Skip to main content
Top
Published in: Journal of General Internal Medicine 2/2007

01-02-2007 | Original Article

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

Authors: Matthew R. Thomas, MD, Liselotte N. Dyrbye, MD, Jefrey L. Huntington, MPH, Karen L. Lawson, MD, Paul J. Novotny, MS, Jeff A. Sloan, PhD, Tait D. Shanafelt, MD

Published in: Journal of General Internal Medicine | Issue 2/2007

Login to get access

Objective

To 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.

Design

Multi-institutional, cross-sectional survey.

Setting

All medical schools in Minnesota (a private medical school, a traditional public university, and a public university with a focus in primary care).

Participants

A total of 1,098 medical students.

Measurements

Validated instruments were used to measure empathy, distress (i.e., burnout and symptoms of depression), and well-being (high quality of life).

Results

Medical 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.

Conclusions

Both 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.
Literature
2.
go back to reference Brownell AK, Cote L. Senior residents’ views on the meaning of professionalism and how they learn about it. Acad Med 2001;76(7):734–7.PubMed Brownell AK, Cote L. Senior residents’ views on the meaning of professionalism and how they learn about it. Acad Med 2001;76(7):734–7.PubMed
3.
go back to reference Halpern J. What is clinical empathy? J Gen Intern Med 2003;18(8):670–4.PubMed Halpern J. What is clinical empathy? J Gen Intern Med 2003;18(8):670–4.PubMed
4.
go back to reference Hojat M, Gonnella JS, Mangione S, et al. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ 2002;36(6):522–7.PubMed Hojat M, Gonnella JS, Mangione S, et al. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ 2002;36(6):522–7.PubMed
5.
go back to reference The Medical School Objectives Writing Group. Learning objectives for medical student education-guidelines for medical schools: report I of the Medical School Objectives Project. Acad Med 1999;74(1):13–8. The Medical School Objectives Writing Group. Learning objectives for medical student education-guidelines for medical schools: report I of the Medical School Objectives Project. Acad Med 1999;74(1):13–8.
6.
go back to reference Diseker RA, Michielutte R. An analysis of empathy in medical students before and following clinical experience. J Med Educ. 1981;56(12):1004–10.PubMed Diseker RA, Michielutte R. An analysis of empathy in medical students before and following clinical experience. J Med Educ. 1981;56(12):1004–10.PubMed
7.
go back to reference Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medical school. Med Educ 2004;38(9):934–41.PubMed Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medical school. Med Educ 2004;38(9):934–41.PubMed
8.
go back to reference Bellini LM, Shea JA. Mood change and empathy decline persist during three years of internal medicine training. Acad Med 2005;80(2):164–7.PubMed Bellini LM, Shea JA. Mood change and empathy decline persist during three years of internal medicine training. Acad Med 2005;80(2):164–7.PubMed
9.
go back to reference Tutton PJ. Psychometric test results associated with high achievement in basic science components of a medical curriculum. Acad Med 1996;71(2):181–6.PubMed Tutton PJ. Psychometric test results associated with high achievement in basic science components of a medical curriculum. Acad Med 1996;71(2):181–6.PubMed
10.
go back to reference McManus IC, Paice E, Keeling AA. Stress, burnout, and doctors’ attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Med 2004;2:29.PubMed McManus IC, Paice E, Keeling AA. Stress, burnout, and doctors’ attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Med 2004;2:29.PubMed
11.
go back to reference Silver HK, Glicken AD. Medical student abuse. Incidence, severity, and significance [see comment]. JAMA 1990;263(4):527–32.PubMed Silver HK, Glicken AD. Medical student abuse. Incidence, severity, and significance [see comment]. JAMA 1990;263(4):527–32.PubMed
12.
