Jefferson Scale of Empathy: Scoring, versions, and licensing

Key takeaways

The Jefferson Scale of Empathy is copyrighted by Thomas Jefferson University, so no website can legally hand you the 20 items.

Licensing runs from $1,000 a year for a small batch of paper forms up to $5,500 for an online license.

Three versions exist: JSE-HP for practicing health professionals, JSE-S for medical students, and JSE-HPS for all other health professions students.

Scoring reverses exactly 10 of the 20 items, and the remaining 10 are scored as answered.

A total means something only next to norms for your own population, version, and gender, never against a fixed universal cutoff.

Empathy is one of the few clinical qualities training programs genuinely try to measure. The Jefferson Scale of Empathy (JSE) is the instrument most of them reach for. It is a 20-item self-report measure of empathy in patient care, developed at Thomas Jefferson University. Investigators in 91 countries have obtained permission to use it.

Permission is the catch. The JSE is copyrighted, licensed for an annual fee, and Jefferson bars licensees from posting the items on a public page. Any site offering a free JSE download is giving away property that belongs to someone else.

Plenty of the useful work happens before you buy anything. Which version you need, how the scoring rules work, and what a total can honestly carry all follow from who you are assessing.

What is the Jefferson Scale of Empathy?

The Jefferson Scale of Empathy is a 20-item questionnaire measuring empathy in patient care, answered on a 7-point Likert scale. Totals run from 20 to 140, and a higher total reflects more empathy-oriented attitudes.

The scale targets empathy as it shows up in clinical work. That means understanding what a patient is going through, then communicating that understanding back to them. Feeling what the patient feels is treated as a separate construct, which is why several items are worded against empathy and reversed at scoring.

One caveat belongs up front. The JSE captures self-reported attitudes, not observed behavior. A high total tells you a respondent endorses empathy-centered statements. It does not confirm that patients experienced them.

The three versions of the JSE

Jefferson publishes three versions. The content is nearly identical across all three, with wording adjusted so the frame of reference matches the respondent.

• JSE-HP (health professionals): for physicians, nurses, therapists, physician assistants, and anyone else practicing in patient care. This is the version practices and hospitals use for staff and faculty assessment.
• JSE-S (medical students): for medical students only. Programs administer it at matriculation and again later to see whether training moved empathy attitudes.
• JSE-HPS (health professions students): for students in every health profession other than medicine. That covers nursing, pharmacy, physician assistant, dental, and allied health programs.

Two version mix-ups are common enough to name. There is no JSE-O for other occupations, so treat any reference to one as an error. Nursing students belong on the JSE-HPS, not the JSE-S, which is reserved for medical students.

Choosing the wrong version costs you comparability. Published norms are tied to a specific version and population, so a total collected on the wrong form has nothing credible to sit beside.

What a Jefferson Scale of Empathy license costs

Licensing is priced per institution, per year, and the fee depends on the version and how you administer it. The figures below come from Jefferson’s own 2024-25 JSE order form.

Paper pricing steps up with quantity between those two ends, and orders above 400 forms are quoted on request. Rates change between academic years, so confirm the current figures with Jefferson before you set a budget.

Can you host the JSE in your own system?

Yes, on the license tier that covers administration through other survey software. Jefferson attaches conditions. The items must appear unchanged and in their original order. The hosting page must be secure, closed to the public, and reachable by invitation only.

That rules out a public download for everyone, licensee or not. A form sitting behind a staff login can be a legitimate home for a licensed copy. Confirm the arrangement with Jefferson in writing before you build it.

Once permission is in hand, digital forms keep administration consistent. Every respondent sees the same items in the same order, with no photocopier in the loop.

How to score the Jefferson Scale of Empathy

Each of the 20 items is answered on a 7-point scale, and exactly 10 of them are reversed before you add anything up. Getting that list of 10 right is the whole job.

1. Identify the reverse-scored items. These are items 1, 3, 6, 7, 8, 11, 12, 14, 18, and 19, the negatively worded half of the scale.
2. Flip those 10 responses. A 7 becomes 1, a 6 becomes 2, a 5 becomes 3, and a 4 stays 4. The lower values flip the same way upward.
3. Leave the other 10 items as answered. The split is even, 10 positively worded items and 10 reverse-scored items.
4. Add all 20 values. The result is the JSE total score, which ranges from 20 to 140.

Record the total with the date and the version used, whether that was HP, S, or HPS. Sound clinical documentation practice applies here too, because a total without its version cannot be compared to anything later.

