Beyond Self-Report: Curriculum-Embedded Actor-Led Empathy Training for Medical Students

Background: Empathy is a critical component of patient-centered care, influencing clinical outcomes, patient satisfaction, and adherence. Despite its recognized importance, empathy often declines during medical training, particularly in clinical years. Traditional teaching methods, such as reflective writing or self-assessment scales, often fail to promote sustained behavioral change. This study evaluated a structured, skills-focused empathy training program integrated into the third-year medical curriculum, designed to improve observable communication behaviors through actor-led simulation and multi-rater feedback. Methods: This single-group pre-post study evaluated a four-week mandatory intervention embedded within the clinical communication curriculum. Students were assessed before and after the intervention using a 19-item checklist covering five domains of empathy-related communication. Pre-post changes were analyzed using paired-sample t-tests and Cohen’s dz. Results: Thirty-two third-year medical students (mean age 21.25 years, 53% female) participated in the study. Post-intervention scores were significantly higher than baseline scores for the overall empathy-related communication score and across all five domains (all p ≤ 0.001). The overall mean score increased from 7.5 (SD 1.43) to 9.2 (SD 1.14), with a mean difference of 1.7 points (95% CI 1.12 to 2.28; p < 0.001), corresponding to a large paired-sample effect size (Cohen’s dz = 1.03). The largest domain-level gains were observed in verbal and non-verbal communication. Conclusions: This curriculum-embedded, actor-led empathy training intervention was associated with short-term improvement in observed empathy-related communication behaviors among third-year medical students. These findings support the feasibility of behaviorally grounded empathy training within undergraduate medical education, while highlighting the need for controlled and longitudinal studies to assess durability and transferability.