Page 1 of 6
British Journal of Healthcare and Medical Research - Vol. 12, No. 02
Publication Date: April 25, 2025
DOI:10.14738/bjhmr.1202.18492.
Zia, A., Wajid, G., Zia, A., Zia-ul-Miraj, M., Waqar, A., & Mahmood, H. (2025). Empathy in Paediatric Postgraduate Trainees: The
Gender Effect. British Journal of Healthcare and Medical Research, Vol - 12(02). 134-139.
Services for Science and Education – United Kingdom
Empathy in Paediatric Postgraduate Trainees: The Gender Effect
Alina Zia
Department of Medical Education, Al-Aleem Medical College,
Ferozepur Road, Lahore, Pakistan
Gohar Wajid
Health Professions Education, World Health Organization,
EMRO, HSD/HWD, Abdul Razzak Al Sanhouri Street, P.O.
Box 7608, Nasr City, Cairo 11371, Egypt
Aiza Zia
Lahore Medical and Dental College, Canal Road, Harpanspura,
Lahore, Pakistan
Mohammad Zia-ul-Miraj
Department of Medical Education, Al-Aleem Medical College,
Ferozepur Road, Lahore, Pakistan
Ammara Waqar
Quality Enhancement Cell, Al-Aleem Medical College,
Ferozepur Road, Lahore, Pakistan
Hamid Mahmood
Shaheed Zulfiqar Ali Bhutto Medical University, Ravi Road,
G8/3, Islamabad, Pakistan
ABSTRACT
Empathy is a key element of patient-physician relationship. Higher empathy levels
are associated with better clinical outcome. Gender differences have been observed
in prior international studies. The purpose of this study was to explore the empathy
levels among the male and female postgraduate trainee residents in Paediatrics in
Pakistan. This study involved 129 postgraduate trainee residents in Paediatrics.
The participants anonymously completed the Jefferson Scale of Empathy (HP- Version). The data were analysed by SPSS 20. Comparison of empathy score
between males and females was carried out by the independent sample t-test. The
mean empathy score was 102.75. Females had significantly higher empathy levels
than males (105.22 vs. 99.43). The gender difference was statistically significant
(p=0.028). The male residents were significantly less empathic than males.
Targeted educational activities are recommended to sustain and enhance empathy
during postgraduate training.
Keywords: Empathy, Postgraduate Trainees, Paediatrics, Jefferson Scale of Empathy.
Page 2 of 6
135
Zia, A., Wajid, G., Zia, A., Zia-ul-Miraj, M., Waqar, A., & Mahmood, H. (2025). Empathy in Paediatric Postgraduate Trainees: The Gender Effect.
British Journal of Healthcare and Medical Research, Vol - 12(02). 134-139.
URL: http://dx.doi.org/10.14738/bjhmr.1202.18492.
INTRODUCTION
Empathy is the ability to understand other people’s experiences, emotions, and feelings, and an
ability to communicate this understanding to others [1]. It involves both verbal and non-verbal
communication [2]. Empathy is of central importance in patient care. There is a significant link
between physician empathy and optimal clinical outcomes [3,4].
Different aspects of empathy have been explored in several studies. Gender differences in
empathy have also been observed. Females have shown higher empathy scores than males in
several studies [5-9] while a few studies have shown higher scores in males [10] or no gender
difference at all [11,12]. The majority of these studies have been carried out in North America
and Europe. So far, no study has had an explicit focus on examining the empathy levels in
postgraduate trainees in Asian context.
The present study explores the empathy levels in the postgraduate trainees in Paediatrics to
answer the following question:
“Do female Paediatric postgraduate trainee residents have different levels of
empathy than males?”
The following hypothesis was tested:
“Female Paediatric postgraduate trainee residents will have higher empathy scores
than males.”
METERIAL AND METHODS
The study was carried out at The Children’s Hospital and The Institute of Child Health, Lahore.
The study was approved by the Institutional Review Board of the Children’s Hospital and The
Institute of Child Health, Lahore. The study was carried out in accordance with the Declaration
of Helsinki. No harm to the participants was anticipated. The trainees were assured that their
responses would remain confidential.
