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Sathaporn et al.
Katti Sathaporn, M.D., Jarurin Pitanupong, M.D.
Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, ailand.
The Relationship between Mental Health with
the Level of Empathy Among Medical Students in
Southern Thailand: A University-Based Cross-
Sectional Study
ABSTRACT
Objective: To determine the level of and factors associated with empathy among medical students.
Materials and Methods: is cross-sectional study surveyed all rst- to sixth-year medical students at the Faculty
of Medicines, Prince of Songkla University, at the end of the 2020 academic year. e questionnaires consisted of:
1) e personal and demographic information questionnaire, 2) e Toronto Empathy Questionnaire, and 3) ai
Mental Health Indicator-15. Data were analyzed using descriptive statistics, and factors associated with empathy
level were assessed via chi-square and logistic regression analyses.
Results: ere were 1010 participants with response rate of 94%. Most of them were female (59%). More than half
(54.9%) reported a high level of empathy. ere was a statistically signicant dierence in empathy levels between
pre-clinical and clinical medical students; in regards to empathy subgroups (P-value < 0.001). e assessment of
emotional states in others by demonstrating appropriate sensitivity behavior, altruism, and empathic responding
scores among the pre-clinical group were higher than those of the clinical group. Multivariate analysis indicated
that female gender, pre-clinical training level, and minor specialty preference were factors associated with empathy
level. e protective factor that signicantly improved the level of empathy was having fair to good mental health.
Conclusion: More than half of the surveyed medical students reported a high level of empathy. e protective factor
that improved the level of empathy was good mental health. However, future qualitative methods, longitudinal
surveillance, or long-term follow-up designs are required to ensure the trustworthiness of these ndings.
Keywords: Empathy; factor; mental health; medical student (Siriraj Med J 2021; 73: 832-840)
Corresponding author: Jarurin Pitanupong
E-mail: pjarurin@medicine.psu.ac.th
Received 17 June 2021 Revised 17 August 2021 Accepted 30 August 2021
ORCID: https://orcid.org/0000-0001-9312-9775
http://dx.doi.org/10.33192/Smj.2021.108
INTRODUCTION
Empathy is the ability to feel or understand what
another person is experiencing from within their frame of
reference. It is the capability to place oneself in another’s
view. In the past, empathy was initially thought of as a
unitary ability; thus, it was considered to consist of two
components: a cognitive capacity that simplies the
meaning of the emotions of another person, an emotional
aptitude that interprets the experience of the emotions
of another person,
1
or both concurrently.
2,3
In recent
studies, empathy has been dened as being underpinned
by three components: emotional contagion, emotional
disconnection, and cognitive empathy.
4,5
However, empathy is an emotional experience
between a spectator and a subject in which the spectator,
based on auditory and visual clues, recognizes and
temporarily perceives the subject’s emotional condition.
6
To be acknowledged as empathic, the spectator must
communicate this purport to the subject. During the
beginning aspect of this stage, the spectator must not
only recognize but also comprehend the bottom of the
subject’s emotions. Although, usually confounded with
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each other, sympathy and empathy are dierent. Sympathy
is a position of emotional attentive, while empathy reects
emotional comprehension or the capability to recognize
another person’s emotional condition.
7,8
roughout medical school, the importance of
empathy should be emphasized, because a successful
treatment depends on an eective patient-physician
interaction; of which empathy is a critical component.
e physician who comprehends their patient on a personal
status stands a better chance of perceiving and conducting
empathy as well as healing said patient eciently than the
physician who does not have this level of comprehension.
9
It is considered that physicians should have eective
communication skills that enable them to communicate
their actual feelings or experiences to patients. Physicians
who are poor communicators and cannot manifest their
feelings properly are more prone to being misunderstood
by patients and people around them. Even though some
physicians cannot empathize properly, they may still be
able to create a suitable reaction, because they understand
how they should respond in given situations, and may
possess excellent communication skills.
