ObjectivesThis study sought to understand whether UK Foundation doctors perceived the phenomena of ethical erosion and empathy decline during their initial period of clinical practice, and if so, why this occurred. MethodsThis qualitative study used semi-structured interviews with nine doctors in their first year of clinical practice at Royal Bolton Hospital, UK. Participants were invited to discuss the definition of empathy, how individuals acquire and maintain empathic ability, perceptions of ethical erosion in the self and others, and how clinical experiences have influenced their empathic ability. The interviews were transcribed, and analysed to identify emergent themes. ResultsEach participant reported a conscious acknowledgement of empathy decline in their own and their colleagues’ early clinical experiences as doctors. Stressful working environments, the prioritisation of patients’ physical rather than psychological well-being, and the attitudes of senior colleagues were all suggested as possible causes. Some doctors believed that specialties with reduced patient contact had a culture which precluded empathy, and influenced their own practice. In addition, some described how their value judgements of patients had affected their ability to empathise. However, all doctors perceived that empathy skills were desirable in senior clinicians, and some believed that educational interventions may be useful in arresting ethical erosion.   ConclusionsNewly qualified doctors are aware of ethical erosion in themselves and their colleagues as they begin clinical practice. This has serious implications for patient care. Improving working conditions may reverse this trend. Empathy skills training within undergraduate and postgraduate curricula may be a useful intervention.

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Objective: Evidence exists of an apparent decline in empathy during medical training which may be detrimental to patient care. This qualitative study explores the reflections of a group of newly-qualified foundation doctors with regard to empathy in medical training and practice. Methods: Doctors in a UK Foundation Training Programme were invited to reflect on the subject of empathy in medical training and practice. Researchers obtained consent to access their anonymous reflective statements and analyze for recurring themes using framework analysis. Results: Coding of 65 trainees' reflective statements resulted in identification of two thematic categories: (i) preparedness for empathic patient care and (ii) therapeutic effect of empathy. Conclusions: Trainees are aware of the value of empathy as a therapeutic tool. Many use it instinctively but not systematically. Clinical pressures can impact negatively on empathic dealings with patients and relatives. Targeted educational interventions and positive role modeling may assist foundation doctors enhance their skills in patient-centered care.