A colleague working in medical education showed me a fascinating graph – his observations about the trend in ‘interpersonal competence’ over time as medical students went through undergraduate training and then began their careers in medicine. Year one, the idealistic medical students had high levels of interpersonal competence. By the end of undergraduate training – proven by research studies – the capacity for empathy had declined. Medical training is a dehumanising experience.
But the most striking part of the graph was the beginning of work as a doctor: in the extreme stress of beginning a medical career, survival mode took over. Interpersonal competence fell dramatically. I’ve long thought that if we are to rehumanise medicine, we need to focus on emotional support, resilience and wellbeing of our young doctors, nurses and therapists.
Now a new study adds a twist to the story.
Giorgia Silani and collaborators with the International School for Advanced Studies (SISSA) in Trieste published new research in Psychoneuroendocrinology showing that stressed males tend to become more self-centred and less able to distinguish their own emotions and intentions from those of other people. For women the exact opposite is true. The study was coordinated by the Social Cognitive Neuroscience Unit of the University of Vienna and saw the participation of the University of Freiburg.
“There’s a subtle boundary between the ability to identify with others and take on their perspective – and therefore be empathic – and the inability to distinguish between self and other, thus acting egocentrically” explains Silani. “To be truly empathic and behave prosocially it’s important to maintain the ability to distinguish between self and other, and stress appears to play an important role in this”.
Stress is a psycho-biological mechanism that may have a positive function: it enables the individual to recruit additional resources when faced with a particularly demanding situation. The individual can cope with stress in one of two ways: by trying to reduce the internal load of “extra” resources being used, or, more simply, by seeking external support. “Our starting hypothesis was that stressed individuals tend to become more egocentric. Taking a self-centred perspective in fact reduces the emotional/cognitive load. We therefore expected that in the experimental conditions people would be less empathic” explains Claus Lamm, from the University of Vienna and one of the authors of the paper.
The surprise was that our starting hypothesis was indeed true, but only for males. In the experiments, conditions of moderate stress were created in the laboratory (for example, the subjects had to perform public speaking or mental arithmetic tasks, etc.). The participants then had to imitate certain movements (motor condition), or recognise their own or other people’s emotions (emotional condition), or make a judgement taking on another person’s perspective (cognitive condition). Half of the study sample were men, the other half were women.
“What we observed was that stress worsens the performance of men in all three types of tasks. The opposite is true for women” explains Silani.
So far as we know at Hearts in Healthcare, there has been no research on gender differences in the impact of work stress on empathy in the healthcare setting. This study may have major implications for how we set up mentoring and support programs for young health professionals.
Read more about the research study…