The relationship between self-efficacy, learning burnout, willingness to fulfill the contract and empathy of rural-oriented tuition-waived medical students of China: a cross-sectional study

Background The empathy of rural-oriented tuition-waived medical students (RTMSs) is closely related to the construction of good doctor-patient relationship and the quality of rural medical and health services. The purpose of this study is not only to explore the relationship between self-efficacy, learning burnout, willingness to fulfill the contract and empathy, but also to explore the mediating role of self-efficacy between learning burnout and empathy, and between willingness to fulfill the contract and empathy. Methods Four hundred ninety-five rural-oriented tuition-waived medical students from 3 medical universities in Shandong Province were selected as research subjects, and General self-efficacy scale (GSES), Learning burnout of university student (LBUS), Willingness to fulfill the contract scale and Jefferson Scale of Physician Empathy-student version (JSPE-S) were used to investigate. SPSS 25.0 and AMOS 24.0 were used for statistical analysis and path analysis of the data. Results The willingness to fulfill the contract of rural-oriented tuition-waived medical students has a direct positive impact on self-efficacy (beta = 0.11, P < 0.05) and empathy (beta = 0.27, P < 0.001), and a significant direct negative impact on learning burnout (beta = -0.25, P < 0.001). Learning burnout has a significant direct negative impact on self-efficacy (beta = -0.34, P < 0.001), while self-efficacy has a significant direct positive impact on empathy (beta = 0.22, P < 0.001). Learning burnout has no direct impact on empathy (beta = -0.09, P = 0.109). Self-efficacy has a significant mediating effect between willingness to fulfill the contract and empathy (95% CI: 0.02-0.41), and also has a significant mediating effect between learning burnout and empathy [95% CI: -0.41- (-0.11)]. Learning burnout has no mediating effect between willingness to fulfill the contract and empathy (95% CI: -0.02-0.42). Conclusion This study found that learning burnout and willingness to fulfill the contract are important factors affecting rural-oriented tuition-waived medical students' empathy, both of which can influence empathy through the mediating role of self-efficacy. This provides positive suggestions for medical colleges to improve the empathy of students, which is of great practical significance for continuously improving the service quality of general practitioners and ultimately realizing the development of high-quality rural medical and health undertakings. In addition, it also provides an important theoretical reference for the formulation of empathy intervention measures and broadens the direction of rural-oriented tuition-waived medical students' research in the future.