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JAOA/AACOM Medical Education  |   August 2019
Empathy in Medicine National Norms for the Jefferson Scale of Empathy: A Nationwide Project in Osteopathic Medical Education and Empathy (POMEE)
Author Notes
  • From the Center for Research in Medical Education and Health at Sidney Kimmel Medical College at Jefferson (Philadelphia University and Thomas Jefferson University) (Dr Hojat and Ms DeSantis); the American Association of Colleges of Osteopathic Medicine (Drs Shannon and Speicher and Ms Bragan), and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (Dr Calabrese). 
  • Financial Disclosure: None reported. 
  • Support: This study was funded by the American Association of Colleges of Osteopathic Medicine, the American Osteopathic Association, and the Cleveland Clinic. 
  •  *Address correspondence to Mohammadreza Hojat, PhD, Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College, 1015 Walnut St, Ste 320, Philadelphia, PA 19107-5005. Email: mohammadreza.hojat@jefferson.edu
     
Article Information
Medical Education
JAOA/AACOM Medical Education   |   August 2019
Empathy in Medicine National Norms for the Jefferson Scale of Empathy: A Nationwide Project in Osteopathic Medical Education and Empathy (POMEE)
The Journal of the American Osteopathic Association, August 2019, Vol. 119, 520-532. doi:10.7556/jaoa.2019.091
The Journal of the American Osteopathic Association, August 2019, Vol. 119, 520-532. doi:10.7556/jaoa.2019.091
Abstract

Context: National norms are necessary to assess individual scores from validated instruments. Before undertaking this study, no national norms were available on empathy scores. The Project in Osteopathic Medical Education and Empathy (POMEE) provided a unique opportunity to develop the first national norms for medical students.

Objective: To develop national norms for the assessments of osteopathic medical students’ empathy scores on the broadly used and well-validated Jefferson Scale of Empathy (JSE) at all levels of osteopathic medical school education.

Methods: Participants were students from 41 of 48 participating campuses of osteopathic medical schools. Students were invited to complete a web-based survey, which included the JSE, in the 2017-2018 academic year.

Results: A total of 16,149 completed surveys were used to create national norm tables. Three national norm tables were developed for first-year matriculants and for students in preclinical (years 1 and 2) and clinical (years 3 and 4) phases of medical school. The norm tables allow any raw score on the JSE for male and female osteopathic medical students from matriculation to graduation to be converted to a percentile rank to assess an individual's score against national data.

Conclusions: National norms developed in this project, for men and women and at different levels of medical school education, can not only be used for the assessment of student's individual scores on the JSE, but can also serve as a supplementary measure for admissions to medical school and postgraduate medical education programs.

