Empathy and Motivations to study Medicine in University Students from Lima and Province

Empathy and Motivations to study Medicine in University Students from Lima and Province Item Type info:eu-repo/semantics/article Authors Acevedo-Flores, Jessica; Salgado-Lévano, Cecilia; VallejosMamani, Elizabeth Beatriz; Pulido Capurro, Victor DOI 10.19083/ridu.2025.2036 Publisher Universidad Peruana de Ciencias Aplicadas Journal Revista Digital De Investigacion En Docencia Universitaria Rights info:eu-repo/semantics/openAccess; Attribution 4.0 International Download date 04/11/2025 01:55:39 Item License http://creativecommons.org/licenses/by/4.0/ Link to Item http://hdl.handle.net/10757/686658 Empathy and Motivations to study Medicine in University Students from Lima and Province Jessica Acevedo-Flores1; Cecilia Salgado-Lévano 2; Elizabeth Beatriz Vallejos-Mamani3; Victor Pulido Capurro4 1Universidad Privada San Juan Bautista, Professional School of Human Medicine, Ica. https://orcid.org/0000-0002-0050-7886 [email protected], 2Universidad Marcelino Champagnat, Lima, Perú. https://orcid.org/0000-0002-5628-2794 [email protected], 3Pontificia Universidad Católica del Perú, Universidad Peruana de Ciencias Aplicadas, Lima, Perú. https://orcid.org/0000-0002-8022-4703 [email protected], 4Universidad Privada San Juan Bautista, Professional School of Human Medicine, Lima, Perú. https://orcid.org/0000-0002-9238-5387 [email protected] Citar como: Acevedo-Flores, J., Salgado-Lévano, C., Vallejos-Mamani, E. B., & Pulido Capurro, V. (2025). Empathy and Motivations to study Medicine in University Students from Lima and Province. Revista Digital de Investigación en Docencia Universitaria, 19(1), e2036. https://doi.org/10.19083/ridu.2025.2036 Received: 06/12/2024. Revised: 18/01/2025. Published: 20/03/2025. Abstract Introduction: Empathy and motivations to study Medicine are important for the performance of the future doctor and for the quality of service provided. Objective: To establish the relationship between empathy and the social/altruistic and economic/prestige domains of the motivations to study medicine in university students of three Peruvian cities; also, to compare the correlations of the variables according to the sex of the students. Methods: Cross-sectional correlational design. The sample was made up of 249 students of both sexes, 166 women and 83 men, between the ages of 17 and 27, who were studying from the first to the seventh year of Medicine at a private university based in three Peruvian cities (Lima and Province). The instruments used were the Cognitive and Affective Empathy Test and the Motivations Scale to study Medicine. Results: The association between Altruistic Social Dominance (ASD) with Perspective Adoption (AP) and Empathic Joy (EA) was direct and significant for both groups, of medium intensity for women and strong for men. Furthermore, the association between DSA and Emotional Understanding (EC) was also direct and significant for both groups, with a strong intensity in the male group. Finally, the Prestige Economic Domain (DEP) presented significant positive associations of medium intensity with PA, CE and EA in men. Discussion: There are differences in the relationships established between the motivation to study medicine and empathy, according to sex. Male students present a more direct connection between their sense of service to others, achieving professional prestige, and their ability to understand and respond to the emotions of others, unlike women. Keywords: empathy; medical students; medicine; motivation; private university. Empatía y motivaciones para estudiar Medicina en universitarios de Lima y Provincia Resumen Introducción: La empatía y las motivaciones para estudiar Medicina son importantes para el desempeño del futuro médico y para la calidad de servicio que brinda. Objetivo: Establecer la relación entre la empatía y los dominios social/altruista y económico/ *Correspondence: Jessica Acevedo-Flores [email protected] Revista Digital de Investigación en Docencia Universitaria, 19(1) e-ISSN: 2223-2516 © Universidad Peruana de Ciencias Aplicadas https://doi.org/10.19083/ridu.2025.2036 Empathy and Motivations to study Medicine in University Students from Lima and Province Revista Digital de Investigación en Docencia Universitaria 2025, 19(1) 2 it becomes fundamental to build and develop a functional patient physician relationship (Ardenghi et al., 2024). Empathy is studied from different approaches, the cognitive being one of them, which prioritizes the cognitive processes developed by the observer in an effort to understand the others through the mental construction of the role they play (Hojat, 2020). In contrast, the affective approach conceives empathy as the emotional response of individuals in accordance with the emotional state of the observed