Relationship between increased personal well-being and enhanced empathy among

Internal medicine residents


BACKGROUND: While resident distress and its potential to negatively effect patient care have been well documented, little is known about resident well-being or its potential to enhance care.

OBJECTIVE: We measured resident well-being and explored its relationship with empathy.

DESIGN: Anonymous, cross-sectional survey.

PARTICIPANTS: Internal medicine residents at Mayo Clinic Rochester (n=165, summer 2003).

MEASUREMENTS: Well-being was measured using the previously validated Medical Outcomes Study 8-item Short Form (SF-8). Empathy was measured using the previously validated Perspective Taking (PT) and Empathetic Concerns (EC) Sub-scales of the Interpersonal Reactivity Index (IRI).

RESULTS: Eighty-three (50%) residents responded to the survey. Mean scores for well-being as measured by the SF-8 were comparable to the general population, and empathy scores on the IRI were similar to other resident samples. Resident empathy on both the cognitive (PT) and emotive (EC) sub-scales of the IRI was higher for residents with higher mental well-being on the SF-8; however, this difference was statistically significant only for the cognitive sub-scale. The importance of a number of personal wellness promotion strategies differed for residents with higher mental well-being on the SF-8.

CONCLUSIONS: High mental well-being was associated with enhanced resident empathy in this cross-sectional survey. Future studies need to explore the potential for high resident well-being to enhance medical care and competency in addition to exploring the negative consequences of resident distress. Studies investigating how to promote resident well-being are needed.

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  1. 1.

    Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–67.

    PubMed  Google Scholar 

  2. 2.

    Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA. 2002;287:3143–6.

    PubMed  Article  Google Scholar 

  3. 3.

    Lemkau JP, Purdy RR, Rafferty JP, Rudisill JR. Correlates of burnout among family practice residents. J Med Educ. 1988;63:682–91.

    PubMed  CAS  Google Scholar 

  4. 4.

    Firth-Cozens J. Emotional distress in junior house officers. Br Med J (Clin Res Ed). 1987;295:533–6.

    CAS  Google Scholar 

  5. 5.

    Adler R, Werner E, Korsch B. Systematic study of four years of internship. Pediatrics. 1980;66:1000–8.

    PubMed  CAS  Google Scholar 

  6. 6.

    Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44:1017–22.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: status quo after a decade of reform? Ann Intern Med. 2002;136:384–90.

    PubMed  Google Scholar 

  8. 8.

    Hughes PH, Conrad SE, Baldwin DC Jr., Storr CL, Sheehan DV. Resident physician substance use in the United States. JAMA. 1991;265:2069–73.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Reuben DB. Depressive symptoms in medical house officers. Effects of level of training and work rotation. Arch Intern Med. 1985;145:286–8.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Smith JW, Denny WF, Witzke DB. Emotional impairment in internal medicine house staff. Results of a national survey. JAMA. 1986;255:1155–8.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    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;109:154–61.

  12. 12.

    Lavery JP. The physician’s reaction to a malpractice suit. Obstet Gynecol. 1988;71:138–41.

    PubMed  CAS  Google Scholar 

  13. 13.

    Colford JM Jr., McPhee SJ. The ravelled sleeve of care. Managing the stresses of residency training. JAMA. 1989;261:889–93.

    PubMed  Article  Google Scholar 

  14. 14.

    Reuben DB, Novack DH, Wachtel TJ, Wartman SA. A comprehensive support system for reducing house staff distress. Psychosomatics. 1984;25:815–20.

    PubMed  CAS  Google Scholar 

  15. 15.

    Linzer M, Visser MR, Oort FJ, Smets EM, McMurray JE, de Haes HC. Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med. 2001;111:170–5.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    McCue JD, Sachs CL. A stress management workshop improves residents’ coping skills. Arch Intern Med. 1991;151:2273–7.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Shanafelt T, Sloan J, Habermann T. The well-being of physicians. Am J Med. 2003;1114:513–7.

    Article  Google Scholar 

  18. 18.