The study was descriptive analytic one. This was a cross-sectional survey, with data collected
at single point in time. The study population was the Postgraduate trainee doctors in
Paediatrics and various Paediatric sub-specialties at the Children’s Hospital & Institute of Child
Health, Lahore. All 129 postgraduate trainees in Paediatrics at the Children’s Hospital &
Institute of Child Health were included.
The Jefferson Scale of Empathy (JSE), (HP – Version), was the instrument used in the study.
It contains 20 items. Each item is answered on a seven-point Likert-type scale. The responses
from the participants to the scale were coded and entered into IBM SPSS 20.
Gender was the independent variable and the empathy score was the dependent variable.
Descriptive analyses were carried out. For numerical data, mean and standard deviation were
used. For categorical data, percentage and frequencies were used. Comparison of empathy
score between males and females was carried out by the independent sample t-test. A p-value
of <0.05 was considered to indicate statistical significance.
Page 3 of 6
136
British Journal of Healthcare and Medical Research (BJHMR) Vol 12, Issue 02, April-2025
Services for Science and Education – United Kingdom
RESULTS
All the postgraduate trainees completed and returned the questionnaire i.e. JSE (overall
response rate = 100%). All of them replied all the items in the scale (item response rate = 100%)
A total of 129 postgraduate trainee residents in Paediatrics and sub-specialties participated in
the study. Table 1 provides the distribution of basic demographic characteristics of the
participants. Out of these, 74 (57.4%) were females and 55 (42.6%) were males.
Table 1: Socio-demographic characteristics of the participants
Gender Frequency Percent Valid Percent
Male
Female
55
74
42.6
57.4
42.6
57.4
The overall mean empathy score was 102.75 ± 14.80.
Group Comparison by Gender
The means and standard deviations by gender are shown in Table 2. As reported in the table,
overall, the female trainees outscored the males. The mean empathy score for female trainees
was 105.21 (SD= 14.81) and that for male trainees was 99.44 (SD=14.25). This difference was
statistically significant (p=0.028). When looked for different academic years, this gender
difference was found in all grades except for third-year residents (Figure 1).
Table 2: Group differences in empathy score by gender
Gender of resident N Mean Std. Deviation Std. Error Mean
Male
Female
55
74
99.44
105.21
14.25
14.81
1.92
1.72
(P-value: 0.028)
Figure 1. Distribution of mean empathy scores of postgraduate trainee residents in each year
by gender.
Page 4 of 6
137
Zia, A., Wajid, G., Zia, A., Zia-ul-Miraj, M., Waqar, A., & Mahmood, H. (2025). Empathy in Paediatric Postgraduate Trainees: The Gender Effect.
British Journal of Healthcare and Medical Research, Vol - 12(02). 134-139.
URL: http://dx.doi.org/10.14738/bjhmr.1202.18492.
DISCUSSION
The findings of the current study indicate that female postgraduate trainees outscored the
males (Table 2). The difference was statistically significant (p=0.028). Hence, the hypothesis is
confirmed. These findings are in concurrence with the majority of international studies. Studies
from America have shown significant gender difference in favor of females [1,5,13]. Similarly,
studies from Japan [14], Portugal [7], Romania [6], Korea [15] and China [16] have shown
higher empathy levels in female residents and physicians. Though a few studies failed to show
any gender difference [12,17], in general it appears that the female residents express more
empathy.
These higher scores in the female residents and physicians can be attributed to several factors
including both intrinsic and extrinsic ones [18]. The intrinsic factors include evolutionary- biological gender characteristics, while the extrinsic factors include socialization, interpersonal
care and gender role expectation [1,14,19,20]. According to the evolutionary theory of parental
investment, females are expected to develop a stronger sense of caring for offspring than males
[21]. They are also supposed to be more skillful in understanding the needs and emotions of
their offspring. A possible parallel can be drawn between the skills of communication and
understanding, as applied to offspring, and empathy, as applied to patients [7,22]. Females have
advantage in the decoding of non-verbal emotional cues in both visual and auditory modalities
[23,24]. They are quick and more accurate in recognizing facial expressions [24]. Studies have
suggested gender differences in empathy and emotional attunement beginning early in
ontogenic development. Female infants are more responsive to their mother’s voice and initiate
more maternal social interactions [24]. Females are more prosocial from the early childhood
through adolescence. Studies involving preschool and adolescent children indicated that
females outperform males on the tests of theory-of-mind (ToM) [24]. Current neuroscience
studies have investigated the relevant brain networks. The network of the human mirror- neuron system has been found to be strongly linked to empathy competence [25]. Certain
gender differences have been noticed in neuroimaging and neurophysiology. Females display
larger gray matter volumes than males in the pars opercularis and inferior parietal lobules of
the right hemisphere [26]. Gender differences have also been found in mirror neuron system
on the neurobiological level using the functional magnetic resonance imaging (fMRI) studies.
