Empathy involves trying to understand another person’s experience or perspective and communicating that understanding back to them.
In professional practice, empathy is more than feeling concern for another person. A student might recognise that a patient, client or other person is distressed, for example, but professional empathy also involves responding in a way that demonstrates that the person has been heard and understood.
Empathic practice might involve:
This makes empathy a professional capability that can be taught and practised, rather than simply a personality characteristic that students either possess or do not possess.
Empathy is related to, but distinct from, compassion. Empathy concerns understanding and appropriately responding to another person’s experience. Compassion additionally involves motivation to alleviate another person’s suffering. This summary focuses specifically on empathy, because the evidence that empathy can be deliberately developed in university healthcare students is considerably stronger.
Empathy can be deliberately developed through education and training. A recent meta-analysis of randomised controlled trials involving healthcare students found a moderate positive effect on empathy ➕➕➕➕ [1]. Similar moderate effects have been reported across other meta-analyses of empathy training [2,4].
Training that requires students to actively practise empathy appears particularly useful. Simulation-based empathy training has a moderate effect on students’ self-reported empathy ➕➕➕➕ and has also produced improvements when empathy is assessed by simulated patients and other observers [2]. Role-play and rehearsal therefore provide useful opportunities for students to practise recognising and responding to another person’s perspective.
However, there is not yet compelling evidence that one particular empathy-training method is universally best. Recent reviews suggest that active and experiential approaches—including rehearsal, patient interaction, reflection and targeted feedback—are generally more promising than passive teaching alone, but individual components have not produced completely consistent moderator effects across meta-analyses [3–5].
This summary is informed primarily by meta-analyses of empathy interventions in healthcare education, supported by recent umbrella reviews examining how empathy is taught [1–5].
The strongest directly applicable review included 30 randomised controlled trials of healthcare students, with 20 studies included in its meta-analysis [1]. Empathy interventions produced a moderate overall effect (SMD = 0.45, 95% CI 0.25–0.65). The review included students from medicine, nursing and pharmacy and therefore provides broader evidence than earlier medical-student-only reviews. However, heterogeneity was high (I² = 79%) and more than half of the included trials were rated at high risk of bias. We therefore rate this evidence as moderate quality ➕➕➕.
A meta-analysis of 16 simulation-based studies involving healthcare students found improvements whether empathy was assessed by students themselves (SMD = 0.46), simulated patients (SMD = 0.65) or other observers (SMD = 1.27) [2]. This provides useful evidence that empathy training can affect observable performance, although the larger observer-rated estimates are based on smaller evidence pools and should be interpreted cautiously.
A medical-student-only meta-analysis of randomised trials also found a substantial positive effect of empathy education [3]. However, heterogeneity was high and the evidence was restricted to medicine, so we place greater weight on the more recent multidisciplinary student review.
A further RCT-only review including healthcare students and professionals found a moderate effect (SMD = 0.52) and some evidence that improvements remained detectable beyond 12 weeks [4]. However, the authors rated the underlying evidence as low quality.
Finally, recent umbrella reviews support the broad conclusion that active participation, experiential practice, reflection and targeted feedback are useful features of empathy education, while also identifying substantial methodological weaknesses and a need for better long-term assessment [5].
Overall, there is reasonable confidence that educators can deliberately improve students’ empathy, but less confidence about the best particular intervention and about how consistently improvements transfer into sustained empathic behaviour in professional practice.
