Medical Student-Perceived Barriers, Facilitators, and Considerations Regarding Clinical Empathy Training: A Qualitative Study

Abstract

Introduction Clinical empathy involves understanding a patient’s illness experience and acting on it to provide collaborative care. Despite evidence that clinical empathy leads to improved patient outcomes and physician wellbeing, clinical empathy declines in medical students during training. The primary objective of this study was to explore medical students’ perspectives on how elements of medical education influence their clinical empathy. Methods We conducted a qualitative focus group study using adapted constructivist grounded theory methodology. Students from Ontario medical schools took part in semi-structured virtual focus groups between April 2022 and March 2023. Transcripts were coded using constant comparison and adapted into visual networks to conceptualize students’ experiences with clinical empathy training. Feedback on current curricular elements was analyzed descriptively. Results Twenty students participated in five focus groups. The resultant conceptual model illustrated that students learn empathy mostly from structured teaching in preclerkship and the ‘hidden curriculum’ in clerkship. How these experiences affect empathy depends on personal factors (inherent empathy, wellness, cognitive load), preceptor factors (modelling, specialty, behaviour toward learners, burnout) and school factors (curriculum, assessment). Students identified targets for improvement, including integrating humanistic and medical teaching, involving patients in education, promoting interdisciplinary experiences, and teaching psychologically-safe empathy practices. Conclusion Although educational interventions targeting empathy can have positive effects, they can prompt students to deprioritize empathy if implemented incorrectly. A focus on student well-being, supportive learning environments, and empathetic preceptor behaviour is necessary for students to yield optimal benefit from these interventions.