National norms for empathy scores or for any other personality-measuring instrument in medical students have been unavailable. To address this gap, the nationwide Project in Osteopathic Medical Education and Empathy (POMEE), sponsored by the American Association of Colleges of Osteopathic Medicine (AACOM), the American Osteopathic Association, and the Cleveland Clinic, in collaboration with the Sidney Kimmel Medical College at Jefferson (Philadelphia University and Thomas Jefferson University) and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, was launched. The broader scope of POMEE is to explore associations between empathy in medical students and their demographics, academic background, work experiences, and career interests. The POMEE goals also include examining changes in empathetic orientation toward patient care and factors associated with positive and negative changes in empathy as students progress through medical school. This ongoing study provides a unique opportunity to develop the first national empathy score norms in osteopathic medical students using the Jefferson Scale of Empathy (JSE). The present study is part of the larger, ongoing POMEE. 
Empathy and the JSE
Empathy has been identified as a major element of professionalism in medicine.1 Cultivating empathy is among the goals of medical education and has been endorsed by professional medical organizations.2,3 The National Board of Osteopathic Medical Examiners lists the cultivation of humanistic behavior and exhibition of compassionate treatment, altruism, and empathy among the required competencies in the practice of osteopathic medicine.4(pp26-27) 
A European medical education guide5 suggests that assessing and enhancing personal qualities such as empathy must be considered a mandate—not just declared desirable—by leaders in medical education and medical professional organizations. Furthermore, it has been proposed that the assessment of medical school applicants’ empathy should be considered a supplementary measure for admissions decisions, particularly in situations in which applicants have comparable academic qualifications.6 
However, empathy is an elusive concept that is difficult to define and hard to quantify. To clarify the conceptual ambiguity associated with empathy, clinical empathy in the context of health care professions education and patient care was defined as a predominantly cognitive (rather than an affective or emotional) attribute that involves an understanding (rather than a feeling) of pain and suffering of the patient combined with a capacity to communicate this understanding and with an intention to help.7,8 The 4 key terms in this definition are italicized to underscore their significance in the construct of clinical empathy. 
Based on the aforementioned definition of clinical empathy, the JSE was developed for measuring empathy specifically in the context of medical education and patient care.7-10 Before the development of the JSE, no psychometrically sound instrument was available for measuring empathy in that context. Although a few instruments were available and used for measuring empathy in medical education research,7(pp57-68) none had face and content validity in the context of patient care.11,12 Thus, there was a need for a content-specific and context-relevant empathy-measuring instrument. The JSE was developed in response to that need. 
Researchers in the United States and abroad have accumulated an abundance of evidence in support of the psychometrics of the JSE through samples of health care professionals, allopathic medical students, and practitioners.7(pp84-128,276-286) For example, statistically significant associations have been reported between allopathic medical students’ scores on the JSE and ratings of clinical competence given by medical school faculty.13 Also, statistically significant associations were observed between students’ JSE scores and ratings of clinical competence given by standardized patients in objective structured clinical examination stations.14,15 
More importantly, statistically significant associations have been reported between physicians’ scores on the JSE and tangible clinical outcomes in diabetic patients in the United States16 and Italy.17 Although researchers at the Cleveland Clinic failed to reproduce significant associations between physician empathy and patient outcomes,18 this inability to reproduce the findings was attributed to issues related to the internal and external validity of the findings.19 Another study20 in China showed that physician scores on the JSE had a mediating role in the immunocompetence of patients with advanced prostate cancer. 
Also, statistically significant correlations have been reported between medical students’ JSE scores and conceptually relevant measures, such as indicators of communication skills,21 from observations of empathetic communication patterns with standardized patients.22 In a study at the Cleveland Clinic,23 statistically significant associations were observed between physicians’ JSE scores and standardized measures of patients’ communication experiences with their physicians. Also, studies have found that medical students’ scores on the JSE are associated with personal qualities that are conducive to relationship building; these qualities include empathetic concern and perspective-taking24,25; warmth, dutifulness, and compassion8; sociability26; agreeableness; openness to experience; conscientiousness and extraversion27; emotional intelligence28-30; cooperativeness31; desirable professional behavior32; positive attitudes toward patient-centered care and orientation toward integrative patient care in osteopathic medical students33; positive social influence34; humanistic excellence by peer nomination35; personal accomplishment36; and orientation toward teamwork and interprofessional collaboration in allopathic37 and osteopathic medical students.33,38 
Conversely, JSE scores were negatively correlated with personal qualities that are detrimental to relationship building, including aggression-hostility,26,39 indicators of burnout such as depersonalization and emotional exhaustion,36,40,41 and neuroticism.42 In a 2018 study43 (using POMEE data), we found strong evidence in support of the measurement properties, underlying components, and latent variable structure of the JSE in a nationwide sample of first-year matriculants to osteopathic medical schools. 
Internal consistency reliability (determined by Cronbach α) in the United States and abroad are mostly reported in magnitudes ranging from 0.70 to 0.89.7(pp276-286) Stability of scores over time indicated by test-retest reliability (0.60-0.69) has been reported in physicians10 and in osteopathic medical students who participated in POMEE (Hojat et al, unpublished data, 2019). These studies24-43 provide strong evidence of the validity and reliability of the JSE. The JSE has been translated into 56 languages and is used in more than 85 countries.7 Because of its worldwide use and extensive psychometric support, the JSE has been recognized as the most researched44 and widely used instrument in medical education research.45 
National Norms
Norms are performance data based on large representative samples from well-defined target populations that are used as references to assess, interpret, or place individual performance against the corresponding normative populations. Development of national norms requires pertinent data collected from nationwide and representative samples from target populations. The present study aimed to develop the first national norm tables for the assessment of osteopathic medical students’ scores on the JSE. 
Methods
Participants
Forty-one of 48 campuses of US colleges of osteopathic medicine participated in this project, representing 85% of all osteopathic college campuses in the country at that time. Student participants were broken into 5 samples: first-year matriculants who responded to the study survey at the beginning of the 2017-2018 academic year (sample 1) and first-year students (sample 2), second-year students (sample 3), third-year students (sample 4), and fourth-year students (sample 5) who completed the study survey at the end of the 2017-2018 academic year. 
Survey
The web-based survey consisted of questions about respondents’ demographics (age, gender, race/ethnicity), academic background, career interest, work experience before medical school, and year of medical school education, plus the following 2 scales: 
  • The JSE S-Version The JSE is a 20-item instrument for measuring empathy in the context of health care professionals’ education and patient care. Items are answered on a 7-point Likert-type scale (1=strongly disagree, 7=strongly agree). The JSE S-Version, or medical student version, was used.
  • Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ)46 This 10-item scale uses true/false responses to identify respondents with invalid records. For example, one item is, “I never met a person that I didn't like.” Scores higher than 3 on this scale indicate questionable validity of the respondent's record.46(p383) This scale has previously been used with medical students to detect and control for the tendency to make “good impression” responses.7,26
One of the shortcomings of self-reported personality surveys is the confounding effect of good impression response bias. Respondents can manipulate their answers to produce good impressions. Such attempts to present oneself in a more socially acceptable light is known as the “social desirability response set.” Because most items of the JSE are transparent, they can be answered in a way that seems more socially acceptable. Such attempts to manipulate responses can confound research findings and lead to invalid conclusions. A unique feature of the POMEE study was the statistical control for the confounding effect of good impression response bias on the JSE scores using the Infrequency Scale of the ZKPQ, which allowed us to identify and remove those with exaggerated good impression response bias from data used to develop norm tables. 
Procedures
The study survey underwent several iterations and 2 pilot testings (alpha and beta). The purpose of the alpha testing was to improve the clarity and comprehensiveness of the study survey; reviewers included medical education researchers and medical students. The purpose of the beta testing was to detect any possible bugs or crashes in its online administration and to explore the limits of the web-based product when using different desktop and mobile devices. Participants in beta testing were mostly student volunteers from 1 allopathic and 1 osteopathic medical school. 
The Jefferson team submitted the institutional review board application for the project to the institutional review board of Thomas Jefferson University. An exemption status was granted. All participating colleges submitted applications to their own institutional review board and received approval related to human subjects research. 
We arranged to have 1 or 2 senior administrators or faculty-level research coordinators from each participating college to serve as a liaison between the college and research teams at AACOM and Jefferson. These liaisons, who also administered the web-based survey at their college campuses, proved to be vital to the project.47 
Reminders to complete the survey were sent 1, 2, and up to 3 weeks after the initial invitation was sent. Surveys were considered usable and were included in the study if respondents provided year of medical school education and responded to at least 16 items of the JSE and all items of the Infrequency scale. 
Statistical Analyses
We used the t test for comparing mean differences in age between each sample and its respective population. We also used the z test for proportions to compare gender composition of samples and their respective population. Additionally, the χ2 test was used to determine goodness of fit on race/ethnicity of samples and populations. Statistical significance was set at P<.05. For determining the practical (or clinical) significance of the findings, we considered any effect size estimate of 0.20 or less as practically unimportant, regardless of statistical significance.48,49 
Results
We received 16,760 usable surveys. The usable sample of first-year matriculants represented 83% (n=6009) of its respective population. Usable samples for the first-, second-, third-, and fourth-year students represented 50% (n=3616), 41% (n=2764), 36% (n=2413), and 40% (n=1958) of their respective populations. 
Demographics
The mean age was 24.8 years for first-year matriculants, and the mean ages increased progressively by about 1 year for each class in medical school (25.5, 26.3, 27.4, and 28.6 in years 1-4, respectively). About half of the students in each group were men (53%, 51%, 49%, 50%, and 49% in first-year matriculants and in years 1-4, respectively). Only 1% or less of the students in each group self-identified as transgender, gender variant/nonconforming, or declined to answer. 
The majority of respondents were white/Caucasian (60%-68%), followed by Asian (19%-27%), Hispanic/Latino/Spanish (3%-6%), and black/African American (3%-4%) (Table 1). 
Table 1.
Age, Gender, and Race/Ethnicity Comparisons of the Study Samples With Respective Populationsa in National Samples From 41 Campuses of US Colleges of Osteopathic Medicine
First-Year
Matriculantsb
Year 1c Year 2c Year 3c Year 4c
Sample Population Sample Population Sample Population Sample Population Sample Population
(n=6009) (n=7197) (n=3616) (n=7197) (n=2764) (n=6778) (n=2413) (n=6683) (n=1958) (n=4894)
Age,d y
Mean (SD) 24.8 (3.4) 25.1 (3.1) 25.5 (3.2) 25.8 (3.1) 26.3 (3.2) 26.8 (3.2) 27.4 (3.4) 27.8 (3.2) 28.6 (3.5) 29.0 (3.4)
Range 19-51 19-51 20-50 20-52 20-56 20-59 23-55 23-55 24-53 18-62
Gender,e No. (%)
Men 3175 (53%) 3934 (55%) 1839 (51%) 3934 (55%) 1348 (49%) 3661 (54%) 1198 (50%) 3683 (55%) 966 (49%) 2566 (52%)
Women 2795 (47%) 3255 (45%) 1738 (48%) 3255 (45%) 1383 (50%) 3102 (46%) 1180 (49%) 2937 (44%) 970 (50%) 2087 (43%)
Race/Ethnicity, No. (%)
White/Caucasian 3618 (60%) 4049 (56%) 2283 (63%) 4049 (56%) 1805 (65%) 3952 (58%) 1609 (67%) 4117 (62%) 1325 (68%) 3180 (65%)
Black/African American 216 (4%) 266 (4%) 107 (3%) 266 (4%) 83 (3%) 217 (3%) 78 (3%) 244 (4%) 56 (3%) 120 (2%)
Hispanic/Latino/Spanish 337 (6%) 448 (6%) 207 (6%) 448 (6%) 114 (4%) 340 (5%) 100 (4%) 337 (5%) 64 (3%) 74 (2%)
Asian 1627 (27%) 1914 (27%) 842 (23%) 1914 (27%) 607 (22%) 1798 (27%) 470 (19%) 1681 (25%) 385 (20%) 406 (8%)
Otherf/no response 211 (3%) 520 (7%) 177 (5%) 520 (7%) 155 (6%) 471 (7%) 156 (6%) 304 (5%) 128 (6%) 1114 (23%)

a Population data were taken from AACOM prematriculation surveys for students in years 1-3 and from the AACOM exit survey in year 4.

b First-year matriculants who completed the study survey at the beginning of the 2017-2018 academic year.

c Students in the first, second, third, and fourth years who completed the study survey at the end of the 2017-2018 academic year.

d Students who did not specify their age information or who were outside the population age range were excluded (approximately 1%).

e Students who did not specify their gender or who reported other gender categories were excluded (5% or less).

f Students who specified their race/ethnicity as American Indian/Alaskan or Hawaiian/Pacific Islander were included in the "Other" category (approximately 1%).

