The Effects of Integrating Visual Thinking Strategies on Intellectual Humility, Tolerance of Ambiguity, Empathy, and Observation Skills: A pre-post Study among Medical Students

Visual Thinking Strategies (VTS) are increasingly explored in medical education for their potential to foster key professional competencies, including intellectual humility, tolerance of ambiguity, empathy, and observational skills. However, empirical evidence supporting their educational impact remains limited. This pre-post controlled study with non-random group assignment based on administrative scheduling included 138 second-year Italian medical students (53.4% female; mean age = 20.20 ± 1.62) attending a mandatory communication skills module. The experimental group (n = 102) received a blended curriculum combining standard training with VTS-based sessions, while the control group (n = 36) followed the standard curriculum alone. Outcomes comprised three self-report questionnaires – the Comprehensive Intellectual Humility Scale (CIHS), the Multidimensional Attitudes Toward Ambiguity Scale (MATAS), and the Questionnaire of Cognitive and Affective Empathy (QCAE) – and two rubric-based measures of observational ability, administered only to the experimental group. Data were analyzed using 2 × 2 mixed-design ANOVAs (time [T0, T1] × group [experimental, control]) and repeated-measures t-tests. Significant main effects of time emerged for CIHS subscales (Independence of intellect and ego, Respect for others’ viewpoints, Lack of intellectual overconfidence), Need for complexity and novelty of the MATAS, and Peripheral responsivity of the QCAE, indicating overall improvements across groups. No significant main effects of group or time × group interactions were observed. Conversely, rubric-based analyses revealed significant pre-post gains in observational and interpretive skills in the experimental group. VTS yielded effects on CIHS, MATAS, and QCAE comparable to the standard curriculum, while rubric-based findings suggest it enhances visual analysis and reflective observation, complementing traditional communication training.