Two areas superficially associated with mirroring include posterior inferior frontal and
anterior inferior parietal cortex. The mirror neurons have a peculiar feature of firing when a
specific action is observed or executed. Females have also been found to recruit more mirror- neurons than males during empathic interactions [25,26]. Event-related potentials (ERP)
studies have also demonstrated gender differences during emotion processing. Females were
found more sensitive and processed emotions more automatically than males [24].
Extrinsic factors such as role expectation, socialization and interpersonal relationships may
also effect the empathic behavior. There is a gender difference between role expectations.
Females express better emotional receptivity, social sensitivity, and caring attitude [7,8,15].
Females exhibit more caring prosocial moral judgment and reasoning. In contrast, males appear
to show more utilitarian behavior. Males have more deliberate control over their production of
expressions [24]. Studies of economic games and the analytic data of charitable behavior
indicates high altruism in females [24]. In addition, women are more likely to develop and value
interpersonal relationships. On the contrary, males generally exhibit an attitude of dominance,
authority, control and independence [12,13]. In a meta-analytic review, it was found that
Page 5 of 6
138
British Journal of Healthcare and Medical Research (BJHMR) Vol 12, Issue 02, April-2025
Services for Science and Education – United Kingdom
compared to males, the female physicians engaged in more patient-centered communication
including psychosocial support, counseling, positive talk and patient enlistment. Furthermore,
female physicians spent more time with their patients than their male colleagues [27].
CONCLUSION
In the present study, the male residents expressed significantly low empathy levels compared
to the female residents. The findings of significant gender-based differences in empathy scores
in doctors may have potential implications. These findings may provide a reference for the
policy making for postgraduate training. There should be increased awareness in the
curriculum planners about the potential gender difference in empathy. This may help to plan
remedial educational interventions especially directed to those who are potentially expected to
have low empathy scores.
Conflict of interest: The authors declare no conflict of interest.
References
[1] 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; 13: 1563-1569
[2] Neumann M, Sceffer C, Tauschel D, lutz G, Wirtz M, Edelhauser F. Physician empathy: definition, outcome
relevance and its measurement in patient care and medical education. GMS Zeitschrift fur Medizinische
Ausbidung, 2012; 29: 1-10
[3] Jani BD, Blane DN, Mercer SW. The role of empathy and the physician-patient relationship. Forsch
Komplementmed, 2012; 19: 252-257
[4] Hojat M, DeSantis J, Shannon SC, Speicher MR, Dragon L, Calabrese LH. Empathy as related to gender, age,
race and ethnicity, academic background and career interest: A nationwide study of osteopathic medical
students in the United States. Med. Educ. 2020; 54: 571-581
[5] Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen
Intern Med 2007; 22: 434-438
[6] Rahimi-Madeshi Mohammad, Tavakol M, Dennick R, Nasiri J. Empathy in Iranian medical students: A
preliminary psychometric analysis and differences by gender and year of medical school. Med Teach. 2010;
32: e471-478
[7] Magalhaes E, Salgueira AP, Costa P, Costa M. Empathy in senior and first year medical students: a cross- sectional study. BMC Med. Educ. 2011; 11:52-59
[8] Voinescu BI, Szentagotal A, Coogen A. Residents’ clinical empathy: gender and speciality comparison – a
Romanian study. Acta Medica Academia 2009; 38: 11-15
[9] Higazi I, Wilson I. Maintaining empathy in medical school: it is possible. Med Teach. 2013; 35: 1002-1008
[10] Mocny-Pachonska K, Lanowy P, Trzcionka A, Skaba D, Tanasiewicz M. Gender related changes of empathy
level among Polish dental students over the course of training. Medicine. 2020; 99: 1-5
[11] Loffler CS, Greitemeyer T. Are women the more empathetic gender? The effects of gender role expectations.
