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Medical Students’ Empathy for Vulnerable Groups: Results From a Survey and Reflective Writing Assignment

Wellbery, Caroline MD; Saunders, Pamela A. PhD; Kureshi, Sarah MD, MPH; Visconti, Adam MD, MPH

doi: 10.1097/ACM.0000000000001953
Research Reports

Purpose As medical education curricula increasingly acknowledge the contributions of the social determinants of health to individual health, new methods of engaging students in the care of vulnerable groups are needed. Empathy is one way to connect students with patients, but little is known about how to nurture students’ empathy on behalf of populations. This study examined the relationship between individual and social empathy as groundwork for cultivating students’ empathy for vulnerable groups.

Method In 2014–2015, first-year medical students completed the Social Empathy Index at the start and end of a two-semester population health course, and they completed a reflective writing assignment exploring the challenges of caring for vulnerable patients. Pre- and posttest mean survey scores were compared, and reflective writing assignments were analyzed for themes concerning social empathy.

Results Data from 130 students were analyzed. Scores for the contextual understanding of systemic barriers domain increased significantly. There was a trend toward increased cumulative social empathy scores that did not reach statistical significance. Students’ essays revealed three themes relating to individual empathy as the foundation for social empathy; civic and moral obligations; and the role of institutional practices in caring for vulnerable groups.

Conclusions This study extends understanding of empathy beyond care for the individual to include care for vulnerable groups. Thus, social empathy may function as a valuable concept in developing curricula to support students’ commitment to care for the underserved. Educators first need to address the many barriers students cited that impede both individual and social empathy.

Supplemental Digital Content is available in the text.

C. Wellbery is professor, Department of Family Medicine, Georgetown University Medical Center, Washington, DC.

P.A. Saunders is associate professor, Department of Neurology, Georgetown University Medical Center, Washington, DC.

S. Kureshi is assistant professor, Department of Family Medicine, Georgetown University Medical Center, Washington, DC.

A. Visconti is assistant professor, Department of Family and Community Medicine, University of Maryland Medical Center, Baltimore, Maryland.

Funding/Support: The Dean of Medical Education’s Curricular Innovation, Research, and Creativity in the Learning Environment (CIRCLE) program at Georgetown University School of Medicine provided funding for this project.

Other disclosures: None reported.

Ethical approval: The Georgetown University institutional review board approved this study.

Previous presentations: This work was presented at the Association for Prevention Teaching and Research meeting on March 15, 2016, in Albuquerque, New Mexico.

Supplemental digital content for this article is available at

Correspondence should be addressed to Caroline Wellbery, Georgetown University School of Medicine, 3900 Reservoir Rd. NW, Pre-Clinical Science Building, Room GB-01B, Washington, DC 20007; telephone: (202) 687-8647; e-mail:

© 2017 by the Association of American Medical Colleges