Background. Physician empathy is recognized as an important element of patient care
and should as such be cherished in medical students. Being empathic however is a known
risk factor for burnout. This relation is complex and in literature contradicting evidence
is seen. Empathy as a multidimensional construct comprises both affective and cognitive
aspects, such as emotion sharing and perspective-taking. Most research focusses on either
cognitive or affective aspects of empathy. Social neuroscience uses a model in which
cognitive aspects are integrated with affective aspects and this could lead to a more
complete view on before mentioned relation between burnout and empathy.
Aims. Aim of this study was to shed light on the association of both affective and cognitive
aspects of empathy and their possible interaction, with burnout in medical students in
Methods. We conducted two validated questionnaires, the Empathy Assessment Index
(EAI-22) and part (subscale Exhaustion) of the Maslach Burnout Inventory - Student
Survey (MBI-SS-16) in a population of first-year medical students (n = 218). Because
the EAI-22 was translated into Dutch we assessed the internal consistency of the trans-
lated items. Correlations were calculated and multiple regression models were built in
order to test hypotheses regarding expected associations between empathy aspects, their
interaction and burnout. We stratified into Dutch students versus international students.
Results. In our sample we saw one significant correlation between an empathy subscale
(emotion regulation) and burnout: Pearson’s r -0.30 in the Dutch group and -0.33 in the
international group. Other correlations were low, not significant or even reverse in both
groups. In the regression models the association between empathic response subscales
of the EAI-22 and burnout was assessed with the regulatory strategies subscales as a
moderator, also interaction between these subscales was accounted for in the models.
While we saw significant beta coefficients for the subscales emotion response and self-
other awareness as a moderator on the before mentioned association in our Dutch group,
this was not the case for the international group.
Conclusion and discussion. Like we expected emotion regulation is negatively associated
with burnout. Other associations between empathy aspects and burnout were diffuse.
Problematic in our study was the poor performance of the EAI-22 in our population,
internal consistency for a number of subscales was not adequate. This study is one of
the first studies that combines both affective and cognitive aspects of empathy while
researching their association with burnout.
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