Objective A reason for empathy decline during medical training has not been fully elucidated. Empathy may decrease acutely during an inpatient hematology–oncology rotation because of the acuity of death exposures. This study aimed to explore physician trainee empathy, distress, death exposures, and their attributed meaning for the trainee. Methods Internal medicine interns and residents at a single academic center were evaluated before and after hematology–oncology ward rotations using Interpersonal Reactivity Index for empathy, previously cited reasons for empathy decline, Impact of Event Scale‐Revised for distress, death exposures (no. of dying patients cared for) and attributed sense of meaning (yes/no) (post‐rotation). Results Fifty‐six trainees completed both pre‐rotation and post‐rotation questionnaires (58% response). Empathy averaged 58.9 (SD 12.0) before and 56.8 (SD 11.1) after the rotation (2.1 point decrease) (p = 0.018). Distress was elevated but did not change significantly during the rotation. Residents cared for 4.28 dying patients. Seventy‐three percent reported that death was the most stressful event during the rotation, yet 68% reported that they derived a sense of meaning from caring for dying patients. Empathy and distress scales were positively correlated before the rotation (r = 0.277, p = 0.041) but not after (r = .059, p = 0.69). Conclusion This study suggests that an acute drop in empathy can occur over several weeks in residents rotating through inpatient hematology–oncology, similar to empathy decline associated with years of training in other studies. Empathy decline may be associated with elevated distress and death exposures on the hematology–oncology ward and should be explored further in other medical training environments. Copyright © 2016 John Wiley & Sons, Ltd.