Table 1.
Age, Gender, and Race/Ethnicity Comparisons of the Study Samples With Respective Populationsa in National Samples From 41 Campuses of US Colleges of Osteopathic Medicine
First-Year
Matriculantsb
Year 1c Year 2c Year 3c Year 4c
Sample Population Sample Population Sample Population Sample Population Sample Population
(n=6009) (n=7197) (n=3616) (n=7197) (n=2764) (n=6778) (n=2413) (n=6683) (n=1958) (n=4894)
Age,d y
Mean (SD) 24.8 (3.4) 25.1 (3.1) 25.5 (3.2) 25.8 (3.1) 26.3 (3.2) 26.8 (3.2) 27.4 (3.4) 27.8 (3.2) 28.6 (3.5) 29.0 (3.4)
Range 19-51 19-51 20-50 20-52 20-56 20-59 23-55 23-55 24-53 18-62
Gender,e No. (%)
Men 3175 (53%) 3934 (55%) 1839 (51%) 3934 (55%) 1348 (49%) 3661 (54%) 1198 (50%) 3683 (55%) 966 (49%) 2566 (52%)
Women 2795 (47%) 3255 (45%) 1738 (48%) 3255 (45%) 1383 (50%) 3102 (46%) 1180 (49%) 2937 (44%) 970 (50%) 2087 (43%)
Race/Ethnicity, No. (%)
White/Caucasian 3618 (60%) 4049 (56%) 2283 (63%) 4049 (56%) 1805 (65%) 3952 (58%) 1609 (67%) 4117 (62%) 1325 (68%) 3180 (65%)
Black/African American 216 (4%) 266 (4%) 107 (3%) 266 (4%) 83 (3%) 217 (3%) 78 (3%) 244 (4%) 56 (3%) 120 (2%)
Hispanic/Latino/Spanish 337 (6%) 448 (6%) 207 (6%) 448 (6%) 114 (4%) 340 (5%) 100 (4%) 337 (5%) 64 (3%) 74 (2%)
Asian 1627 (27%) 1914 (27%) 842 (23%) 1914 (27%) 607 (22%) 1798 (27%) 470 (19%) 1681 (25%) 385 (20%) 406 (8%)
Otherf/no response 211 (3%) 520 (7%) 177 (5%) 520 (7%) 155 (6%) 471 (7%) 156 (6%) 304 (5%) 128 (6%) 1114 (23%)

a Population data were taken from AACOM prematriculation surveys for students in years 1-3 and from the AACOM exit survey in year 4.

b First-year matriculants who completed the study survey at the beginning of the 2017-2018 academic year.

c Students in the first, second, third, and fourth years who completed the study survey at the end of the 2017-2018 academic year.

d Students who did not specify their age information or who were outside the population age range were excluded (approximately 1%).

e Students who did not specify their gender or who reported other gender categories were excluded (5% or less).

f Students who specified their race/ethnicity as American Indian/Alaskan or Hawaiian/Pacific Islander were included in the "Other" category (approximately 1%).

×
Study Samples and Their Respective Populations
We compared age, gender, and race/ethnicity of the usable samples with their respective populations using AACOM data to examine representativeness of the study samples. The study samples closely resembled their respective populations with regard to age, gender, and race/ethnicity. The means of students’ ages in each of the 5 samples and their respective populations were very similar. However, results of t tests comparing sample and population mean ages showed statistically significant differences (P<.01) that can be attributed to the large size of the samples. However, the magnitudes of the effect size estimates of the mean differences were lower than 0.20, indicating a lack of clinically important differences.48,49 
Gender proportions were also similar between samples and their respective populations. Although the results of the z tests for proportions were statistically significant (P<.01), the magnitude of none of the effect size estimates for proportions (by using the arcsine transformation) reached the 0.20 mark, indicating that the observed differences in gender proportions between samples and their respective populations were clinically unimportant. 
Similarly, composition of race/ethnicity was similar between the study samples and their respective populations, with one exception. There was a substantial 12% difference in the Asian ethnic group in the fourth-year students (20% in the sample and 8% in the population). However, a reverse change was also observed for fourth-year students in the “other/no response” category (6% of the sample and 23% of the population). The effect size estimates of the goodness of fit tests showed values less than 0.20 for all of the study samples, with the exception of the fourth-year students, for whom the effect size was 0.67, most likely due to a discrepancy between proportions of self-reported Asian students in the sample and its respective population. 
Norm Tables
Samples Used
To minimize confounding factors in creating the national norm tables, we excluded students (2%-3%) who scored higher than 3 on the Infrequency Scale of the ZKPQ. Also, because of notable gender differences in empathy reported in many studies with medical students,7(pp169-187),8,10,13,50 including POMEE, we excluded those who did not specify their gender as male or female (<1%) from the data used in preparing each of the norm tables and those who scored higher than 3 on the Infrequency Scale of the ZKPQ. 
We combined first- and second-year students in a single corresponding national norm table for preclinical students because JSE means (SDs) and score distributions were similar for students in these 2 years (115.0 [12.5] in the first year and 114.7 [12.1] in the second year). Similarly, a single corresponding national norm table for students in the clinical phase of medical school was created because JSE means (SDs) and score distributions were similar for third- and fourth-year students (113.4 [13.0] in the third year and 113.0 [13.2] in the fourth year). Final samples used in the national norm tables included 5818 first-year matriculants (3071 men and 2747 women) (Table 2); 6115 students (3042 men and 3073 women) in the preclinical phase (Table 3); and 4216 students (2099 men and 2117 women) in the clinical phase of medical school (Table 4). 
Table 2.
National Norms for the JSE S-Version: First-Year Matriculants in a National Sample From 41 Campuses of US Colleges of Osteopathic Medicine at the Beginning of Medical Schoola
JSE Men (n=3071) Women (n=2747) Combined (n=5818)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 19 19 <1 5 5 <1 24 24 <1
81-82 12 31 1 2 7 <1 14 38 1
83-84 7 38 1 1 8 <1 8 46 1
85-86 8 46 1 3 11 <1 11 57 1
87-88 8 54 2 5 16 <1 13 70 1
89-90 24 78 2 5 21 1 29 99 1
91-92 26 104 3 5 26 1 31 130 2
93-94 34 138 4 8 34 1 42 172 3
95-96 31 169 5 21 55 2 52 224 3
97-98 70 239 7 30 85 3 100 324 5
99-100 79 318 9 35 120 4 114 438 7
101-102 102 420 12 34 154 5 136 574 9
103-104 125 545 16 70 224 7 195 769 12
105-106 139 684 20 78 302 10 217 986 15
107-108 183 867 25 110 412 13 293 1279 19
109-110 199 1066 31 115 527 17 314 1593 25
111-112 211 1277 38 153 680 22 364 1957 31
113-114 218 1495 45 147 827 27 365 2322 37
115-116 221 1716 52 204 1031 34 425 2747 44
117-118 203 1919 59 207 1238 41 410 3157 51
119-120 208 2127 66 237 1475 49 445 3602 58
121-122 198 2325 72 211 1686 58 409 4011 65
123-124 175 2500 79 212 1898 65 387 4398 72
125-126 144 2644 84 203 2101 73 347 4745 79
127-128 119 2763 88 206 2307 80 325 5070 84
129-130 89 2852 91 161 2468 87 250 5320 89
131-132 92 2944 94 117 2585 92 209 5529 93
133-134 59 3003 97 82 2667 96 141 5670 96
135-136 37 3040 98 48 2715 98 85 5755 98
137-138 16 3056 99 28 2743 99 44 5799 99
139-140 15 3071 >99 4 2747 >99 19 5818 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (<1%) and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a good impression).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

Source: This table is reproduced from Hojat et al, 2018.