10,11
Besides this,
the goal of medicine is not to simply cure the disease,
but rather to treat the patient in a holistic sense by
alleviating suering of any kind; therefore, empathy is
a key component of a physician’s clinical skills.
12
When
patients perceive that the physician understands their
conditions, they may feel more content and willing to
conde in the physician. e process of telling one’s
story can be therapeutic
13
and may also simplify the
healing process.
14,15
Finally, empathy is advantageous
to physicians as well; it reects that they can attune to
the psychosocial aspects of their patients.
16
Even though empathy is very important for a good
physician-patient relationship, previous studies have
suggested that the empathy level may decline as medical
students go through clinical training. It has, therefore,
been proposed that the course of medical education or
clinical training may impact empathy among medical
trainees negatively.
17
Furthermore, it is a challenge for
medical educators to ensure that empathy becomes a
prominent component of medical professionalism.
The Division of Medical Education, Faculty of
Medicine, Prince of Songkla University proposes nine core
competencies for medical graduates. According to these
competencies, empathy is one constituent of professional
habits, communication, and interpersonal skills.
18,19
A
prior study identied that most medical students at the
Faculty of Medicine, Prince of Songkla University used
adaptive coping strategies,
20
and when they were medical
doctors, who worked at hospitals either in the restive or
non-restive areas of the Southern ailand insurgency,
most of them were at normal levels of resilience.
21
However,
limited data concerning empathy levels are available.
In ailand, only one study on empathy levels among
medical students has been conducted in the past nine
years (2012). It found that female medical students at the
pre-clinical level had higher empathy scores than their
male counterparts that were undergoing clinical-level
training.
22
erefore, it was deemed both interesting and
helpful to study the level of empathy, and its associating
factors among ai medical students. is study provides
useful information for the establishment of educational
programs in the medical curriculum geared at enhancing
medical professionalism among medical school graduates.
MATERIALS AND METHODS
Aer approval from e Human Research Ethics
Committee of the Faculty of Medicine, Prince of Songkla
University (REC: 63-456-3-4), this cross-sectional study
surveyed all the rst- to sixth-year medical students enrolled
at the Faculty of Medicines, Prince of Songkla University,
including the Hat Yai Hospital Medical Education Center
and the Yala Hospital Medical Education Center, at the
end of the 2020 academic year. ere were 1075 medical
students, who were categorized by academic year as
follows: 192 1
st
-year, 190 2
nd
-year, 184 3
rd
-year, 174 4
th
-
year, 181 5
th
-year, and 154 6
th
-year medical students. To be
included, one had to meet the criteria of being a medical
student, aged no less than 18 years and completing all
the questionnaires in full. Meanwhile, those who were
foreign students, who declined to participate, or decided
to withdraw from the study were excluded.
Data collection
e data were collected as follows. e research assistant
approached all the medical students in class and handed
them an information sheet, which described the rationale
for the study and the allotted time to complete the survey.
ey had at least 10-15 minutes to consider whether to
join in the study or not. If they wished to participate, the
research assistant distributed the questionnaires. Adhering
to the policy of strict condentiality, the signatures of the
participants were not required, and they were informed
that they retained the right to withdraw from the research
at any time without having to provide any explanation
or reason for doing so. All participants were allowed to
nish, and return the questionnaires immediately or at
a later time. ey could submit the questionnaires via
two options drop them in the case at the front of the
classroom, or return and place them in the case located
at the Psychiatry Department, protecting respondent
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Sathaporn et al.
condentiality was retained. Furthermore, the data were
stored securely, and only the researcher could access
them via a password.
Instruments
1) The personal and demographic information
questionnaire consisted of questions related to age,
gender, religion, hometown, income, cumulative GPA,
medical school, history of substance use, physical or
psychiatric illness, and specialty preference.
