gms | German Medical Science

Introduction: Empathy plays a crucial role in healthcare service delivery, impacting both patient outcomes and provider well-being [1]. Hence, medical, nursing and midwifery schools worldwide incorporate empathy teaching and training into their curricula [2]. Studies indicate a concerning decline in healthcare students’ empathy as they progress in their academic and professional path [3]. We therefore aimed to identify determinants of empathy across students of different healthcare disciplines, considering personality traits, socio-economic background, and elitist attitudes.

Methods: In a cross-sectional online-survey we assessed empathy among 252 students from 4 disciplines (n=173 medicine, n=35 BSc midwifery, n=24 BSc nursing and n=20 MSc health care and nursing) at one German university, using the Jefferson Scale of Empathy for Health Profession Students (JSE-HPS). Additionally, the questionnaire explored personality traits and elitist attitudes through the NEO-Five-Factor-Inventory, Narcissistic Personality Inventory, and instruments assessing social dominance orientation and positionality. Data were analyzed using multiple linear regression models, controlling for relevant confounders.

Results: Results indicate variations in mean empathy levels across disciplines, with BSc midwifery students exhibiting highest empathy scores (114.83, 95%-CI = 111.77 – 117.88), and BSc nursing students the lowest (106.25, 95%-CI = 103.1 – 109.4). Hereby, in multiple regression empathy is associated with the personality traits openness (b = 2.67, 95%-CI = 1.16 – 4.19), agreeableness (b = 5.92[FA6] , 95%-CI = 3.8 – 8.05), and conscientiousness (b = 2.34, 95%-CI = 0.004 – 4.69), as well as with having children (b = 4.88, 95%-CI = 0.08 – 9.67). Students with non-medical training prior to university (b = -9.97, 95%-CI = -16.97 – -2.97) and higher social dominance orientation (b = -0.59, 95%-CI = -1.08 – -0.11) showed lower empathy scores.

Conclusion: This study supports the previously established finding that the personality traits openness, agreeableness and conscientiousness are positively influencing empathy [4]. In addition to validating past assumptions, the study identifies social dominance orientation as an interesting new factor negatively associated with empathy among healthcare students. Social dominance orientation generally refers to a belief system with a favoring of social hierarchy and a preference for inequality among social groups [5]. In this context, the association between social dominance orientation and empathy prompts novel and interesting questions about the dynamics and perception of hierarchical structures, within the healthcare domain, such as power differentials in the doctor-patient relationship and internal authority gradients.

This study offers valuable insights for educational institutions aiming to strengthen empathy among healthcare students to create a positive impact on the well-being of both providers and patients. These findings could have broader implications for healthcare education and practice. Understanding the impact of social dominance orientation on empathy may lead to the development of targeted interventions, educational programs, or changes in institutional policies to foster a more empathetic healthcare workforce. This study emphasizes the need for comprehensive and interdisciplinary approaches and the importance of addressing hierarchical attitudes, building a collaborative and empathetic environment beyond traditional professional boundaries.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.