Table 2.
National Norms for the JSE S-Version: First-Year Matriculants in a National Sample From 41 Campuses of US Colleges of Osteopathic Medicine at the Beginning of Medical Schoola
JSE Men (n=3071) Women (n=2747) Combined (n=5818)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 19 19 <1 5 5 <1 24 24 <1
81-82 12 31 1 2 7 <1 14 38 1
83-84 7 38 1 1 8 <1 8 46 1
85-86 8 46 1 3 11 <1 11 57 1
87-88 8 54 2 5 16 <1 13 70 1
89-90 24 78 2 5 21 1 29 99 1
91-92 26 104 3 5 26 1 31 130 2
93-94 34 138 4 8 34 1 42 172 3
95-96 31 169 5 21 55 2 52 224 3
97-98 70 239 7 30 85 3 100 324 5
99-100 79 318 9 35 120 4 114 438 7
101-102 102 420 12 34 154 5 136 574 9
103-104 125 545 16 70 224 7 195 769 12
105-106 139 684 20 78 302 10 217 986 15
107-108 183 867 25 110 412 13 293 1279 19
109-110 199 1066 31 115 527 17 314 1593 25
111-112 211 1277 38 153 680 22 364 1957 31
113-114 218 1495 45 147 827 27 365 2322 37
115-116 221 1716 52 204 1031 34 425 2747 44
117-118 203 1919 59 207 1238 41 410 3157 51
119-120 208 2127 66 237 1475 49 445 3602 58
121-122 198 2325 72 211 1686 58 409 4011 65
123-124 175 2500 79 212 1898 65 387 4398 72
125-126 144 2644 84 203 2101 73 347 4745 79
127-128 119 2763 88 206 2307 80 325 5070 84
129-130 89 2852 91 161 2468 87 250 5320 89
131-132 92 2944 94 117 2585 92 209 5529 93
133-134 59 3003 97 82 2667 96 141 5670 96
135-136 37 3040 98 48 2715 98 85 5755 98
137-138 16 3056 99 28 2743 99 44 5799 99
139-140 15 3071 >99 4 2747 >99 19 5818 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (<1%) and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a good impression).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

Source: This table is reproduced from Hojat et al, 2018.

×
Table 3.
National Norms for the JSE S-Version: First- and Second-Year Osteopathic Medical Students (Preclinical Years) in National Samples From 41 Campuses of US Colleges of Osteopathic Medicinea
JSE Men (n=3042) Women (n=3073) Combined (n=6115)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 58 58 2 10 10 <1 68 68 1
81-82 19 77 2 2 12 <1 21 89 1
83-84 18 95 3 9 21 1 27 116 2
85-86 19 114 3 5 26 1 24 140 2
87-88 22 136 4 6 32 1 28 168 3
89-90 36 172 5 15 47 1 51 219 3
91-92 35 207 6 13 60 2 48 267 4
93-94 46 253 8 19 79 2 65 332 5
95-96 62 315 9 18 97 3 80 412 6
97-98 77 392 12 40 137 4 117 529 8
99-100 82 474 14 39 176 5 121 650 10
101-102 100 574 17 65 241 7 165 815 12
103-104 152 726 21 93 334 9 245 1060 15
105-106 163 889 27 99 433 12 262 1322 19
107-108 163 1052 32 126 559 16 289 1611 24
109-110 182 1234 38 138 697 20 320 1931 29
111-112 189 1423 44 173 870 25 362 2293 35
113-114 201 1624 50 185 1055 31 386 2679 41
115-116 195 1819 57 201 1256 38 396 3075 47
117-118 205 2024 63 219 1475 44 424 3499 54
119-120 181 2205 70 230 1705 52 411 3910 61
121-122 167 2372 75 257 1962 60 424 4334 67
123-124 152 2524 80 239 2201 68 391 4725 74
125-126 136 2660 85 204 2405 75 340 5065 80
127-128 103 2763 89 190 2595 81 293 5358 85
129-130 87 2850 92 175 2770 87 262 5620 90
131-132 81 2931 95 149 2919 93 230 5850 94
133-134 51 2982 97 82 3001 96 133 5983 97
135-136 28 3010 98 43 3044 98 71 6054 98
137-138 22 3032 99 19 3063 99 41 6095 99
139-140 10 3042 >99 10 3073 >99 20 6115 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (1%) and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a good impression).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

Table 3.
National Norms for the JSE S-Version: First- and Second-Year Osteopathic Medical Students (Preclinical Years) in National Samples From 41 Campuses of US Colleges of Osteopathic Medicinea
JSE Men (n=3042) Women (n=3073) Combined (n=6115)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 58 58 2 10 10 <1 68 68 1
81-82 19 77 2 2 12 <1 21 89 1
83-84 18 95 3 9 21 1 27 116 2
85-86 19 114 3 5 26 1 24 140 2
87-88 22 136 4 6 32 1 28 168 3
89-90 36 172 5 15 47 1 51 219 3
91-92 35 207 6 13 60 2 48 267 4
93-94 46 253 8 19 79 2 65 332 5
95-96 62 315 9 18 97 3 80 412 6
97-98 77 392 12 40 137 4 117 529 8
99-100 82 474 14 39 176 5 121 650 10
101-102 100 574 17 65 241 7 165 815 12
103-104 152 726 21 93 334 9 245 1060 15
105-106 163 889 27 99 433 12 262 1322 19
107-108 163 1052 32 126 559 16 289 1611 24
109-110 182 1234 38 138 697 20 320 1931 29
111-112 189 1423 44 173 870 25 362 2293 35
113-114 201 1624 50 185 1055 31 386 2679 41
115-116 195 1819 57 201 1256 38 396 3075 47
117-118 205 2024 63 219 1475 44 424 3499 54
119-120 181 2205 70 230 1705 52 411 3910 61
121-122 167 2372 75 257 1962 60 424 4334 67
123-124 152 2524 80 239 2201 68 391 4725 74
125-126 136 2660 85 204 2405 75 340 5065 80
127-128 103 2763 89 190 2595 81 293 5358 85
129-130 87 2850 92 175 2770 87 262 5620 90
131-132 81 2931 95 149 2919 93 230 5850 94
133-134 51 2982 97 82 3001 96 133 5983 97
135-136 28 3010 98 43 3044 98 71 6054 98
137-138 22 3032 99 19 3063 99 41 6095 99
139-140 10 3042 >99 10 3073 >99 20 6115 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (1%) and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a good impression).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

