Hierarchy hurts: a comparative cross-sectional analysis of empathy and its determinants in medical, midwifery, and nursing students

Abstract

Background: Empathy plays a crucial role in healthcare, affecting both patient outcomes and provider well-being. Despite its importance, the adaptive nature of empathy remains not fully understood, making it challenging for educational institutions to effectively teach it. This study addresses this gap by investigating two key questions: What is the relationship between social dominance orientation and empathy among students in medicine, nursing, and midwifery? And, what individual factors – including personality traits, sociodemographic background, and self-perceived empathy – are associated with variations in empathy across these student groups?

Methods: This cross-sectional study, conducted in April 2023 at Martin Luther University Halle-Wittenberg, Germany, examined empathy among medical, BSc Midwifery, BSc Nursing, and MSc Health and Nursing Sciences students, aiming to identify its determinants, considering personality traits, socio-economic background, and elitist attitudes. The survey included the Jefferson Scale of Empathy for Health Profession Students (JSE-HPS), NEO-Five-Factor-Inventory (NEO-FFI-30), Narcissistic Personality Inventory (NPI-15), the Short Scale on Social Dominance Orientation (KSDO-3), and the MacArthur Scale. The authors analyzed the data using multiple linear regression models, controlling for relevant confounders.

Results: A total of 252 students participated in the survey, including 173 medical, 35 BSc Midwifery, 24 BSc Nursing, and 20 MSc Health and Nursing Sciences students. Empathy levels varied between disciplines, with BSc Midwifery students exhibiting the highest scores (114.83, 95%-CI = 111.77; 117.88), and BSc Nursing students the lowest (106.25, 95%-CI = 103.1; 109.4). Multiple regression analysis revealed that empathy was positively associated with Openness (β = 2.68, 95%-CI = 1.16; 4.19), Agreeableness (β = 6.01, 95%-CI = 3.9; 8.12), and having children (β = 5.02, 95%-CI = 0.25; 9.79). Conversely, students with non-medical training prior to university (β = -9.86, 95%-CI = -16.84; -2.88) and higher Social Dominance Orientation (β = -0.64, 95%-CI = -1.11; -0.16) showed lower empathy scores.

Conclusions: In addition to confirming previous findings, this study is, to the best of our knowledge, the first to investigate Social Dominance Orientation in the context of healthcare students’ empathy and describe its negative association. The findings suggest that addressing hierarchical attitudes in empathy education could positively impact healthcare delivery.

Trial registration: This was not undertaken as the research did not involve a health care intervention on human participants.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12909-025-07683-w.

Keywords: Elitism; Empathy; Medical students; Midwifery students; Nursing students; Personality.

Fig. 1

Relationship between Social Dominance Orientation and Empathy among Healthcare Students. Figure 1. Scatter plot showing the relationship between Social Dominance Orientation (SDO) and Empathy (JSE-HPS) among healthcare students. The data was collected from 252 healthcare students from Martin-Luther-University Halle-Wittenberg in April 2023. Each dot represents the SDO score plotted against the corresponding empathy score for an individual student. A slight negative linear relationship is observed, as indicated by the trendline (y = -1.1078x + 119.27). The results suggest that as Social Dominance Orientation increases, empathy scores tend to decrease slightly among this sample of healthcare students