Empathy, mental health, and burnout during medical school: A longitudinal study of reciprocal influences.

Purpose
The level of medical students' empathy may be related to mental health and burnout. Whether one predicts the other remains to be tested. The present study sought to test the reciprocal influences between empathy and mental health or burnout in a population of medical students using a longitudinal design.Method
From 2021 to 2024, a questionnaire was sent annually to all medical students at the University of Lausanne (Switzerland). The questionnaire included validated measures of empathy (cognitive, affective, and behavioral as well as an emotion recognition test), mental health (depression symptoms, anxiety, and stress), and burnout (emotional exhaustion, cynicism, and academic efficacy). Random-Intercept Cross-Lagged Panel Models were used to estimate how empathy predicts mental health or burnout the following time point and vice versa.Results
In total, 1852 medical students filled in at least one yearly questionnaire. The cross-sectional correlations showed that cognitive and behavioral empathy were related to better mental health and less burnout, whereas affective empathy was related to more mental health issues and burnout. Empathy, mental health, and burnout levels were predicted by their respective previous level as well as gender identification and curriculum years of the medical students. However, neither empathy nor mental health or burnout predicted the other from one time point to the next.Conclusions
The present study does not support a reciprocal relationship between empathy and mental health or burnout, but rather a parallel evolution across years. The results of this study emphasize the importance of recognizing each student's individuality. They further advocate for learning environments that support the development of communication competencies and nurture the well-being of medical students.[Box: see text].