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


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.

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This study was funded through an Academic Primary Care Grant, provided by the division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, and through a Professionalism Grant, provided by the Department of Medicine, Mayo Clinic College of Medicine. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. The primary author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Matthew R. Thomas MD.

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Thomas, M.R., Dyrbye, L.N., Huntington, J.L. et al. How Do Distress and Well-being Relate to Medical Student Empathy? A Multicenter Study. J GEN INTERN MED 22, 177–183 (2007).

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Key words

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