go back to reference Elnicki DM, Curry RH, Fagan M, et al. Medical students’ perspectives on and responses to abuse during the internal medicine clerkship. Teach Learn Med 2002;14(2):92–7.PubMed Elnicki DM, Curry RH, Fagan M, et al. Medical students’ perspectives on and responses to abuse during the internal medicine clerkship. Teach Learn Med 2002;14(2):92–7.PubMed
13.
go back to reference Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 1994;69(11):861–71.PubMed Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 1994;69(11):861–71.PubMed
14.
go back to reference Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med 1998;73(4):403–7.PubMed Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med 1998;73(4):403–7.PubMed
15.
go back to reference Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work [see comment]. Lancet 1996;347(9003):724–8.PubMed Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work [see comment]. Lancet 1996;347(9003):724–8.PubMed
16.
go back to reference Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med 1997;44(7):1017–22.PubMed Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med 1997;44(7):1017–22.PubMed
17.
go back to reference Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136(5):358–67.PubMed Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136(5):358–67.PubMed
18.
go back to reference Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA 2002;287(23):3143–6.PubMed Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA 2002;287(23):3143–6.PubMed
19.
go back to reference Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med [Med Psychol Med Sociol] 1980;14A(6):495–9. Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med [Med Psychol Med Sociol] 1980;14A(6):495–9.
20.
go back to reference DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol 1993;12(2):93–102.PubMed DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol 1993;12(2):93–102.PubMed
21.
go back to reference Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J. Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Med Care 1985;23(10):1171–8.PubMed Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J. Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Med Care 1985;23(10):1171–8.PubMed
22.
go back to reference Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med 2000;15(2):122–8.PubMed Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med 2000;15(2):122–8.PubMed
23.
go back to reference Williams ES, Konrad TR, Scheckler WE, et al. Understanding physicians’ intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. Health Care Manage Rev 2001;26(1):7–19.PubMed Williams ES, Konrad TR, Scheckler WE, et al. Understanding physicians’ intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. Health Care Manage Rev 2001;26(1):7–19.PubMed
24.
go back to reference Freeborn DK. Satisfaction, commitment, and psychological well-being among HMO physicians. West J Med 2001;174(1):13–8.PubMed Freeborn DK. Satisfaction, commitment, and psychological well-being among HMO physicians. West J Med 2001;174(1):13–8.PubMed
25.
go back to reference Lichtenstein RL. The job satisfaction and retention of physicians in organized settings: a literature review. Med Care Rev 1984;41(3):139–79.PubMed Lichtenstein RL. The job satisfaction and retention of physicians in organized settings: a literature review. Med Care Rev 1984;41(3):139–79.PubMed
26.
go back to reference Schmoldt RA, Freeborn DK, Klevit HD. Physician burnout: recommendations for HMO managers. HMO Pract 1994;8(2):58–63.PubMed Schmoldt RA, Freeborn DK, Klevit HD. Physician burnout: recommendations for HMO managers. HMO Pract 1994;8(2):58–63.PubMed
27.
go back to reference Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med 2003;114(6):513–9.PubMed Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med 2003;114(6):513–9.PubMed
28.
go back to reference Weiner EL, Swain GR, Wolf B, Gottlieb M. A qualitative study of physicians’ own wellness-promotion practices. West J Med 2001;174(1):19–23.PubMed Weiner EL, Swain GR, Wolf B, Gottlieb M. A qualitative study of physicians’ own wellness-promotion practices. West J Med 2001;174(1):19–23.PubMed
29.
go back to reference Yamey G, Wilkes M. Promoting wellbeing among doctors. BMJ 2001;322(7281):252–3.PubMed Yamey G, Wilkes M. Promoting wellbeing among doctors. BMJ 2001;322(7281):252–3.PubMed
