Does empathy really decline during residency training? A longitudinal look at changes in measured empathy in a community program

Abstract

Introduction Some studies, most cross sectional and urban, have shown a decline in empathy during residency training prompting medical educators to consider changes in curriculum or training environment. Our aim was to determine if there was a decline using a longitudinal, paired annual empathy measure across three years of a family medicine residency in a rural community hospital. Methods We administered a validated measure from 2015 through 2020 and of the 116 opportunities for survey completion, 112 from 48 residents were available for scoring. We also asked our residents to rank 10 factors that affected their empathy scores. The Baptist Health Madisonville IRB approved the protocol as exempt and the authors have no conflicts of interest.. Results With a response rate of 97%, we found no statistically significant decrease in our resident scores across the three years. Scores after our PG-1 year were significantly lower than two previous comparable studies. The longitudinal, paired study design revealed very wide ranges among individual residents even when group means indicated a statistical difference. Residents also differed widely on their rankings of factors that could affect the score, with only outlook on life showing a narrow range and high ranking. Conclusions The very wide range of individual paired scores as well as the broad range of factors the residents thought affected their scores indicate that empathy is a very individual concept. Some of our residents actually increased scores leading to resilience and others declined toward cynicism. Those seeking to make changes to curriculum or training environment to facilitate empathy during residency should consider this diversity of individual resident training experience.

Empathy and Burnout During Residency: Which Changes First?

“…Focus groups with our residents prior to some recent program improvements showed that adequate sleep and minimizing administrative work unassociated with learning were ranked as most important overall, and first-year residents were concerned with learning a new electronic medical record and adapting to a new city. 17 A recent national study of 2,509 family medicine residents showed that although burnout scores were not associated with in-training exam scores, they were correlated with failure to meet the professional conduct and accountability milestone. This study also reported that adequate salary given local cost of living is important.…”

“…We have reported some results from this residency previously, and we will continue those efforts. 17 We also invite other programs to replicate our studies and combine results across programs.…”

Beyond empathy training for practitioners: Cultivating empathic healthcare systems and leadership

“…A stressful workplace environment, undue focus on the biomedical model, and inadequate role models leads to maladaptive coping strategies such as cynicism, professional distancing, and eventually to burnout 39,40 . A similar pattern is emerging in postgraduate medical training, where empathy seems to decline even further 41,42 . The increased levels of burnout is leading to the medical profession leaving in droves 43 .…”

“…39,40 A similar pattern is emerging in postgraduate medical training, where empathy seems to decline even further. 41,42 The increased levels of burnout is leading to the medical profession leaving in droves. 43 To reverse this trend, empathy and compassion need to be viewed as key to professionalism, alongside integrity, honesty and a commitment to person centred care within medical education.…”