Empathy, spirituality and wellness in physicians practicing at Brazilian university hospitals: a multicentric study

Felix, Gabriel de Almeida Arruda; Gouveia, Lara Oliveira; Cardeliquio, Isabella Azevedo; Santos, Nathália Alves; Paes, Larissa Figueiredo; Santos, Daniela Vieira da Silveira; Gouveia, Heitor Oliveira; Veiga, Daniela Francescato

doi:10.1590/1981-5271v49.1-2024-0154

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ORIGINAL ARTICLE • Rev. bras. educ. med. 49 (2) • 2025 • https://doi.org/10.1590/1981-5271v49.1-2024-0154.ING linkcopy

Empathy, spirituality and wellness in physicians practicing at Brazilian university hospitals: a multicentric study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: This multicentric study aimed to evaluate empathy, openness to spirituality, and wellness among physicians in Brazilian university hospitals, fundamental in medical training.

Methods: This multicentric cross-sectional study included 1,000 physicians of any age or gender, with at least six months of experience in public or private university hospitals affiliated with the Brazilian Unified Health System (SUS). The Empathy, Spirituality, and Wellness in Medicine Scale (ESWIM), validated in Brazil, was used, with scores ranging from 1 to 5, where higher scores indicate greater empathy, openness to spirituality, or wellness. The statistical analysis included Mann-Whitney and Kruskal-Wallis tests with a significance level of 0.05.

Results: Of the 1,000 physicians invited, 445 completed the survey. The median scores (interquartile range) were 3.90 (0.60) for empathy, 4.00 (0.67) for openness to spirituality, and 3.00 (0.86) for wellness. No significant differences in empathy were found between genders (p=0.047). Factors such as family dynamics (p=0.003), academic roles (p=0.004), and parental status (p=0.003) were associated with higher empathy scores. Younger physicians demonstrated greater openness to spirituality (p=0.019), with regional variations observed. Wellness scores were influenced by gender, experience, age, specialty, academic degree, and frontline COVID-19 duties, with frontline clinicians exhibiting lower wellness scores (p<0.001).

Conclusions: Empathy, openness to spirituality, and wellness among physicians in Brazilian university hospitals are influenced by various characteristics.

Keywords:
Physicians; Empathy; Spirituality; Quality of Life; Hospitals, University

Variable	N=445 (100%)
Sex
Male	235 (52.8%)
Female	210 (47.2%)
Age
Up to 35 years old	148 (33.3%)
From 35 to 50 years old	137 (30.8%)
From 52 to 65 years old	127 (28.5%)
66 years or older	33 (7.4%)
Ethnicity
Caucasian	379 (85.2%)
Non-Caucasian	66 (14.8%)
Marital status
With partner	336 (75.5%)
No partner	109 (24.5%)
Family status
With children	256 (57.5%)
Childless	189 (42.5%)
Time since graduation
Up to 10 years	151 (33.9%)
Between 10 and 25 years	124 (27.9%)
More than 25 years	170 (38.2%)
Graduation Institution
Public	211 (47.4%)
Private	234 (52.6%)
Medical specialty
Clinical	285 (64.0%)
Surgical	160 (36.0%)
Highest academic degree
Associate Professor/Full Professor	71 (15.9%)
Doctorate/Master’s Degree	163 (36.7%)
Specialization/Graduation	211 (47.4%)
Sector in which you work
Public	136 (30.6%)
Private	25 (5.6%)
Both	284 (63.8%)
University Professor
No	229 (51.5%)
Yes	216 (48.5%)
Worked during COVID-19 pandemic
No	41 (9.2%)
Yes, in-person	237 (53.3%)
Yes, remote	29 (6.5%)
Yes, both	138 (31.0%)
State
Minas Gerais	101 (22.7%)
São Paulo	296 (66.5%)
Other^*	48 (10.8%)
Worked on the front line of COVID-19
No	277 (62.2%)
Yes	168 (37,8%)

Variable	Scores
	Empathy		Openness to Spirituality		Wellness
	Median (IQR^♦)	p	Median (IQR^♦)	p	Median (IQR^♦)	p
Sex
Female	3.90 (0.50)	NS	4.08 (0.50)	p<0.001^a	2.86 (0.71)	p<0.001^a
Male	3.80 (0.60)		3.83 (0.83)		3.14 (0.79)
Age group
Up to 35 years old	3.80 (0.60)	p=0.044b	4.00 (0.66)	p=0.006^b	2.86 (0.75)	p<0.001^b
From 35 to 50 years old	3.90 (0.50)		4.00 (0.66)		2.86 (0.72)
From 51 to 65 years old	4.00 (0.50)		3.83 (0.83)		3.14 (0.71)
66 years or older	3.80 (0.60)		3.67 (0.92)		3.43 (0.86)
State
Minas Gerais	3.90 (0.55)	NS	4.17 (0.66)	p=0.002b	2.86 (0.72)	NS
São Paulo	3.80 (0.60)		4.00 (0.83)		3.00 (0.72)
Other^*	3.80 (0.58)		4.00 (0.66)		3.00 (0.72)
Family status
Childless	3.80 (0.70)	p=0.003^a	4.00 (0.66)	NS	2.86 (0.86)	p<0.001^a
With children	3.90 (0.60)		4.00 (0.66)		3.14 (0.86)
Time since graduation
Up to 10 years	3.80 (0.60)		4.17 (0.66)		2.86 (0.78)	p<0.001^b
Between 10 and 25 years old	3.90 (0.55)	p=0.019^b	4.00 (0.66)	p=0.012^b	2.86 (0.75)
More than 25 years	3.90 (0.50)		3.83 (0.66)		3.14 (0.85)
Specialty
Clinical	3.90 (0.60)	NS	4.00 (0.66)	p=0.014^a	2.86 (0.72)	p<0.001^a
Surgical	3.90 (0.60)		3.83 (0.83)		3.14 (0.85)
Highest academic Degree
Graduation/Specialization	3.80 (0.60)		4.00 (0.66)		2.86 (0.72)
Master’s Degree/Doctorate	3.90 (0.50)	NS	4.00 (0.66)	p<0.001^b	3.14 (0.86)	p<0.001^b
Post-doctorate/Full Professor	3.90 (0.60)		3.67 (0.84)		3.29 (1.00)
University Professor
No	3.80 (0.60)	p=0.004^a	4.00 (0.66)	NS	2.86 (0.79)	p<0.001^a
Yes	3.90 (0.50)		4.00 (0.66)		3.14 (0.71)
Worked on the COVID-19 frontline
No	3.90 (0.60)	NS	4.00 (0.83)	NS	3.14 (0.86)	p<0.001^a
Yes	3.90 (0.67)		4.00 (0.66)		2.86 (0.71)
Total (n=445)	3.90 (0.60)	-	4.00 (0.67)	-	3.00 (0.86)	-

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[TFN8] ^*
Federal District, Paraná, Rio de Janeiro, Santa Catarina, Tocantins.

[TFN9] Source: Prepared by the authors.