×
Table 4.
National Norms for the JSE-S Version: Third- and Fourth-Year Osteopathic Medical Students (Clinical Years) in National Samples From 41 Campuses of US Colleges of Osteopathic Medicinea
JSE Men (n=2099) Women (n=2117) Combined (n=4216)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 64 64 3 14 14 1 78 78 2
81-82 15 79 3 5 19 1 20 98 2
83-84 13 92 4 7 26 1 20 118 3
85-86 21 113 5 4 30 1 25 143 3
87-88 19 132 6 5 35 2 24 167 4
89-90 27 159 7 9 44 2 36 203 4
91-92 39 198 9 13 57 2 52 255 5
93-94 28 226 10 13 70 3 41 296 7
95-96 39 265 12 21 91 4 60 356 8
97-98 51 316 14 36 127 5 87 443 9
99-100 74 390 17 37 164 7 111 554 12
101-102 90 480 21 56 220 9 146 700 15
103-104 77 557 25 62 282 12 139 839 18
105-106 118 675 29 67 349 15 185 1024 22
107-108 124 799 35 117 466 19 241 1265 27
109-110 137 936 41 97 563 24 234 1499 33
111-112 126 1062 48 130 693 30 256 1755 39
113-114 108 1170 53 156 849 36 264 2019 45
115-116 145 1315 59 166 1015 44 311 2330 52
117-118 134 1449 66 162 1177 52 296 2626 59
119-120 141 1590 72 147 1324 59 288 2914 66
121-122 120 1710 79 154 1478 66 274 3188 72
123-124 96 1806 84 130 1608 73 226 3414 78
125-126 78 1884 88 136 1744 79 214 3628 84
127-128 65 1949 91 126 1870 85 191 3819 88
129-130 53 2002 94 97 1967 91 150 3969 92
131-132 39 2041 96 60 2027 94 99 4068 95
133-134 31 2072 98 47 2074 97 78 4146 97
135-136 4 2076 99 30 2104 99 34 4180 99
137-138 14 2090 99 9 2113 >99 23 4203 99
139-140 9 2099 >99 4 2117 >99 13 4216 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (<1%), and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a “good impression”).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

Table 4.
National Norms for the JSE-S Version: Third- and Fourth-Year Osteopathic Medical Students (Clinical Years) in National Samples From 41 Campuses of US Colleges of Osteopathic Medicinea
JSE Men (n=2099) Women (n=2117) Combined (n=4216)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 64 64 3 14 14 1 78 78 2
81-82 15 79 3 5 19 1 20 98 2
83-84 13 92 4 7 26 1 20 118 3
85-86 21 113 5 4 30 1 25 143 3
87-88 19 132 6 5 35 2 24 167 4
89-90 27 159 7 9 44 2 36 203 4
91-92 39 198 9 13 57 2 52 255 5
93-94 28 226 10 13 70 3 41 296 7
95-96 39 265 12 21 91 4 60 356 8
97-98 51 316 14 36 127 5 87 443 9
99-100 74 390 17 37 164 7 111 554 12
101-102 90 480 21 56 220 9 146 700 15
103-104 77 557 25 62 282 12 139 839 18
105-106 118 675 29 67 349 15 185 1024 22
107-108 124 799 35 117 466 19 241 1265 27
109-110 137 936 41 97 563 24 234 1499 33
111-112 126 1062 48 130 693 30 256 1755 39
113-114 108 1170 53 156 849 36 264 2019 45
115-116 145 1315 59 166 1015 44 311 2330 52
117-118 134 1449 66 162 1177 52 296 2626 59
119-120 141 1590 72 147 1324 59 288 2914 66
121-122 120 1710 79 154 1478 66 274 3188 72
123-124 96 1806 84 130 1608 73 226 3414 78
125-126 78 1884 88 136 1744 79 214 3628 84
127-128 65 1949 91 126 1870 85 191 3819 88
129-130 53 2002 94 97 1967 91 150 3969 92
131-132 39 2041 96 60 2027 94 99 4068 95
133-134 31 2072 98 47 2074 97 78 4146 97
135-136 4 2076 99 30 2104 99 34 4180 99
137-138 14 2090 99 9 2113 >99 23 4203 99
139-140 9 2099 >99 4 2117 >99 13 4216 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (<1%), and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a “good impression”).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

