The role of difficulties in emotion regulation in predicting empathy and patient-centeredness in pre-clinical medical students: a cross-sectional study

While empathy and patient-centeredness (PC) are considered core variables in high-quality healthcare education and care, research suggests that empathy and PC decrease during the clinical years of study and that impairments in empathy and PC may be related to difficulties in emotion regulation. There is a growing interest in identifying the psycho-social variables that sustain and foster empathy and PC in medical students throughout their education. This study explored whether and to what extent emotion dysregulation predicted empathy and PC in medical students controlling for gender. Three hundred ninety-eight pre-clinical medical students enrolled at a university in northern Italy completed the Difficulties in Emotion Regulation Scale (DERS), the Interpersonal Reactivity Index (IRI) and the Patient-Practitioner Orientation Scale - 8 Items - Italian version (PPOS-8-IT). All statistically significant correlation coefficients between DERS, IRI and PPOS-8-IT scores were negative (rs from -.130 to -.336, ps ≤ 01), except for IRI Personal Distress and IRI Fantasy Scale that were mainly positively related to DERS scores (rs from .130 to .305, ps ≤ .01). Hierarchical multiple-regression analyses showed that DERS scores accounted for a significant amount of additional variance in both IRI and PPOS-8-IT components above and beyond gender. Emotion dysregulation was positively associated with Personal Distress (βs from .135 to .250, ps ≤ .007), whereas Empathic Concern, Perspective Taking, and the PC components were negatively predicted by emotion regulation difficulties (βs from -.131 to -.309, ps ≤ .005). Female students showed higher levels of all empathy and PC measures than males (ts from -3.49 to -5.54, ps ≤ 001) except for Perspective Taking. Tailored educational approaches that provide medical students with emotion regulation strategies implemented along the pre-clinical curriculum may sustain empathy and PC and equip students to appropriately and functionally face the emotional and interpersonal aspects of the clinical internship experience.