2) e Toronto Empathy Questionnaire (TEQ),
which was used to evaluate empathy, consisted of 16
questions and employed a 5-point rating scale for each
question. e item responses were scored according to
the following scale for positively worded items: 0 (never),
1 (rarely), 2 (sometimes), 3 (oen), and 4 (always). e
same scale was used to reverse score negatively worded
items. e scores of all 16 questions were summed,
and they ranged from 0 to 64. Higher scores indicated
high levels of self-reported empathy, while total scores
below 45 were indicative of below-average empathy
levels. e Cronbach’s alpha coecient for this tool
was 0.85. Additionally, empathy was divided into six
subgroups; perception of an emotional state in another
that stimulates the same emotion in oneself; assessment
of emotion comprehension in others; assessment of
emotional states in others by indexing the frequency
of behaviors demonstrating appropriate sensitivity;
sympathetic physiological arousal; altruism; behaviors
engaging higher-order empathic responding, such as
pro-social helping behavior.
23
3) e ai Mental Health Indicator-15 (TMHI-15)
consisted of 15 questions. e score of each question
ranged from 1 to 4. e following scale was used to
reverse score negatively worded items. e scores of all
15 questions were summed, and the total scores, which
ranged from 15 to 60, were categorized as follows: less
than 43 (poor mental health), 44-50 (fair mental health),
and 51-60 (good mental health). e Cronbach’s alpha
coecient for this tool was 0.7.
24
Statistical analysis
Descriptive statistics; such as proportion, mean, and
standard deviation (SD), or medians and inter-quartile
ranges (IQR) were calculated. Bivariate and multivariate
analyses using logistic regressions were employed to
identify the association with level of empathy. e analyses
were conducted using R version 3.4.1 (R Foundation
for Statistical Computing). Statistical signicance was
dened as a p-value of less than 0.05.
RESULTS
Demographic characteristics
One thousand and ten rst- to sixth-year medical
students completed the questionnaires, from the total
of 1075 students, who were approached; the response
rate was 94%. e majority of them were female (59%),
Buddhist (79.1%), and the accumulative GPA was 3.4
(3.1-3.6) (Table 1). Overall, the median age (IQR) was
21 years (20-23), and the income per month was 9,000
baht (6,500-10,000). No statistically signicant dierences
in demographic data (gender, religion, and physical
illnesses) between the pre-clinical and clinical groups
of medical students were detected.
Empathy level
Using the Toronto Empathy Questionnaire, 554
participants (54.9%) reported a high level of empathy
(Table 1). e median TEQ score (IQR) of all participants
was 45 (41-49.7). The median TEQ scores (IQR) of
the pre-clinical and clinical student groups were 49
(45.8-52) and 46 (42.2-50), respectively. Of the six TEQ
subgroups, the assessment of emotion comprehension
in others, behaviors engaging higher-order empathic
responding, and altruism had the highest median scores
(IQR) (3 (2-3), 3 (2-3), and 3 (2.7-3.7), respectively),
whereas perception of an emotional state in another
that stimulates the same emotion in oneself exhibited
the lowest score (IQR) [2.5 (2-3)] (Table 2).
A statistically signicant dierence in the level of
empathy, in terms of subgroups between the groups,
was observed (P-value <0.001) (Table 1). Among the
pre-clinical medical students, the empathy subgroups
of assessment of emotional states in others by indexing
the frequency of behaviors demonstrating appropriate
sensitivity, behaviors engaging higher-order empathic
responding, and altruism had higher scores than among
those studying at the clinical level (Table 2).
Mental health
Using the ai Mental Health Indicator-15 (TMHI-
15), most participants reported fair to good mental health
(51.2% and 27.4%, respectively), and only 216 (21.4%)
respondents had poor mental health (Table 1). ere
was a statistically signicant dierence in mental health
between the pre-clinical and clinical groups of medical
students (P-value <0.001).
Concerning perceived stress, 920 (91.1%) participants
reported having experienced stress within the previous
year. e most common stresses were academic course
work and examinations (92%), learning environment
(38.9%), and living with friends (29.7%).
