Cent Eur J Nurs Midw. X:X

Empathy (non)erosion: a cross-sectional study of empathy levels and trait emotional intelligence in Slovak medical students

Miroslava Galasová1, Nikola Ondrík Andreánska2, Lucia Konečná3
1 Department of Psychology, Pedagogical Faculty, University of Matej Bel in Banská Bystrica, Slovakia
2 Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, United Kingdom
3 Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University in Bratislava, Slovakia

Aim: Empathy is a vital component of medical and nursing practice. However, research on empathy erosion among healthcare students has produced mixed findings, potentially due to measurement-related limitations. This study is the first to examine empathy erosion among Slovak medical students within the framework of trait emotional intelligence (TEI).

Design:  Quantitative, correlational-comparative, cross-sectional study.

Methods: Data were collected from 545 medical students across all six years of study (57% women; Mage = 22.3, SDage = 2.1) via an online questionnaire assessing empathy (Empathy Quotient; EQ) and trait emotional intelligence (TEIQue–SF). ANOVA was used to compare empathy and TEI across study years, followed by correlational and linear regression analyses to explore the relationships between empathy and TEI.

Results: No significant differences in empathy or TEI were observed across study years. Female students scored higher in empathy. TEI and its factors were significant predictors of EQ, explaining 14% and 36% of the variance in empathy scores, respectively.

Conclusion: The findings indicate that empathy, TEI, and its factors do not vary significantly across the demanding years of medical training. These results highlight the importance of careful selection of measurement tools when assessing psychological constructs.

Keywords: empathy erosion, empathy quotient, medical students, Trait Emotional Intelligence (TEI)

Received: April 5, 2025; Revised: August 19, 2025; Accepted: August 19, 2025; Prepublished online: September 18, 2025 

Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Abe, K., Niwa, M., Fujisaki, K., & Suzuki, Y. (2018). Associations between emotional intelligence, empathy and personality in Japanese medical students. BMC Medical Education, 18(1), 47. https://doi.org/10.1186/s12909-018-1165-7 Go to original source... Go to PubMed...
    2. Aguilar-Ferrándiz, M. E., Toledano-Moreno, S., Casas-Barragán, A., Albornoz-Cabello, M., Tapia-Haro, R. M., & Correa-Rodríguez, M. (2024). Correction: implementation of a coaching training for enhancing empathy and emotional intelligence skills in health science students: a prospective study. BMC Medical Education, 24(1), 183. https://doi.org/10.1186/s12909-024-05168-w Go to original source... Go to PubMed...
    3. Andersen, F. A., Johansen, A.-S. B., Søndergaard, J., Andersen, C. M., & Assing Hvidt, E. (2020). Revisiting the trajectory of medical students' empathy, and impact of gender, specialty preferences and nationality: a systematic review. BMC Medical Education, 20(1). 52. https://doi.org/10.1186/s12909-020-1964-5 Go to original source... Go to PubMed...
    4. American Psychological Association. (2020). Journal article reporting standards (JARS) for quantitative research in psychology: table 1. Information recommended for inclusion in manuscripts that report new data collections regardless of research design. APA. https://apastyle.apa.org/jars/quant-table-1.pdf
    5. Baron-Cohen, S., & Wheelwright, S. (2004). The empathy quotient: an investigation of adults with asperger syndrome or high functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders, 34(2), 163-175. https://doi.org/10.1023/b:jadd.0000022607.19833.00 Go to original source... Go to PubMed...
    6. Bertram, K., Randazzo, J., Alabi, N., Levenson, J., Doucette, J., & Barbosa, P. (2016). Strong correlations between empathy, emotional intelligence, and personality traits among podiatric medical students: a cross-sectional study. Education for Health, 29(3), 186-194.
    7. Brunero, S., Lamont, S., & Coates, M. (2010). A review of empathy education in nursing. Nursing Inquiry, 17(1), 65-74. https://doi.org/10.1111/j.1440-1800.2009.00482.x Go to original source... Go to PubMed...
    8. Chen, D., Lew, R., Hershman, W., & Orlander, J. (2007). A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine, 22(10), 1434-1438. https://doi.org/10.1007/s11606-007-0298-x Go to original source... Go to PubMed...
    9. Chew, B. H., Zain, A. M., & Hassan, F. (2013). Emotional intelligence and academic performance in first and final year medical students: a cross-sectional study. BMC Medical Education, 13(1), 44. https://doi.org/10.1186/1472-6920-13-44 Go to original source... Go to PubMed...
    10. Chierchia, G., & Singer, T. (2017). The neuroscience of compassion and empathy and their link to prosocial motivation and behavior. In J.-C. Dreher, & L. Tremblay (Eds.), Decision neuroscience: an integrative approach (pp. 247-257). Academic Press. https://doi.org/10.1016/B978-0-12-805308-9.00020-8 Go to original source...
    11. Christov-Moore, L., Simpson, E. A., Coudé, G., Grigaityte, K., Iacoboni, M., & Ferrari, P. F. (2014). Empathy: gender effects in brain and behavior. Neuroscience & Biobehavioral Reviews, 46(4), 604-627. https://doi.org/10.1016/j.neubiorev.2014.09.001 Go to original source... Go to PubMed...
    12. Cocker, F., & Joss, N. (2016). Compassion fatigue among healthcare, emergency and community service workers: a systematic review. International Journal of Environmental Research and Public Health, 13(6), 618. https://doi.org/10.3390/ijerph13060618 Go to original source... Go to PubMed...
    13. Cuff, B., Brown, S. J., Taylor, L., & Howat, D. (2014). Empathy: a review of the concept. Emotion Review, 8(2), 144-153. https://doi.org/10.1177/1754073914558466 Go to original source...
    14. De Hert S. (2020). Burnout in healthcare workers: prevalence, impact and preventative strategies. Local and Regional Anesthesia, 13, 171-183. https://doi.org/10.2147/LRA.S240564 Go to original source... Go to PubMed...
    15. Del Canale, S., Louis, D. Z., Maio, V., Wang, X., Rossi, G., Hojat, M., & Gonnella, J. S. (2012). The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine, 87(9), 1243-1249. https://doi.org/10.1097/ACM.0b013e3182628fbf Go to original source... Go to PubMed...
    16. Díaz-Narváez, V. P., Calzadilla-Núñez, A., López-Orellana, P., Utsman-AbarVíctorca, R., & Alonso-Palacio, L. M. (2020). Empathic decline and training in nursing students. Revista da Escola de Enfermagem da USP, 54, e03619. https://doi.org/10.1590/S1980-220X2019006803619 Go to original source... Go to PubMed...
    17. Ferri, P., Rovesti, S., Panzera, N., Marcheselli, L., Bari, A., & Di Lorenzo, R. (2017). Empathic attitudes among nursing students: a preliminary study. Acta Biomedica, 88(Suppl 3), 22-30.
    18. Gaspar, A., & Esteves, F. (2022). Empathy development from adolescence to adulthood and its consistency across targets. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.936053 Go to original source... Go to PubMed...
    19. Grühn, D., Rebucal, K., Diehl, M., Lumley, M., & Labouvie-Vief, G. (2008). Empathy across the adult lifespan: longitudinal and experience-sampling findings. Emotion, 8(6), 753-765. https://doi.org/10.1037/a0014123 Go to original source... Go to PubMed...
    20. Görgens-Ekermans, G., & Brand, T. (2012). Emotional intelligence as a moderator in the stress-burnout relationship: a questionnaire study on nurses. Journal of Clinical Nursing, 21(15-16), 2275-2285. https://doi.org/10.1111/j.1365-2702.2012.04171.x Go to original source... Go to PubMed...
