At baseline, students were asked to fill an internet-based questionnaire, which gathered information about their age, previous studies and/or profession, participation in training courses before the entrance exam, their number of attempts at the medical school entrance exam and their parents’ professions.

The internet-based study questionnaire also evaluated the participants’ levels of empathy and self-reflection ability, using the Interpersonal Reactivity Index (IRI) [13] and the Self Reflection and Insight Scale (SRIS) [14]. The IRI was developed to evaluate an individual’s level of empathy. It includes 28 items, each answered on a 5-point Likert scale from “Does not describe me well” (zero points) to “Describes me very well” (four points), with negatively-worded items scored in reverse. The items are divided into four subscales, each with 7 items: perspective taking (PT; ability to adopt another person’s psychological point of view), personal distress (PD; propensity to react with feelings of personal distress in response to another person’s distress) empathic concern (EC; tendency to feel concern for other people) and fantasy (F; the tendency to become imaginatively involved with fictional characters and situations) [13]. The SRIS was developed to evaluate an individual’s capacity for self-reflection. It includes 20 items also answered on a 5-point Likert scale. In that case statements are scored from one to five with one equating to “Strongly agree” and five to “Strongly disagree” except for reversed-scored items, which are scored from five to one. The statements are related to three levels of reflection: need for self-reflection (NSR), engaging in self-reflection (ESR) and insight (I). The maximum possible score is 30 points for both the “NSR” and “ESR” components, and 40 points for the “I” dimension [14].

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