30.
go back to reference Yiu V. Supporting the well-being of medical students. CMAJ 2005;172(7):889–90.PubMed Yiu V. Supporting the well-being of medical students. CMAJ 2005;172(7):889–90.PubMed
31.
go back to reference Spilker B. Quality of life and pharmacoeconomics in clinical trials. New York: Lippincott-Raven; 1996. Spilker B. Quality of life and pharmacoeconomics in clinical trials. New York: Lippincott-Raven; 1996.
32.
go back to reference Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient [see comment]. JAMA 1997;278(6):502–9.PubMed Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient [see comment]. JAMA 1997;278(6):502–9.PubMed
33.
go back to reference Novack DH, Epstein RM, Paulsen RH. Toward creating physician-healers: fostering medical students’ self-awareness, personal growth, and well-being. Acad Med 1999;74(5):516–20.PubMed Novack DH, Epstein RM, Paulsen RH. Toward creating physician-healers: fostering medical students’ self-awareness, personal growth, and well-being. Acad Med 1999;74(5):516–20.PubMed
34.
go back to reference Epstein RM. Mindful practice [see comment]. JAMA 1999;282(9):833–9.PubMed Epstein RM. Mindful practice [see comment]. JAMA 1999;282(9):833–9.PubMed
35.
go back to reference Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med 2005;20(7):559–64.PubMed Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med 2005;20(7):559–64.PubMed
36.
go back to reference Davis MH. A multidimensional approach to individual differences in empathy. Catalog of Selected Documents in Psychology 1980;10 MS. 2124: p 85. Davis MH. A multidimensional approach to individual differences in empathy. Catalog of Selected Documents in Psychology 1980;10 MS. 2124: p 85.
37.
go back to reference Davis MH. Measuring individual differences in empathy: Evidence for a multidimensional approach. J Pers Soc Psychol 1983;44(1):113–126. Davis MH. Measuring individual differences in empathy: Evidence for a multidimensional approach. J Pers Soc Psychol 1983;44(1):113–126.
38.
go back to reference Coman GJ, Evans BJ, Stanley RO. Scores on the Interpersonal Reactivity Index: a sample of Australian medical students. Psychol Rep. 1988;62(3):943–5.PubMed Coman GJ, Evans BJ, Stanley RO. Scores on the Interpersonal Reactivity Index: a sample of Australian medical students. Psychol Rep. 1988;62(3):943–5.PubMed
39.
go back to reference Maslach C. Maslach Burnout Inventory Manual. Palo Alto, CA: Consulting Psychologists Press; 1986. Maslach C. Maslach Burnout Inventory Manual. Palo Alto, CA: Consulting Psychologists Press; 1986.
40.
go back to reference Rafferty JP, Lemkau JP, Purdy RR, Rudisill JR. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol 1986;42(3):488–92.PubMed Rafferty JP, Lemkau JP, Purdy RR, Rudisill JR. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol 1986;42(3):488–92.PubMed
41.
go back to reference Spitzer RL, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;272(22):1749–56.PubMed Spitzer RL, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;272(22):1749–56.PubMed
42.
go back to reference Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 1997;12(7):439–45.PubMed Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 1997;12(7):439–45.PubMed
43.
go back to reference Ware J, Kosinski M, Dewey J, Gandek B. How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey. Lincoln, RI: QualityMetric Incorporated; 2001. Ware J, Kosinski M, Dewey J, Gandek B. How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey. Lincoln, RI: QualityMetric Incorporated; 2001.
44.
go back to reference Larson EB, Yao X. Clinical empathy as emotional labor in the patient–physician relationship. JAMA 2005;293(9):1100–6.PubMed Larson EB, Yao X. Clinical empathy as emotional labor in the patient–physician relationship. JAMA 2005;293(9):1100–6.PubMed
45.
go back to reference Brock CD, Salinsky JV. Empathy: an essential skill for understanding the physician–patient relationship in clinical practice. Fam Med 1993;25(4):245–8.PubMed Brock CD, Salinsky JV. Empathy: an essential skill for understanding the physician–patient relationship in clinical practice. Fam Med 1993;25(4):245–8.PubMed
46.