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TABLE 1. Demographic characteristics, mental health, and level of empathy between two groups of medical students.
Group N (%)
Variables
Total
Pre-clinical Clinical
Chi
2
(n=1010)
(n=544) (n=466)
P-value
Gender 0.103
Male 409 (40.5) 207 (38.3) 202 (43.5)
Female 596 (59.0) 334 (61.7) 262 (56.5)
No answer 5 (0.5)
Religion 0.569
Buddhism 799 (79.1) 433 (83.8) 366 (85.3)
Other (Islam, Christianity, other) 147 (14.6) 84 (16.2) 63 (14.7)
No answer 64 (6.3)
GPA: median (IQR) 3.4 (3.1-3.6) 3.6 (3.3-3.8) 3.3 (3.0-3.5) <0.001
a
Home province <0.001
Southern Region 905 (89.6) 471 (87.1) 434 (93.7)
Other 99 (9.8) 70 (12.9) 29 (6.3)
No answer 6 (0.6)
Physical illness 0.322
No 844 (83.6) 448 (82.7) 396 (85.2)
Yes 163 (16.1) 94 (17.3) 69 (14.8)
No answer 3 (0.3)
Psychiatric illness <0.001
No 947 (93.8) 527 (97.1) 420 (91.1)
Yes 57 (5.6) 16 (2.9) 41 (8.9)
No answer 6 (0.6)
Alcohol consumption 0.058
No 703 (69.6) 392 (72.7) 311 (67)
Yes 300 (29.7) 147 (27.3) 153 (33)
No answer 7 (0.7)
Substance use 1
No 999 (98.9) 540 (99.4) 459 (99.4)
Yes 6 (0.6) 3 (0.6) 3 (0.6)
No answer 5 (0.5)
Specialty preference <0.001
General / not specied 270 (26.7) 112 (20.6) 158 (33.9)
Major 491 (48.6) 291 (53.5) 200 (42.9)
Minor 249 (24.7) 141 (25.9) 108 (23.2)
Mental health <0.001
Poor 216 (21.4) 78 (14.3) 138 (29.6)
Fair 517 (51.2) 280 (51.5) 237 (50.9)
Good 277 (27.4) 186 (34.2) 91 (19.5)
Level of empathy <0.001
<45 456 (45.1) 190 (34.9) 266 (57.1)
≥45 554 (54.9) 354 (65.1) 200 (42.9)
Note: a = P-value from rank sum test
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TABLE 2. Subgroups of empathy.
Median (IQR)
Domain of empathy Total Pre-clinical Clinical
(n=1010) (n=544) (n=466)
Perception of an emotional state in another that 2.5 (2.0-3.0) 2.5 (2.5-3.0) 2.5 (2.0-3.0)
stimulates the same emotion in oneself
Assessment of emotion comprehension in others 3.0 (2.0-3.0) 3.0 (2.0-3.0) 3.0 (2.0-3.0)
Assessment of emotional states in others by
indexing the frequency of behaviors demonstrating 2.8 (2.4-3.2) 3.0 (2.6-3.2) 2.6 (2.4-3.0)
appropriate sensitivity
Sympathetic physiological arousal 2.7 (2.5-3.0) 2.8 (2.5-3.2) 2.8 (2.5-3.0)
Altruism 3.0 (2.7-3.7) 3.3 (3.0-3.7) 3.0 (2.7-3.3)
Behaviors engaging higher-order empathic responding 3.0 (2.0-3.0) 3.0 (2.0-3.0) 2.0 (2.0-3.0)
such as pro-social helping behavior
e association of demographic characteristics and
mental health with level of empathy
To identify factors associated with the level of
empathy, demographic characteristics, and mental health
were included in the multivariate analysis. Variables
with p-values of less than 0.2 from the bivariate analysis
were included in the initial model of the multivariate
analysis (Table 3). e multivariate analysis indicated
that females and pre-clinical level students had a higher
level of empathy than their male and clinical-level
counterparts [odds ratio 1.8 (1.36, 2.37) and 1.97 (1.49,
2.59), respectively]. Additionally, medical students who
preferred minor specialties had a higher level of empathy
than those who preferred pursuing general medicine,
[odds ratio 1.87 (1.27, 2.74)] (Table 4). e same was
true when comparing them with those who preferred
major specialties [odds ratio 1.48 (1.05, 2.1)]. A protective
factor that signicantly improved the level of empathy
was having fair to good mental health.
