Table 1 The methodological characteristics of the research-type studies included in this review

Thomas et al.,

2007,

USA

How do distress and well-being relate to medical student empathy? A multicenter study

To determine whether lower levels of empathy among a sample of medical students in the United States are associated with personal and professional distress and to explore whether a high degree of personal well-being is associated with higher levels of empathy.

Multi-institutional, Cross-sectional study

1098 medical students

IRI

Empathy scores were negatively correlated with burnout and positively correlated with well-being.

von Harscher et al.,

2007,

USA

The impact of empathy on burnout in medical students: new findings

To understand the relationship between empathy (Empathic Concern and Personal Distress) and burnout in medical students.

Longitudinal study

353 medical students

MBI,

IRI

Students with high levels of empathic concern had statistically lower scores of burnout, while students with high levels of personal distress showed statistically higher scores of burnout.

Carrard et al.,

2022,

Switzerland

The relationship between medical students’ empathy, mental health, and burnout: A cross-sectional study

To investigate how medical students’ empathy is related to their mental health and burnout.

Cross-sectional study

886 medical students

JSPE,

QCAE,

IRI,

AMSP

Positive associations were found between affective empathy and more mental health issues such as depression, anxiety and burnout, while cognitive empathy was the opposite.

Patricia et al.,

2021,

Spain

Depression, anxiety, burnout and empathy among Spanish medical students

To conduct a nationwide analysis of the prevalence of mental health problems among medical students.

Multi-center Cross-sectional study

5216 medical students

BDI-II,

MBI-SS,

STAI,

JSE

Students who scored higher in the JSE had a lower risk of depression.

Li et al.,

2022,

China

The relationship between dimensions of empathy and symptoms of depression among university students during the COVID-19 pandemic: A network analysis

To investigate the nuanced associations between deferent dimensions of empathy and individual symptoms of depression using a network model during the pandemic.

Network analysis

1177 medical students

IRI,

PHQ-9

The study showed positive relationships between personal distress and symptoms of depression.

Pitanupong et al.,

2023,

Thailand

Relationship of mental health and burnout with empathy among medical students in Thailand: A multicenter cross-sectional study

To explore mental health, burnout, and the factors associated with the level of empathy among Thai medical students.

Multicenter Cross-sectional study

336 medical students

Personal and demographic information questionnaire,

Thai Mental Health Indicator,

MBI,

TEQ

The multivariate analysis indicated that mental health was statistically significantly associated with the level of empathy.

Sathaporn et al.,

2021,

Thailand

The Relationship between Mental Health with the Level of Empathy Among Medical Students in Southern Thailand: A University-Based Cross-Sectional Study

To determine the level of and factors associated with empathy among medical students.

Cross-sectional study

1010 medical students

TEQ,

Thai Mental Health Indicator-15

High empathy was a positive factor for mental health.

Brazeau et al.,

2010,

USA

Relationships Between Medical Student Burnout, Empathy, and Professionalism Climate

To explore relationships between burnout and professionalism using validated instruments.

Cross-sectional study

127 medical students

MBI,

JSPE-S,

PCI

Scores indicative of higher medical student burnout were associated with lower medical student empathy scores.

Sulaiman et al.,

2023,

Qatar

Experiences of burnout, anxiety, and empathy among health profession students in Qatar University during the COVID-19 pandemic: a cross-sectional study

To evaluates the prevalence of burnout and its relationship to anxiety and empathy during the COVID-19 pandemic among health profession students in the main governmental institution in Doha, Qatar using validated instruments.

Cross-sectional study

272 medical students

GAD-7,

MBI-GS,

IRI

Burnout was positively associated with empathy.

Paro et al.,

2014,

Brazil

Empathy among Medical Students: Is There a Relation with Quality of Life and Burnout?

To assess medical students’ empathy and its associations with gender, stage of medical school, quality of life and burnout.

Cross-sectional, multi-centric study

1350 medical students

MBI-HSS,

WHOQOL-BREF,

IRI

The empathy scores were moderately correlated with burnout.

Wu et al.,

2022,

China

Empathy alleviates the learning burnout of medical college students through enhancing resilience

To investigate the relationship between empathy and learning burnout, as well as the mediation effect of resilience in this relation.

Cross-sectional study

588 medical students

Basic empathy scale,

Connor-Davidson Resilience Scale,

Learning Burnout Scale

Medical students’ empathy ability and their levels of learning burnout were negatively correlated.

Austin et al.,

2007,

UK

A preliminary study of empathy, emotional intelligence and examination performance in MBChB students

To compare empathy levels in medical students in Years 2, 3 (pre-clinical) and 5 (clinical), to examine gender differences in empathy and EI, and to investigate whether EI and empathy are related to academic success.

Cross-sectional and Longitudinal study

273 medical students

JSPE

There was no relationship between empathy scores and academic performance of medical students.