go back to reference Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkships? Acad Med 2004;79(9):832–9.PubMed Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkships? Acad Med 2004;79(9):832–9.PubMed
47.
go back to reference Charon R. The patient–physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA 2001;286(15):1897–902.PubMed Charon R. The patient–physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA 2001;286(15):1897–902.PubMed
48.
go back to reference Carmel S, Glick SM. Compassionate–empathic physicians: personality traits and social-organizational factors that enhance or inhibit this behavior pattern. Soc Sci Med 1996;43(8):1253–61.PubMed Carmel S, Glick SM. Compassionate–empathic physicians: personality traits and social-organizational factors that enhance or inhibit this behavior pattern. Soc Sci Med 1996;43(8):1253–61.PubMed
49.
go back to reference Evans BJ, Stanley RO, Burrows GD. Measuring medical students’ empathy skills. Br J Med Psychol 1993;66(Pt 2):121–33.PubMed Evans BJ, Stanley RO, Burrows GD. Measuring medical students’ empathy skills. Br J Med Psychol 1993;66(Pt 2):121–33.PubMed
50.
go back to reference Evans BJ, Stanley RO, Coman GJ, Burrows GD. Psychological tests to measure the effects of medical education on students’ interpersonal skills. Med Educ 1989;23(6):492–497.PubMed Evans BJ, Stanley RO, Coman GJ, Burrows GD. Psychological tests to measure the effects of medical education on students’ interpersonal skills. Med Educ 1989;23(6):492–497.PubMed
51.
go back to reference Lee RT, Ashforth BE. A meta-analytic examination of the correlates of the three dimensions of job burnout. J Appl Psychol 1996;81(2):123–33.PubMed Lee RT, Ashforth BE. A meta-analytic examination of the correlates of the three dimensions of job burnout. J Appl Psychol 1996;81(2):123–33.PubMed
52.
go back to reference Leiter MP, Durup J. The discriminant validity of burnout and depression: a confirmatory factor analytic study. Anxiety Stress Coping 1994;7:357–73. Leiter MP, Durup J. The discriminant validity of burnout and depression: a confirmatory factor analytic study. Anxiety Stress Coping 1994;7:357–73.
53.
go back to reference Sloan JA, Loprinzi CL, Kuross SA, et al. Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer. J Clin Oncol 1998;16(11):3662–73.PubMed Sloan JA, Loprinzi CL, Kuross SA, et al. Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer. J Clin Oncol 1998;16(11):3662–73.PubMed
54.
go back to reference Loprinzi CL, Kugler JW, Sloan JA, et al. Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. J Clin Oncol 1999;17(10):3299–306.PubMed Loprinzi CL, Kugler JW, Sloan JA, et al. Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. J Clin Oncol 1999;17(10):3299–306.PubMed
55.
go back to reference Jatoi A, Yamashita J, Sloan JA, Novotny PJ, Windschitl HE, Loprinzi CL. Does megestrol acetate down-regulate interleukin-6 in patients with cancer-associated anorexia and weight loss? A North Central Cancer Treatment Group investigation [see comment]. Support Care Cancer 2002;10(1):71–5.PubMed Jatoi A, Yamashita J, Sloan JA, Novotny PJ, Windschitl HE, Loprinzi CL. Does megestrol acetate down-regulate interleukin-6 in patients with cancer-associated anorexia and weight loss? A North Central Cancer Treatment Group investigation [see comment]. Support Care Cancer 2002;10(1):71–5.PubMed
56.
go back to reference Gill P, Kaur JS, Rummans T, Novotny PJ, Sloan JA. The hospice patient’s primary caregiver. What is their quality of life? J Psychosom Res 2003;55(5):445–51.PubMed Gill P, Kaur JS, Rummans T, Novotny PJ, Sloan JA. The hospice patient’s primary caregiver. What is their quality of life? J Psychosom Res 2003;55(5):445–51.PubMed
57.
go back to reference Loprinzi L, Barton DL, Sloan JA, et al. Pilot evaluation of gabapentin for treating hot flashes [see comment]. Mayo Clin Proc 2002;77(11):1159–63.PubMed Loprinzi L, Barton DL, Sloan JA, et al. Pilot evaluation of gabapentin for treating hot flashes [see comment]. Mayo Clin Proc 2002;77(11):1159–63.PubMed
58.
