Supplemental Digital Appendix 1

Supplemental digital content for Costa P, de Carvalho-Filho MA, Schweller M, Thiemann P, Salgueira A, Benson J, Costa MJ, Quince T. Measuring Medical Students’ Empathy: Exploring the Underlying Constructs of and Associations Between Two Widely Used Self-report Instruments in Five Countries. Acad Med.

1 Copyright by the Association of American Medical Colleges. Unauthorized reporduction is prohibited.

Supplemental Digital Appendix 1

Results of Analysis of Variance (ANOVA) of Gender and Country Effects

We used multivariate analysis of variance (MANOVA) to examine the gender and country effects on the subscale scores of both instruments and ANOVA to examine the effects on the JSE-S total score. We calculated partial eta squared (Ƞ

²p

) and used the reference values for interpretation as proposed by Cohen (1988) of 0.01 = small, 0.06 = medium, 0.14 = large.

MANOVA for Davis’s Interpersonal Reactivity Index (IRI) Sub Scales: Gender and Country Effects

MANOVA for IRI dimensions considering gender and country revealed significant main effects for country [F

(16, 12236)

= 8.01, P < .001, Ƞ

²p

= 0.010], and for gender [F

(4, 3056)

= 27.5, P < .001, Ƞ

²p

= 0.035], but no significant interaction effects [F

(16,12236)

= 1.26, P = .212, Ƞ

²p

= 0.002].

Gender main effects were found for IRI-Personal Distress (PD), IRI-Fantasy Scale (FS) and IRI-Empathic Concern (EC) with females recording higher scores but no gender differences were observed for IRI-PT.

However, Brazilian female students recorded marginally lower scores than their male counterparts.

Significant country main effects were found for IRI-PD, IRI-EC and IRI-Perspective Taking (PT). No

country differences were observed in IRI-FS. Scores for IRI-PD recorded for students in Portugal, Brazil

and New Zealand were significantly higher than those recorded for UK and Irish students. Students in Brazil

presented lower scores for IRI-EC and IRI-PT than students in other countries.

Supplemental digital content for Costa P, de Carvalho-Filho MA, Schweller M, Thiemann P, Salgueira A, Benson J, Costa MJ, Quince T. Measuring Medical Students’ Empathy: Exploring the Underlying Constructs of and Associations Between Two Widely Used Self-report Instruments in Five Countries. Acad Med.

2 Copyright by the Association of American Medical Colleges. Unauthorized reporduction is prohibited.

Appendix Table A1: MANOVA Results for IRI Subscales (Gender and Country Effects)

Gender Country

main effects

Female Male Total

Country M SD N M SD N M SD N

IRI-PD (Personal Distress)

Portugal 9.28 4.108 197 8.97 3.835 96 9.18^a 4.017 293

F(4,3059)

= 14.772, P <.001, Ƞ²p = 0.019 Brazil 9.49 4.955 168 8.41 4.182 134 9.01^a 4.652 302

United Kingdom 8.20 4.027 1263 7.07 3.733 796 7.77^b 3.954 2059 New Zealand 9.04 3.880 186 7.73 3.802 119 8.53^a 3.896 305 Ireland 7.48 4.375 73 6.97 4.640 37 7.31^b 4.451 110 Total 8.49 4.155 1887 7.44 3.878 1182 8.08 4.082 3069 Gender main

effects F(1,3059) = 13.685, P < .001, Ƞ²p = 0.004

IRI-FS (Fantasy scale)

Portugal 14.90 5.079 197 12.57 4.528 96 14.14 5.018 293

F(4,3059)

= 2.284, P = .058, Ƞ²p = 0.003 Brazil 14.70 5.554 168 13.54 5.248 134 14.19 5.442 302

United Kingdom 15.37 5.043 1263 13.40 5.193 796 14.61 5.190 2059 New Zealand 16.20 4.697 186 13.78 4.669 119 15.26 4.825 305 Ireland 15.95 5.131 73 13.08 5.609 37 14.98 5.444 110 Total 15.36 5.074 1887 13.38 5.110 1182 14.60 5.178 3069 Gender main

effects

F(1,3059) = 52,157, P < .001, Ƞ²p = 0.017

IRI-EC (Empathic Concern )

Portugal 18.26 2.742 197 16.20 3.355 96 17.58^a 3.106 293

F(4,3059) = 8.328, P <.001, Ƞ²p = 0.011 Brazil 17.23 3.590 168 15.54 3.819 134 16.48^b 3.782 302

United Kingdom 18.38 3.348 1263 16.86 3.762 796 17.79^a 3.590 2059 New Zealand 18.40 3.427 186 16.46 3.822 119 17.65^a 3.704 305 Ireland 18.05 3.797 73 17.14 3.164 37 17.75^a 3.608 110 Total 18.25 3.351 1887 16.62 3.746 1182 17.62 3.597 3069 Gender main

effects

F(1,3059) = 63.465, P < .001, Ƞ²p = 0.020

IRI- PT (Perspective Taking)

Portugal 16.80 3.578 197 17.42 3.304 96 17.00^a 3.498 293

F(4,3059)

= 10.568, P <.001, Ƞ²p = 0.014 Brazil 15.16 3.937 168 15.47 4.129 134 15.30^b 4.020 302

United Kingdom 16.89 3.685 1263 16.59 3.876 796 16.78^a 3.762 2059 New Zealand 16.62 4.008 186 16.29 4.019 119 16.49^a 4.009 305 Ireland 16.81 3.770 73 16.76 3.767 37 16.79^a 3.752 110 Total 16.70 3.761 1887 16.50 3.893 1182 16.62^a 3.813 3069 Gender main

effects

F(1,3059) = 0.045, P = 0.833, Ƞ²p < 0.001

a

Indicates that group of countries in which students recorded significantly higher total mean scores when compared to students in countries in group “b” (

^b

). For example students in Brazil recorded a statistically significant lower mean score for IRI-PT than students in all other countries.