DISCUSSION
is study found that more than half of our medical
students (54.9%) reported a high level of empathy.
However, being female, pre-clinical level medical students,
and preferring minor specialties were associated with
having a higher level of empathy than being male, a
clinical-level student, and preferring general medicine
or major specialties. In addition, having fair to good
mental health was found to be a protective factor that
statistically signicantly improved the level of empathy
of our respondents. Comparing the level of empathy
discovered by our study with those reported by previous
studies, ours was similar to those of studies conducted
in ailand and the United States
22,25
as well as to that
of another recent systematic review of studies, which
also suggested that empathy level worsens distinctly
throughout medical school. e explication for this
might point to the clinical practice phase of training,
and the hardship generated by aspects of the “hidden,”
“formal,” and “informal” curricula as the principal causes
for the downfall in empathy level.
26
Since, according to this study’s results, most participants
(91.1%) reported having stress during the previous year and
identied medical courses or examinations (92%) as well as
learning environment (38.9%) as the most common causes
of stress, it might be plausible that medical education or
clinical training impacts empathy negatively.
17
Although
the deterioration in empathy is mainly observed as a
valid research nding,
27-29
previous systematic reviews
of studies on empathy have highlighted the diversity of
measurements available to survey empathy as well as the
point that correlations between self-reported and observed
empathy might be dierent. Hence, disagreements remain
concerning the validity of self-report questionnaires as a
precise measure of empathy results.
30,31
erefore, future
in-depth studies with a qualitative research design are
required in order to ensure the trustworthiness of the
ndings.
Empathy comprises of the cognitive, aective or
emotional domain. e cognitive domain refers to ‘the
capacity to comprehend the patient’s inner experience
and viewpoint, and an ability to communicate this
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TABLE 3. Bivariate analysis of level of empathy.
Level of empathy N (%)
Variables
Total N (%)
<45 ≥45
Chi
2
(n=1010)
(n=456) (n=554)
P-value
Gender <0.001
Male 409 (40.5) 219 (48.2) 190 (34.5)
Female 596 (59.0) 235 (51.8) 361 (65.5)
No answer 5 (0.5)
Medical training level < 0.001
Pre-clinical 544 (53.9) 190 (41.7) 354 (63.9)
Clinical 466 (46.1) 266 (58.3) 200 (36.1)
Religion 1
Buddhism 799 (79.1) 359 (84.5) 440 (84.5)
Others (Islam, Christ, others) 147 (14.6) 66 (15.5) 81 (15.5)
No answer 64 (6.3)
GPA : median (IQR) 3.4 (3.1-3.6) 3.4 (3.0-3.6) 3.4 (3.1-3.7) 0.284
a
Home province 0.09
South 905 (89.6) 415 (92) 490 (88.6)
Others 99 (9.8) 36 (8) 63 (11.4)
No answer 6 (0.6)
Physical illness 0.733
No 844 (83.6) 383 (84.4) 461 (83.4)
Yes 163 (16.1) 71 (15.6) 92 (16.6)
No answer 3 (0.3)
Psychiatric illness 0.574
No 947 (93.8) 427 (94.9) 520 (93.9)
Yes 57 (5.6) 23 (5.1) 34 (6.1)
No answer 6 (0.6)
Alcohol consumption 0.262
No 703 (69.6) 324 (72) 379 (68.5)
Yes 300 (29.7) 126 (28) 174 (31.5)
No answer 7 (0.7)
Substance use 1
No 999 (98.9) 450 (99.3) 549 (99.5)
Yes 6 (0.6) 3 (0.7) 3 (0.5)
No answer 5 (0.5)
Specialty preference <0.001
General / not specied 270 (26.7) 154 (33.8) 116 (20.9)
Major 491 (48.6) 209 (45.8) 282 (50.9)
Minor 249 (24.7) 93 (20.4) 156 (28.2)
Mental health <0.001
Poor 216 (21.4) 151 (33.1) 65 (11.7)
Fair 517 (51.2) 249 (54.6) 268 (48.4)
Good 277 (27.4) 56 (12.3) 221 (39.9)
Note: a = P-value from rank sum test
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TABLE 4. Factors associated with high level of empathy.
