Empathy erosion in medical students: a cross-sectional comparison of first- and fifth-year students in relation to self-compassion, burnout, and alexithymia

Purpose: This study compared empathy between first-year and fifth-year medical students and examined how self-compassion, burnout, and alexithymia relate to empathy in a Turkish medical school.Materials and Methods: In this cross-sectional study, 155 medical students (88 first-year, 67 fifth-year) completed the Jefferson Scale of Empathy (student version), the Maslach Burnout Inventory, the Self-Compassion Scale, and the Toronto Alexithymia Scale. Results: Fifth-year students scored higher on empathy than first-year students (99.1 ± 12.8 vs. 90.8 ± 12.7; r = 0.38). Burnout was higher in fifth-year students (45.4 ± 7.3 vs. 40.4 ± 8.9; d = 0.61) and alexithymia higher in first-year students (55.1 ± 9.2 vs. 50.3 ± 8.7; d = 0.54). Greater overidentification was associated with lower empathy (Spearman's ρ = −0.22), an association confined to first-year students. In hierarchical regression, class year was the only individual predictor of empathy (β = 0.43) and explained about ten times more variance than all psychological variables combined. Sensitivity analyses confirmed this effect.Conclusion: In this sample, empathy was higher in students nearing graduation, contrary to the empathy erosion hypothesis. The cross-sectional design cannot separate cohort from training effects; longitudinal, multi-institutional studies are needed.