Jung et al.,

2022,

Korea

Correlation between medical student empathy and a Korean nationwide comprehensive clinical assessment score at a medical school in Korea

To determine the relationship between JSE-S and clinical comprehensive assessment scores.

Cross-sectional study

108 medical students

JSE-S

Academic performance and empathy were not significantly associated.

Hojat et al.,

2002,

USA

Empathy in medical students as related to academic performance, clinical competence and gender

To test two hypotheses: firstly, that medical students with higher empathy scores would obtain higher ratings of clinical competence in core clinical clerkships; and secondly, that women would obtain higher empathy scores than men.

Longitudinal study

371 medical students

JSPE

Empathy scores were associated with ratings of clinical competence and gender, but not with performance in objective examinations.

Colliver et al.,

1998,

USA

Assessment of empathy in a standardized-patient examination

To determine the extent to which 4th-year medical students were checked “empathic” by standardized patients on a performance-based examination, to evaluate the psychometric properties of this simple empathy measure, and to see whether empathy was related to clinical performance on history taking and physical examination.

Cross-sectional study

1048 medical students

interpersonal-and communication-skills checklist

Empathy was an enabling factor in clinical competence, the empathy measure was related to history-taking and physical-examination performance.

Ogle et al.,

2013,

Australia

Empathy is related to clinical competence in medical care

To investigate the relationship between empathy and clinical competence among medical students.

Cross-sectional study

57 medical students

REM,

JSPE-S,

OSCE

Observable empathy was strongly associated with medical students’ clinical competence. Self-rated empathy, however, was not associated with clinical competence.

Casas et al.,

2017,

USA

Associations of medical student empathy with clinical competence

To examine if self-reported empathy in medical students was associated with clinical competence.

Cross-sectional study

590 medical students

JSPE,

OSCE

JSPE scores were positively associated with OSCE communication scores in medical students.

Wright et al.,

2014,

USA

Examiner and simulated patient ratings of empathy in medical student final year clinical examination: are they useful?

To evaluate the empathy scores of examiners and simulated patients in the clinical examination of medical students in the final year.

Cross-sectional study

133 medical students

OSCE

Empathy scores show significant correlation with the interaction based OSCE stations and virtually no correlation with the skills-based stations.

Benabbas

2016,

Iran

Empathy in Iranian medical students: A comparison by age, gender, academic performance and specialty preferences

To investigate empathy among Iranian medical students and the possible differences between students of different levels of medical education.

Cross-sectional study

459 medical students

JSE

No statistically significant correlation was found between empathy score and academic performance or specialty of choice.

Javaeed et al.,

2022,

Pakistan

Empathy scores amongst undergraduate medical students and its correlation to their academic performance

To assess the relationship between empathy and gender, and the academic performance of undergraduate medical students of Azad Kashmir.

Cross-sectional study

151 medical students

IRI

No significant correlation was found between the empathy scores and academic performance.

Wimmers et al.,

2010,

USA

Assessing medical students’ empathy and attitudes towards patient-centered care with an existing clinical performance exam (OSCE)

To study the ability of OSCE to capture the degree of students’ patient-centeredness and empathy as measured by the PPOS and the JSE.

Cross-sectional study

101 medical students

OSCE,

PPOS,

JSE

Students’ level of empathy had a moderate association with students’ score on the patient-provider interaction component of the OSCE.

Hussain et al.,

2020,

Pakistan

Empathy among Students of a Public-Sector Medical University: A Cross-Sectional Study

To determine the empathy among medical students of Pakistan.

Cross-sectional study

273 medical students

JSE-S

The results provided a slight difference in empathy score of students opting for different specialty choices, but it was not statistically significant.

Guilera et al.,

2018,

Spain

Empathy and specialty preference in medical students.

Follow-up study and feedback

To explore the evolution of empathy among medical students based on gender and specialty preferences using several validated scales.

Cross-sectional study

151 medical students

JSPE,

IRI,

EQ,

Students who preferred people-oriented specialties score higher empathy scores in JSPE and EQ.

Kötter et al.,

2021,

Germany

The Development of Empathy and Associated Factors during Medical Education: A Longitudinal Study

To investigate the development of empathy during medical education and assessed potential predictors of empathy at different time points in the course of medical studies.

Longitudinal study

43 medical students

JSE-S,

HADS,

Perceived Medical School Stress scale

A preference for a people-oriented specialty was associated with a higher JSE-S sum score.

HADS depression was negatively correlated with JSE-S empathy score.

Stefanović et al.,

2015,

Serbia

EMPATHY PREDICTING CAREER CHOICE IN FUTURE PHYSICIANS

To address the differences in empathy in the context of career decision making by future physicians.

Cross-sectional study

363 medical students

TEQ

The empathy had a positive effect on choice of people-oriented medical disciplines.

