Moral courage efficacy among medical students: associations with environmental professionalism, empathy attitudes, and communication self-efficacy.

Background: Moral courage efficacy is the belief in one's perceived ability to take an active stand or action in the face of others- and self-wrongdoing or moral injustice, despite a risk of negative consequences. Although moral courage is important for enhancing patient safety and quality of care, there is limited research on moral courage efficacy and its environmental and personal contributing factors to guide educational interventions. The current study examined the complex relationships between environmental professionalism, empathy attitudes, communication self-efficacy, and moral courage efficacy. Methods: The sample included 178 clinical medical students who had completed online self-reported questionnaires. Data were analyzed via Pearson's correlation tests and Hayes's regression-based PROCESS macro. Results: The study findings showed that environmental professionalism was directly associated with moral courage efficacy toward others ( Conclusion: The findings highlight the need for educational interventions to focus on organizational (environmental) and personal (enhancing empathy and communication self-efficacy) levels to enhance moral courage efficacy. Intervening on both levels may help create a safer space, increased motivation, and perceived ability for students to disclose others' and their own wrongdoing, thus potentially promoting a safer and more moral medical environment.