Medical Science Educator

, Volume 29, Issue 1, pp 277–284 | Cite as

Anecdote or Reality: Are People From the South and/or Rural Areas of the USA More Empathetic?

  • Vanessa P. Nguyen
  • Bruce W. NewtonEmail author
Original Research


Although numerous studies have analyzed empathy scores of allopathic and osteopathic medical students and how these scores fluctuate throughout undergraduate medical education, little is known about whether demographics have an impact on medical students’ empathy scores. Using the Balanced Emotional Empathy Scale (BEES) and Jefferson Scale of Empathy (JSE) surveys to measure affective and cognitive empathy, respectively, this present study examined the relationship between empathy scores with the following demographic data from first and second year students at a southeastern US osteopathic medical school: the classification of whether students came from a rural or urban background, the region of the US students lived in prior to matriculation to medical school, and the town/city size of where they were currently living at the time of applying to medical school. Data analyses showed only one statistically significant data point (p < 0.04) that revealed first year osteopathic medical students (OMS-I) from towns with < 10,000 occupants had higher JSE scores in comparison to students coming from towns with 50,000–99,999 occupants. However, trends could be established. For example, anecdotally, it is often presumed people from the southern United States tend to be friendlier than those from the northern states; however, contrary to this, the data revealed OMS-I students from the southern United States had a slightly lower BEES scores than OMS-I students from the northeastern states. JSE scores were nearly identical across all four US census bureau regions. Additionally, OMS-I students coming from an urban background had a higher BEES scores than those coming from a rural background. Compared to population norms, combined male and female BEES scores for OMS-I and -II students were within ± 0.5 s.d. of the norm and are considered to be “average” scores. Combined OMS-I JSE scores were below the population norm at the 37th percentile, and combined OMS-II JSE scores were also at the 37th percentile, except for students from the western region at the 44th percentile.


Affective empathy Cognitive empathy BEES JSE Undergraduate medical education Demographics Regional differences 



The authors thank the medical students who voluntarily filled out the survey forms. The data analyses were performed during the 2017 CUSOM Medical Student Summer Research Program supported by CUSOM funds. These data were presented in abstract form at the June, 2018 International Association of Medical Science Educators (IAMSE) meeting in Henderson, NV, USA.

Author Contributions

BWN collected the data and edited the drafts. VPN analyzed the data, performed literature searches and wrote the initial drafts.

Funding Information

Funds for data analyses was provided to Ms. Vanessa P. Nguyen by the CUSOM Medical Student Summer Research Program.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in this study.

This study was approved by Campbell University IRB Committee (No. 30, 7-1-2013).


