Journal of Educational Evaluation for Health Professions

Research articles

Empathy and tolerance of ambiguity in medical students and doctors participating in art-based observational training at the Rijksmuseum in Amsterdam, the Netherlands: a before-and-after study: Stella Anna Bult, Thomas van Gulik; J Educ Eval Health Prof. 2025;22:3. Published online January 14, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.3

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Purpose
This research presents an experimental study using validated questionnaires to quantitatively assess the outcomes of art-based observational training in medical students, residents, and specialists. The study tested the hypothesis that art-based observational training would lead to measurable effects on judgement skills (tolerance of ambiguity) and empathy in medical students and doctors.
Methods
An experimental cohort study with pre- and post-intervention assessments was conducted using validated questionnaires and qualitative evaluation forms to examine the outcomes of art-based observational training in medical students and doctors. Between December 2023 and June 2024, 15 art courses were conducted in the Rijksmuseum in Amsterdam. Participants were assessed on empathy using the Jefferson Scale of Empathy (JSE) and tolerance of ambiguity using the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale.
Results
In total, 91 participants were included; 29 participants completed the JSE and 62 completed the TAMSAD scales. The results showed statistically significant post-test increases for mean JSE and TAMSAD scores (3.71 points for the JSE, ranging from 20 to 140, and 1.86 points for the TAMSAD, ranging from 0 to 100). The qualitative findings were predominantly positive.
Conclusion
The results suggest that incorporating art-based observational training in medical education improves empathy and tolerance of ambiguity. This study highlights the importance of art-based observational training in medical education in the professional development of medical students and doctors.

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Observational training for surgical residents using visual arts in the museum
Thomas M. van Gulik, Stella A. Bult, Pien E.J. de Ruiter, Floortje Huizing, Alexander de Mol van Otterloo, Alexander Leijdesdorff, Sjoerd Lagarde
Surgery.2026; 190: 109843. CrossRef
Developing a Feasible Arts and Humanities Course Using Visual Thinking Strategies and Haiku Writing: A Mixed-Methods Study
Hirohisa Fujikawa, Takayuki Ando, Junji Haruta
Medical Science Educator.2025;[Epub] CrossRef
Understanding uncertainty and ambiguity in medicine and medical education: a narrative review with implications for training
Sarine Sarkis, Christian Raphael
Postgraduate Medical Journal.2025;[Epub] CrossRef

Development of a character qualities test for medical students in Korea using polytomous item response theory and factor analysis: a preliminary scale development study: Yera Hur, Dong Gi Seo; J Educ Eval Health Prof. 2023;20:20. Published online June 26, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.20

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Abstract PDF Supplementary Material

Purpose
This study aimed to develop a test scale to measure the character qualities of medical students as a follow-up study on the 8 core character qualities revealed in a previous report.
Methods
In total, 160 preliminary items were developed to measure 8 core character qualities. Twenty questions were assigned to each quality, and a questionnaire survey was conducted among 856 students in 5 medical schools in Korea. Using the partial credit model, polytomous item response theory analysis was carried out to analyze the goodness-of-fit, followed by exploratory factor analysis. Finally, confirmatory factor and reliability analyses were conducted with the final selected items.
Results
The preliminary items for the 8 core character qualities were administered to the participants. Data from 767 students were included in the final analysis. Of the 160 preliminary items, 25 were removed by classical test theory analysis and 17 more by polytomous item response theory assessment. A total of 118 items and sub-factors were selected for exploratory factor analysis. Finally, 79 items were selected, and the validity and reliability were confirmed through confirmatory factor analysis and intra-item relevance analysis.
Conclusion
The character qualities test scale developed through this study can be used to measure the character qualities corresponding to the educational goals and visions of individual medical schools in Korea. Furthermore, this measurement tool can serve as primary data for developing character qualities tools tailored to each medical school’s vision and educational goals.

