinical benchmark.

10. Instrument / Measurement Tool

• Scale Type: Self-report, psychometrically validated, multidimensional cognitive empathy inventory.
• Target Populations:
  • S-Version: Medical Students (Undergraduate and Graduate medical education).
  • HP-Version: Practicing Physicians, Specialists, Residents, and Advanced Practice Clinicians.
  • HPS-Version: Allied Health Professions Students (e.g., Nursing, Pharmacy, Dentistry, Physical Therapy, Paramedic Sciences).
• Item Count: Exactly 20 items.
• Response Scale: 7-point Likert-type agreement scale anchored as follows:
  • 1 = Strongly Disagree
  • 2 = Moderately Disagree
  • 3 = Slightly Disagree
  • 4 = Neither Agree nor Disagree
  • 5 = Slightly Agree
  • 6 = Moderately Agree
  • 7 = Strongly Agree
• Item Polarity & Scoring Mechanics:
  • Positively Scored Items (10 items): Items 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10. Scored directly as marked (1 = 1, 2 = 2, 3 = 3, 4 = 4, 5 = 5, 6 = 6, 7 = 7).
  • Reverse Scored Items (10 items – marked with ‘R’): Items 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20. Must be reverse-transformed prior to aggregate calculation using the formula: Reversed Score = 8 – Raw Score (i.e., 1 becomes 7, 2 becomes 6, 3 becomes 5, 4 becomes 4, 5 becomes 3, 6 becomes 2, and 7 becomes 1).
• Total Score Range: Theoretical minimum score of 20; theoretical maximum score of 140. Higher total scores denote a greater degree of clinical empathy.
• Administration Modality: Available in supervised paper-and-pencil formats and standardized online institutional survey engines. Average completion time is 5 to 10 minutes.

11. Permissions & Fee and Test Year

Year of Primary Publication: The Jefferson Scale of Physician Empathy was first formally published in 2001 by Mohammadreza Hojat, Salvatore Mangione, Thomas J. Nasca, and associates at Thomas Jefferson University.

Copyright and Ownership: The Jefferson Scale of Empathy (across all variants: S, HP, and HPS) is protected under international copyright law by Thomas Jefferson University. All intellectual property rights are managed by the Center for Research in Medical Education and Health Care (CRMEHC) within the Sidney Kimmel Medical College.

Licensing and Fee Structure: The scale is proprietary and is not in the public domain. It is made available to academic researchers, medical educators, and healthcare systems following institutional registration and payment of nominal licensing and processing fees. Fee schedules are differentiated based on project scope, user category (sponsored institutional research, unfunded educational evaluation, doctoral dissertation research), and the number of survey administrations requested. Academic packages typically include access to standardized scoring rubrics, national normative percentile reference tables, and user manuals. Researchers seeking official permission, translated authorized editions (over 55 language translations currently exist), or scoring licensing must submit an official application through the Thomas Jefferson University Empathy Project Portal.

12. References

Del Canale, S., Louis, D. Z., Maio, V., Wang, X., Rossi, G., Hojat, M., & Gonnella, J. S. (2012). 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(9), 1243–1249. https://doi.org/10.1097/ACM.0b013e3182628fbf

Hojat, M. (2007). Empathy in patient care: Antecedents, development, measurement, and outcomes. Springer Science+Business Media. https://doi.org/10.1007/0-387-33608-7

Hojat, M., Gonnella, J. S., Mangione, S., Nasca, T. J., Veloski, J. J., & Erdmann, J. B. (2002). Empathy in medical students as related to academic performance, clinical competence and gender. Medical Education, 36(6), 522–527. https://doi.org/10.1046/j.1365-2923.2002.01234.x

Hojat, M., Gonnella, J. S., Nasca, T. J., Mangione, S., Vergare, M., & Magee, M. (2004). Physician empathy: Definition, components, measurement, and relationship to gender and specialty. American Journal of Psychiatry, 159(9), 1563–1569. https://doi.org/10.1176/appi.ajp.159.9.1563

Hojat, M., Mangione, S., Kane, G. C., & Gonnella, J. S. (2005). Relationships between scores of the Jefferson Scale of Physician Empathy (JSPE) and the Interpersonal Reactivity Index (IRI). Medical Teacher, 27(7), 625–628. https://doi.org/10.1080/01421590500069744

Hojat, M., Mangione, S., Nasca, T. J., Cohen, M. J., Gonnella, J. S., Erdmann, J. B., Veloski, J., & Magee, M. (2001). The Jefferson Scale of Physician Empathy: Development and preliminary psychometric data. Educational and Psychological Measurement, 61(2), 349–365. https://doi.org/10.1177/00131640121971158

Kane, G. C., Gotto, J. L., Mangione, S., West, S., & Hojat, M. (2007). Jefferson Scale of Patient’s Perceptions of Physician Empathy: Preliminary psychometric data. Croatian Medical Journal, 48(1), 81–86.

Shariat, S. V., Eshtad, E., & Ansari, S. (2010). Empathy and its correlates in Iranian physicians: A preliminary psychometric study of the Jefferson Scale of Physician Empathy. Medical Teacher, 32(10), e417–e421. https://doi.org/10.3109/0142159X.2010.498488

Ward, J., Cody, J., Schaal, M., & Hojat, M. (2012). The empathy enigma: An empirical study of decline in empathy among undergraduate nursing students. Journal of Professional Nursing, 28(1), 34–40. https://doi.org/10.1016/j.profnurs.2011.10.007

Williams, B., Brown, T., Boyle, M., & Dousek, S. (2013). Psychometric testing of the Jefferson Scale of Empathy Health Profession Students’ version with Australian paramedic students. Nursing & Health Sciences, 15(1), 45–50. https://doi.org/10.1111/nhs.12003

13. Items of the Scale (Questionnaire)