person (Hojat, 2023). This response is considered vicarious, allowing sharing one’s feelings and exposure to those of others (Moreto et al., 2021). However, in recent years, both approaches have been articulated in an integrative view of empathy, defining it as a multidimensional process that involves cognitive and affective components of understanding and identification with the thoughts, feelings, and emotional states of others (Batson, 2011; Gibbons, 2011). In this line, this study has considered the multidimensional theoretical model framed within the integrative approach, consisting of two dimensions—cognitive and affective—and their respective components or subscales (LópezPérez et al., 2008). In the healthcare context, empathy can facilitate the doctor-patient bond, which can prestigio de las motivaciones para estudiar Medicina en estudiantes universitarios de tres ciudades peruanas; además, comparar las correlaciones entre las variables según el sexo de los estudiantes. Métodos: Diseño transversal correlacional. La muestra estuvo conformada por 249 estudiantes de ambos sexos, 166 mujeres y 83 varones, con edades entre 17 y 27 años, que cursaban del primero al séptimo año de Medicina en una universidad privada con sede en tres ciudades peruanas (Lima y Provincia) Los instrumentos utilizados fueron el Test de Empatía Cognitiva y Afectiva y la Escala de Motivaciones para estudiar Medicina. Resultados: La asociación entre Dominio Social Altruista (DSA) con Adopción de Perspectiva (AP) y Alegría Empática (AE) fue directa y significativa para ambos grupos, de intensidad media para las mujeres y fuerte para los varones. Además, la asociación entre DSA y Comprensión Emocional (CE) también fue directa y significativa para ambos grupos, con una intensidad fuerte en el grupo masculino. El Dominio Económico Prestigio (DEP) presentó asociaciones positivas significativas y de intensidad media con AP, CE y AE en varones. Discusión: Existen diferencias en las relaciones que se establecen entre la motivación para estudiar Medicina y la empatía, según sexo. Los varones presentan una conexión más directa entre su sentido de servicio a los demás, alcanzar el prestigio profesional y su capacidad para comprender y responder a las emociones de otros, a diferencia de las mujeres. Palabras clave: empatía; estudiantes universitarios; medicina; motivación; universidad privada. Introduction Professional education is paramount in medical schools for future physicians and society (Vilagra et al., 2024) given its importance for health. Faced with this scenario, challenges arise that must be faced in medical training. In this line, it is currently observed that the medical profession seems to experience a gradual dehumanization (Moreto et al., 2018), which generates enormous concern for its negative impact on health care and public health (Nimmon & Stenlund, 2024). In this context, interest arises in studying the social skills and personal characteristics of health professionals that contribute to increasing the humanity and effectiveness in work performance, especially during the university training of future physicians (Galarza et al., 2023). Specifically, it is important to analyze empathy, as it is an aspect of personality (García-Estañ et al., 2022) considered to be a complex and multidimensional attribute (Acosta-Martinez et al., 2024) that allows knowing what another person is thinking or feeling, understanding their actions and intentions, predicting their behavior, and experiencing emotions in response to emotions that have been understood (Baron-Cohen & Wheelwright, 2004). This skill is particularly interesting in medical students, as, for them, Acevedo-Flores, J., Salgado-Lévano, C., Vallejos-Mamani, E. B., & Pulido Capurro, V. Revista Digital de Investigación en Docencia Universitaria 2025, 19(1) 3 al., 2020; Keshtkar et al., 2024; Triffaux et al., 2019), which is paradoxical, given that, in their last stage of training, students would require improving soft skills such as empathy due to the increasing interaction with patients. However, some studies contradict this phenomenon of empathy attrition (Blanco et al., 2020; Samarasekera et al., 2022), which could be due to different factors, such as curriculum design, prioritization of biomedical knowledge, teaching influence, sociocultural values of the country, among others (Howick et al., 2023; Samarasekera et al., 2022). Given this scenario, some authors point out the importance of complementing the training of medical students to improve their empathy through some educational strategies, such as training in communication skills, early clinical exposure, shadowing patients, among others (Cayo-Rojas et al., 2021; Gullera et al., 2020). In Peru, some research has been conducted regarding the empathic capacity of medical students, interns, and