Interpreting a JSE total score

There is no universal JSE cutoff. Published norms differ by population, version, and gender, so a total carries meaning only beside a reference group that resembles yours.

The cutoffs above isolate roughly the bottom and top 7% of each group, and the authors call them tentative. Carrying them over to practicing clinicians, nursing students, or a non-US sample would stretch them past what the data supports.

Notice how narrow the real spread is. Both student samples average in the mid-110s out of a possible 140. A neat one-third split of the 20 to 140 range would file almost every respondent under high empathy. You will not find such a split in the literature.

One total score, three components

Reported Cronbach’s alpha for the JSE sits around 0.82, which says the items hang together closely enough to be summed. It does not say they measure a single thing.

Factor analysis of a national sample of 6,009 medical students found three correlated factors rather than one. Perspective taking accounted for 10 items, compassionate care for 6, and walking in the patient’s shoes for 2.

That has a practical consequence. Two respondents can reach the same total from different profiles, so an unchanged total can hide movement inside a factor. When you are evaluating a communication curriculum, the factor pattern often matters more than the headline number.

Higher JSE scores track alongside patient-centered attitudes and communication skill, and they run in the opposite direction to burnout and cynicism. Jefferson has released translations in 62 languages and dialects, and recommends checking the psychometrics on your own sample rather than assuming equivalence.

Using the JSE in education and practice

The JSE was built as a research and program-evaluation instrument, and that is where it holds up best.

• Curriculum evaluation: administer at entry and again later in the program, then compare cohort means against the norm sample for that version.
• Faculty and staff development: read aggregate JSE-HP results to decide whether communication training earns the calendar time it would take.
• Longitudinal tracking: repeat the same version annually, so peer support or wellbeing initiatives can be judged against something measurable.
• Research: the JSE supplies a quantifiable empathy outcome, which is what most of the published literature uses it for.

Two uses are worth avoiding. High-stakes selection is not supported by tentative cutoffs drawn from small reference samples. An individual score also has no place in a performance review, because self-report invites the answer the respondent thinks is wanted.

Wherever the results end up, store them somewhere they can be read again. A client record system keeps assessment results, notes, and dates on one timeline instead of in a spreadsheet nobody reopens.

How Pabau turns empathy work into something you can measure

A JSE total tells you what your clinicians believe about empathy. It says nothing about what your patients experienced last Tuesday. Most practices never close that loop, because the survey lives in a spreadsheet and the patient record lives somewhere else entirely.

Practice management software like Pabau closes it from the patient side. Digital forms collect post-visit feedback without anyone chasing a paper copy. Pabau’s measurements and tracking tools score repeat questionnaires and chart the results per client over time.

Results land in the client record alongside notes and appointments. A shift in what patients report can then be read next to what actually happened in the room. Your empathy initiative gets an outcome measure that does not come from staff self-report.

Jefferson licenses a patient-facing counterpart too. The Jefferson Scale of Patient Perception of Physician Empathy appears on the same order form. It sits among the assessment scales covered by a $1,000 unlimited annual license. It is short enough to run as a routine patient portal follow-up.

Turn empathy training into a measurable outcome

Pabau's digital forms, questionnaire scoring, and client records collect patient-reported feedback in one place. You can see whether an empathy initiative changed what patients actually say.

Book a demo

Conclusion

The JSE earns its reputation, and it is not free. Budget for the license, then pick the version that matches your respondents. Reverse the right 10 items, and compare totals only against a reference group that resembles yours.

Anyone offering the item text for nothing has skipped the step Jefferson requires. Using that copy puts your program on the wrong side of a copyright, and it takes one email to avoid. Write to [email protected] instead.

Measuring attitudes is only half the work. Book a demo to see how Pabau collects patient-reported feedback and tracks it against every visit, so empathy work shows up in your records.

Continue your research

Need an assessment framework you can actually distribute? Psychiatric evaluation template gives you a full intake structure that is yours to use, unlike the JSE.

Collecting sensitive questionnaires from clients? Group therapy informed consent covers the consent language that should travel with them.

Want repeat questionnaires scored without a spreadsheet? Measurements and tracking scores each submission and charts the results per client.

Seeing empathy slip as your team gets stretched? Therapist burnout signs, causes and prevention covers the drivers JSE studies link to lower scores.

Want patients more involved between visits? How to improve patient engagement turns empathy-centered intent into the everyday touchpoints patients notice.

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