Factors
Crude OR Adjusted OR P-value
(95% CI) (95% CI) LR-test
Gender <0.001
Male Reference Reference
Female 1.77 (1.37, 2.28) 1.8 (1.36, 2.37)
Medical training level <0.001
Clinical Reference Reference
Pre-clinical 2.52 (1.95, 3.26) 1.97 (1.49, 2.59)
Specialty preference 0.005
General/ not specied Reference Reference
Major 1.78 (1.31, 2.4) 1.26 (0.9, 1.75)
Minor 2.20 (1.55, 3.13) 1.87 (1.27, 2.74)
Mental health <0.001
Poor Reference Reference
Fair 2.46 (1.75, 3.45) 2.17 (1.53, 3.09)
Good 9.27 (6.13, 14.04) 7.92 (5.14, 12.2)
comprehension’,
32
whereas, the aective domain refers
to ‘the capacity to conceive the patient’s emotions and
aspects’.
33
Concerning the empathy subgroups, this study
showed that assessment of emotional states in others by
indexing behaviors demonstrating appropriate sensitivity,
behaviors engaging higher-order empathic responding,
e.g., pro-social helping behavior, and altruism declined
when the medical students progressed to clinical-level
training. is might signify that most of our medical
students can comprehend the patient’s inner experience
as well as conceive the patient’s feelings or aspects, but
they might lack the ability to express their empathy
toward others, or that their empathy might decline with
medical training. Moreover, this study identied that
being female was associated with having a higher level
of empathy than being male. erefore, in clinical-level
training, medical students; especially the male group,
should be instructed to express empathy, which builds
patient trust, calmness, and leads to increased patient
gratication. is point should be a signicant concern
to medical educators.
It is widely accepted that eective articulation or good
communication skills on the part of physicians should
enable them to convey their actual feelings or experiences
to patients. Physicians who are poor communicators
and do not express their feelings properly might be
misapprehended by patients and people close to them.
10
erefore, many studies have tried to create a variety
of types of intervention aiming to promote empathy
competency, by employing patient narrative and creative
arts, writing, drama, and communication skills training.
34
e patient narrative and creative arts interventions
were based around the patient narrative and creative
arts; such as imaginative composition, lyric, poem,
fable, novel, and motion picture. Such interventions
t primarily into the aective dimension of empathy.
35
Regarding writing interventions, studies have used
various genres of writing to heighten empathy with
the rationale that agendas that substantiate humanistic
behavior might conduce towards the medical students’
continuance of empathy.
36
Drama interventions, using
drama to teach empathy, have undertaking the task
of training students “how to act-in-role.” e means
employed communication seminars directing the cognitive
dimension, the exercises in such studies concentrated
upon building the participants’ acting skills as a way to
heighten their capacity to impersonate empathy, and were
found to be successful in signicantly increasing their
level of empathy.
37
Finally, concerning communication
skills training interventions, the use of communication
skills training as an intervention reected the authors’
preference for the cognitive dimension of empathy. In
such studies, communication skills training consisted
of role-play and small-group interactive training.