health science professionals (Morales-Concha et al., 2018; Moya-Salazar et al., 2023), finding medium and low levels of empathy, which generates concern as it implies the need to develop their empathic skills. In this framework, it should be noted that the future physicians not only need to be empathetic, but also to be highly motivated to perform efficiently and effectively, with commitment and dedication. Some studies point out that there is an association between both constructs (Piumatti et al., 2018), with the intensity of this association varying according to the type of motivation. Motivation is the energy that directs behaviors, including the intentions involved and the resulting actions (Deci & Ryan, 1985). Specifically, motivations to study medicine refer to the energy that guides the student’s behavior and leads them to opt for a medical career, which are influenced by multiple personal and social factors, intrinsic and extrinsic, that vary in each person (Flores Meléndez et al., 2020). It is appropriate to study motivation in order to prevent attrition, dissatisfaction, frustration, as well as loss of human and economic resources. For example, studies conducted in Peru have highlighted that high dropout rates in human medicine schools lead to optimized diagnosis, satisfaction with the quality of clinical care, communication with the patient, and, in general, to greater clinical competence, in addition to positively influencing adherence to treatment and its outcomes (Lopez, 2022; Nembhard et al., 2023). Thus, empathy can help raise the quality of medical interactions and is associated with academic and clinical performance of medical students (Huang et al., 2024) and with various benefits for patients and health professionals (Müller et al., 2024) because it is positively correlated with patient satisfaction; treatment adherence; and lower rates of burnout, depression, and anxiety among physicians themselves (Brar et al., 2024). Due to the high academic demands in medical programs, it is usual for medical students to experience high levels of stress and mental health problems (Triebner et al., 2024), which can even lead to emotional burnout of the medical professional. Therefore, it is necessary for them to develop empathic skills in order to be better equipped to handle stress and burnout (Gradiski et al., 2022) as empathy can help them understand and manage their own emotions and those of their patients (Páez Cala & Castaño Castrillón, 2020). Some studies found that more empathetic students present greater personal satisfaction, while less empathetic students show greater deficiencies in social skills (Tacuri et al., 2024). For their part, Chen et al. (2024) found that medical students who score higher in empathy tend to have better mental health, better communication skills, and tend to choose people oriented specialties. On the other hand, several studies have reported the correlation between empathy and the sex of medical students, finding heterogeneous results. Some studies showed that the score of female students is generally higher than that of their male peers (Abdullah et al., 2023; Baig et al, 2023; Javaeed et al., 2022; Myobhav et al., 2022); however, other research reported the absence of differences in empathy depending on sex (Tacuri et al., 2024). A fact that draws attention is that, according to some research, the training received by medical students tends to decrease the level of empathy as their studies progress (Aziz et al., 2024; Hojat et Empathy and Motivations to study Medicine in University Students from Lima and Province Revista Digital de Investigación en Docencia Universitaria 2025, 19(1) 4 academic and professional decisions. Some studies have related this type of motivation to depression and anxiety (Karaoglu & Seker, 2010), as well as to low work drive in rural areas, becoming a problem in countries where medical staff is insufficient in areas far from urban areas (Rocha et al., 2020). There are few studies that address the relationship between empathy and motivations to study medicine (Findyartini et al., 2020; Piumatti et al., 2018). Research conducted in Indonesia identified a consistent relationship between empathy and motivation type, which also had significant association with the year of study of undergraduate students who were candidates for medicine programs (Findyartini et al., 2020). Additionally, most students had highly intrinsic and highly controlled motivation profiles and achieved high empathy scores. Meanwhile, in Switzerland, the association between motivational factors for studying medicine and empathy of medical school candidates was examined, concluding that there is a significant and median positive correlation between empathy and intrinsic motivations, which also scored higher compared to