Investigating the Effects of a Short Narratology Education Module on Empathy and Patient-centred Communication in Early-stage Medical Students.

Investigating the Effects of a Short Narratology Education Module on Empathy and Patient-centred Communication in Early-stage Medical Students: an Empirical Mixed-methods Pilot Study.

Effective communication is a fundamental skill in clinical medicine; however, traditional approaches often fail to equip learners with an ability to authentically and empathically engage with the complexities of real patients' experiences. Narratology education has been proposed as a pedagogical framework for augmenting empathy and patient-centred communication in medical students.

In April 2025, we undertook a mixed-methods pilot study to evaluate the impact of a one-week narratology education module on second-year undergraduate medical students at the Royal College of Surgeons in Ireland (RCSI), Dublin. The module involved close reading, group viewings, facilitated small-group workshops, and whole-group discussions in response to narrative works by Irish writers and storytellers, followed by written personal reflections. At the outset and conclusion of the module, each student undertook a clinical history with a simulated patient (SP) portraying early-stage dementia. SPs assessed each student's empathy and communication using the CARE Measure.

Study Overview

• Status: Completed
• Conditions: Narrative Medicine; Empathy; Patient-centredness
• Intervention / Treatment: Other: Narratology education module

Detailed Description

Effective communication is a fundamental skill in clinical medicine; however, traditional approaches often fail to equip learners with an ability to authentically and empathically engage with the complexities of real patients' experiences. Narratology education has been proposed as a pedagogical framework for augmenting empathy and patient-centred communication in medical students.

In April 2025, we undertook a mixed-methods pilot study to evaluate the impact of a one-week narratology education module on second-year undergraduate medical students at the Royal College of Surgeons in Ireland (RCSI), Dublin. The module involved close reading, group viewings, facilitated small-group workshops, and whole-group discussions in response to narrative works by Irish writers and storytellers, followed by written personal reflections. At the outset and conclusion of the module, each student undertook a clinical history with a simulated patient (SP) portraying early-stage dementia. SPs assessed each student's empathy and communication using the CARE Measure.

Included students undertook two encounters with a simulated patient (SP): one immediately before and one immediately after the one-week narratology education module. In each encounter, students carried out a 7-minute history-taking exercise with an SP portraying cognitive decline/early-stage dementia. Immediately following each encounter, each SP completed the CARE Measure (11) - a validated tool to assess empathy and communication skills in healthcare workers. In the CARE Measure, ten items are rated on a five-point scale from 1 (poor) to 5 (excellent), with the total score being the sum of those ten items; in the event of missing or not applicable (N/A) ratings, the mean rating of available items was calculated and then multiplied by ten to estimate the total score. The CARE Measure items cover key aspects of empathy and clinical communication, including "Really listening," "Letting you tell your story," "Showing care and compassion," and "Being interested in you as a whole person." Ten SPs, with experience in medical education, were employed to perform a scripted-narrative of cognitive decline/early-stage dementia that had been iteratively developed by the investigating team and agreed by consensus prior to the start of the module. Each SP received the approved scripted-narrative one-week prior to the start of the module; in addition, they undertook a one-hour group pre-briefing session immediately prior to each simulation to ensure consistency of performance. Both pre-briefing sessions were facilitated by the investigating team including the narratology-expert.

At the end of the module, students submitted a reflective essay, i.e., 500-words using the Gibbs cycle as a framework, articulating how they had interrogated the narrative works of Irish writers and storytellers during the week and how narratology education had affected their appreciation for point-of-view and perspective in personal stories, their evolving narrative competence, and their empathy, communication, and performance in healthcare encounters.

Statistical analyses were undertaken using Stata/SE 17.0 (StataCorp [2021] Stata: Release 17. College Station, TX: StataCorp LLC.), GraphPad Prism version 10 (GraphPad Software, Boston, Massachusetts USA), and NVivo 15 (Lumivero [2023] NVivo (Version 15). Lumivero.).

Central tendencies for ordinal data are presented as median (interquartile range [IQR]). Pre- and post-intervention CARE Measure total scores and their individual item ratings were compared using the Wilcoxon matched-pairs signed-rank test, with a two-tailed P < 0.05 considered statistically significant.

Reflection essays were uploaded to NVivo 15 for thematic analysis.

• Study Type: Observational
• Enrollment (Actual): 22

Contacts and Locations

Study Locations

• Ireland
  • Dublin, Ireland, D02 YN77
    • RCSI School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Second-year medical students at RCSI Dublin

Description

Inclusion Criteria:

Second-year medical students at RCSI Dublin Over 18 years of age Electing to take the student-choice module in Narrative Medicine

Exclusion Criteria:

English not as a first language

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in total Consultation and Relational Empathy (CARE) Measure score as assessed by Simulated Patients	In the CARE Measure, ten items are rated on a five-point scale from 1 (poor) to 5 (excellent), with the total score being the sum of those ten items (maximum score 50, minimum score zero); in the event of missing or not applicable (N/A) ratings, the mean rating of available items was calculated and then multiplied by ten to estimate the total score.	1 week
Change in individual Consultation and Relational Empathy (CARE) Measure score items' scores as assessed by Simulated Patients	In the CARE Measure, ten items are rated on a five-point scale from 1 (poor) to 5 (excellent), with the total score being the sum of those ten items (maximum score 50, minimum score zero); in the event of missing or not applicable (N/A) ratings, the mean rating of available items was calculated and then multiplied by ten to estimate the total score.	1 week

Collaborators and Investigators

• Sponsor: Connolly Hospital Blanchardstown

Study record dates

Study Major Dates

• Study Start (Actual): April 2, 2025
• Primary Completion (Actual): April 30, 2025
• Study Completion (Actual): July 10, 2025

Study Registration Dates

• First Submitted: July 17, 2025
• First Submitted That Met QC Criteria: July 17, 2025
• First Posted (Actual): July 24, 2025

Study Record Updates

• Last Update Posted (Actual): August 7, 2025
• Last Update Submitted That Met QC Criteria: August 4, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: medical education; Empathy; narrative medicine; Patient-centred communication
• Other Study ID Numbers: REC202405007

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No