Empathy and resilience among Latin American medical students: examining associations with ecological resilience in a multicountry cross-sectional study

BACKGROUND: Empathy is a core competency in medical education and underpins patient-centered care, yet empathy-related attitudes may decline during training, particularly under sustained academic and clinical stress. Resilience may help preserve empathic functioning, but its multidimensional associations with specific empathy domains remain insufficiently examined in large, culturally heterogeneous medical student samples. OBJECTIVE: To examine associations between empathy dimensions and engineering, ecological, and adaptive resilience among medical students, and to evaluate the measurement properties of the study instruments across countries and gender. METHODS: A cross-sectional multicountry study included 7,011 medical students from 11 universities in six Latin American countries. Structural equation modeling examined latent associations between empathy and resilience dimensions. Confirmatory factor analyses evaluated the factorial structure of the Jefferson Scale of Empathy-Health Professions Students and the Resilience Trait Scale, followed by measurement invariance testing by gender. Measurement models were evaluated before structural model estimation. RESULTS: Ecological resilience showed the strongest positive associations with empathy dimensions, whereas engineering and adaptive resilience showed smaller negative associations with selected empathy dimensions. In the total sample, both measurement models showed acceptable global fit, although some country-specific empathy models and the Walking in the Patient's Shoes subscale showed psychometric limitations. Gender invariance was supported in most analyses. CONCLUSIONS: The findings suggest that resilience is a multidimensional correlate of empathy-related attitudes in medical students, with ecological resilience emerging as the dimension most consistently aligned with empathic functioning. Psychometric limitations should be considered when interpreting these associations. Educational strategies that support students' capacity to maintain psychological stability under adversity may therefore warrant further evaluation as one component of broader efforts to sustain empathy and well-being during medical training. Because the data are cross-sectional, these implications should be tested in longitudinal and intervention studies.