extrinsic motivations (Piumatti et al., 2018). As can be seen, the motivations to study medicine have not received much attention in the scientific literature, probably because they are very specific and have few instruments developed; however, due to its relationship with other aspects of interest such as university dropout, academic performance, stress, and burnout, their research is of utmost importance to distinguish the motivations that prevail in university students, particularly due to the rigorous and demanding nature of the health sciences studies (Chino-Loza et al., 2022). It is also important to point out that sex can generate differences in the development of other non cognitive variables related to academic performance, which would help to explain why there would be differences in the motivations to study medicine and empathy according to the sex of the university students. In this regard, Alhadabi et al. (2023) found that gender significantly predicts profile affiliation based on three variables (academic motivations, represent a real problem in the training of human resources in health (Bermúdez & Cassana, 2016); furthermore, student dropout in health sciences programs is a global problem (Heredia Alarcón et al., 2015; Sinval et al., 2024) which has not been efficiently addressed in the scientific community, constituting a serious problem among institutions that provide higher education (González et al., 2021). Therefore, it is important to study the motivations of medical students. One way to categorize these motivations is through the social/altruistic domain (dominio social/altruista, DSA), which corresponds to intrinsic motivations that have a humanistic altruistic purpose of social interest and service; a scientific academic nature of contribution for the benefit of society with a desire for constant improvement. The other, is the economic/ prestige domain (dominio económico/prestigio, DEP), which is related to extrinsic perspectives related to desires to achieve prestige, obtain economic benefits from their career, and family influence (Karaoglu & Seker, 2010; Mayta-Tristán et al., 2015; Uyen et al., 2024). DSA and DEP motivations are essential for understanding the psychological and sociological bases that drive the behaviors of future physicians, since these two forms of motivation play an important role. DSA seeks social welfare enhancement that seeks to understand how and why people engage in altruistic actions—those that benefit others— without direct selfish interest, which, in the field of medicine, is essential to improve the population’s health. According to Tacuri et al. (2024), the choice of a career in medicine is influenced by individual factors such as altruistic motivation and predisposition towards learning. In turn, DSA has reported a positive association with the completion of medical studies (Žuljević & Buljan, 2022), which is of special interest in developing countries such as Peru, where there is a deficit in human resources in health, which are insufficient to serve the population (Murillo-Peña et al., 2021). On the other hand, the DEP allows us to understand how perceptions of prestige can influence the students’ decision to pursue a career in medicine and how this can affect their other Acevedo-Flores, J., Salgado-Lévano, C., Vallejos-Mamani, E. B., & Pulido Capurro, V. Revista Digital de Investigación en Docencia Universitaria 2025, 19(1) 5 Table 1 Socio-Educational Characteristics of Participants Characteristics M; SD; n (%) Age [range] M = 20.3; SD = 2.53; [17 27] Sex Females Males M=50.7; SD=2.51; 166 (66.7%) M=20.1; SD=2.52; 83 (33.3%) Origin Lima Outside provinces 103 (41.36%) 146 (58.64%) Year of study First Second Third Fourth Fifth Sixth Seventh 51 (20.5%) 38 (15.3%) 42 (16.9%) 35 (14.1%) 38 (15.3%) 27 (10.8%) 18 (7.2%) Note. M = mean; SD = standard deviation; n = number; % = percentage. To better understand the results, the differences in the distributions were analyzed using the χ2 calculator for differences in proportions. Thus, with respect to sex, it was found that there were significant differences in the proportion between males and females (χ2 = 27.67; p < .001). With respect to age, two categories were generated from the distribution of the sample taking the median as a reference (Me = 20 years); those younger than 20 years were placed (n = 115) in the first group, and those who were 20 or older (n = 134) were placed in the second group. In this case, the distributions did not present statistically significant differences (χ22 = 1.45; p > 0.05). With regard to origin, 103 were from Lima and 146 came from outside provinces; in this case, statistically significant differences were also found in the proportions of the groups (χ2 = 7.43; p < .01). Finally, the distribution according to year of study was explored, and