go back to reference Grunberg SM, Groshen S, Steingass S, Zaretsky S, Meyerowitz B. Comparison of conditional quality of life terminology and visual analogue scale measurements. Qual Life Res 1996;5(1):65–72.PubMed Grunberg SM, Groshen S, Steingass S, Zaretsky S, Meyerowitz B. Comparison of conditional quality of life terminology and visual analogue scale measurements. Qual Life Res 1996;5(1):65–72.PubMed
59.
go back to reference Gudex C, Dolan P, Kind P, Williams A. Health state valuations from the general public using the visual analogue scale. Qual Life Res 1996;5(6):521–31.PubMed Gudex C, Dolan P, Kind P, Williams A. Health state valuations from the general public using the visual analogue scale. Qual Life Res 1996;5(6):521–31.PubMed
60.
go back to reference Hyland ME, Sodergren SC. Development of a new type of global quality of life scale, and comparison of performance and preference for 12 global scales. Qual Life Res 1996;5(5):469–80.PubMed Hyland ME, Sodergren SC. Development of a new type of global quality of life scale, and comparison of performance and preference for 12 global scales. Qual Life Res 1996;5(5):469–80.PubMed
61.
go back to reference Sriwatanakul K, Kelvie W, Lasagna L, Calimlim JF, Weis OF, Mehta G. Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther 1983;34(2):234–9.PubMedCrossRef Sriwatanakul K, Kelvie W, Lasagna L, Calimlim JF, Weis OF, Mehta G. Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther 1983;34(2):234–9.PubMedCrossRef
62.
go back to reference Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena [see comment]. Res Nurs Health 1990;13(4):227–36.PubMed Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena [see comment]. Res Nurs Health 1990;13(4):227–36.PubMed
63.
go back to reference Shanafelt TD, Novotny P, Johnson ME, et al. The well-being and personal wellness promotion strategies of medical oncologists in the North Central Cancer Treatment Group. Oncology 2005;68(1):23–32.PubMed Shanafelt TD, Novotny P, Johnson ME, et al. The well-being and personal wellness promotion strategies of medical oncologists in the North Central Cancer Treatment Group. Oncology 2005;68(1):23–32.PubMed
64.
go back to reference Armitage P. Tests for linear trend in proportions and frequencies. Biometrics 1955;11:375–386. Armitage P. Tests for linear trend in proportions and frequencies. Biometrics 1955;11:375–386.
65.
go back to reference Dyrbye LN, Thomas MR, Shanafelt TD, et al. Personal life events and medical student burnout: a multicenter study. Acad Med 2006;81(4):374–84.PubMed Dyrbye LN, Thomas MR, Shanafelt TD, et al. Personal life events and medical student burnout: a multicenter study. Acad Med 2006;81(4):374–84.PubMed
66.
go back to reference Newton BW, Savidge MA, Barber L, et al. Differences in medical students’ empathy. Acad Med. 2000;75(12):1215.PubMed Newton BW, Savidge MA, Barber L, et al. Differences in medical students’ empathy. Acad Med. 2000;75(12):1215.PubMed
67.
go back to reference Crandall SJ, Volk RJ, Loemker V. Medical students’ attitudes toward providing care for the underserved. Are we training socially responsible physicians? JAMA 1993;269(19):2519–23.PubMed Crandall SJ, Volk RJ, Loemker V. Medical students’ attitudes toward providing care for the underserved. Are we training socially responsible physicians? JAMA 1993;269(19):2519–23.PubMed
68.
go back to reference Woloschuk W, Harasym PH, Temple W. Attitude change during medical school: a cohort study. Med Educ 2004;38(5):522–34.PubMed Woloschuk W, Harasym PH, Temple W. Attitude change during medical school: a cohort study. Med Educ 2004;38(5):522–34.PubMed
69.
go back to reference Patenaude J, Niyonsenga T, Fafard D. Changes in students’ moral development during medical school: a cohort study [see comment]. CMAJ 2003;168(7):840–4.PubMed Patenaude J, Niyonsenga T, Fafard D. Changes in students’ moral development during medical school: a cohort study [see comment]. CMAJ 2003;168(7):840–4.PubMed
70.
go back to reference McCue JD. The effects of stress on physicians and their medical practice. N Engl J Med 1982;306(8):458–63.PubMedCrossRef McCue JD. The effects of stress on physicians and their medical practice. N Engl J Med 1982;306(8):458–63.PubMedCrossRef
71.
go back to reference Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med 1980;14A:495–499. Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med 1980;14A:495–499.
