Stress and empathy among internal medicine trainees on an inpatient hematology-oncology ward.

Abstract

231 Background: Effectively managing patient distress in oncology is challenging. Just as patients and their families experience distress over cancer, trainees in oncology also experience distress. This study evaluates whether increased physician-in-training distress acutely reduces empathy. Terror Management Theory provides the theoretical framework for the hypothesis. Methods: 35 internal medicine interns and residents completed a pre and post rotation Impact of Events (IES) and Interpersonal Reactivity Index (IRI) for comparison after 2-4 weeks. IES and IRI measure distress and empathy respectively. Results: Overall IRI empathy decreased (paired t-test, p=0.02) but only significantly in the Fantasy subscale (p=0.008). Empathy scores were below historical controls and did not differ between males and females (p=0.06). Pre and post rotation IES scores averaged 19.7 and 20.7. Distress was significant (>8) in 82% and 88% and severe (>33-PTSD range) in 20% and 22% of Pre/Post IES, respectively. Time on the ward averaged 2.6 weeks and residents attended to 4.6 actively dying patients, of which 38% stated it was "the most stressful experience"; however, 56% found "meaning" in the work. 48% mentioned patient death as the traumatic event (responding to IES). Conclusions: Residents demonstrated pathological levels of distress which affected aspects of empathy in a short period of time and related predominately to death experiences. Ultimately, physician self-management of vicarious distress during oncology training and enhanced maintenance of empathy could improve patient distress management, but this idea will require further study. [Table: see text]