Curr. Psychol. 2021; 9: 1-12
[12] DiLillo M, Cichetti A, LoScalzo A, Torani F, Hojat M. The Jefferson Scale of Physician Empathy. Preliminary
psychometrics and group comparison in Italian physicians. Acad. Med. 2009; 84: 1198-1202
Page 6 of 6
139
Zia, A., Wajid, G., Zia, A., Zia-ul-Miraj, M., Waqar, A., & Mahmood, H. (2025). Empathy in Paediatric Postgraduate Trainees: The Gender Effect.
British Journal of Healthcare and Medical Research, Vol - 12(02). 134-139.
URL: http://dx.doi.org/10.14738/bjhmr.1202.18492.
[13] Hojat M, Honella JS, Nasca TJ, Mangione S, Veloski JJ, Magee M. The Jefferson Scale of Physician Empathy:
further psychometric data and differences by gender and specialty at item level. Acad. Med. 2002b; 77: 58-
60
[14] Kataoka HU, Hoide N, Hojat M, Gonnella JS. Measurement and correlates of empathy among female Japanese
physicians. BMC Med Education. 2012; 12: 48
[15] Suh DH, Hong JS, Lee DH, Gonnella JS, Hojat M. The Jefferson Scale of Physician Empathy: A preliminary
psychometric study and group comparisons in Korean physicians. Med. Teach. 2012; 34: e464-468
[16] 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: 130
[17] Tariq N, Tayyab A, Jaffery T. Differences in empathy levels of medical students based on gender, year of
medical school and career choice. J Coll Physicians Surg Pak 2018; 28: 310-313
[18] Santos MA, Grosseman S, Morelli TC, Gluliano ICB, Erdmann TR. Empathy differences by gender and
specialty preference in medical students: a study in Brazil. Int. J. Med. Educ. 2016; 7: 149-153
[19] Hojat M, Mangione S, Nasca TJ, Cohen MJ, Gonnella JS, Erdmann JB et al. The Jefferson Scale of Physician
Empathy: development and preliminary psychometric data. Aduc. Psychol. Measur. 2001; 61: 349-365
[20] Mostafa A, Hoque R, Mostafa M, Rana MM, Mostafa F. Empathy in undergraduate medical students of
Bangladesh: Psychometric analysis and differences by gender, academic year, and specialty preference.
ISRN Psychiatry, 2014; 1-7
[21] Hojat M, Gonnella J, Mangione S, Nasca T, Magee M. Physician empathy in medical education and practice:
experience with the Jefferson Scale of physician empathy. Seminars in Integrated Medicine. 2003; 1: 25-41
[22] Bagash AS, Ali NF, Shehzad AH, Haqqi S. Maintenance of empathy levels among first and final year medical
students: a cross sectional study. Published online, F1000Res. 2013; 2: 157
[23] Hall JA, Cartet JD, Horgan TG. Gender differences in the nonverbal communication of emotion. In: Fischer
AH (Ed), Gender and emotion: Social Psychological Perspectives. Cambridge University Press, Paris. 2000;
pp. 97-117
[24] Christov-Moore L, Simpson EA, Coude G, Grigaityte K, Iacoboni M, Ferrari PF. Empathy: Gender effects in
brain and behavior. Neurosci Biobehav Rev. 2014; 46: 604-627
[25] Schulte-Ruther M, Markowitsch HJ, Shah NJ, Fink GR, Piefke M. Gender differences in brain networks
supporting empathy. Neuroimage 2008; 42: 393-403
[26] Cheng Y, Chou KH, Decety J, Chen IY, Hung D, Tzeng OJ et al. Sex differences in the neuroanatomy of human
mirror-neuron system: a voxel-based morphometric investigation. Neuroscience 2009; 158: 713-720
[27] Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication. A meta-analytic review. JAMA
2002; 288: 756-764