72.
go back to reference Firth-Cozens J. Emotional distress in junior house officers. Br Med J (Clin Res Ed) 1987;295(6597):533–6. Firth-Cozens J. Emotional distress in junior house officers. Br Med J (Clin Res Ed) 1987;295(6597):533–6.
73.
go back to reference Firth-Cozens J. Interventions to improve physicians’ well-being and patient care. Soc Sci Med 2001;52:215–222.PubMed Firth-Cozens J. Interventions to improve physicians’ well-being and patient care. Soc Sci Med 2001;52:215–222.PubMed
74.
go back to reference Purdy RR, Lemkau JP, Rafferty JP, Rudisill JR. Resident physicians in family practice: who’s burned out and who knows? Fam Med 1987;19(3):203–8.PubMed Purdy RR, Lemkau JP, Rafferty JP, Rudisill JR. Resident physicians in family practice: who’s burned out and who knows? Fam Med 1987;19(3):203–8.PubMed
75.
go back to reference Whippen DA, Canellos GP. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol 1991;9(10):1916–20.PubMed Whippen DA, Canellos GP. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol 1991;9(10):1916–20.PubMed
76.
go back to reference Lemkau J, Rafferty J, Gordon R, Jr. Burnout and career-choice regret among family practice physicians in early practice. Fam Pract Res J 1994;14(3):213–22.PubMed Lemkau J, Rafferty J, Gordon R, Jr. Burnout and career-choice regret among family practice physicians in early practice. Fam Pract Res J 1994;14(3):213–22.PubMed
77.
go back to reference Whitley TW, Allison EJ, Jr., Gallery ME, et al. Work-related stress and depression among practicing emergency physicians: an international study. Ann Emerg Med 1994;23(5):1068–71.PubMed Whitley TW, Allison EJ, Jr., Gallery ME, et al. Work-related stress and depression among practicing emergency physicians: an international study. Ann Emerg Med 1994;23(5):1068–71.PubMed
78.
go back to reference Ramirez AJ, Graham J, Richards MA, et al. Burnout and psychiatric disorder among cancer clinicians [see comment]. Br J Cancer. 1995;71(6):1263–9.PubMed Ramirez AJ, Graham J, Richards MA, et al. Burnout and psychiatric disorder among cancer clinicians [see comment]. Br J Cancer. 1995;71(6):1263–9.PubMed
79.
go back to reference Campbell DA, Jr., Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery 2001;130(4):696–702; discussion 702–5. Campbell DA, Jr., Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery 2001;130(4):696–702; discussion 702–5.
80.
go back to reference Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J R Soc Med 1998;91(5):237–43.PubMed Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J R Soc Med 1998;91(5):237–43.PubMed
81.
go back to reference Daly MG, Willcock SM. Examining stress and responses to stress in medical students and new medical graduates. Med J Aust. 2002;177(suppl):S14–5.PubMed Daly MG, Willcock SM. Examining stress and responses to stress in medical students and new medical graduates. Med J Aust. 2002;177(suppl):S14–5.PubMed
82.
go back to reference Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc 2005;80(12):1613–1622.PubMedCrossRef Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc 2005;80(12):1613–1622.PubMedCrossRef
83.
go back to reference Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: status quo after a decade of reform? Ann Intern Med 2002;136(5):384–90.PubMed Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: status quo after a decade of reform? Ann Intern Med 2002;136(5):384–90.PubMed
84.
go back to reference Stress and impairment during residency training: strategies for reduction, identification, and management. Resident Services Committee, Association of Program Directors in Internal Medicine. Ann Intern Med 1988;109(2):154–61. Stress and impairment during residency training: strategies for reduction, identification, and management. Resident Services Committee, Association of Program Directors in Internal Medicine. Ann Intern Med 1988;109(2):154–61.
85.
go back to reference Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the physician worklife study [see comment]. J Gen Intern Med 2000;15(7):441–50.PubMed Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the physician worklife study [see comment]. J Gen Intern Med 2000;15(7):441–50.PubMed