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Development and validation of a fall health literacy scale for Chinese hospitals from the perspective of older adults
Tianxin Miao, Ke Chen, Dianli Han, Yingna Zhao, Liran Duan, Lan Zhang, Ying Yao
Frontiers in Public Health.2025;[Epub] CrossRef
The Values of Local Wisdom in the Jong Racing Tradition as a Means of Character Education for Students
Rika Komalasari, Pittanauli Sialagan, Ima Turyani, Zaitun Zaitun, Tety Kurmalasari, J. bin Surif, G.M. Jacobs, D. Wei Dai, M.V. Reddy, T. Yamamoto, H. Pardi
SHS Web of Conferences.2024; 205: 03005. CrossRef

Self-care perspective taking and empathy in a student-faculty book club in the United States: Rebecca Henderson, Melanie Gross Hagen, Zareen Zaidi, Valentina Dunder, Edlira Maska, Ying Nagoshi; J Educ Eval Health Prof. 2020;17:22. Published online July 31, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.22

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Purpose
We aimed to study the impact of a combined faculty-student book club on education and medical practice as a part of the informal curriculum at the University of Florida College of Medicine in the United States.
Methods
Sixteen medical students and 7 faculties who participated in the book club were interviewed through phone and recorded. The interview was then transcribed and entered into the qualitative data analysis program QSR NVivo (QSR International, Burlington, MA, USA). The transcripts were reviewed, and thematic codes were developed inductively through collaborative iteration. Based on these preliminary codes, a coding dictionary was developed and applied to all interviews within QSR Nvivo to identify themes.
Results
Four main themes were identified from interviews: The first theme, the importance of literature to the development and maintenance of empathy and perspective-taking, and the second theme, the importance of the book club in promoting mentorship, personal relationships and professional development, were important to both student and faculty participants. The third and fourth themes, the need for the book club as a tool for self-care and the book club serving as a reminder about the world outside of school were discussed by student book club members.
Conclusion
Our study demonstrated that an informal book club has a significant positive impact on self-care, perspective-taking, empathy, and developing a “world outside of school” for medical school students and faculty in the United States. It also helps to foster meaningful relationships between students and faculty.

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“Showing up to the conversation”: Qualitative reflections from a diversity, equity, and inclusion book club with emergency medicine leadership
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Clubes de lectura: una revisión sistemática internacional de estudios (2010-2022)
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The implementation of a required book club for medical students and faculty
David B. Ney, Nethra Ankam, Anita Wilson, John Spandorfer
Medical Education Online.2023;[Epub] CrossRef
Cultivating critical consciousness through a Global Health Book Club
Sarah L. Collins, Stuart J. Case, Alexandra K. Rodriguez, Acquel C. Allen, Elizabeth A. Wood
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Advancing book clubs as non-formal learning to facilitate critical public pedagogy in organizations
Robin S Grenier, Jamie L Callahan, Kristi Kaeppel, Carole Elliott
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Not Just for Patrons: Book Club Participation as Professional Development for Librarians
Laila M. Brown, Valerie Brett Shaindlin
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Medical Students’ Creation of Original Poetry, Comics, and Masks to Explore Professional Identity Formation
Johanna Shapiro, Juliet McMullin, Gabriella Miotto, Tan Nguyen, Anju Hurria, Minh Anh Nguyen
Journal of Medical Humanities.2021; 42(4): 603. CrossRef

Impact of a narrative medicine program on reflective capacity and empathy of medical students in Iran: Saeideh Daryazadeh, Payman Adibi, Nikoo Yamani, Roya Mollabashi; J Educ Eval Health Prof. 2020;17:3. Published online January 27, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.3

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Abstract PDF Supplementary Material

Purpose
Narrative medicine consists of the expression of medical experiences and the reflection on narratives to foster empathic communication with patients. Reflecting on narratives increases self-awareness and recognition of the feelings of the narrator or the story’s main character, which in turn affects the audience. This study was conducted to examine the impact of a narrative medicine program on the reflective capacity and empathy of medical students.
Methods
A quasi-experimental study was performed during the 2018–2019 academic year at Isfahan University of Medical Sciences in Iran involving 135 medical interns in 2 groups (control [n=66] and experimental [n=69]). Interns in the experimental group took part in seven 2-hour reflective practice sessions, while those in the control group underwent no educational intervention. Pre-test and post-test assessments were conducted for both groups using 2 valid and reliable tools for the assessment of reflective capacity and empathy. Mean reflection and empathy scores were compared within groups (between pre- and post-test values) and between groups (using the paired-t test and the t-test; P≤0.05).
Results
The mean reflection and empathy scores of the experimental group significantly increased from pre-test to post-test, but those of the control group did not. Moreover, the mean post-test scores were significantly different between the 2 groups (P<0.001).
Conclusion
Narrative medicine is an effective teaching method that can improve reflective capacity and empathy, thereby ultimately promoting professionalism as a core competency in medicine. Consideration of learning conditions and interdisciplinary teaching are necessary for implementing a narrative medicine program.