statistically significant differences were found (χ2 = 18.94; p < .001). Instruments Test of Cognitive and Affective Empathy. The Test of Cognitive and Affective Empathy (Test de Empatía Cognitiva y Afectiva, TECA) by López-Pérez et al. (2008) was used to measure determination, and self-control). This allows inferring the importance of studying sex/gender as a predictor variable in university students. In this sense, the present study aimed to establish the relationship between empathy and motivations in the social/altruistic and economic/prestige domains of motivations to study medicine in students in a private Peruvian university with locations in three cities and, in addition, to compare these correlations according to the sex of the participants. Método Design This research work corresponds to a cross-sectional design of correlational type, considering empathy and motivations to study medicine as variables in a sample of students in a private university according to sex. Participants The sample was selected through non-probabilistic convenience sampling (Otzen & Manterola, 2017) and was calculated through G*POWER (Faul et al., 2007) with a two-tailed correlation parameter, H1 = .35, probability of error of .05, power = .95, with which a total of 148 participants was obtained as the minimum recommended sample. However, given that the application was done virtually and taking into account the margin of rejection of surveys in this modality (Arroyo & Finkel, 2019), it was thought convenient to include 101 more participants, obtaining a sample of 249 male and female firstthrough seventh-year medicine students in a private Peruvian university with locations in the cities of Lima, Ica, and Chincha (outside provinces). Inclusion criteria included students aged 17 to 27 with regular academic status in this private university where the authors had access and permission to apply the instruments. All students responded anonymously, freely, and voluntarily, without incentives. Table 1 shows the socio-educational characteristics of the participants, all of whom were undergraduate students of Peruvian nationality, single, with regular enrollment. Empathy and Motivations to study Medicine in University Students from Lima and Province Revista Digital de Investigación en Docencia Universitaria 2025, 19(1) 6 .09). This indicates that the model of four related factors without the reverse worded items turns out to be a measure with a valid, interpretable, and parsimonious internal structure. As for the standardized factor loadings, it was observed that, in general, they were higher than the minimum of .32 required (Tabachnick & Fidell, 2007). Evidence of reliability was found by means of McDonald’s Omega coefficients, obtaining values equal to or greater than .686 (AP = .806, CE = .811, EE = .686, AE = .880). Thus, the TECA was made up of 20 questions: AP, five items; CE, six items; EE, three items; and AE, six items. Motivations to Study Medicine Scale. The Motivations to Study Medicine scale (escala de Motivaciones para Estudiar Medicina, MEM12) by Mayta-Tristán et al. (2015) measures the motivations for studying medicine in Latin American students. It is composed of the social/ altruistic domain (DSA), of 6 items, and the economic/prestige domain (DEP), of 6 items. It is constructed through a 5-point Likert scale (1 = totally disagree; 5 = totally agree) and reports, through the score obtained by adding the items of each domain, which of the two types of motivations prevails in the medical student. In the present study, according to the results obtained in the evaluation of the fit of the two factor model, acceptable goodness-of-fit indices were obtained (χ2 = 121, gl = 51, p < .001), with a CFI equal to .977 and a RMSEA equal to .075 (CI90% = .058, .092). This indicates that the related two-domain measurement model presents an adequate fit to the data, presenting evidence of validity based on internal structure (CFI = .98; RMSEA = .08) and reliability (omega coefficients equal to or greater than .90), which were adequate. Procedure Arrangements were made with the authorities of the private university locations in Lima and outside provinces where the instruments were applied in order to conduct the study, clarify the terms of participation, and request their collaboration. Likewise, access to the sample was requested, indicating that the data would be handled confidentially. On the other empathy, which is composed of two dimensions: cognitive and affective. The former contains the subscales perspective adoption (adopción de perspectiva, AP) , with eight items, and emotional understanding (comprensión emocional, CE), with nine items; the latter comprises the subscales empathic stress (estrés empático, EE), with eight items, and empathic joy (alegría empática, AE) , with eight