  1. 1.
    Newton BW. Walking a fine line: is it possible to remain an empathic physician and have a hardened heart? Front Hum Neurosci. 2013;7:233.CrossRefGoogle Scholar
  2. 2.
    Hojat M. Empathy in health professions education and patient care. New York: Springer; 2016.CrossRefGoogle Scholar
  3. 3.
    Casas RS, Xuan Z, Jackson AH, Stanfield LE, Harvey NC, Chen DC. Associations of medical student empathy with clinical competence. Patient Educ Couns. 2017;100:742–7.CrossRefGoogle Scholar
  4. 4.
    Mehrabian A, Young AL, Sato S. Emotional empathy and associated individual differences. Curr Psychol Res Rev. 1988;8:221–40.CrossRefGoogle Scholar
  5. 5.
    Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159:1563–9.CrossRefGoogle Scholar
  6. 6.
    Park KH, Roh H, Suh DH, Hojat M. Empathy in Korean medical students: findings from a nationwide survey. Med Teach. 2015;37(10):943–8.CrossRefGoogle Scholar
  7. 7.
    Kataoka HU, Koide N, Ochi K, Hojat M, Gonnella JS. Measurement of empathy among Japanese medical students: psychometrics and score differences by gender and level of medical education. Acad Med. 2009;84(9):1192–7.CrossRefGoogle Scholar
  8. 8.
    Shariat SV, Habibi M. Empathy in Iranian medical students: measurement model of the Jefferson scale of empathy. Med Teach. 2013;35(1):e913–8.CrossRefGoogle Scholar
  9. 9.
    Hasan S, Al-Sharqawi N, Dashti F, Abdul-Aziz M, Abdullah A, Shukkur M, et al. Level of empathy among medical students in Kuwait University, Kuwait. Med Princ Pract. 2013;22(4):385–9.CrossRefGoogle Scholar
  10. 10.
    Tariq N, Rasheed T, Tavakol M. A quantitative study of empathy in Pakistani medical students: a multicentered approach. J Prim Care Community Health. 2017;8(4):294–9.CrossRefGoogle Scholar
  11. 11.
    Chatterjee A, Ravikumar R, Singh S, Chauhan PS, Goel M. Clinical empathy in medical students in India measured using the Jefferson scale of empathy-student version. J Educ Eval Health Prof. 2017;14:33.CrossRefGoogle Scholar
  12. 12.
    Wen D, Ma X, Li H, Liu Z, Xian B, Liu Y. Empathy in Chinese medical students: psychometric characteristics and differences by gender and year of medical education. BMC Med Educ. 2013;13(1):130.CrossRefGoogle Scholar
  13. 13.
    Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med. 2007;22(10):1434–8.CrossRefGoogle Scholar
  14. 14.
    Paro HBMS, Daud-Gallotti RM, Tibério IC, Pinto RMC, Martins MA. Brazilian version of the Jefferson scale of empathy: psychometric properties and factor analysis. BMC Med Educ. 2012;12(1):73.CrossRefGoogle Scholar
  15. 15.
    Calabrese LH, Bianco JA, Mann D, Massello D, Hojat M. Correlates and changes in empathy and attitudes towards interprofessional collaboration in osteopathic medical students. J Am Osteopath Assoc. 2013;113:898–907.CrossRefGoogle Scholar
  16. 16.
    Hojat M, Gonella JS. Eleven years of data on the Jefferson scale of empathy—medical student version (JSE-S): proxy norm data and tentative cut off scores. Med Princ Pract. 2015;24:344–50.CrossRefGoogle Scholar
  17. 17.
    Chopik WJ, O’Brien E, Konrath SH. Differences in empathic concern and perspective taking across 63 countries. J Cross-Cultl Psychol. 2017;48(1):23–38.CrossRefGoogle Scholar
  18. 18.
    Plaut VC, Markus HR, Lachman ME. Place matters: consensual features and regional variation in American well-being and self. J Pers Soc Psychol. 2002;83:160–84.CrossRefGoogle Scholar
  19. 19.
    Rentfrow PJ, Gosling SD, Potter J. A theory of the emergence, persistence, and expression of geographic variation in psychological characteristics. Perspect Psychol Sci. 2008;3:339–69.CrossRefGoogle Scholar
  20. 20.
    Park N, Peterson C. Does it matter where we live? The urban psychology of character strengths. Am Psychol. 2010;65(6):535–47.CrossRefGoogle Scholar
  21. 21.
    Bach RA, Defever AM, Chopik WJ, Konrath SH. Geographic variation in empathy: a state-level analysis. J Res Pers. 2017;68:124–30.CrossRefGoogle Scholar
  22. 22.
    Rentfrow PJ. Statewide differences in personality. Toward a psychological geography of the United States. Am Psychol. 2010;65(6):548–58.CrossRefGoogle Scholar
  23. 23.
    Eisenberg N. Empathy-related responding and prosocial behavior. Novartis Found Symp. 2007;278:71–80.Google Scholar
  24. 24.
    Mehrabian A. Manual for the Balanced Emotional Empathy Scale (BEES). 2000 (No longer available from Dr. Albert Mehrabian, Emeritus Professor, UCLA.)Google Scholar
  25. 25.
    Hojat M, DeSantis J, Shannon SC, Mortensen LH, Speicher MR, Bragan L, et al. The Jefferson scale of empathy: a nationwide study of measurement properties, underlying components, latent variable structure, and national norms in medical students. Adv Health Sci Educ Theory Pract. 2018, July 2;23:899–920. Scholar
  26. 26.
    “Geography Atlas - Regions.” United States Census Bureau, Accessed 12 Dec 2018.
  27. 27.
    Definitions of rural vs. urban areas. Accessed 12 Dec 2018.
  28. 28.
    Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83(3):244–9.CrossRefGoogle Scholar
  29. 29.
    Newton BW, Vaskalis ZT. A longitudinal study of affective and cognitive empathy of an osteopathic class of 2017. Med Sci Educator. 2017a;27(suppl. 1):S29.Google Scholar
  30. 30.
    Newton BW, Vaskalis ZT. A cross-sectional study of affective and cognitive empathy of the osteopathic classes of 2017-2020. Med Sci Educator. 2017b;27(suppl. 1):S22.Google Scholar
  31. 31.
    Newton BW. Insights on the nationwide project in osteopathic medical education and empathy (POMEE). J Am Osteopath Assoc. 2018;118(6):e28–32.CrossRefGoogle Scholar

Copyright information

© International Association of Medical Science Educators 2019

Authors and Affiliations

  1. 1.Department of AnatomyCampbell University School of Osteopathic MedicineLillingtonUSA

Personalised recommendations