All differences indicated are at the level of P < .05

Supplemental digital content for Costa P, de Carvalho-Filho MA, Schweller M, Thiemann P, Salgueira A, Benson J, Costa MJ, Quince T. Measuring Medical Students’ Empathy: Exploring the Underlying Constructs of and Associations Between Two Widely Used Self-report Instruments in Five Countries. Acad Med.

3 Copyright by the Association of American Medical Colleges. Unauthorized reporduction is prohibited.

MANOVA for the Jefferson Scale of Empathy-version for students (JSE-S) Dimensions and ANOVA for JSE-S Total Score: Gender and Country Effects

MANOVA for JSE-S subscales considering country and gender revealed significant main effects for country [F

(12,9177)

= 33.6, P < .001, Ƞ

²p

= 0. 042], and for gender [F

(3, 3057)

= 8.4, P < .001, Ƞ

²p

= 0.008] and also significant interaction effects for country*gender [F

(12,9177)

= 2.28, P = .007, Ƞ

²p

= 0.003]. The two-way ANOVA for the JSPE empathy total score revealed gender and country significant main effects and also significant interaction effects for country*gender [F

(4,3059)

= 4.26, P = .002, Ƞ

²p

= 0.006].

Appendix Table A2: MANOVA for JSE-S Sub Scales and ANOVA Results for JSE-S Total Score (Gender and Country Effects)

Gender Country

main effects

Female Male Total

Country M SD N M SD n M SD N

JSE-CC Compassionate care

Portugal 46.85 5.452 197 45.84 5.346 96 46.52^b 5.429 293

F(4,3059) = 51.125, P < .001, Ƞ²p = 0.063 Brazil 48.98 3.891 168 49.14 4.862 134 49.05^a 4.342 302

United

Kingdom 45.90 4.866 1263 43.75 5.818 796 45.07^b 5.357 2059 New

Zealand 48.27 4.435 186 45.50 4.986 119 47.19^b 4.843 305 Ireland 45.36 5.834 73 44.35 5.717 37 45.02^b 5.788 110 Total 46.49 4.966 1887 44.73 5.852 1182 45.81 5.393 3069 Gender

main effects

F(1,3059) = 20.224, P < .001, Ƞ²p = 0.007

JSE-SPS Standing in the patient’s shoes

Portugal 9.23 2.232 197 8.33 2.116 96 8.94^a 2.231 293

F(4,3059) = 32.621, P < .001, Ƞ²p = 0.041 Brazil 7.45 2.493 168 7.75 2.705 134 7.59^b 2.589 302

United

Kingdom 9.51 2.423 1263 9.13 2.614 796 9.36^a 2.504 2059 New

Zealand 9.62 2.442 186 8.85 2.547 119 9.32^a 2.508 305 Ireland 9.03 2.576 73 8.59 2.204 37 8.88^a 2.456 110 Total 9.29 2.486 1887 8.87 2.606 1182 9.13^a 2.541 3069 Gender

main effects

F(1,3059) = 9.057, P = .003, Ƞ²p = 0.003

Supplemental digital content for Costa P, de Carvalho-Filho MA, Schweller M, Thiemann P, Salgueira A, Benson J, Costa MJ, Quince T. Measuring Medical Students’ Empathy: Exploring the Underlying Constructs of and Associations Between Two Widely Used Self-report Instruments in Five Countries. Acad Med.

4 Copyright by the Association of American Medical Colleges. Unauthorized reporduction is prohibited.

JSE-PT Perspective taking

Portugal 57.24 6.380 197 56.92 6.230 96 57.13^b 6.322 293

F(4,3059) = 10.69, P < .001, Ƞ²p = 0.014 Brazil 59.59 5.720 168 59.98 5.953 134 59.76^a 5.818 302

United

Kingdom 58.46 6.266 1263 57.16 6.857 796 57.96^b 6.530 2059 New

Zealand 60.30 5.958 186 58.16 6.682 119 59.47^a 6.327 305 Ireland 59.79 5.548 73 58.43 8.074 37 59.34 6.502 110 Total 58.67 6.220 1887 57.60 6.788 1182 58.25 6.464 3069 Gender

main effects

F(1,3059) = 6.431, P = .011, Ƞ²p = 0.002

JSE Total Score

Portugal 113.31 10.767 197 111.09 10.654 96 112.59^b 10.763 293

F(4,3059) = 16.34, P <.001, Ƞ²p = 0.021 Brazil 116.02 8.639 168 116.87 10.324 134 116.40^a 9.417 302

United Kingdom

113.87 10.329 1263 110.04 11.571 796 112.39^b 10.984 2059 New

Zealand

118.20 9.876 186 112.51 11.352 119 115.98^a 10.821 305 Ireland 114.18 9.194 73 111.38 10.164 37 113.24 9.577 110 Total 114.44 10.238 1887 111.19 11.490 1182 113.19 10.852 3069 Gender

main effects

F(1,3059) = 19.50, P < .001, Ƞ²p = 0.006

a

Indicates that group of countries in which students recorded significantly higher total mean scores when compared to students in countries in group “b” (

^b

). For example students in Brazil and New Zealand recorded statistically

significantly higher mean JSE total scores than students in Portugal and the UK, but not significantly higher than students in Ireland.

All differences indicated are at the level of P < .05

In summary, results showed that females recorded higher mean scores for most IRI subscales and all JSE-S

subscales. No significant consistent country differences were found for the IRI but students from Brazil and

New Zealand tended to record higher total JSE-S mean scores.