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The Gratitude Mediates the Relationship Between Self-Esteem and Empathy Among Medical Students


 Background: One of the important parts of medical students' competence is empathy, which is believed to significantly influence patient satisfaction, clinical outcomes, and the sense of professional fulfillment. Objective: This study explored the potential mediating effect of gratitude on the relationship between self-esteem, cognitive empathy, and affective empathy, which may provide fundamental data for educational programs aiming to promote cognitive empathy and affective empathy. Design: The paper surveyed a total of 344 medical students with the Self-Esteem Scale, Gratitude Questionnaire-6, and the Chinese version of the Interpersonal Reactivity Index Scale. It uses descriptive analysis to determine the levels of self-esteem, gratitude, and empathy, and Pearson’s correlation to analyze correlations between them. It also conducts the pathway analysis with the equipment of structured equation modeling to test the mediating effect of gratitude on the association between self-esteem and empathy. Results: A total of 306 (88.95%) medical students completed the survey. It finds that, first, the levels of self-esteem, gratitude, cognitive empathy, and affective empathy are significantly correlated. Second, self-esteem has a direct, positive effect on cognitive empathy and affective empathy. Third, gratitude has a mediating role between self-esteem, cognitive empathy [b self-esteem - gratitude - cognitive empathy = 0.072, 95% CI = (0.013 to 0.131), p< 0.05], and affective empathy [bself-esteem - gratitude - affective empathy = 0.241, 95% CI = (0.018 to 0.134), p< 0.001]. Conclusion: Based on the role of self-esteem and gratitude in predicting cognitive empathy and affective empathy, this model can be used in the practice of clinical education to promote cognitive empathy and affective empathy in medical students.