Purpose: Studies have shown that, as medical learners progress through
their training, compassion and empathy decrease, while cynicism increases.
This is linked with burnout, job dissatisfaction, and attrition from the
field. Though factors contributing to this evolution, such as fatigue and
workload, have been identified, the process through which these changes occur
has not been studied in detail. The purpose of this work was to develop a
better understanding of the process of the loss of compassion and empathy and
rise of cynicism during medical training.
Methods: We conducted a qualitative study in the constructivist grounded
theory approach. First, we collected Reddit narratives to develop an
understanding of the process from a variety of perspectives. Subsequently, we
invited participants (medical student to attending physician) to provide
detailed descriptions of the process in order to expand on the insights
gained from Reddit and allow for a conversation around experiences (reducing
one of the limitations of narrative analyses). Constant comparative analysis
was used to track the developing process throughout.
Results: 77 Reddit narratives and eight participant descriptions comprised
85 data slices. Analysis of the data identified a four-step process through
which compassion and empathy are generally lost, and cynicism gained. Steps
consisted of a real-world awakening to the realities of the medical field,
interpersonal struggles compounded by lack of support, realised emotions in
response to these realities and struggles, and development of a coping
mechanism. While this process is neither unidirectional nor linear, these four
steps help to describe how the evolution from compassionate, empathetic
junior learner to more cynical physician may occur.
Conclusion: Across all sources, the loss of compassion and rise of cynicism
was noted as a coping mechanism to deal with the realities of medicine. Our
study offers several potential points of intervention and study for future
work.