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The effects of an empathy role-playing program for operating room nursing students in Iran: Negin Larti, Elaheh Ashouri, Akram Aarabi; J Educ Eval Health Prof. 2018;15:29. Published online December 13, 2018; DOI: https://doi.org/10.3352/jeehp.2018.15.29

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Abstract PDF Supplementary Material

Purpose
The purpose of this study was to investigate the effects of a role-playing training program conducted among operating room nursing students on empathetic communication with patients through measurements of empathy scores.
Methods
This study was carried out among 77 operating room nursing students from the first to the fourth years studying at the School of Nursing and Midwifery of Isfahan University of Medical Sciences in the academic year 2017–2018. The intervention administered to the experimental group included a 12-hour training program on expressing empathy to patients that incorporated roleplaying. The Jefferson Scale of Empathy-Health Profession Student version was completed by the participants before, immediately after, and 1 month after the intervention. A comparative analysis of these 3 time points was conducted.
Results
No significant difference was found in the total pre-intervention mean empathy scores before the intervention between the control group and the experimental group (P= 0.50). However, the total mean empathy scores in the experimental group immediately after and 1 month after the intervention were higher than those in the control group (P< 0.001).
Conclusion
Empathy training through a role-playing technique was effective at improving the empathy scores of operating room nursing students, and this finding also underscores the fact that empathy can be promoted by education. Changing the educational curriculum of operating room nursing students is suggested in order to familiarize them with the concept of empathy in the operating room.

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Clinical empathy in medical students in India measured using the Jefferson Scale of Empathy–Student Version: Anirban Chatterjee, Rajkrishna Ravikumar, Satendra Singh, Pranjal Singh Chauhan, Manu Goel; J Educ Eval Health Prof. 2017;14:33. Published online December 27, 2017; DOI: https://doi.org/10.3352/jeehp.2017.14.33

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Abstract PDF Supplementary Material

Purpose
The purpose of this study was to assess the clinical empathy of a cohort of medical students spanning 4 years of undergraduate study and to identify factors associated with empathy.
Methods
A cross-sectional study to assess the empathy of undergraduate medical students at the University College of Medical Sciences and GTB Hospital in Delhi, India, was conducted using the Jefferson Scale of Empathy–Student Version. Demographic data were obtained using a pre-tested, semi-open-ended questionnaire.
Results
Of the 600 students, 418 participated in the survey (69.7%). The mean empathy score was 96.01 (of a maximum of 140), with a standard deviation of 14.56. The empathy scores decreased from the first to the third semester, plateaued at the fifth semester, and rose again in the seventh semester. Empathy was found to be significantly associated with the gender of the participant, with females having higher scores (P<0.001). The age of the participant, place of residence, whose decision it was for the student to enroll in an MBBS (bachelor of medicine and bachelor of surgery) program, and the choice of future specialty were not significantly associated with students’ empathy scores.
Conclusion
The study found significant gender differences in empathy among the participants. The empathy scores tended to decline initially and then rebound over time. The mean empathy levels found in this study are lower than those reported in most similar studies around the world; therefore, further studies are needed to analyze and address the underlying factors associated with this discrepancy.

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Research Article

Reflective writing and its impact on empathy in medical education: systematic review: Isabel Chen, Connor Forbes; J Educ Eval Health Prof. 2014;11:20. Published online August 16, 2014; DOI: https://doi.org/10.3352/jeehp.2014.11.20

50,869 View
501 Download
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93 Crossref

Abstract PDF

Purpose
Medical schools are increasingly aware of the ways in which physician empathy can have a profound impact on patients’ lives and have developed humanities initiatives to address this concern. Reflective writing in particular is more commonly promoted in medical curricula, but there is limited research on the impact of reflective writing on medical student empathy levels. It aims to find the emotional effects of reflective writing interventions on medical and healthcare students by systemic review. Methods: Two investigators independently reviewed educational publications for critical analysis. This review focused systematically on quantitative papers that measure the impact of reflective writing on empathy. Results: Of the 1,032 studies found on Medline and CINAHL, only 8 used quantitative measures pre- and postwritten reflection to measure any impact on empathy outcomes. The outcomes measured included impact of reflective writing exercises on student wellness, aptitude, and/or clinical skills. Of these studies, a significant change in student empathy was observed in 100% of the studies, demonstrating a significant change in outcomes. Conclusion: Although the lack of homogeneity in outcome measurement in the literature limits possible conclusion from this review, the overwhelmingly positive reporting of outcomes suggests that reflective writing should be considered in any medical curriculum.

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