Akgün et al.,

2020,

Turkey

Medical Students’ Empathy Level Differences by Medical Year, Gender, and Specialty Interest in Akdeniz University

To evaluate the level of empathy among medical students in all years of medical training using two different instruments: the Jefferson Scale of Physician Empathy and the Toronto Empathy Questionnaire.

Cross-sectional descriptive study

300 medical students

JSPE-S,

TEQ

Students intending to follow the clinical specialty had higher empathy scores. However, the score difference between specialties was not statistically significant.

Magalhães et al.,

2011,

Portugal

Empathy in senior year and first year medical students: a cross-sectional study

To study empathy in senior year and first year medical students and the relationship between empathy, gender, and specialty preference.

Cross-sectional study

476 medical students

JSPE-spv

Significant differences in empathy were not found between the students who prefer people-oriented specialties compared to those who favor the technology-oriented specialties.

Mostafa et al.,

2014,

Bangladesh

Empathy in Undergraduate Medical Students of Bangladesh: Psychometric Analysis and Differences by Gender, Academic Year, and Specialty Preferences

To measure and examine empathy among a sample of undergraduate medical students of Bangladesh.

Cross-sectional study

426 medical students

JSE-S

A nonsignificant difference was found between empathy scores and specialty preferences.

Tavakol et al.,

2011,

UK

Empathy in UK medical students: differences by gender, medical year and specialty interest

To explore the relationship between undergraduate medical students’ empathy scores relevant to gender, medical school year and future career ambitions.

Cross-sectional study

853 medical students

JSPE

Those students preferring people-oriented specialties would score higher on the empathy scale than students choosing technology-oriented specialties.

O’Tuathaigh et al.,

2019,

Ireland

Medical students’ empathy and attitudes towards professionalism: Relationship with personality, specialty preference and medical programme

To study how empathy, personality, and background factors might impact on students’ attitudes towards professionalism in medicine.

Cross-sectional study

241 medical students

JSE;

NEO-FFI-3;

Attitudes towards Professionalism Scale

Empathy did not vary according to career specialty preference.

Chen et al.,

2007,

USA

A Cross-sectional Measurement of Medical Student Empathy

To measure and examine student empathy across medical school years.

Cross-sectional study

658 medical students

JSPE-S

Students preferring people-oriented specialties had higher empathy scores than students preferring technology-oriented specialties.

Santos et al.,

2016,

Brazil

Empathy differences by gender and specialty preference in medical students: a study in Brazil

To assess medical students’ empathy and to examine empathy differences by students’ socio-demographic characteristics, including gender, and specialty preference

Cross-sectional and descriptive study

226 medical students

JSPE,

IRI

Medical students who intended to pursue a people-oriented profession had higher empathy.

Guilera et al.,

2019,

Spain

Empathy and big five personality model in medical students and its relationship to gender and specialty preference: a cross-sectional study

To explore the relationship between empathy and personality, and taking into account gender and specialty preference.

Cross-sectional study

110 medical students

JSPE,

IRI,

EQ,

NEO-FFI

Higher scores on empathy were found among students who favored people-focused majors.

Chen et al.,

2012,

USA

Characterizing changes in student empathy throughout medical school

To examine the trend of empathy longitudinally; determined differences in empathy according to gender and medical specialty preferences.

Longitudinal study

1162 medical students

JSPE-S

Students preferring technology-oriented specialties had lower empathy scores.

Hojat et al.,

2005,

USA

Empathy in medical students as related to specialty interest, personality, and perceptions of mother and father

To examine relationships between empathy, specialty interest, personality and perceptions of mother and father.

Cross-sectional study

422 medical students

JSPE

Higher scores on empathy were found among students who favored people-focused majors.

Assing et al.,

2022,

Denmark

A cross-sectional study of student empathy across four medical schools in Denmark-associations between empathy level and age, sex, specialty preferences and motivation.

To examine the associations between empathy scores among Danish medical students and medical school, year of curriculum, age, sex, co-habitation, and parental status, specialty preferences and motivations for choosing medicine as a future profession.

Cross-sectional study

672 medical students

JSE-S

The positive associations were found between empathy scores and specialty preferences for psychiatry and general practice and altruistic motivations for choosing to enroll.

Shashikumar et al.,

2014,

India

Cross sectional assessment of empathy among undergraduates from a medical college

To assess the empathy ability of medical college undergraduates.

Cross-sectional study

488 medical students

JSPE-S

The relation of mean empathy scores and choice of specialty is inconclusive.

Hasan et al.,

2013,

Kuwait

Level of empathy among medical students in Kuwait University, Kuwait

To evaluate the level of empathy among medical students in Kuwait University Medical School and its association with sociodemographic factors, stress levels and personality.

Cross-sectional study

264 medical students

JSPE-S,

ZKPQ,

PSS

Empathy could not affect medical students’ specialty preferences.