Factors Influencing Empathy in Clinical Medical Education

Abstract Background: Empathy is a fundamental professional competence in medical education, yet evidence suggests that empathy development may stagnate during medical training. Emotional intelligence and self-efficacy have been proposed as important psychological predictors of empathy; however, their relative roles across different stages of medical education remain unclear. Methods: This study employed a two-wave cohort design to investigate empathy development among undergraduate clinical medicine students in China. Participants completed validated measures of empathy, emotional intelligence, and self-efficacy during the early stage of training and again in the later stage. Descriptive analyses, group comparisons, and multivariate regression models were used to examine developmental changes and the relative contributions of emotional intelligence and self-efficacy to empathy. Results: Empathy levels showed only modest improvement across training stages. Emotional intelligence demonstrated a stable and significant positive association with empathy at both time points, whereas self-efficacy showed weak and inconsistent effects after controlling for emotional intelligence. Among emotional intelligence dimensions, emotional perception and emotional regulation emerged as the strongest predictors of empathy. In addition, gender and rural–urban background were associated with differences in empathy levels and the strength of these relationships. Conclusions: The findings indicate that emotional intelligence, rather than self-efficacy, plays a central role in empathy development among medical students. These results suggest that confidence-based educational approaches alone may be insufficient to foster empathic competence in emotionally complex clinical contexts. Integrating emotional intelligence–focused training into early medical curricula may provide a more effective pathway for supporting sustainable empathy development in medical education.