Medical student self-reported levels of empathy tend to decrease with time
spent in medical training.
Further, for students with longer experience in training, factors affecting
interpersonal functioning—such as burnout, time constraints, and patient
attitudes—tend to be reported most often as the factors affecting
Those are a few of the conclusions from a survey of medical students and
interns at one academic medical center. The student self-reports roughly track
previous research findings on empathy that used more objective measures of
empathy, said Jeffrey Winseman, M.D., associate director of psychiatry
residency training at Albany Medical Center. He conducted the survey along
with Victoria Balkoski, M.D., director of psychiatry residency training at
"Most students' self-reported level of empathy didn't change over the
period of training, but if it did change, more often than not it
decreased," Winseman told Psychiatric News. "And as a
cohort, the level of empathy decreased from year one to year four."
Winseman presented the survey results in a poster at last month's meeting
of the American Association of Directors of Psychiatric Residency Training in
Tucson, Ariz. The poster was titled "Role Modeling, Burnout, Patient
Attitudes, and Time Constraints: Medical Students and Interns Tell Us Their
Views on Factors Affecting Empathy."
Winseman said the survey is a prelude to a fuller report that will appear
in Academic Psychiatry in November, using "concept
mapping" to chart students' self-reports on empathy. Concept mapping is
a statistical tool used to derive conclusions from qualitative data, such as
subjective responses to a survey.
The researchers undertook the study, he said, after hearing stories
anecdotally from medical students about their educational experiences."
We began to wonder how these experiences were affecting the students'
ability to be empathic with the patients they would be treating," he
At the beginning of the 2005-2006 academic year, a "brainstorming
survey" was sent by e-mail to all 637 medical students and PGY-1
residents at Albany Medical College. The survey asked for responses to the
following statement: "During the course of becoming a doctor, a variety
of things occur that affect one's ability to be empathic. Please list all the
factors you can think of."
In addition, participants were asked to indicate whether their level of
empathy had increased, decreased, or remained the same and to rate the
importance of empathy in a physician.
A total of 293 individuals responded, only 17 of whom were first-year
residents. (Because of the small number of residents, there was no way to
break down results by specialty.)
The responses included 1,683 "statements" about empathy, most
of which were redundant. Those statements were analyzed and synthesized down
to 160 "factors" affecting empathy.
There were approximately 20 factors that were frequently listed by
respondents, and four were mentioned most often: amount of time spent with
patients; being mentally, spiritually, and physically drained by school,
stress, and work overload, which the researchers termed as"
burnout"; clinical experience; and "examples set by senior
teachers and doctors" (role modeling).
Winseman said the factors affecting empathy varied with year of training,
self-reported level of empathy, and gender. For instance, while students in
later years emphasized the importance of factors affecting interpersonal
functioning, first-year students were more likely to list "understanding
disease" as a factor affecting empathy, reflecting those students'
efforts to cognitively master the nature of a patient's illness.
Among students whose empathy decreased over time, the most commonly listed
factors were burnout, debt, and financial pressures, whereas those whose
empathy increased over time listed "understanding disease" and"
clinical experience" as factors.
Women tended to rate empathy higher in importance and to cite illness in
family and friends as affecting empathy.
"We think those whose empathy diminished over time seem to be more
burdened personally and preoccupied with factors affecting quality of life,
while those whose empathy increased were more engaged in the mainstream
educational process and may have had more positive role models,"
Winseman said. ▪