×
Interpreting the National Norm Tables
Because of the notable gender difference on the JSE, we took students’ gender into consideration in the development of norm tables by preparing percentile ranks for men and women separately. If a student's gender is known, we strongly recommend using the corresponding gender-related percentile ranks from the norm tables. If a student's gender is unknown, then the percentile rank on the norm tables for men and women combined can be used as an estimate. 
The following guidelines can be used to determine the percentile rank of an individual's JSE score. First, locate the student's raw empathy score interval in the first column of the appropriate national norm table. Then, move across the row to locate the score's corresponding percentile rank in the column that corresponds to the student's gender. For example, if a score of 125 is obtained by a third-year male student, first find the raw score interval (125-126) by looking in the first column of Table 4, then find the corresponding percentile rank for that score interval by looking across the 125-126 row until reaching the column showing the percentile rank for men, which reads 88%. This percentile rank means that a score of 125 on the JSE for a third-year male student places him in the 88th percentile of all male students in that population. In other words, 88% of the male students in this norm group scored below 125. Using the same guidelines, a third-year female student with a similar score will be placed in the 79th percentile. 
Discussion
This study, as part of the larger nationwide POMEE with a broader scope (Hojat et al, unpublished data, 2019) is the first of its kind, to our knowledge, to be undertaken in medical education research. It is unique in its scope because it includes a large national sample of medical students at all levels of medical school education, from first-year matriculation before exposure to formal medical education to completion of medical school. We believe the rich nationwide data in the POMEE database will serve to address a number of issues of interest to medical education researchers, beginning with the national norms for osteopathic medical students at all levels of medical school. Future studies are underway to improve our understanding of relationships between empathy scores and demographic variables (age, gender, race/ethnicity), undergraduate major, career interest, and employment experience before medical school. Patterns of changes in empathy scores in different years of osteopathic medical school compared with findings in allopathic medical students will also be explored. 
Among the strengths of this ground-breaking study are that it uses large and representative samples at all levels of medical education; it uses a well-established empathy-measuring instrument specifically developed for administration to medical students with face and content validities and strong psychometric support in allopathic and osteopathic medical students; and it controls for good impression response bias. One limitation of this study is relatively low response rates (<50%) in samples of second-, third- and fourth-year students. However, this limitation is mitigated by support for the representativeness of the samples based on gender, age, and race/ethnicity. 
In a cross-sectional study of a single institution, Rizkalla and Henderson51 found that osteopathic medical students in preclinical years of training (years 1 and 2) had similar empathy scores and that students in clinical years of training (years 3 and 4) also had similar empathy scores. Similar findings in POMEE led us to group first- and second-year osteopathic medical students and third- and fourth-year osteopathic medical students into preclinical and clinical norm tables, respectively. However, we must emphasize that the national norm tables developed in this study can only be used for osteopathic medical students. Different sets of norms should be created for allopathic and other health professions students. 
The national norms developed in this study have important implications for assessing osteopathic medical students’ individual and group scores against national norms. Percentile ranks in norm tables corresponding to students’ raw scores can provide supplementary measures for admissions to medical school or to postgraduate medical education programs. Medical schools and postgraduate medical education programs are accountable to select qualified applicants with the best potential to become caring physicians.6 Traditional admission measures (eg, Medical College Admission Test, undergraduate grade point averages) may help in selecting those who can successfully pass examinations of recalling factual knowledge in the early years of medical school, but are not predictive of caring for the patient. The contention that admission interviews, letters of recommendation, essays, and personal statements can reliably assess personal qualities such as caring attitudes and empathetic orientation awaits empirical verification.5 We believe that the assessment of empathy from using the norm tables reported in the present study can be helpful to fill this gap. Concern about the possibility of a respondent's attempt to fake responses in self-reported tests such as the JSE can be addressed by using approaches to detect the social desirability response set, or the good impression response bias measured by using the Infrequency Scale of the ZKPQ in the present study. 
Looking forward, we believe national norms could serve as a tie-breaker for applicants with similar academic qualifications. Moreover, the national norm tables could help to identify the degree of students’ need for remedial education to improve their empathy. In addition, national norms tables could potentially be used to assess the outcomes of educational programs, interventions, or remedies implemented in different years of osteopathic medical school training. Thus, not only can these norm tables be used to assess individuals’ scores against national data, but they can also help to evaluate group changes in percentile ranks over time to assess outcomes of targeted educational programs. Further research is needed to investigate these and other uses of the national norm tables for osteopathic medical students. 
Conclusion
Interest in recognizing, assessing, and enhancing empathy among health care professionals is increasing, particularly as studies uncover improved educational and patient outcomes associated with increased empathy in health professions students and practitioners. The national norm tables for osteopathic medical students reported in this nationwide study provide a compass for colleges of osteopathic medicine as they review admissions criteria and student performance. Further research in the POMEE's ongoing national longitudinal study will evaluate changes in empathy scores over time and will elucidate specific educational and institutional factors that are associated with positive and negative changes as students progress through medical school. 
Acknowledgments
We thank the many people who contributed to this project, especially those who made a significant contribution to this project’s success: members of the AACOM team, especially Thomas Levitan, MEd, who was instrumental at the onset of this project in developing the survey instrument; Jefferson research team colleagues Shira Carroll, BS; Daniel Z. Louis, MS; J. Jon Veloski, MS; and Vittorio Maio, PharmD, MS, MSPH; Tracy Treadway; and Luke Kedziora, BS, at the Jefferson Department of Information Services and Technology, who helped us in preparing the web-based research survey for online administration and correcting computer glitches during and after pilot testing; deans of participating Colleges of Osteopathic Medicine and each of the research coordinators from participating college campuses (listed here in alphabetic order): Michael Becker, DO; Joe Bianco, PhD; Linda Boyd, DO; Joseph Brewer, PhD; Lisa Carroll, MD; Mark Clark, PhD; Karen Clayton, PhD; Glenn E. Davis, PhD; Robyn Dreibelbis, DO; Kyle Henderson, PhD; Ana Maria Homs, PsyD; Justina Hyfantis, PhD; Britt Johnson, PhD; Gretchen Lovett, PhD; Susan Mackintosh, DO; Elizabeth McClain, PhD; Edward Magalhaes, PhD; Patience Mason, MEd; Terrence Miller, PhD; Malcolm Modrzakowski, PhD; David Mokler, PhD; Bruce Newton, PhD; Lorree Ratto, PhD; Sean Reeder, DO; Mireille Rizkalla, PhD; Raquel Malina Romanick, JD; Miko Rose, DO; Katherine Ruger, EdD; Amy Schlueter, MPA; Trish Sexton, DHEd, MS; Dana Shaffer, DO; Robert Sorrells, PhD; Vivian Stevens, PhD; Mary Ann Taylor, PhD; Clinton Whitson, MS; and Rynn Ziller, EdD. We are also thankful to Dorissa Bolinski, BA; and Pamela Walter, MFA, for editorial polishing of this article. Last, but not least, we give special thanks to all of the thousands of osteopathic medical students in the academic year of 2017-2018 who made history in medical education research by voluntarily and willingly completing and submitting the online survey of this project. 
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Table 1.
Age, Gender, and Race/Ethnicity Comparisons of the Study Samples With Respective Populationsa in National Samples From 41 Campuses of US Colleges of Osteopathic Medicine
First-Year
Matriculantsb
Year 1c Year 2c Year 3c Year 4c
Sample Population Sample Population Sample Population Sample Population Sample Population
(n=6009) (n=7197) (n=3616) (n=7197) (n=2764) (n=6778) (n=2413) (n=6683) (n=1958) (n=4894)
Age,d y
Mean (SD) 24.8 (3.4) 25.1 (3.1) 25.5 (3.2) 25.8 (3.1) 26.3 (3.2) 26.8 (3.2) 27.4 (3.4) 27.8 (3.2) 28.6 (3.5) 29.0 (3.4)
Range 19-51 19-51 20-50 20-52 20-56 20-59 23-55 23-55 24-53 18-62
Gender,e No. (%)
Men 3175 (53%) 3934 (55%) 1839 (51%) 3934 (55%) 1348 (49%) 3661 (54%) 1198 (50%) 3683 (55%) 966 (49%) 2566 (52%)
Women 2795 (47%) 3255 (45%) 1738 (48%) 3255 (45%) 1383 (50%) 3102 (46%) 1180 (49%) 2937 (44%) 970 (50%) 2087 (43%)
Race/Ethnicity, No. (%)
White/Caucasian 3618 (60%) 4049 (56%) 2283 (63%) 4049 (56%) 1805 (65%) 3952 (58%) 1609 (67%) 4117 (62%) 1325 (68%) 3180 (65%)
Black/African American 216 (4%) 266 (4%) 107 (3%) 266 (4%) 83 (3%) 217 (3%) 78 (3%) 244 (4%) 56 (3%) 120 (2%)
Hispanic/Latino/Spanish 337 (6%) 448 (6%) 207 (6%) 448 (6%) 114 (4%) 340 (5%) 100 (4%) 337 (5%) 64 (3%) 74 (2%)
Asian 1627 (27%) 1914 (27%) 842 (23%) 1914 (27%) 607 (22%) 1798 (27%) 470 (19%) 1681 (25%) 385 (20%) 406 (8%)
Otherf/no response 211 (3%) 520 (7%) 177 (5%) 520 (7%) 155 (6%) 471 (7%) 156 (6%) 304 (5%) 128 (6%) 1114 (23%)

a Population data were taken from AACOM prematriculation surveys for students in years 1-3 and from the AACOM exit survey in year 4.

b First-year matriculants who completed the study survey at the beginning of the 2017-2018 academic year.

c Students in the first, second, third, and fourth years who completed the study survey at the end of the 2017-2018 academic year.

d Students who did not specify their age information or who were outside the population age range were excluded (approximately 1%).

e Students who did not specify their gender or who reported other gender categories were excluded (5% or less).

f Students who specified their race/ethnicity as American Indian/Alaskan or Hawaiian/Pacific Islander were included in the "Other" category (approximately 1%).

