When patients teach students empathy: a systematic review of interventions for promoting medical student empathy





Background: Despite growing emphasis on empathic care, numerous studies demonstrate diminishing empathy in medical students. Involving patient educators in medical curricula may be a solution. Therefore, we conducted a systematic review to evaluate patient-involved interventions that promote empathy among medical students. 

Method: A literature search of MEDLINE, Embase, PsycINFO, and ERIC databases was performed using the keywords “empathy,” “medical student,” and their synonyms. Results were independently screened in duplicate. Conflicts were resolved by group consensus. All English studies describing interventions that promote empathy in medical students engaging patient educators were included. Relevant data was extracted and summarized.

Results: 1467 studies were screened. 14 studies were included, of which 10 were pilot studies. Studies included patient involved interventions such as storytelling (5/14), shadowing patients (3/14), recorded videos (3/14), or combinations of methods (3/14). Qualitative measurements of empathy included written feedback and group discussions. Quantitative measurements included validated scales measuring empathy. All studies demonstrated increase in empathy among medical students. Participants reported satisfaction with training and patients reported being proud of giving back by training future physicians.

Conclusion: Interventions engaging patient educators were shown to have a positive impact on medical student empathy. Furthermore, patient-led education was shown to increase medical student understanding of subject and knowledge retention while empowering patients. Further implementation of patient-involved education is an important step forward in patient-partnered care and may identify additional advantages of patient engagement in medical education.


Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52(Suppl):S9-

Riess H. The Science of Empathy. J Patient Exp. 2017;4(2):74- https://doi.org/10.1177/2374373517699267

Shapiro J. Walking a mile in their patients’ shoes: empathy and othering in medical students’ education. Philos Ethics Humanit Med. 2008 Mar 12;3: https://pubmed.ncbi.nlm.nih.gov/18336719

Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182– https://doi.org/10.1097/ACM.0b013e3181b17e55

Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996–10 https://doi.org/10.1097/ACM.0b013e318221e615

Ferreira-Valente A, Monteiro JS, Barbosa RM, Salgueira A, Costa P, Costa MJ. Clarifying changes in student empathy throughout medical school: a scoping review. Advances. 2017;22(5):1293-3 https://doi.org/10.1007/s10459-016-9704-7

Kerasidou A, Horn R. Making space for empathy: supporting doctors in the emotional labour of clinical care. BMC Med Ethics. 2016;17(1) https://doi.org/10.1186/s12910-016-0091-7

Kerasidou A. Empathy and efficiency in healthcare at times of austerity. Heal Care Anal. 2019;27(3):171– https://doi.org/10.1007/s10728-019-00373-x

Riess H, Kelley JM, Bailey RW, Dunn EJ, Phillips M. Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. J Gen Intern Med. 2012;27(10):1280-12 https://doi.org/10.1007/s11606-012-2063-z

Moudatsou M, Stavropoulou A, Philalithis A, Koukouli S. The Role of Empathy in Health and Social Care Professionals. Healthcare (Basel). 2020;8(1):Published 2020 Jan https://doi.org/10.3390/healthcare8010026

Brunero S, Lamont S, Coates M. A review of empathy education in nursing. Nurs Inq. 2010 Mar 1;17(1):65– https://doi.org/10.1111/j.1440-1800.2009.00482.x

Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009 Sep 23;302(12):1284– https://doi.org/10.1001/jama.2009.1384

Brennan TA, Leape LL, Laird NM, et al. incidence of adverse events and negligence in hospitalized patients. N Engl J Med. 1991 Feb 7;324(6):370– https://doi.org/10.1056/NEJM199102073240604

Spencer J, Blackmore D, Heard S, et al. Patient‐oriented learning: a review of the role of the patient in the education of medical students. Med Educ. 2000;34(10):851– https://doi.org/10.1046/j.1365-2923.2000.00779.x

Dijk SW, Duijzer EJ, Wienold M. Role of active patient involvement in undergraduate medical education: a systematic review. BMJ Open. 2020;10(7):e0372 https://doi.org/10.1136/bmjopen-2020-037217

Towle A, Bainbridge L, Godolphin W, Katz A, Kline C, Lown B, et al. Active patient involvement in the education of health professionals. Med Educ. 2010;44(1):64– https://doi.org/10.1111/j.1365-2923.2009.03530.x

Dornan T, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2006;28(1):3– https://doi.org/10.1080/01421590500410971

Chandrasekar H, Harte S, Sherman J, Park KT, Lee HC. Gaining perspectives on patient and family disease experiences by storytelling. Acad Pediatr. 2018;18(4):475– https://doi.org/10.1016/j.acap.2018.01.014

Lucchetti ALG, Duarte BSVF, de Assis T V, Laurindo BO, Lucchetti G. Is it possible to teach Geriatric Medicine in a stimulating way? Measuring the effect of active learning activities in Brazilian medical students. Australas J Ageing. 2019;38(2):e58– https://doi.org/10.1111/ajag.12626

Sweeney K, Baker P. Promoting empathy using video‐based teaching. Clin Teach. 2018;15(4):336– https://doi.org/10.1111/tct.12693

Cumberland D, Sawning S, Church-Nally M, et al. Experiential learning: transforming theory into practice through the Parkinson’s Disease buddy program. Teach Learn Med. 2019;31(4): 453-465, https://doi.org/10.1080/10401334.2019.1580583

