Original Article

Journal of General Internal Medicine

, Volume 22, Issue 2, pp 177-183

First online:

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

  • Matthew R. ThomasAffiliated withDepartment of Internal Medicine, Mayo Clinic Email author 
  • , Liselotte N. DyrbyeAffiliated withDepartment of Internal Medicine, Mayo Clinic
  • , Jefrey L. HuntingtonAffiliated withDepartment of Clinical Operations, Intermountain Healthcare
  • , Karen L. LawsonAffiliated withCenter for Spirituality and Healing, University of Minnesota
  • , Paul J. NovotnyAffiliated withCancer Center Statistics, Mayo Clinic
  • , Jeff A. SloanAffiliated withCancer Center Statistics, Mayo Clinic
  • , Tait D. ShanafeltAffiliated withDepartment of Internal Medicine, Mayo Clinic

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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.


Multi-institutional, cross-sectional survey.


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


A total of 1,098 medical students.


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


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.


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.

Key words

empathy well-being burnout professionalism quality of life competency undergraduate medical education