Does Medical Students' High Expression of Empathy Correlate with Their Choice of Primary Care Residencies?

There are many factors that influence medical students' (MS) decisions when choosing a career. Some prominent factors include life-work balance, indebtedness, and flexibility of work hours. Whereas the expression of empathy has many positive correlates with a trusting and meaningful physician-patient interaction, only a few studies have analyzed the association of MS empathy expression and primary care residency selection. The results of these studies about the relationship of MS expression of empathy and their selection of primary care specialties have been conflicting, depending on the empathy instrument used. In addition, there have been other variables that have affected career decision making in more recent years not previously encountered. The objectives of our study were to analyze the association of The George Washington University School of Medicine and Health Sciences (GWU) MS Interpersonal Reactivity Index (IRI) scores and their residency selection, to compare our results with previous studies to determine whether the IRI provided more definitive relationships between empathy and career choice, and to assess whether our results confirmed the theoretical construct linking empathy with primary care physicians.

GWU third-year MS (MS3s), representing the classes of 2008-2011, completed the perspective taking and empathy subscales of the IRI, which measure cognitive and affective empathy, respectively. MS empathy scores for individual specialty were compared to those scores in internal medicine (IM) using a linear regression model. Empathy scores for patient-oriented versus technology-oriented specialties and primary versus surgical specialties were compared using the independent t test.

A total of 593 (77.5%) MS3s had mean IRI scores of 45.1 (standard error 4.8), higher than a recent study involving MS. There were no significant differences between patient- and technology-oriented specialties (-0.65 to 0.88), primary care versus surgical residencies (-0.87 to 1.4), and women versus men (-0.20 to 1.4). Our study did not clarify previous conflicting studies in the literature.

There are no significant differences in expression of empathy in GWU students who chose patient- versus technology-oriented and primary care versus surgical residencies. The authors can only speculate why students' high expression of empathy was not associated with selecting primary care residencies, namely, women are outnumbering men entering medicine and are selecting technology-related specialties previously identified predominantly with men, and millennials have specific traits inherent in their generation that can affect their specialty choice. The results of our study shed doubt that the theoretical construct linking MS high empathy expression and choice of primary care careers is valid today.