How Do Distress and Well-being Relate to Medical Student Empathy? A Multicenter Study

Abstract

ObjectiveTo determine whether lower levels of empathy among a sample of medical students in the United States are associated with personal and professional distress and to explore whether a high degree of personal well-being is associated with higher levels of empathy.DesignMulti-institutional, cross-sectional survey.SettingAll medical schools in Minnesota (a private medical school, a traditional public university, and a public university with a focus in primary care).ParticipantsA total of 1,098 medical students.MeasurementsValidated instruments were used to measure empathy, distress (i.e., burnout and symptoms of depression), and well-being (high quality of life).ResultsMedical student empathy scores were higher than normative samples of similarly aged individuals and were similar to other medical student samples. Domains of burnout inversely correlated with empathy (depersonalization with empathy independent of gender, all P < .02, and emotional exhaustion with emotive empathy for men, P = .009). Symptoms of depression inversely correlated with empathy for women (all P ≤ .01). In contrast, students’ sense of personal accomplishment demonstrated a positive correlation with empathy independent of gender (all P < .001). Similarly, achieving a high quality of life in specific domains correlated with higher empathy scores (P < .05). On multivariate analysis evaluating measures of distress and well-being simultaneously, both burnout (negative correlation) and well-being (positive correlation) independently correlated with student empathy scores.ConclusionsBoth distress and well-being are related to medical student empathy. Efforts to reduce student distress should be part of broader efforts to promote student well-being, which may enhance aspects of professionalism. Additional studies of student well-being and its potential influence on professionalism are needed.

Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic

“…This is contrary to previous studies that used only physicianreported data to link burnout with low levels of empathy, 6,7,19 patient-centered doctoring, 2,19 and quality of care. 4,5 Higher scores on the empathy (CARE) and enablement (PEI) instruments used in our study predicted symptom improvement and enhanced well-being in patients at subsequent office encounters.…”

“…We used estimates of effect size of the association between physician burnout and patient-rated outcomes based on prior studies 6,19,20 in our power calculations. To account for the nested design effect (patients within provider), a design effect calculation was performed to determine the potential degradation in sample size.…”

“…[2][3][4] Burnedout residents self-report increased rates of medical errors, 4,5 suboptimal patient care, 2 and reduced empathy. 6,7 A few studies have tried to substantiate these findings with independent observational data but have not provided confirmatory evidence. Fahrenkopf found that although burned-out residents reported increased rates of medical errors, a review of their charts failed to identify any differences between them and their peers.…”

“…Because of the negative relationships between burnout and physician-reported empathic behavior, 6,7 and the positive associations between clinical outcomes and patient perceptions of physician empathy and enablement [9][10][11][12] (defined as healthrelated activation and empowerment), we conducted an observational study to examine relationships between patient perceptions of care and physician-reported burnout. We used validated scales to measure physician burnout and patient assessments of physician empathy and enablement among a sample of internal medicine residents and their clinic patients.…”

Can Doctors Maintain Good Character? An Examination of Physician Lives

“…According to one study, self-reported burnout amongst intern residents rose sharply from the beginning to the end of their first postgraduate year (Rosen 2006). Another study reported that the level of burnout was inversely correlated to the medical student's empathy scores (Thomas 2007). That is to say, the longer the physician practices, the more likely she is to experience burnout and that burnout contributes to eroding virtues such as compassion, empathy, and pride in one's work.…”