Background: Empathy is crucial for effective clinical practice, and patient care. Despite its importance, the comparative studies and effectiveness analyses focusing on empathy-training strategies within both medical education and clinical practice are limited, particularly in China. The objective of this study is to compare empathy levels across doctors, nurses, medical students, and nursing students in China, exploring how workplace settings, professional roles, and training stages influence empathy development, to inform targeted empathy education strategies. Methods: A cross-sectional survey was conducted using the Chinese Version of the Jefferson Scale of Healthcare Professional Empathy (C-JSHPE). Participants included doctors, nurses, medical students and nursing students from primary, secondary, and tertiary hospitals, as well as medical schools located in eastern (economically developed), central (moderately developed), and western (less developed) regions of China. Results: Qualified professionals (licensed nurses and doctors) exhibited significantly higher empathy scores than healthcare students (doctors vs medical students t = 12.959, p < 0.001; nurses vs nursing students t = 7.135, p < 0.001). Nurses exhibited significantly higher empathy than doctors (t = 4.081, p < 0.001), and nursing students likewise exhibited markedly greater empathy than their medical student counterparts (t = 5.221, p < 0.001). Significant differences in empathy scores were observed between nursing students who participated in internships and those who did not (t = 2.548, p < 0.05). In contrast, no such differences emerged among medical students (t = − 0.228, p > 0.05). Both doctors and nurses with more clinical experience demonstrated higher empathy scores (F physician = 10.696, p < 0.001; F nurse = 30.029, p < 0.001). In contrast, those working in tertiary hospitals reported reduced empathy (F physician = 94.018, p < 0.001; F nurse = 486.586, p < 0.001). Conclusions: This study underscored the importance of both developing and retaining empathy in qualified professionals and healthcare students, and highlighted the significant role of clinical work environments and stages of professional development in shaping empathic capacity. The findings suggested that empathy was not static, but evolved in response to the demands, pressures, and relational dynamics of different clinical roles. Simulation-based education and other experiential learning approaches represent promising avenues for fostering empathy, particularly when integrated longitudinally throughout training and aligned with authentic clinical contexts. Embedding these strategies into the continuum of medical education may be key to sustaining empathy as a core professional competence in complex healthcare systems. © 2025 Elsevier Ltd
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