Empathy for Patients on the Decline Among Medical Students and Residents

Authors of a 2011 report that surveyed the medical literature between 1990 and 2010 for studies that investigated empathy during medical school and residency found that none of the studies they looked at documented increases in trainees’ self-assessed empathy (Acad Med. 2011;86(8):996-1009). Two of the studies showed increases in empathy during early student years but showed significant declines when the same students entered clinical practice.

So why does empathy change in trainees during medical school and residency? The researchers found that distress, burnout and depression in medical students and residents were major causes of a decline in empathy. Here are several ways these medical trainees experience stress:

• Mistreatment by superiors or mentors—Medical students may experience situations of harassment, belittlement, degradation, humiliation, gender-specific discrimination or sexual harassment.
• Vulnerability—Values of idealism, enthusiasm and humanity are present in students at the beginning of medical school, but these may diminish as trainees are confronted with the clinical realities of illness, human suffering and death, and their focus shifts to technology and objectivity rather than the humanistic aspects of medicine.
• Social support problems—Students and residents suffer from reduced contact with their families and a lack of social support from their peer groups.
• High workload—Students and residents face long working hours, with an associated lack of sleep and inadequate relaxation time.

The investigators of the 2011 report found that several additional factors influenced the trainees’ decline in empathy:

• Unrealistic expectations—Inadequate role models, combined with the media’s idealized view of the medical profession, can set students up with unrealistic expectations regarding physician behavior.
• Unsuitable learning environment—This may include unstructured studying, few “bedside interactions” and the treatment of medical students as immature human beings.
• Short length of stay of the patient—Short stays can result in a fragmented patient-physician relationship and allow no time for related work or corresponding learning from and with the patient.