Empathy is a fundamental component of effective clinical practice, encompassing the ability to understand a patient’s experiences, feelings, and perspectives, and to communicate this understanding effectively for better patient care outcomes [1]. In medical education, empathy contributes to the development of professionalism, patient-centered communication, and improved therapeutic relationships [2]. Empathetic physicians tend to have higher patient satisfaction scores, better adherence to treatment, and improved clinical outcomes[3]. However, several studies have reported a decline in empathy levels as students’ progress through medical training, possibly due to academic stress, workload, and emotional detachment mechanisms [4]. The second year of medical education, often corresponding to the preclinical or early clinical transition phase, represents a crucial stage for fostering and assessing empathy [5]. The Jefferson Scale of Empathy (JSE), developed specifically for health professions students, is a widely validated instrument designed to measure empathy in medical and healthcare education contexts [6]. It assesses three core domains: perspective taking, compassionate care, and the ability to “walk in the patient’s shoes” [7]. Evaluating empathy among second-year medical students provides insight into their emotional and professional readiness for clinical exposure. Such assessment helps identify the need for curricular interventions that enhance empathy and emotional intelligence early in medical training [8]. Hence, the present study aims to assess clinical empathy among second-year medical students using the Jefferson Scale of Empathy (JSE), and to analyze the distribution of empathy scores among the study participants.

A cross-sectional descriptive study was conducted among second-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students at Fathima institute of medical sciences, during the academic year 2024–2025. A total of 95 second-year medical students participated in the study. Participation was voluntary, and students who provided informed consent were included. Questionnaire was distributed among the students as Google form. Empathy was assessed using the Jefferson Scale of Empathy – Student Version (JSE-S), a validated self-administered questionnaire comprising 20 items rated on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). The scale evaluates three domains: perspective taking (10 items), compassionate care (8 items), and standing in the patient’s shoes (2 items) [6]. The JSE-S questionnaire was distributed to all eligible participants during a scheduled academic session. Students were informed about the study objectives, confidentiality, and anonymity of responses. Responses were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics (mean, standard deviation, and range) were used to summarize empathy scores. Differences in empathy scores by gender or other variables were analyzed using appropriate inferential tests such as the independent t-test or ANOVA. A p-value <0.05 was considered statistically significant. Participation was voluntary, and informed written consent was obtained from all participants. Data confidentiality was maintained throughout the study.

A total of 95 second-year MBBS students participated in the study. Among them, 52 (54.7%) were females and 43 (45.3%) were males. The mean age of participants was 19.8 ± 0.7 years (range: 18–21 years). The mean total empathy score using the Jefferson Scale of Empathy – Student Version (JSE-S) was 108.6 ± 12.4 (range: 82–134). Female students obtained a higher mean score (111.3 ± 11.8) compared to males (105.4 ± 12.7), and this difference was statistically significant (p = 0.03) (Table 1). Table 1. Mean Jefferson Scale of Empathy Scores by Gender (n = 95) S.No Variable n Mean ± SD (JSE-S Score) p-value 1 Male 43 105.4 ± 12.7 — 2 Female 52 111.3 ± 11.8 0.03 3 Total 95 108.6 ± 12.4 — Empathy Domain Scores The mean scores for the three domains of the JSE-S were 60.5 ± 7.4 for Perspective Taking, 40.2 ± 6.1 for Compassionate Care, and 7.9 ± 1.8 for Standing in the Patient’s Shoes. Female participants consistently scored higher than males across all domains, although a statistically significant difference was observed only in the Compassionate Care domain (p = 0.04). These results indicate that most students demonstrated a strong cognitive understanding of patients’ perspectives along with moderate affective concern. When empathy scores were categorized, 21 students (22.1%) exhibited low empathy (<95), 54 (56.8%) had moderate empathy (95–115), and 20 (21.1%) displayed high empathy (>115). Thus, a majority of participants fell within the moderate empathy range. Correlation with Demographic Variables Pearson’s correlation analysis revealed a mild positive correlation between empathy scores and academic performance (r = 0.24, p = 0.02), indicating that higher-performing students tended to exhibit greater empathy. No significant correlation was found between empathy and age (p = 0.42) or residential background (p = 0.18). The details are presented in Table 2. Table 2. Correlation between Empathy Scores and Demographic Variables (n = 95) S.No Variable Correlation Coefficient (r) p-value Interpretation 1 Age 0.08 0.42 No significant correlation 2 Academic performance (marks %) 0.24 0.02 * Mild positive correlation (statistically significant) 3 Residential background (Urban = 1, Rural = 0) 0.10 0.18 No significant correlation * p < 0.05 considered statistically significant. Correlation among Empathy Domains Inter-domain analysis demonstrated a strong positive correlation between Perspective Taking and Compassionate Care (r = 0.68, p < 0.001), and moderate positive correlations between other domain pairs. These findings confirm the internal consistency of the JSE-S scale and the interrelated nature of empathy dimensions (Table 3). Table 3. Correlation between Empathy Domains of the Jefferson Scale (n = 95) S.No Empathy Domain Pair Pearson’s P-value Interpretation 1 Perspective Taking Vs Compassionate Care 0.68 < 0.001 Strong positive correlation 2 Perspective Taking Vs Standing in Patient’s Shoes 0.55 < 0.001 Moderate positive correlation 3 Compassionate Care Vs Standing in Patient’s Shoes 0.59 < 0.001 Moderate positive correlation In the present study, female students demonstrated significantly higher empathy, while empathy correlated positively with academic performance but not with age or residential background. Inter-domain correlations affirmed that cognitive and affective aspects of empathy are closely linked within the student population.

The present study assessed the level of clinical empathy among second-year medical students using the Jefferson Scale of Empathy (JSE-S). The mean empathy score obtained in this study (108.6 ± 12.4) indicates a moderate level of empathy, which aligns with findings from similar studies conducted in India and abroad [9,10]. The observed gender difference, with female students scoring higher than males, is consistent with previous literature suggesting that females tend to demonstrate greater empathic concern and emotional responsiveness in patient-related situations [11,12]. The positive correlation between academic performance and empathy suggests that students who are more engaged academically may also possess greater interpersonal understanding and emotional awareness. This finding reinforces the notion that empathy is not only an affective quality but also a cognitive skill that can be nurtured through reflective learning and communication-based training [13]. Interestingly, no significant correlation was found between empathy and age or residential background, similar to findings by Chen et al. [5], implying that demographic factors may have limited influence on empathy among students at this academic stage. The strong positive correlations observed between the three domains of the JSE perspective taking, compassionate care, and standing in the patient’s shoes demonstrate the internal consistency of the scale and reaffirm empathy as a multidimensional construct encompassing both cognitive and affective components [6,7]. Several longitudinal studies have documented a gradual decline in empathy as students advance through medical school, particularly during clinical years [4,7]. This highlights the need to incorporate structured empathy training early in the medical curriculum, including modules on communication skills, patient narratives, and reflective practice. Educational interventions such as role-playing, standardized patient interactions, and small-group discussions have been shown to help sustain empathy levels among medical trainees [14,15]. The findings from this study underscore the importance of recognizing empathy as a teachable and measurable professional attribute. Integrating empathy-oriented activities within preclinical teaching can help bridge the gap between technical proficiency and patient-centered care.

Empathy is an essential attribute for medical students that directly influences the quality of patient care and communication. This study revealed a moderate level of empathy among second-year medical students, with significantly higher scores among females. Strong inter-domain correlations confirmed the internal reliability of the JSE-S instrument. The study emphasizes the need for curricular strategies that nurture empathy during early medical training to promote compassionate, patient-centered physicians in the future.

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