38-40
Moreover, ndings from previous have suggested that
medical curriculums could be successful in heightening
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and keeping up empathy in medical students. Continuing
to achieve such strategies would help to further clarify
best practices, and more precise studies, particularly,
large-scale and suitably controlled longitudinal research,
is required to instruct recommendations for medical
education. Moving forward, medical education academics
and investigators should consider addressing the widely
reported phenomenon of the deterioration in empathy
among medical students by focusing on psychological factors;
such as, exhaustion and stress, the “hidden curriculum”,
uncertain study setting, loss of enthusiasm, and the
perceived need for detachment. Noteworthy, is also the
need to highlight the prominence of role models and the
reciprocal nature of empathy improvement in training;
this suggests that “Indeed, perhaps students need to obtain
more empathy from their faculty, other physicians, and
even their patients before they can comprehend how to
establish empathic connections”.
41
Additionally, mental health includes having
healthy self-esteem, being satised with life, feeling
secure, having the sense of ‘appointment in life,’ being
condent in emotional control, being empathetic and
happy when helping others, and acknowledging or
accepting problems that are dicult to solve.
24
is
study indicated that good mental health was a protective
factor that signicantly improved the level of empathy.
us, medical educators should consider practicing
relationship-centered care, promoting good mental
health, preventing the negative impacts of stress, fatigue,
burnout, poor sleep quality,
42
and identifying the hidden
curricula or mistreatment suered by medical students
43
as the fundamental building blocks medical of education.
is could help foster the creation and powerful expression
of empathy, which builds patient trust, calmness anxiety,
leads to fewer mistakes, increases patient satisfaction,
and improves health outcomes.
Strengths and limitations
is study had a few noteworthy strengths and
limitations. To our knowledge, this is the rst study with
a high response rate (94.0%) that explored the level of
empathy and mental health as well as factors associated
with empathy among ai medical students. However, it
was a cross-sectional survey, lacked baseline measurements
and long-term follow-up, as well as which it utilized self-
administered questionnaires. Some misunderstandings
regarding the intended meaning of the questions might have
occurred. Nevertheless, to minimize this, questionnaires
with good reliability were utilized (good Cronbach’s
alpha coecient values). Other drawbacks were that
our data were quantitative, and the sample size was
limited to medical students enrolled at only one faculty
of medicine. Hence, this dataset may not fairly represent
the situation of all ai medical students in the faculties
of medicine countrywide.
Henceforward, studies are recommended to include
all medical students from all faculties of medicine in
ailand. In other words, a comprehensive multi-center
study should be conducted. Moreover, future research
should concentrate upon the denite attributes that
inspire a student to be more responsive to dierent
interventions, utilize more qualitative designs, employ
longitudinal surveillance or long-term follow-up, and
include control groups.
CONCLUSION
More than half of the surveyed medical students
reported a high level of empathy. ose who were female,
in the pre-clinical level of studies, and preferred a minor
specialty had a higher empathy level than those who were
male, studying at the clinical level, and preferred general
medicine specialties. e protective factor that improved
the level of empathy was good mental health. However,
future qualitative methods, longitudinal surveillance,
or long-term follow-up designs focusing on medical
students’ empathy are to ensure the trustworthiness of
these ndings.
ACKNOWLEDGMENTS
is project was endorsed by the Human Research
Ethics Committee, and fully funded by the Faculty of
Medicine, Prince of Songkla University (REC: 63-456-
3-4). e authors gratefully acknowledge the invaluable
contributions of the Student Aairs Division, Undergraduate
Education Division, and Medical Education Division of
the Faculty of Medicine, Prince of Songkla University
as well as of Ms. Kruewan Jongborwanwiwat and Mrs.
Nisan Werachattawanand regarding the collection of
data and statistical analysis. Moreover, we genuinely
appreciate the Department of International Affairs,
Faculty of Medicine, Prince of Songkla University for
their assistance in editing the manuscript.
Conict of interest: e authors declare no conict of
interest.
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