86.
go back to reference Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: results from the Women Physicians’ Health Study. Society of General Internal Medicine Career Satisfaction Study Group. Arch Intern Med 1999;159(13):1417–26.PubMed Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: results from the Women Physicians’ Health Study. Society of General Internal Medicine Career Satisfaction Study Group. Arch Intern Med 1999;159(13):1417–26.PubMed
87.
go back to reference Stoddard JJ, Hargraves JL, Reed M, Vratil A. Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med 2001;16(10):675–84.PubMed Stoddard JJ, Hargraves JL, Reed M, Vratil A. Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med 2001;16(10):675–84.PubMed
88.
go back to reference Catalan J, Burgess A, Pergami A, Hulme N, Gazzard B, Phillips R. The psychological impact on staff of caring for people with serious diseases: the case of HIV infection and oncology. J Psychosom Res 1996;40(4):425–35.PubMed Catalan J, Burgess A, Pergami A, Hulme N, Gazzard B, Phillips R. The psychological impact on staff of caring for people with serious diseases: the case of HIV infection and oncology. J Psychosom Res 1996;40(4):425–35.PubMed
89.
go back to reference Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA 2001;286(23):3007–14.PubMed Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA 2001;286(23):3007–14.PubMed
90.
go back to reference Myers DG. The funds, friends, and faith of happy people. Am Psychol. 2000;55(1):56–67.PubMed Myers DG. The funds, friends, and faith of happy people. Am Psychol. 2000;55(1):56–67.PubMed
91.
go back to reference Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Intern Med 1990;150(9):1857–61.PubMed Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Intern Med 1990;150(9):1857–61.PubMed
92.
go back to reference Shanafelt TD. Finding meaning, balance, and personal satisfaction in the practice of oncology. J Support Oncol 2005;3(2):157–62, 164. Shanafelt TD. Finding meaning, balance, and personal satisfaction in the practice of oncology. J Support Oncol 2005;3(2):157–62, 164.
93.
go back to reference Rabow MW, McPhee SJ. Doctoring to heal: fostering well-being among physicians through personal reflection. West J Med 2001;174(1):66–9.PubMed Rabow MW, McPhee SJ. Doctoring to heal: fostering well-being among physicians through personal reflection. West J Med 2001;174(1):66–9.PubMed
94.
go back to reference Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;50(10):1129–36.PubMed Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;50(10):1129–36.PubMed
95.
go back to reference Kellerman SE, Herold J. Physician response to surveys. A review of the literature. Am J Prev Med 2001;20(1):61–7.PubMed Kellerman SE, Herold J. Physician response to surveys. A review of the literature. Am J Prev Med 2001;20(1):61–7.PubMed
96.
go back to reference Clark DC, Eckenfels EJ, Daugherty SR, Fawcett J. Alcohol-use patterns through medical school. A longitudinal study of one class. JAMA 1987;257(21):2921–6.PubMed Clark DC, Eckenfels EJ, Daugherty SR, Fawcett J. Alcohol-use patterns through medical school. A longitudinal study of one class. JAMA 1987;257(21):2921–6.PubMed
97.
go back to reference Mangus RS, Hawkins CE, Miller MJ. Tobacco and alcohol use among 1996 medical school graduates. JAMA 1998;280(13):1192–3, 1195. Mangus RS, Hawkins CE, Miller MJ. Tobacco and alcohol use among 1996 medical school graduates. JAMA 1998;280(13):1192–3, 1195.
98.
go back to reference Clark DC, Daugherty SR, Zeldow PB, Gotterer GS, Hedeker D. The relationship between academic performance and severity of depressed mood during medical school. Compr Psychiatry 1988;29(4):409–20.PubMed Clark DC, Daugherty SR, Zeldow PB, Gotterer GS, Hedeker D. The relationship between academic performance and severity of depressed mood during medical school. Compr Psychiatry 1988;29(4):409–20.PubMed
99.
go back to reference Ball S, Bax A. Self-care in medical education: effectiveness of health-habits interventions for first-year medical students. Acad Med 2002;77(9):911–7.PubMed Ball S, Bax A. Self-care in medical education: effectiveness of health-habits interventions for first-year medical students. Acad Med 2002;77(9):911–7.PubMed