Bramstedt KA, Prang M, Dave S, Shin PNH, Savy A, Fatica RA. Telemedicine as an ethics teaching tool for medical students within the nephrology curriculum. Prog Transplant. 2014;24(3):294– https://doi.org/10.7182/pit2014289

Shuja F, Ansari S, Babar T, et al. Empathy building in undergraduate medical students through an interaction with persons with disabilities in their natural home environment a descriptive qualitative study. Rawal Med J. 2014;39(2):208–

Player E, Gure-Klinke H, North S, et al. Humanising medicine: teaching on tri-morbidity using expert patient narratives in medical education. Educ Prim Care. 2019;30(6):368– https://doi.org/10.1080/14739879.2019.1670097

Singh SP, Modi CM, Patel CP, Pathak AG. Low-fidelity simulation to enhance understanding of infection control among undergraduate medical students. Natl Med J India. 2017;30(4):2 https://doi.org/10.4103/0970-258X.218677

Chen A, Hanna JJ, Manohar A, Tobia A. Teaching empathy: The implementation of a video game into a psychiatry clerkship curriculum. Acad Psychiatry. 2018;42(3):362– https://doi.org/10.1007/s40596-017-0862-6

Chretien KC, Swenson R, Yoon B, et al. Tell me your story: a pilot narrative medicine curriculum during the medicine clerkship. J Gen Intern Med. 2015;30(7):1025– https://doi.org/10.1007/s11606-015-3211-z

Hendriksz T. Using patient perspective sessions to increase empathy and recall in preclinical medical students. J Am Osteopat Assoc. 2016;116(10):662– https://doi.org/10.7556/jaoa.2016.130

Hennrikus EF, Skolka MP, Hennrikus N. Applying metacognition through patient encounters and illness scripts to create a conceptual framework for basic science integration, storage, and retrieval. J Med Educ Curric Dev. 2018;5:23821205187777 https://doi.org/10.1177/2382120518777770

Morhardt, D. (2006). Educating medical students on Alzheimer's disease and related disorders: an overview of the Northwestern University Buddy Program. Dementia. 448-410.1177/147130120600500311. https://doi.org/10.1177/147130120600500311

Shapiro J, Youm J, Kheriaty A, Pham T, Chen Y, Clayma R. The human kindness curriculum: an innovative preclinical initiative to highlight kindness and empathy in medicine. Educ Health (Abingdon). 2019;32(2):53– https://doi.org/10.4103/efh.EfH_133_18

Gordon M, Gupta S, Thornton D, Reid M, Mallen E, Melling A. Patient/service user involvement in medical education: a best evidence medical education (BEME) systematic review: BEME Guide No. Med Teach. 2020;42(1):4– https://doi.org/10.1080/0142159X.2019.1652731

Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: an updated, systematic review. Acad Med. 2013;88(8):1171– https://doi.org/10.1097/ACM.0b013e318299f3e3

Morhardt, D. (2018), P3-642: The Buddy Program Increases Medical Student Knowledge, Empathy And Attitudes Toward Persons Living With Dementia. Alzheimer's & Dementia, 14: P1379 P13 https://doi.org/10.1016/j.jalz.2018.06.2009

Karazivan P, Dumez V, Flora L, et al. The patient-as-partner approach in health care: a conceptual framework for a necessary transition. Acad Med. 2015 Apr 1;90(4):437- https://doi.org/10.1097/ACM.0000000000000603

Chen DCR, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach. 2012;34(4):305– https://doi.org/10.3109/0142159X.2012.644600

Werner ER, Korsch BM. The vulnerability of the medical student: Posthumous presentation of LL Stephens’ ideas. Pediatrics. 1976;57(3):321– https://doi.org/10.1542/peds.57.3.321

West CP, Shanafelt TD. The influence of personal and environmental factors on professionalism in medical education. BMC Med Educ. 2007;7(1):1– https://doi.org/10.1186/1472-6920-7-29

Rosenthal S, Howard B, Schlussel YR et al. Humanism at heart: preserving empathy in third-year medical students. Acad Med. 2011;86(3):350– https://doi.org/10.1097/ACM.0b013e318209897f

Dale, E. (1969). Audio-Visual Methods in Teaching (3rd ed., p. 108). Holt, Rinehart & Winston, New York: Dryden Press.

Gruppen LD, Branch VK, Laing TJ. The use of trained patient educators with rheumatoid arthritis to teach medical students. Arthritis Rheum Off J Am Coll Rheumatol. 1996;9(4):302–

Oswald A, Czupryn J, Wiseman J, Snell L. Patient‐centred education: what do students think? Med Educ. 2014;48(2):170– https://doi.org/10.1111/medu.12287

Bombeke K, Van Roosbroeck S, De Winter B, et al. Medical students trained in communication skills show a decline in patient-centred attitudes: an observational study comparing two cohorts during clinical clerkships. Patient Educ Couns. 2011;84(3):310– https://doi.org/10.1016/j.pec.2011.03.007

Mercer SW, Maxwell M, Heaney D, Watt G. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21(6):699–7 https://doi.org/10.1093/fampra/cmh621




How to Cite

Boshra M, Lee A, Kim I, Malek-Adamian E, Yau M, LaDonna K. When patients teach students empathy: a systematic review of interventions for promoting medical student empathy. Can. Med. Ed. J [Internet]. 2022 Oct. 18 [cited 2023 May 29];13(6):46-5. Available from: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/73058



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