Table 1.
Age, Gender, and Race/Ethnicity Comparisons of the Study Samples With Respective Populationsa in National Samples From 41 Campuses of US Colleges of Osteopathic Medicine
First-Year
Matriculantsb
Year 1c Year 2c Year 3c Year 4c
Sample Population Sample Population Sample Population Sample Population Sample Population
(n=6009) (n=7197) (n=3616) (n=7197) (n=2764) (n=6778) (n=2413) (n=6683) (n=1958) (n=4894)
Age,d y
Mean (SD) 24.8 (3.4) 25.1 (3.1) 25.5 (3.2) 25.8 (3.1) 26.3 (3.2) 26.8 (3.2) 27.4 (3.4) 27.8 (3.2) 28.6 (3.5) 29.0 (3.4)
Range 19-51 19-51 20-50 20-52 20-56 20-59 23-55 23-55 24-53 18-62
Gender,e No. (%)
Men 3175 (53%) 3934 (55%) 1839 (51%) 3934 (55%) 1348 (49%) 3661 (54%) 1198 (50%) 3683 (55%) 966 (49%) 2566 (52%)
Women 2795 (47%) 3255 (45%) 1738 (48%) 3255 (45%) 1383 (50%) 3102 (46%) 1180 (49%) 2937 (44%) 970 (50%) 2087 (43%)
Race/Ethnicity, No. (%)
White/Caucasian 3618 (60%) 4049 (56%) 2283 (63%) 4049 (56%) 1805 (65%) 3952 (58%) 1609 (67%) 4117 (62%) 1325 (68%) 3180 (65%)
Black/African American 216 (4%) 266 (4%) 107 (3%) 266 (4%) 83 (3%) 217 (3%) 78 (3%) 244 (4%) 56 (3%) 120 (2%)
Hispanic/Latino/Spanish 337 (6%) 448 (6%) 207 (6%) 448 (6%) 114 (4%) 340 (5%) 100 (4%) 337 (5%) 64 (3%) 74 (2%)
Asian 1627 (27%) 1914 (27%) 842 (23%) 1914 (27%) 607 (22%) 1798 (27%) 470 (19%) 1681 (25%) 385 (20%) 406 (8%)
Otherf/no response 211 (3%) 520 (7%) 177 (5%) 520 (7%) 155 (6%) 471 (7%) 156 (6%) 304 (5%) 128 (6%) 1114 (23%)

a Population data were taken from AACOM prematriculation surveys for students in years 1-3 and from the AACOM exit survey in year 4.

b First-year matriculants who completed the study survey at the beginning of the 2017-2018 academic year.

c Students in the first, second, third, and fourth years who completed the study survey at the end of the 2017-2018 academic year.

d Students who did not specify their age information or who were outside the population age range were excluded (approximately 1%).

e Students who did not specify their gender or who reported other gender categories were excluded (5% or less).

f Students who specified their race/ethnicity as American Indian/Alaskan or Hawaiian/Pacific Islander were included in the "Other" category (approximately 1%).

×
Table 2.
National Norms for the JSE S-Version: First-Year Matriculants in a National Sample From 41 Campuses of US Colleges of Osteopathic Medicine at the Beginning of Medical Schoola
JSE Men (n=3071) Women (n=2747) Combined (n=5818)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 19 19 <1 5 5 <1 24 24 <1
81-82 12 31 1 2 7 <1 14 38 1
83-84 7 38 1 1 8 <1 8 46 1
85-86 8 46 1 3 11 <1 11 57 1
87-88 8 54 2 5 16 <1 13 70 1
89-90 24 78 2 5 21 1 29 99 1
91-92 26 104 3 5 26 1 31 130 2
93-94 34 138 4 8 34 1 42 172 3
95-96 31 169 5 21 55 2 52 224 3
97-98 70 239 7 30 85 3 100 324 5
99-100 79 318 9 35 120 4 114 438 7
101-102 102 420 12 34 154 5 136 574 9
103-104 125 545 16 70 224 7 195 769 12
105-106 139 684 20 78 302 10 217 986 15
107-108 183 867 25 110 412 13 293 1279 19
109-110 199 1066 31 115 527 17 314 1593 25
111-112 211 1277 38 153 680 22 364 1957 31
113-114 218 1495 45 147 827 27 365 2322 37
115-116 221 1716 52 204 1031 34 425 2747 44
117-118 203 1919 59 207 1238 41 410 3157 51
119-120 208 2127 66 237 1475 49 445 3602 58
121-122 198 2325 72 211 1686 58 409 4011 65
123-124 175 2500 79 212 1898 65 387 4398 72
125-126 144 2644 84 203 2101 73 347 4745 79
127-128 119 2763 88 206 2307 80 325 5070 84
129-130 89 2852 91 161 2468 87 250 5320 89
131-132 92 2944 94 117 2585 92 209 5529 93
133-134 59 3003 97 82 2667 96 141 5670 96
135-136 37 3040 98 48 2715 98 85 5755 98
137-138 16 3056 99 28 2743 99 44 5799 99
139-140 15 3071 >99 4 2747 >99 19 5818 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (<1%) and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a good impression).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

Source: This table is reproduced from Hojat et al, 2018.

Table 2.
National Norms for the JSE S-Version: First-Year Matriculants in a National Sample From 41 Campuses of US Colleges of Osteopathic Medicine at the Beginning of Medical Schoola
JSE Men (n=3071) Women (n=2747) Combined (n=5818)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 19 19 <1 5 5 <1 24 24 <1
81-82 12 31 1 2 7 <1 14 38 1
83-84 7 38 1 1 8 <1 8 46 1
85-86 8 46 1 3 11 <1 11 57 1
87-88 8 54 2 5 16 <1 13 70 1
89-90 24 78 2 5 21 1 29 99 1
91-92 26 104 3 5 26 1 31 130 2
93-94 34 138 4 8 34 1 42 172 3
95-96 31 169 5 21 55 2 52 224 3
97-98 70 239 7 30 85 3 100 324 5
99-100 79 318 9 35 120 4 114 438 7
101-102 102 420 12 34 154 5 136 574 9
103-104 125 545 16 70 224 7 195 769 12
105-106 139 684 20 78 302 10 217 986 15
107-108 183 867 25 110 412 13 293 1279 19
109-110 199 1066 31 115 527 17 314 1593 25
111-112 211 1277 38 153 680 22 364 1957 31
113-114 218 1495 45 147 827 27 365 2322 37
115-116 221 1716 52 204 1031 34 425 2747 44
117-118 203 1919 59 207 1238 41 410 3157 51
119-120 208 2127 66 237 1475 49 445 3602 58
121-122 198 2325 72 211 1686 58 409 4011 65
123-124 175 2500 79 212 1898 65 387 4398 72
125-126 144 2644 84 203 2101 73 347 4745 79
127-128 119 2763 88 206 2307 80 325 5070 84
129-130 89 2852 91 161 2468 87 250 5320 89
131-132 92 2944 94 117 2585 92 209 5529 93
133-134 59 3003 97 82 2667 96 141 5670 96
135-136 37 3040 98 48 2715 98 85 5755 98
137-138 16 3056 99 28 2743 99 44 5799 99
139-140 15 3071 >99 4 2747 >99 19 5818 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (<1%) and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a good impression).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

Source: This table is reproduced from Hojat et al, 2018.

×
Table 3.
National Norms for the JSE S-Version: First- and Second-Year Osteopathic Medical Students (Preclinical Years) in National Samples From 41 Campuses of US Colleges of Osteopathic Medicinea
JSE Men (n=3042) Women (n=3073) Combined (n=6115)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 58 58 2 10 10 <1 68 68 1
81-82 19 77 2 2 12 <1 21 89 1
83-84 18 95 3 9 21 1 27 116 2
85-86 19 114 3 5 26 1 24 140 2
87-88 22 136 4 6 32 1 28 168 3
89-90 36 172 5 15 47 1 51 219 3
91-92 35 207 6 13 60 2 48 267 4
93-94 46 253 8 19 79 2 65 332 5
95-96 62 315 9 18 97 3 80 412 6
97-98 77 392 12 40 137 4 117 529 8
99-100 82 474 14 39 176 5 121 650 10
101-102 100 574 17 65 241 7 165 815 12
103-104 152 726 21 93 334 9 245 1060 15
105-106 163 889 27 99 433 12 262 1322 19
107-108 163 1052 32 126 559 16 289 1611 24
109-110 182 1234 38 138 697 20 320 1931 29
111-112 189 1423 44 173 870 25 362 2293 35
113-114 201 1624 50 185 1055 31 386 2679 41
115-116 195 1819 57 201 1256 38 396 3075 47
117-118 205 2024 63 219 1475 44 424 3499 54
119-120 181 2205 70 230 1705 52 411 3910 61
121-122 167 2372 75 257 1962 60 424 4334 67
123-124 152 2524 80 239 2201 68 391 4725 74
125-126 136 2660 85 204 2405 75 340 5065 80
127-128 103 2763 89 190 2595 81 293 5358 85
129-130 87 2850 92 175 2770 87 262 5620 90
131-132 81 2931 95 149 2919 93 230 5850 94
133-134 51 2982 97 82 3001 96 133 5983 97
135-136 28 3010 98 43 3044 98 71 6054 98
137-138 22 3032 99 19 3063 99 41 6095 99
139-140 10 3042 >99 10 3073 >99 20 6115 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (1%) and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a good impression).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