    Weiner EL, Swain GR, Wolf B, Gottlieb M. A qualitative study of physicians’ own wellness-promotion practices. West J Med. 2001;174:19–23.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    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. JAMA. 1997;278:502–9.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Intern Med. 1990;150:1857–61.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Novack D, Epstein R, Paulsen R. Toward creating physician-healers: fostering medical students’ self-awareness, personal growth, and well-being. Acad Med. 1999;74:516–20.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    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.

    Google Scholar 

  23. 23.

    Turner-Bowker D, Bayliss M, Ware JE Jr., Kosinski M. Usefulness of the SSF-8 health survey for comparing the impact of migraine and other conditions. Qual Life Res. 2003;12:1003–12.

    PubMed  Article  Google Scholar 

  24. 24.

    ACGME ACGME Outcome Project. 2004.

  25. 25.

    Brownell A, Cote L. Senior residents’ views on the meaning of professionalism and how they learn about it. Acad Med. 2001;76:734–7.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Halpern J. What is clinical empathy. J Gen Intern Med. 2001;18:670–4.

    Article  Google Scholar 

  27. 27.

    Brock C, Salinsky J. Empathy: an essential skill for understanding the physician-patient relationship in clinical practice. Educ Res Methods. 1993;25:245–48.

    CAS  Google Scholar 

  28. 28.

    Epstein R. Mindful practice. JAMA. 1999;282:833–9.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkships. Acad Med. 2004;79:832–9.

    PubMed  Article  Google Scholar 

  30. 30.

    Spiro H. What is empathy and can it be taught? Ann Intern Med. 1992;116:843–6.

    PubMed  CAS  Google Scholar 

  31. 31.

    Branch W, Pels R, Hafler J. Medical students’ empathic understanding of their patients. Acad Med. 1998;71:360–2.

    Article  Google Scholar 

  32. 32.

    Charon R. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286:1897–902.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    More E. Empathy as a hermeneutic practice. Theor Med. 1996;17:243–54.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Davis M. A multidimensional approach to individual differences in empathy. JSAS Catalog Selected Documents Psychol. 1980;10:85.

    Google Scholar 

  35. 35.

    Davis M. Measuring individual differences in empathy: evidence for a multi-dimensional approach. J Pers Soc Psychol. 1983;44:113–26.

    Article  Google Scholar 

  36. 36.

    Evans B, Stanley R, Burrows G. Measuring medical students empathy skills. Br J Med Psychol. 1993;66:121–33.

    PubMed  Google Scholar 

  37. 37.

    Evans B, Stanley R, Coman G, Burrows G. Psychological tests to measure the effects of medical education on students’ interpersonal skills. Med Educ. 1989;23:492–7.

    PubMed  CAS  Google Scholar 

  38. 38.

    Coman G, Evans B, Stanley R. Scores on the interpersonal reactivity index: a sample of Australian medical students. Psychol Rep. 1988;62:943–5.

    PubMed  CAS  Google Scholar 

  39. 39.

    Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287:226–35.

    PubMed  Article  Google Scholar 

  40. 40.

    Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med [Med Psychol Med Sociol]. 1980;14A:495–9.

    CAS  Article  Google Scholar 

  41. 41.

    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;12:93–102.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    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;15:122–8.

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    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;23:1171–8.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Lichtenstein RL. The job satisfaction and retention of physicians in organized settings: a literature review. Med Care Rev. 1984;41:139–79.

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Winefield H, Chur-Jansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ. 2000;34:90–94.

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Shapiro J, Morrison E, Bocker J. Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Educ Health. 2004;17:73–84.

    Article  Google Scholar 

  47. 47.

    Shapiro J, Rucker L. Can poetry make better doctors? Teaching the humanities and arts to medical students and residents at the University of California, Irvine, College of Medicine. Acad Med. 2003;78:953–7.

    PubMed  Article  Google Scholar 

  48. 48.

    Kopelman L. Values and virtures: how should they be taught? Acad Med. 1999;12:1307–10.

    Article  Google Scholar 

  49. 49.

    Branch W. Supporting the moral development of medical students. J Gen Intern Med. 2000;15:503–8.

