Characterizing the early relationship between covert narcissism and cognitive empathy in medical students: a cross-sectional study

Background In medicine, empathy refers to a predominantly cognitive attribute (rather than an emotional one), which is important as a foundation for positive physician-patient relationships. Physicians with a narcissistic personality trait have an assortment of characteristics that undermine their interpersonal functioning in clinical encounters with their patients. Evidence suggests an inverse relationship between empathy and certain characteristics of a narcissistic personality trait in general population. The aim of this study was to characterize the relationship between cognitive empathy and covert narcissistic personality trait in newly enrolled medical students. Methods A cross-sectional study was conducted in a Mexican school of medicine during the COVID-19 lockdown. The study sample included first-year medical students attending on-line classes. The Spanish version for medical students of the Jefferson Scale of Empathy (JSE-S), and the Hypersensitive Narcissism Scale (HSNS), were used as measures of cognitive empathy and covert narcissism, respectively. In addition, gender, age, speciality interest, and semester of enrolment were collected. Comparative, correlation and multiple regression analyses were performed among the variables analysed. Results In a sample of 283 students (207 females), differences in cognitive empathy and covert narcissism were observed by gender (p < 0.001). Comparison analyses showed that covert narcissism was greater in students enrolled after one semester attending on-line classes than those who were starting their first semester (p = 0.01). A correlation analysis confirmed an inverse association between empathy and covert narcissism (rho=-0.23; p < 0.001). Based on this, a multiple regression model was created explaining 12% of the variance of covert narcissism based on a lineal regression with empathy (p < 0.001), gender (p = 0.01), and semester (p = 0.003). This model complied with the necessary conditions for statistic inference and showed an effect size from medium to large. Conclusions These findings provide novel information of the relationship between cognitive empathy and covert narcissism in newly enrolled medical students.