    21. Herber-Valdez, C. R., Blow, J. A., Salazar, T. T., Horn, K. V., Herrera, D. G., Lacy, N. L., Beinhoff, L., & de la Rosa, J. M. (2024). The integrated curriculum and student empathy: a longitudinal multi-cohort analysis. Advances in Health Sciences Education, 29(4), 1131-1153. https://doi.org/10.1007/s10459-023-10292-1 Go to original source... Go to PubMed...
    22. 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. Academic Medicine, 84(9), 1182-1191. https://doi.org/10.1097/ACM.0b013e3181b17e55 Go to original source... Go to PubMed...
    23. Juniarta, Eka, N. G. A., & Sitanggang, Y. F. (2023). Empathy in nursing students: a scoping review. Journal of Holistic Nursing, 42(2_suppl), S59-S86. https://doi.org/10.1177/08980101231163966 Go to original source... Go to PubMed...
    24. Kaliská, L., Virostková Nabělková, E., & Salbor, V. (2015). Dotazníky črtovej emocionálnej inteligencie TEIQue-SF/TEIQue-CSF: manuál k skráteným formám [Trait Emotional Intelligence Questionnaires TEIQue-SF/TEIQue-CSF: a manual for the short forms] (1st ed.). Belianum.
    25. Karimi, L., Leggat, S. G., Bartram, T., Afshari, L., Sarkeshik, S., & Verulava, T. (2021). Emotional intelligence: predictor of employees' wellbeing, quality of patient care, and psychological empowerment. BMC Psychology, 9(1). 93. https://doi.org/10.1186/s40359-021-00593-8 Go to original source... Go to PubMed...
    26. Ledoux, K. (2015). Understanding compassion fatigue: understanding compassion. Journal of Advanced Nursing, 71(9), 2041-2050. https://doi.org/10.1111/jan.12686 Go to original source... Go to PubMed...
    27. Mattingly, V., & Kraiger, K. (2019). Can emotional intelligence be trained? A meta-analytical investigation. Human Resource Management Review, 29(2), 140-155. https://doi.org/10.1016/j.hrmr.2018.03.002 Go to original source...
    28. Mikolajczak, M., Luminet, O., & Menil, C. (2006). Predicting resistance to stress: incremental validity of trait emotional intelligence over alexithymia and optimism. Psicothema, 18, 79-88.
    29. Newton, B. W., Barber, L., Clardy, J., Cleveland, E., & OʼSullivan, P. (2008). Is there hardening of the heart during medical school? Academic Medicine, 83(3), 244-249. https://doi.org/10.1097/acm.0b013e3181637837 Go to original source... Go to PubMed...
    30. O'Boyle, E. H., Humphrey, R. H., Pollack, J. M., Hawver, T. H., & Story, P. A. (2011). The relation between emotional intelligence and job performance: a meta-analysis. Journal of Organizational Behavior, 32(5), 788-818. https://doi.org/10.1002/job.714 Go to original source...
    31. Ponnamperuma, G., Yeo, S. P., & Samarasekera, D. D. (2019). Is empathy change in medical school geo-socioculturally influenced? Medical Education, 53(7), 655-665. https://doi.org/10.1111/medu.13819 Go to original source... Go to PubMed...
    32. Petrides, K. (2011). Ability and trait emotional intelligence. In The Wiley-Blackwell handbook of individual differences (pp. 656-678). Blackwell Publishing Ltd. Go to original source...
    33. Petrides, K. V. (2009). Psychometric properties of the Trait Emotional Intelligence Questionnaire (TEIQue). In C. Stough, D. H. Saklofske, & J. D. A. Parker (Eds.), Assessing emotional intelligence: theory, research, and applications (pp. 85-101). Springer Science + Business Media. Go to original source...
    34. Petrides, K. V., & Furnham, A. (2006). The role of trait emotional intelligence in a gender-specific model of organizational variables. Journal of Applied Social Psychology, 36(2), 552-569. https://doi.org/10.1111/j.0021-9029.2006.00019.x Go to original source...
    35. R Core Team. (2021). R: a language and environment for statistical computing. R Foundation for Statistical Computing. https://www.R-project.org
    36. Sinclair, S., Beamer, K., Hack, T. F., McClement, S., Raffin Bouchal, S., Chochinov, H. M., & Hagen, N. A. (2016). Sympathy, empathy, and compassion: a grounded theory study of palliative care patients' understandings, experiences, and preferences. Palliative Medicine, 31(5), 437-447. https://doi.org/10.1177/0269216316663499 Go to original source... Go to PubMed...
    37. Strauss, C., Lever Taylor, B., Gu, J., Kuyken, W., Baer, R., Jones, F., & Cavanagh, K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clinical Psychology Review, 47(1), 15-27. https://doi.org/10.1016/j.cpr.2016.05.004 Go to original source... Go to PubMed...
    38. Tavakol, S., Dennick, R., & Tavakol, M. (2011). Empathy in UK medical students: differences by gender, medical year and specialty interest. Education for Primary Care, 22(5), 297-303. https://doi.org/10.1080/14739879.2011.11494022 Go to original source... Go to PubMed...
    39. Ward, J., Cody, J., Schaal, M., & Hojat, M. (2012). The empathy enigma: an empirical study of decline in empathy among undergraduate nursing students. Journal of Professional Nursing, 28(1), 34-40. https://doi.org/10.1016/j.profnurs.2011.10.007 Go to original source... Go to PubMed...
    40. West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: contributors, consequences, and solutions. Journal of Internal Medicine, 283(6), 516-529. https://doi.org/10.1111/joim.12752 Go to original source... Go to PubMed...
    41. World Health Organization. (n.d.). Health workforce. WHO. https://www.who.int/health-topics/health-workforce
    42. Wickham, H. (2016). ggplot2: Elegant graphics for data analysis. Springer. Go to original source...
    43. Wilkinson, H., Whittington, R., Perry, L., & Eames, C. (2017). Examining the relationship between burnout and empathy in healthcare professionals: a systematic review. Burnout Research, 6, 18-29. https://doi.org/10.1016/j.burn.2017.06.003 Go to original source... Go to PubMed...
    44. Yu, J., & Kirk, M. (2008). Measurement of empathy in nursing research: systematic review. Journal of Advanced Nursing, 64(5), 440-454. https://doi.org/10.1111/j.1365-2648.2008.04831.x Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return