    PubMed  Article  Google Scholar 

  50. 50.

    DiLalla L, Hull S, Dorsey J. Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teach Learn Med. 2004;16:165–70.

    PubMed  Article  Google Scholar 

  51. 51.

    Kopelman L. Philosophy and medical education. Acad Med. 1995;70:795–805.

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Roter D, Stewart M, Putnam S, Lipkin M Jr., Stiles W, Inui T. Communication patterns of primary care physicians. JAMA. 1997;277:350–6.

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Hornblow A, Kidson M, Jones K. Measuring medical students’ empathy: a validation study. Med Educ. 1977;11:7–12.

    PubMed  CAS  Google Scholar 

  54. 54.

    Nightingale S, Yarnold P, Greenberg M. Sympathy, empathy, and physician resource utiliation. J Gen Intern Med. 1991;6:420–3.

    Article  CAS  Google Scholar 

  55. 55.

    Hojat M, Gonnella J, Nasca T, Veloski SM, Magee M. The Jefferson scale of physician empathy: further psychometric data and differences by gender and specialty at item level. Acad Med. 2002;77:S58–60.

    PubMed  Article  Google Scholar 

  56. 56.

    Hojat M, Gonnella J, Mangione S, et al. Empathy in medical students as related to academic performance, clinical competence, and gender. Med Educ. 2002;36:522–27.

    PubMed  Article  CAS  Google Scholar 

  57. 57.

    Oswald P. Does the interpersonal reactivity index perspective-taking scale predict who will volunteer time to counsel adults entering college? Percept Motor Skills. 2003;97:1184–6.

    PubMed  Google Scholar 

  58. 58.

    Asch D, Jedrziewski M, Christakis N. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50:1129–36.

    PubMed  Article  CAS  Google Scholar 

  59. 59.

    Kellerman S, Herold J. Physician response to surveys A review of the literature. Am J Prev Med. 2001;20:61–71.

    PubMed  Article  CAS  Google Scholar 

  60. 60.

    Girard DE, Elliot DL, Hickam DH, et al. The internship—a prospective investigation of emotions and attitudes. West J Med. 1986;144:93–8.

    PubMed  CAS  Google Scholar 

  61. 61.

    Gross E. Gender differences in physician stress: why the discrepant findings. Women Health. 1997;26:1–14.

    PubMed  Article  CAS  Google Scholar 

  62. 62.

    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;159:1417–26.

    PubMed  Article  CAS  Google Scholar 

  63. 63.

    McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group. J Gen Intern Med. 2000;15:372–80.

    PubMed  CAS  Google Scholar 

  64. 64.

    Cooper CL, Rout U, Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ. 1989;298:366–70.

    PubMed  CAS  Article  Google Scholar 

  65. 65.

    Sekeres MA, Chernoff M, Lynch TS Jr., Kasendorf EI, Lasser DH, Greenberg DB. The impact of a physician awareness group and the first year of training on hematology-oncology fellows. J Clin Oncol. 2003;21:3676–82.

    PubMed  Article  Google Scholar 

  66. 66.

    Shanafelt T, Novotny P, Johnson ME, et al. The well-being and personal wellness promotion practices of medical oncologists in the north central cancer treatment group. Oncology (Karger). 2005;68:23–32.

    Article  Google Scholar 

  67. 67.

    Kash KM, Holland JC, Breitbart W, et al. Stress and burnout in oncology. Oncology (Huntingt). 2000;14:1621–33; discussion 1633–4, 1636–7.

    CAS  Google Scholar 

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Corresponding author

Correspondence to Dr. Tait D. Shanafelt MD.

Additional information

The authors have no conflicts of interest to disclose.

This study was funded through institutional grants from the Mayo Clinic Department of Medicine MIDAS Program. The investigators received financial support from the Mayo Clinic.

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Shanafelt, T.D., West, C., Zhao, X. et al. Relationship between increased personal well-being and enhanced empathy among. J GEN INTERN MED 20, 559–564 (2005).

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Key words

  • resident
  • well-being
  • empathy
  • competency
  • distress