Table 3.
National Norms for the JSE S-Version: First- and Second-Year Osteopathic Medical Students (Preclinical Years) in National Samples From 41 Campuses of US Colleges of Osteopathic Medicinea
JSE Men (n=3042) Women (n=3073) Combined (n=6115)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 58 58 2 10 10 <1 68 68 1
81-82 19 77 2 2 12 <1 21 89 1
83-84 18 95 3 9 21 1 27 116 2
85-86 19 114 3 5 26 1 24 140 2
87-88 22 136 4 6 32 1 28 168 3
89-90 36 172 5 15 47 1 51 219 3
91-92 35 207 6 13 60 2 48 267 4
93-94 46 253 8 19 79 2 65 332 5
95-96 62 315 9 18 97 3 80 412 6
97-98 77 392 12 40 137 4 117 529 8
99-100 82 474 14 39 176 5 121 650 10
101-102 100 574 17 65 241 7 165 815 12
103-104 152 726 21 93 334 9 245 1060 15
105-106 163 889 27 99 433 12 262 1322 19
107-108 163 1052 32 126 559 16 289 1611 24
109-110 182 1234 38 138 697 20 320 1931 29
111-112 189 1423 44 173 870 25 362 2293 35
113-114 201 1624 50 185 1055 31 386 2679 41
115-116 195 1819 57 201 1256 38 396 3075 47
117-118 205 2024 63 219 1475 44 424 3499 54
119-120 181 2205 70 230 1705 52 411 3910 61
121-122 167 2372 75 257 1962 60 424 4334 67
123-124 152 2524 80 239 2201 68 391 4725 74
125-126 136 2660 85 204 2405 75 340 5065 80
127-128 103 2763 89 190 2595 81 293 5358 85
129-130 87 2850 92 175 2770 87 262 5620 90
131-132 81 2931 95 149 2919 93 230 5850 94
133-134 51 2982 97 82 3001 96 133 5983 97
135-136 28 3010 98 43 3044 98 71 6054 98
137-138 22 3032 99 19 3063 99 41 6095 99
139-140 10 3042 >99 10 3073 >99 20 6115 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (1%) and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a good impression).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

×
Table 4.
National Norms for the JSE-S Version: Third- and Fourth-Year Osteopathic Medical Students (Clinical Years) in National Samples From 41 Campuses of US Colleges of Osteopathic Medicinea
JSE Men (n=2099) Women (n=2117) Combined (n=4216)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 64 64 3 14 14 1 78 78 2
81-82 15 79 3 5 19 1 20 98 2
83-84 13 92 4 7 26 1 20 118 3
85-86 21 113 5 4 30 1 25 143 3
87-88 19 132 6 5 35 2 24 167 4
89-90 27 159 7 9 44 2 36 203 4
91-92 39 198 9 13 57 2 52 255 5
93-94 28 226 10 13 70 3 41 296 7
95-96 39 265 12 21 91 4 60 356 8
97-98 51 316 14 36 127 5 87 443 9
99-100 74 390 17 37 164 7 111 554 12
101-102 90 480 21 56 220 9 146 700 15
103-104 77 557 25 62 282 12 139 839 18
105-106 118 675 29 67 349 15 185 1024 22
107-108 124 799 35 117 466 19 241 1265 27
109-110 137 936 41 97 563 24 234 1499 33
111-112 126 1062 48 130 693 30 256 1755 39
113-114 108 1170 53 156 849 36 264 2019 45
115-116 145 1315 59 166 1015 44 311 2330 52
117-118 134 1449 66 162 1177 52 296 2626 59
119-120 141 1590 72 147 1324 59 288 2914 66
121-122 120 1710 79 154 1478 66 274 3188 72
123-124 96 1806 84 130 1608 73 226 3414 78
125-126 78 1884 88 136 1744 79 214 3628 84
127-128 65 1949 91 126 1870 85 191 3819 88
129-130 53 2002 94 97 1967 91 150 3969 92
131-132 39 2041 96 60 2027 94 99 4068 95
133-134 31 2072 98 47 2074 97 78 4146 97
135-136 4 2076 99 30 2104 99 34 4180 99
137-138 14 2090 99 9 2113 >99 23 4203 99
139-140 9 2099 >99 4 2117 >99 13 4216 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (<1%), and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a “good impression”).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

Table 4.
National Norms for the JSE-S Version: Third- and Fourth-Year Osteopathic Medical Students (Clinical Years) in National Samples From 41 Campuses of US Colleges of Osteopathic Medicinea
JSE Men (n=2099) Women (n=2117) Combined (n=4216)
Raw Score f cf Percentile Rank f cf Percentile Rank f cf Percentile Rank
≤ 80 64 64 3 14 14 1 78 78 2
81-82 15 79 3 5 19 1 20 98 2
83-84 13 92 4 7 26 1 20 118 3
85-86 21 113 5 4 30 1 25 143 3
87-88 19 132 6 5 35 2 24 167 4
89-90 27 159 7 9 44 2 36 203 4
91-92 39 198 9 13 57 2 52 255 5
93-94 28 226 10 13 70 3 41 296 7
95-96 39 265 12 21 91 4 60 356 8
97-98 51 316 14 36 127 5 87 443 9
99-100 74 390 17 37 164 7 111 554 12
101-102 90 480 21 56 220 9 146 700 15
103-104 77 557 25 62 282 12 139 839 18
105-106 118 675 29 67 349 15 185 1024 22
107-108 124 799 35 117 466 19 241 1265 27
109-110 137 936 41 97 563 24 234 1499 33
111-112 126 1062 48 130 693 30 256 1755 39
113-114 108 1170 53 156 849 36 264 2019 45
115-116 145 1315 59 166 1015 44 311 2330 52
117-118 134 1449 66 162 1177 52 296 2626 59
119-120 141 1590 72 147 1324 59 288 2914 66
121-122 120 1710 79 154 1478 66 274 3188 72
123-124 96 1806 84 130 1608 73 226 3414 78
125-126 78 1884 88 136 1744 79 214 3628 84
127-128 65 1949 91 126 1870 85 191 3819 88
129-130 53 2002 94 97 1967 91 150 3969 92
131-132 39 2041 96 60 2027 94 99 4068 95
133-134 31 2072 98 47 2074 97 78 4146 97
135-136 4 2076 99 30 2104 99 34 4180 99
137-138 14 2090 99 9 2113 >99 23 4203 99
139-140 9 2099 >99 4 2117 >99 13 4216 >99

a Excluded were respondents who did not specify their gender as “male” or “female” (<1%), and those who scored >3 on the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire (for identifying respondents who attempted to make a “good impression”).

Abbreviations: cf, cumulative frequency; f, frequency; JSE S-Version, Jefferson Scale of Empathy medical student version.

×