items—a total of 33 items. It was evaluated through a 5 point Likert scale (1 = strongly disagree; 5 = strongly agree). The evidence of validity based on internal structure was analyzed by taking as a sample all the participants of the present study by means of Confirmatory Factor Analysis (CFA), assessing compliance with the following requirements: (a) Standardized Chi-square (χ2 /gl) with values less than 3; (b) Comparative Fit Index (CFI) and Tucker Lewis Index (TLI) with values between .90 - .95; (c) Root Mean Squared Error of Approximation (RMSEA)— which evaluates the degree of error associated with the model analyzed, with values below .06 as optimal and below .08 as acceptable. In a first analysis, goodness-of-fit indices were obtained below acceptable (χ2 /gl = 18.05, p < .001), with a CFI equal to .73, a TLI equal to .71, and a RMSEA equal to .26 (95% CI = .25, .27). When reviewing the standardized factor loadings, it became evident that the reveres worded items presented values below acceptable (λ < .32) (Tabachnick & Fidell, 2007). For this reason, the decision was made to conduct a new CFA without considering the reverse-worded items for each dimension of the TECA. Such decision was supported by evidence from specialized literature where it is pointed out that the inclusion of reverse-worded items can produce method effects associated with poor adjustments in the factor structures and a deterioration of reliability (Suárez-Álvarez et al., 2018; Tomás et al., 2013). Moreover, empirical evidence supports that, when these items are excluded, the models present better fit (Grimaldo et al., 2022; Grimaldo Muchotrigo et al., 2020). Thus, in the second CFA, considering only 20 positively worded items of the scale, the results showed a better fit compared to the first model (χ2 /gl = 2.67, p < .001), with a CFI equal to .99, TLI equal to .98, and a RMSEA equal to .08 (CI90% = .07, Acevedo-Flores, J., Salgado-Lévano, C., Vallejos-Mamani, E. B., & Pulido Capurro, V. Revista Digital de Investigación en Docencia Universitaria 2025, 19(1) 7 > .51 had a large effect (Cohen, 1988). In addition, to determine if the difference is statistically significant, the confidence intervals were reviewed; in case the interval includes zero, the values are not statistically significant (VenturaLeón & Caycho, 2017). Likewise, to give greater rigor to the estimated values, the difference of correlation coefficients was examined as proposed by Amón Hortelano (2013), for a Z equal to ±1.96: 𝑍𝑍 =$1 2'∗ln+1+𝑟𝑟1 1−𝑟𝑟1/−$1 2'∗ln+1+𝑟𝑟2 1−𝑟𝑟2/ 01/(𝑛𝑛1−3)+1/(𝑛𝑛2−3)) ! Rxyc = !"#%!"&∗!#& √)%!"&!∗*)%!#&! Finally, to control for the effect of year of study on the relationship between the variables, a partial correlation was applied: 𝑍𝑍 =$1 2'∗ln+1+𝑟𝑟1 1−𝑟𝑟1/−$1 2'∗ln+1+𝑟𝑟2 1−𝑟𝑟2/ 01/(𝑛𝑛1−3)+1/(𝑛𝑛2−3)) ! Rxyc = !"#%!"&∗!#& √)%!"&!∗*)%!#&! Here, Rxy is the conventional correlation coefficient; Rxc, the correlation between x and c (variable to be controlled); and Ryc, the correlation between y and c (variable to be controlled). Ethical Considerations The present study was evaluated and approved by the Institutional Ethics Committee of Universidad Privada San Juan Bautista (UPSJB), Peru, the university where the instruments were applied. This research was financed entirely by the authors. Results An exploratory analysis was performed in order to identify outliers, and then comparisons were made by analyzing the proportions of the groups according to sex, age, origin, and year of study; the measures of central tendency, dispersion, and asymmetry were also analyzed, and the differences in correlations according to sex were compared. hand, requests were sent to the authors of the instruments to obtain authorization for their application to the selected sample, which were satisfactorily answered. Once we had access to the institutional e-mail of the undergraduate students of human medicine at the university locations, we invited them to participate in the study by including the link to the Google Forms questionnaire. The questionnaire consisted of two instruments, a socio academic information sheet, and an informed consent form. The questionnaire was administered virtually and was available for four weeks in October 2022. Data Analysis The data were analyzed using the IBM SPSS version 25 and Rstudio statistical software. Initially, an exploratory analysis was carried out to identify outliers using the Careless package, with which insufficient effort responding was identified. The response options for each of the instruments used (> 5%) were also counted. Given that comparisons were sought, the proportions of the groups were analyzed according to sex, age, origin, and year of study using the Chi-squared test for difference of proportions (χ2). Subsequently, the measures of central tendency, dispersion, and