Empathy and Burnout During Residency: Which Changes First?

Abstract

Background and Objectives: The issue of declining empathy and increasing burnout among residents is of concern for most programs. Numerous studies have shown these changes in both medical students and residents. However, the sequence of empathy decline and increasing burnout is unresolved and most studies have been cross sectional. This paper reports an individually-paired longitudinal analysis intended to clarify the sequence of these changes. Methods: Beginning in 2017, 35 family medicine residents across all 3 years of training at a rural program completed an established empathy survey and a previously-validated single burnout question at the start of each year and at the midpoint. First, the empathy score for each resident was aligned with the next following burnout measure, and then the reverse sequence was followed, with burnout aligned with the following empathy score. Results: With 125 responses to 133 survey opportunities, we saw a 94% response rate. Empathy scores across residency years decreased slightly and then improved almost to baseline. However, the analysis of variance test for quadratic trend was not significant. The burnout measure increased significantly over the residency years (J-T Statistic=4.89, P<.001). The correlation of the empathy score changing first showed a nonsignificant correlation (Rs=-.150, P=.133). The Spearman’s ρ of the burnout measure changing first was significant (Rs=-.300, P=.006). Conclusions: In this group of residents, changes in burnout occurred before changes in empathy. If further research supports this finding, residency programs could focus more on efforts to address burnout to mitigate decreases in empathy.

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.…”

The employment of art therapy to develop empathy and foster wellbeing for junior doctors in a palliative medicine rotation - a qualitative exploratory study on acceptability

“…They are involved in symptom management, facilitating complex serious illness conversations, and offering psychosocial and grief support to patients and their families. However, due to the inherent clinical complexities associated with PC, further exacerbated by pandemic-related segregation measures and limited manpower, junior doctors have faced challenges in managing their daily clinical responsibilities [ 23 , 32 – 39 ]. Recognizing the potential of art therapy to address the urgent need for support, a novel art therapy-focused program has been integrated into the existing orientation curriculum for all junior doctors since 2020.…”

A Curious Reflection

“…My perspective on this issue is framed by the last eight years of our longitudinal study of changes in empathy and burnout among our medical students and residents. 1,2,3,4 As we reviewed the literature, the definition for empathy that fits best for us is a true understanding of what it's like to be that patient. When a new diagnosis or a new medication or intervention is considered, how will it fit into the life of the individual in our exam room with us?…”