100.
go back to reference Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students’ depression at one medical school. Acad Med 1997;72(6):542–6.PubMed Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students’ depression at one medical school. Acad Med 1997;72(6):542–6.PubMed
101.
go back to reference Winefield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ 2000;34(2):90–4.PubMed Winefield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ 2000;34(2):90–4.PubMed
102.
go back to reference Kopelman LM. Values and virtues: how should they be taught? Acad Med 1999;74(12):1307–10.PubMed Kopelman LM. Values and virtues: how should they be taught? Acad Med 1999;74(12):1307–10.PubMed
103.
go back to reference Spiro H. What is empathy and can it be taught? Ann Intern Med 1992;116(10):843–6.PubMed Spiro H. What is empathy and can it be taught? Ann Intern Med 1992;116(10):843–6.PubMed
104.
go back to reference More ES. Empathy as a hermeneutic practice. Theor Med 1996;17:243–254.PubMed More ES. Empathy as a hermeneutic practice. Theor Med 1996;17:243–254.PubMed
105.
go back to reference Branch WT, Jr. Supporting the moral development of medical students. J Gen Intern Med 2000;15(7):503–8.PubMed Branch WT, Jr. Supporting the moral development of medical students. J Gen Intern Med 2000;15(7):503–8.PubMed
106.
go back to reference DiLalla LF, Hull SK, Dorsey JK. Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teach Learn Med 2004;16(2):165–70.PubMed DiLalla LF, Hull SK, Dorsey JK. Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teach Learn Med 2004;16(2):165–70.PubMed
107.
go back to reference Kopelman LM. Philosophy and medical education. Acad Med 1995;70(9):795–805.PubMed Kopelman LM. Philosophy and medical education. Acad Med 1995;70(9):795–805.PubMed
108.
go back to reference Roter DL, Stewart M, Putnam SM, Lipkin M, Jr., Stiles W, Inui TS. Communication patterns of primary care physicians. JAMA 1997;277(4):350–6.PubMed Roter DL, Stewart M, Putnam SM, Lipkin M, Jr., Stiles W, Inui TS. Communication patterns of primary care physicians. JAMA 1997;277(4):350–6.PubMed
109.
go back to reference Hornblow AR, Kidson MA, Jones KV. Measuring medical students’ empathy: a validation study. Med Educ 1977;11(1):7–12.PubMed Hornblow AR, Kidson MA, Jones KV. Measuring medical students’ empathy: a validation study. Med Educ 1977;11(1):7–12.PubMed
110.
go back to reference Nightingale SD, Yarnold PR, Greenberg MS. Sympathy, empathy, and physician resource utilization. J Gen Intern Med 1991;6(5):420–3. Nightingale SD, Yarnold PR, Greenberg MS. Sympathy, empathy, and physician resource utilization. J Gen Intern Med 1991;6(5):420–3.
111.
go back to reference Hojat M, Gonnella JS, Nasca TJ, Mangione S, Veloksi JJ, Magee M. The Jefferson Scale of Physician Empathy: further psychometric data and differences by gender and specialty at item level. Acad Med 2002;77(10 Suppl):S58–60.PubMedCrossRef Hojat M, Gonnella JS, Nasca TJ, Mangione S, Veloksi JJ, Magee M. The Jefferson Scale of Physician Empathy: further psychometric data and differences by gender and specialty at item level. Acad Med 2002;77(10 Suppl):S58–60.PubMedCrossRef
112.
go back to reference Oswald PA. Does the interpersonal Reactivity Index Perspective-taking scale predict who will volunteer time to counsel adults entering college? Percept Mot Skills 2003;97(3 Pt 2):1184–6.PubMed Oswald PA. Does the interpersonal Reactivity Index Perspective-taking scale predict who will volunteer time to counsel adults entering college? Percept Mot Skills 2003;97(3 Pt 2):1184–6.PubMed
Metadata
Title
How Do Distress and Well-being Relate to Medical Student Empathy? A Multicenter Study
Authors
Matthew R. Thomas, MD
Liselotte N. Dyrbye, MD
Jefrey L. Huntington, MPH
Karen L. Lawson, MD
Paul J. Novotny, MS
Jeff A. Sloan, PhD
Tait D. Shanafelt, MD
Publication date
01-02-2007
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 2/2007
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-006-0039-6

Other articles of this Issue 2/2007

Journal of General Internal Medicine 2/2007 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.