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Purpose: Empathy, a fundamental pillar of medicine, has been shown to decrease in medical school. Increased stress is linked to decreased empathy, but specific stressors remain unclear. The goal of this study was to qualitatively explore specific stressors among third year medical students.

Methods: Third year medical students (n=248) participated in Reflection Rounds with a clinician and a member of pastoral care at Thomas Jefferson University and in their final sessions created a cartoon to express sentiments surrounding medicine. Qualitative analysis of the cartoons was conducted on both the images and text. Common themes were identified from the students’ visualizations and each cartoon was coded into one or more of these themes. Words, punctuation, and visual facial expressions were thematically coded, and their frequency was tabulated.

Results: The three most common themes in the cartoons were learning (17%), work-life balance (12%), and insecurity (12%). The seven other themes were working with residents, how students are treated, stress, heart, working with attendings, how patients are treated, and burnout. Multiple punctuation marks were present in 34% of the cartoons, and 32% of the cartoons demonstrated a worried facial expression. Some of the prevalent words in the word cloud analysis were “think, know, student, thanks, and time”.

Conclusion: The cartoons demonstrated that medical students have multiple worries, namely: work-life balance, insecurity in their position, and time management. These findings may inform future research on emotional burdens that medical students face, and modifications to these burdens may lead to increased empathy.

Publication Date



medical student burnout, medical education, team dynamics, stressors, empathy


Medicine and Health Sciences


Presented at the 2024 AOA Research Symposium.

Emotional Stressors Faced by Medical Students Expressed Using Cartoons: A Qualitative Study