Context: Medical educators agree that empathy is essential for physicians' professionalism. The Health Professional Version of the Jefferson Scale of Empathy (JSE-HP) was developed in response to a need for a psychometrically sound instrument to measure empathy in the context of patient care. Although extensive support for its validity and reliability is available, the authors recognize the necessity to examine psychometrics of the JSE-HP in different socio-cultural contexts to assure the psychometric soundness of this instrument. The first aim of this study was to confirm its psychometric properties in the cross-cultural context of Spain and Latin American countries. The second aim was to measure the influence of social and cultural factors on the development of medical empathy in health practitioners.Methods: The original English version of the JSE-HP was translated into International Spanish using back-translation procedures. The Spanish version of the JSE-HP was administered to 896 physicians from Spain and 13 Latin American countries. Data were subjected to exploratory factor analysis using principal component analysis (PCA) with oblique rotation (promax) to allow for correlation among the resulting factors, followed by a second analysis, using confirmatory factor analysis (CFA). Two theoretical models, one based on the English JSE-HP and another on the first Spanish student version of the JSE (JSE-S), were tested. Demographic variables were compared using group comparisons.Results: A total of 715 (80%) surveys were returned fully completed. Cronbach's alpha coefficient of the JSE for the entire sample was 0.84. The psychometric properties of the Spanish JSE-HP matched those of the original English JSE-HP. However, the Spanish JSE-S model proved more appropriate than the original English model for the sample in this study. Group comparisons among physicians classified by gender, medical specialties, cultural and cross-cultural backgrounds yielded statistically significant differences (p < 0.001).Conclusions: The findings support the underlying factor structure of the Jefferson Scale of Empathy (JSE). The results reveal the importance of culture in the development of medical empathy. The cross-cultural differences described could open gates for further lines of medical education research.

Some factors involved in the development of empathy that are sensitive to cultural influence have been characterised. The development of future research areas is suggested.

These results confirm previous preliminary data and underline the positive influence of empathy in the development of inter-professional collaboration abilities. In Latin-American physicians who start posgraduate training programs, lifelong learning abilities have a positive influence on the development of other professional competencies.

The aim of this study was to determine the relationship between a clinical environment and the development of empathy, teamwork, and lifelong learning in medical students who are doing their first clinical rotation. The Jefferson Scales of Empathy (JSE), Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC), and Jefferson Scale of Physician Lifelong Learning (JeffSPLLL) were administered to 60 sixth-year medical students, before and after their first clinical rotation in five health care institutions. The Dundee Ready Education Environment Measure questionnaire (DREEM) was administered to measure their perception of the educational environment after the rotation was finished. Scores were compared to determine differences before and after the rotation. Other variables associated with gender, age, and moral perception, were included into the comparisons. A correlation analysis was also performed. The analyses confirmed a positive association among the measured elements of medical professionalism. Lifelong learning decreased (p = 0.03) after the rotation. Associations were found between the educational environment and the development of lifelong learning (P = +0.29; p = 0.03); and between the International Journal of Ethics Education (2016) Area of Health, Nutrition and Bioethics, Iberoamerican University Foundation (FUNIBER), Barcelona, Spain development of attitudes toward teamwork and the educational environment (P = + 0.29; p = 0.03). During the rotational internship, the development of some components of professionalism in medical students is influenced by the clinical environment. Gender, age, and moral perception influence the development of some elements of medical professionalism and the perception of the educational environment.

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