Teaching Medical Students to Care: Review Maps How Empathy Is Built in Medical School

Empathy has long been treated as the soft, unmeasurable side of medicine—something students either bring with them on day one or lose along the way. A new scoping review published in BMC Medical Education challenges that fatalism, assembling evidence from ninety-two studies to map exactly which educational experiences shape empathy during undergraduate medical training. The research team, led by J. Macabrey of Claude Bernard Lyon 1 University in France, systematically combed seven databases, including MEDLINE, Embase, APA PsycINFO, Web of Science, PubMed, CINAHL and LiSSa, for studies published between 2002 and 2025 in English or French. Their conclusion is both encouraging and sobering: empathy can be taught, but the most convincing gains come not from any single lecture or workshop, from layered, longitudinal combinations of theory, simulation and real patient contact.

The stakes are far higher than bedside manner. Decades of clinical research have linked physician empathy to stronger therapeutic relationships, better adherence to treatment, improved clinical outcomes and fewer medical errors. Empathy, as the review frames it, is not a single feeling but a composite construct with four distinguishable components: an emotional dimension that resonates with a patient’s distress, a cognitive dimension that models the patient’s perspective, a moral dimension that motivates altruistic action, and a behavioral dimension that translates all of this into observable communication and care. Medical curricula that target only one of these strands may leave the others untouched, which helps explain why the literature is so scattered in its findings.

Methodologically, the review followed the PRISMA-ScR reporting guidelines and applied strict inclusion criteria. Studies had to measure empathy with validated scales, focus on undergraduate medical students, and examine educational determinants rather than demographic or environmental factors. Purely qualitative studies were excluded, although mixed-methods studies were admitted with only their quantitative data analyzed. Each included study was then appraised with the Medical Education Research Study Quality Instrument, or MERSQI, before a cross-sectional and descriptive synthesis. That rigor matters, because the field of empathy research is notorious for small samples, heterogeneous instruments and self-report measures that invite optimistic interpretation.

The measurement landscape itself tells a story. Of the ninety-two included studies, fifty-six—60.9 percent—relied on the Jefferson Scale of Empathy for medical students, the JSE-MS, a self-report questionnaire that has become the de facto standard in the field. Its dominance brings consistency, but also a shared vulnerability: self-report scales are susceptible to social desirability bias, in which students answer as they believe a good doctor should, and they often lack the sensitivity to detect modest changes over a semester or a clinical rotation. The authors flag this directly, noting that many of the variations observed across studies fall below the thresholds that can be reliably detected, a caveat that should temper enthusiasm for any single impressive-sounding result.

From the mass of studies, five categories of educational determinants emerged. The first is the development of psychosocial skills, such as communication training, reflective writing and interpersonal exercises. The second is empathy-focused curricula, in which empathic engagement is woven into the formal structure of teaching. The third is direct patient encounters, the oldest and most intuitive form of empathy education. The fourth is clinical simulation, including standardized patients and role-play scenarios that let students practice difficult conversations in a controlled setting. The fifth is conceptual teaching on communication and empathy itself, the classroom-based transmission of what empathy is and why it matters.

Each category, on its own, showed evidence of working. Psychosocial skills interventions were the most frequently studied single approach, appearing in thirty-eight studies, or 41.3 percent of the sample, and many reported significant improvements in empathy scores. Simulation-based programs and structured patient encounters likewise produced gains in individual studies. But the review’s most consistent signal was that single-component interventions tend to produce modest, sometimes fragile effects, while combined interventions were reported to have positive effects in seventy-two studies, or 78.3 percent of the sample. Programs that paired theoretical teaching with clinical simulation and genuine patient interaction outperformed those that relied on any one ingredient alone.

That pattern fits a broader theoretical account of how empathy develops in professional training. The cognitive component may respond well to conceptual instruction and perspective-taking exercises, while the emotional and behavioral components require rehearsal in conditions that approximate real clinical encounters. Standardized patients offer a safe rehearsal space, but only authentic patient contact exposes students to the unpredictability, time pressure and emotional weight of actual care. Early clinical experience, the review suggests, is most valuable when it is supported by educators who help students process what they witness, rather than leaving them to absorb or suppress those experiences alone. Reflection, in this model, is not an academic luxury but the mechanism that converts raw exposure into durable empathic competence.

The review also carries a warning that medical educators will recognize: the clinical years themselves can erode empathy. Although the source synthesis focused on educational determinants, the underlying premise is that empathy levels among students are shaped by their educational and clinical environments, for better and for worse. Hidden curricula—the informal lessons transmitted by overworked supervisors, cynical ward cultures and productivity metrics—can undo what formal teaching builds. An integrative, longitudinal approach, the authors argue, is the appropriate response: empathy education should not be a first-year module but a thread running through the entire degree, revisited, practiced and reinforced as students advance.

For researchers, the methodological implications are equally pointed. The authors recommend moving beyond self-report questionnaires toward mixed-methods designs that triangulate student surveys with observational measures, patient-reported outcomes and qualitative accounts. Objective structured clinical examination stations with standardized patients, for example, can capture behavioral empathy that a questionnaire misses, while interviews can reveal the moral and emotional reasoning behind a student’s score. Greater sensitivity to change, better control of social desirability and longer follow-up periods would allow the field to distinguish genuine, durable gains from short-lived boosts that fade before residency begins.

The practical takeaway for medical schools is refreshingly concrete. Empathy is not a fixed personality trait that admissions committees must select for and hope survives training; it is a set of learnable skills and dispositions that respond to deliberate educational design. The strongest programs combine conceptual teaching on what empathy is, simulation to rehearse it safely, early and supported patient encounters to ground it in reality, and reflective practice to consolidate it over time. No single intervention is a silver bullet, and the evidence base remains heterogeneous, with measurement limitations that demand cautious interpretation. But the overall message of this synthesis is optimistic: with an integrative, longitudinal and reflexive curriculum, medical schools can graduate physicians who are not only technically proficient but genuinely attuned to the people in their care.

Subject of Research: Educational determinants of empathy among undergraduate medical students

Article Title: How can we teach empathy to medical students? A scoping review

Article References: How can we teach empathy to medical students? A scoping review. (n.d.). https://doi.org/10.1186/s12909-026-10436-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10436-y

Keywords: empathy, medical students, medical education, scoping review, Jefferson Scale of Empathy, clinical simulation, patient encounters, psychosocial skills, curriculum design, self-report measures, MERSQI, communication skills