Background <p>Empathy education is widely promoted to improve doctor–patient communication. However, the relative responsiveness of stable empathy traits versus students’ attitudes toward learning communication skills and whether these effects differ by gender have received limited empirical attention. This study aimed to examine how different empathy education approaches influence medical students’ empathy traits and communication skills attitudes, and whether these effects vary by gender.</p> Methods <p>This study included 659 third-year medical students from a comprehensive university in China. Students participated in psychodrama-based empathy education, lecture-based empathy education, or a pre-training control condition. Empathy traits were assessed using the Interpersonal Reactivity Index (IRI), and communication-related learning attitudes were assessed using the Communication Skills Attitude Scale (CSAS). A two-way multivariate analysis of variance (MANOVA) was conducted to examine associations of educational method and gender with questionnaire-based outcomes, followed by univariate ANOVAs and simple-effects analyses where appropriate. Partial correlation analyses controlling for gender and educational method were performed to examine associations between empathy traits and communication skills attitudes.</p> Results <p>Educational method, gender, and their interaction were significantly associated with multiple questionnaire-based outcomes. Significant group × gender interactions were observed for total IRI scores and the perspective taking (PT), fantasy (FS), and empathic concern (EC) subscale scores. Simple-effects analyses indicated that, among male students, both psychodrama-based and lecture-based education groups showed higher PT, FS, and total IRI scores than the pre-training control group, whereas the psychodrama-based education group additionally showed higher EC scores. Male students in both educational groups also reported lower negative communication skills attitude scores than those in the control group. In contrast, no significant differences across educational methods were observed among female students for these outcomes. After adjustment for gender and educational method, higher IRI scores were generally associated with more positive attitudes and fewer negative attitudes toward communication skills.</p> Conclusions <p>Empathy-oriented educational experiences were more consistently associated with communication skills attitudes than with broad differences in dispositional empathy questionnaire scores, with gender-specific patterns observed across outcomes. These findings suggest that empathy traits and communication skills attitudes may represent distinct educationally relevant targets and highlight the potential importance of communication-related attitudes in medical empathy education.</p>