The goal of medical education is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions; however, some aspects of training may have unintended negative effects on medical students' mental and emotional health that can undermine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. On a personal level, this distress can contribute to substance abuse, broken relationships, suicide, and attrition from the profession. On a professional level, studies suggest that student distress contributes to cynicism and subsequently may affect students' care of patients, relationship with faculty, and ultimately the culture of the medical profession. In this article, we review the manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress.

Medical Student Distress: Causes, Consequences, and Proposed Solutions

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.

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

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

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Relationship between increased personal well-being and enhanced empathy among internal medicine residents

A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships.

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.

Relationship between increased personal well-being and enhanced empathy among

The aim of this study was to validate the empathy scale (Hogan, 1969) for use in the context of medical education in Australia. Empathy Scale scores of students in their first clinical year at Monash University were correlated with patient ratings, self ratings, and peer ratings of empathy. Inter-rater and intra-rater reliability were assessed. Correlations were also obtained between Empathy Scale scores and course marks in psychiatry. Of the empathy ratings only those by peers correlated significantly with Empathy Scale scores (r = 0-45, P less than 0-05, n = 29). Empathy Scale scores were unrelated to academic performance. In a separate part of the study, not connected to the establishing of criterion-related validity, Empathy Scale scores of the medical student group were found to be significantly higher (t=4-44, df = 52, P less than 0-001) than the scores of psychiatric patients with a diagnosis of "personality disorder". This study provides some support for the Empathy Scale as a measure of interpersonal effectiveness, but has not established it as a valid measure of empathy in a clinical setting.

Measuring medical students' empathy: a validation study

Summary

Medical students' levels of anxiety under different conditions of stress were investigated, as well as the stability of anxiety ratings from one examination to another. After completing an end-of-term psychiatry examination, fourth-year medical students at Monash University were asked to score the Visual Analogue Scale for Anxiety (VASA) for three situational cues; usual day-to-day anxiety, highest anxiety associated with major exams the previous year and anxiety experienced in the end-of-term examination just completed. Twenty-eight weeks later students rated their anxiety in a subsequent end-of-term psychiatry examination. Most students rated themselves toward the lower end of the VASA for day-to-day anxiety and as having significantly, though not markedly higher anxiety in the end-of-term psychiatry examinations. The previous year's examinations, marking the end of pre-clinical training, provoked extremely high anxiety for most students, who achieved academically despite this. Comparison of anxiety ratings for the two end-of-term examinations indicated that VASA ratings shifted substantially for half the class. This variation suggests that students' levels of anxiety are not stable and predictable from one examination to another. Examination anxiety should not be seen necessarily as a consistent response to a specific and recurring situation. It is postulated that a range of situational factors and personal pressures, operating at the time, may determine how much anxiety is experienced as a reaction to the examination.

M. A. Kidson

Papers

Measuring medical students' empathy: a validation study

Examination anxiety in medical students: experiences with the visual analogue scale for anxiety