asymmetry were analyzed. The distribution of the data was evaluated through the Shapiro Wilk (W) test, from which the use of Spearman’s Rho was determined; however, given that this coefficient detects monotonic associations, while Pearson’s correlation coefficient detects linearity of the association, the decision was made to use Pearson’s product moment correlation coefficient (r) with its respective confidence intervals (95% CI) for a better interpretation of the associations between the variables. However, due to the nonnormality of the variables and the relatively small sample size, these values were replicated through a Bootstrap simulation for a sample of 10,000 resamples with replacement. To compare whether there are differences in the correlations according to sex, Cohen’s q statistic was used, given the case where values < .10 had no effect; values .10 to .30 had a small effect; values .31 to .50 had a moderate effect; and values Empathy and Motivations to study Medicine in University Students from Lima and Province moment correlation coefficient, it was necessary to recalculate through a Bootstrap of 1000 resamples without replacement. As a result, biases of less than .005 were obtained. These values suggest unbiased estimates with respect to the original correlations. Table 3 shows the correlations between motivations to study medicine and cognitive and affective empathy. With respect to DSA, statistically significant correlations are predominantly observed, with a positive trend and a moderate (ECOGNI, EAFECT, AP, CE, and AE) and a small magnitude (EE). In the case of DEP, the correlations are statistically significant, positive, and of moderate (ECOGNI, CE) and small (EAFECT, AP, AE, and EE) magnitude. Relationship Between Motivations for Studying Medicine and Empathy in Females Table 4 shows the correlations for the sample made up of women, showing that DSA obtains statistically significant, positive correlations of medium and small magnitudes and does not correlate with EE. The DEP domain does not present statistically significant correlations, with the exception of a small correlation with EE. To provide greater rigor, partial correlations were calculated to control the effect of year of studies on the relationship between motivations to study medicine and empathy. The partial correlations are reported above the diagonal and show similar values (Δ < 0.05). So, it can be concluded that the year of studies does not significantly alter the relationship between the study variables in women. Insufficient Effort Responding and Outliers Detection For the identification of insufficient effort responding, the Mahalanobis distance (D2) versus quartiles was applied for both the scores of the Motivation to Study Medicine scale and the TECA scores (χ2 = 20.10; p < .05). These values indicate the absence of insufficient effort responding, finding an adequate variability in the response options. On the other hand, the identification of outliers allowed us to locate around 60 cases that presented response biases; these values were kept in the general database to avoid a decrease in the representativeness of the data. Nevertheless, the interpretations and findings have considered this situation as an important element in the understanding of the relationship between the variables under study Descriptive Analysis Table 2 shows the descriptive statistics of the variables under study. In general, it can be seen that all the variables present an average that denotes a tendency towards their maximum values, which suggests that there is a strong presence of these attributes. The values of skewness and kurtosis show a partial absence of univariate normality, which is later verified through the Shapiro Wilk statistic; the values of the omega coefficient show the consistency of the scores, which demonstrate that the estimates have adequate reliability. Correlations Between Motivations to Study Medicine and Empathy In view of the lack of normality, the small sample, and given the need to use Pearson productTable 2 Descriptive Statistics for the Domains of Motivations to Study Medicine and Empathy Dimensions and Subscales Variables Min Max MSD g1 g2 W p ω Social-altruistic domain DSA 6.00 30.00 24.86 6.03 -1.92 3.23 0.75 <.001 .97 Economic-prestige domain DEP 6.00 30.00 20.14 5.41 -0.66 0.32 0.95 <.001 .92 Cognitive empathy ECOGNI 14.00 55.00 41.93 7.23 -0.62 0.93 0.97 <.001 .88 Affective Empathy EAFECT 12.00 45.00 33.45 5.91 -0.59 0.74 0.97 <.001 .84 Perspective adoption AP 5.00 25.00 19.59 3.65 -0.84 0.96 0.94 <.001 .81 Emotional understanding CE 9.00 30.00 22.33 4.16 -0.26 0.03 0.98 <.001 .81 Empathic stress EE 3.00 15.00 8.83 2.82 -0.02 -0.35 0.97 <.001 .69 Empathetic joy AE 7.00 30.00 24.62 4.36 -1.15 1.66 0.91 <.001 .88 Note. 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