2026 ECNP Congress

PS04-4183

Empathy, self-compassion, burnout, and alexithymia in first- and fifth-year medical students: a cross-sectional study

Merve Nur Gürlen — M. sancaktar, B. demir, O. gürler, G. elboğa, F. bülbül, A. altındağ · Gaziantep university hospital, psychiatry, GAZİANTEP, Türkiye

2026 ECNP Congress

Study objective: Empathy is a cornerstone of the physician–patient relationship and a core competency of medical professionalism. The widely cited “empathy erosion” phenomenon, drawn primarily from North American cohorts [1], has been challenged by European and Mediterranean reports showing stable or increasing empathy across training [2]. Burnout, alexithymia, and self-compassion have each been proposed as psychological correlates of empathy, yet they have rarely been examined simultaneously, and Turkish data combining these constructs remain scarce. The study aimed to (i) compare empathy between first-year (preclinical) and fifth-year (clinical) Turkish medical students, (ii) examine bivariate associations of empathy with self-compassion, burnout, and alexithymia, and (iii) identify independent predictors of empathy in a multivariable model.

Methods

In this cross-sectional, comparative study at a gaziantep university faculty of medicine, 155 students (88 first-year, 67 fifth-year) completed validated Turkish versions of the Jefferson Scale of Empathy–Student Version (JSE-S) [3], the Maslach Burnout Inventory (MBI), the Self-Compassion Scale (SCS), and the 20-item Toronto Alexithymia Scale (TAS-20), plus a sociodemographic form. Sample size was estimated a priori (Cohen’s d ≈ 0.50, power = 0.80, two-tailed α = 0.05). Group comparisons used independent-samples t-tests (Welch’s correction where appropriate) or Mann–Whitney U tests; categorical variables used the χ² test. Bivariate associations used Pearson’s r or Spearman’s ρ. Multiple linear regression (enter method) identified independent predictors of JSE-S total scores, adjusting for class year, sex, age, total self-compassion, MBI subscales, and TAS-20 total. Multicollinearity was checked via the variance inflation factor; significance was set at p < 0.05. The protocol was approved by the institutional non-interventional clinical research ethics committee, with written informed consent.

Results: Contrary to the empathy-erosion hypothesis, fifth-year students scored significantly higher on the JSE-S than first-year students (99.09 ± 12.84 vs. 90.81 ± 12.68; U = 1639.5, p < 0.001, r = 0.38). Total burnout (45.40 ± 7.34 vs. 40.36 ± 8.86; t = −3.77, p < 0.001, d = 0.61) and emotional exhaustion (p = 0.040, d = 0.34) were higher in the fifth-year group, whereas alexithymia was higher in first-year students (55.14 ± 9.18 vs. 50.27 ± 8.69; t = 3.35, p = 0.001, d = 0.54). Among all psychological variables, only the overidentification subscale of self-compassion correlated significantly with empathy (ρ = −0.221, p = 0.006). The multivariable model was significant (F(8,146) = 2.76, p = 0.007; R² = 0.131); class year was the sole independent predictor of empathy (B = 11.87, β = 0.428, 95% CI 6.16–17.58, p < 0.001), whereas sex, age, total self-compassion, all burnout dimensions, and alexithymia were non-significant. All variance inflation factors remained below 2.14.

Conclusions

In this study, fifth-year medical students reported higher, not lower, empathy than first-year students despite greater burnout, challenging the universality of the empathy-erosion hypothesis. Neither burnout nor alexithymia was independently associated with empathy; overidentification — a marker of emotional dysregulation within self-compassion — was the only psychological correlate of lower empathy. Findings underscore the curricular and cultural context shaping empathy and support longitudinal, multi-institutional research using cognitive and affective measures.

References

  1. Hojat, M., Vergare, M.J., Maxwell, K., Brainard, G., Herrine, S.K., Isenberg, G.A., Veloski, J., Gonnella, J.S., 2009. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad. Med. 84 (9), 1182–1191.
  2. Ardenghi, S., Russo, S., Rampoldi, G., Bani, M., Strepparava, M.G., 2024. Does medical curriculum impact on empathy? A longitudinal study in a sample of undergraduate medical students. Med. Sci. Educ. 34 (4), 873–881.
  3. Gönüllü, İ., Öztuna, D., 2012. A Turkish adaptation of the student version of the Jefferson Scale of Physician Empathy. Marmara Med. J. 25 (2), 87–92.