Film-Based Medical Education and Social Justice Course: Effects on Alexithymia and Empathy in Medical Students

Effect of a Film-Based "Medical Education and Social Justice" Elective on Medical Students' Alexithymia Levels and Empathy Skills: A Nonrandomized Controlled Pretest-Posttest Study

This study will examine whether a 14-week elective course that uses films and guided discussion on social justice in health care can improve medical students' empathy skills and reduce alexithymia (difficulty recognizing and describing emotions). Approximately 50 volunteer medical students will participate. Students who choose the elective course will form the intervention group, and students who do not take the course will form a comparison group. All participants will complete the same questionnaires/assessments at the beginning and at the end of the semester. The main goal is to compare changes in empathy and alexithymia scores between the two groups.

Study Overview

• Status: Enrolling by invitation
• Conditions: Education, Medical; Alexithymia; Health Equity; Empathy Skills; Social Justice Advocacy
• Intervention / Treatment: Behavioral: Film-Based Medical Education and Social Justice Elective

Detailed Description

This is a prospective, nonrandomized controlled pretest-posttest study conducted at Canakkale Onsekiz Mart University Faculty of Medicine. Participants are volunteer medical students (≥18 years). The intervention group consists of students who enroll in the elective course, and the comparison group consists of students from the same student population who do not enroll during the same period.

Data will be collected at two time points: baseline prior to the start of the elective period (T0) and immediately after the end of the elective period (T1, approximately 14 weeks later). At each time point, participants will complete the study instruments administered in a standardized manner. In the intervention group, reflective journals will also be collected throughout the course period to support qualitative interpretation of findings.

The primary analysis will compare within-group change from T0 to T1 and between-group differences in change scores. Descriptive statistics will summarize participant characteristics. Depending on data distribution, paired tests and independent-group tests (or their nonparametric equivalents) will be used for continuous outcomes. Multivariable models may be used to adjust for baseline differences (e.g., class year) if imbalance is observed. Missing data will be handled using a predefined approach (e.g., complete-case analysis with sensitivity checks). No clinical procedures or medical treatments are involved.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Çanakkale
    • Çanakkale, Çanakkale, Turkey (Türkiye), 17100
      • Faculty of medicine

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Enrolled medical student at Canakkale Onsekiz Mart University Faculty of Medicine, registered in Year 1, 2, or 3 during the study period.
• Age 18 years or older.
• Provides written/electronic informed consent after being informed about the study.
• For the intervention arm: enrolled in the elective "Film-Based Medical Education and Social Justice" course.
• For the control arm: from the same academic year/cohort during the same period and not enrolled in the elective course.
• Willing and able to complete both baseline (T0) and end-of-course (T1) assessments (has sufficient cognitive/communication ability to complete questionnaires).

Exclusion Criteria:

• Does not provide consent or withdraws consent at any stage.
• Younger than 18 years.
• Does not complete at least one of the two assessments (T0 or T1).
• Leaves critical sections of the questionnaires/assessments largely blank (e.g., substantial missing items on TAS-20 or incomplete scenario responses preventing scoring).
• Duplicate/duplicate submission (more than one form from the same participant for the same assessment).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Film-Based Medical Education and Social Justice Elective; Participants enrolled in the elective "Film-Based Medical Education and Social Justice" course. The course is delivered over one semester (~14 weeks) and uses selected films/film clips with structured group discussion and reflection activities.	Behavioral: Film-Based Medical Education and Social Justice Elective; A 14-week elective course (approximately 2 hours/week) using selected films/film clips with structured group discussion and reflective activities/journaling.; Other Names: Film-Based Medical Education and Social Justice Course
No Intervention: No Course / Usual Curriculum; Participants who do not enroll in the elective course during the same period and continue usual curriculum without additional sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Toronto Alexithymia Scale (TAS-20) Total and Subscale Scores (Change)	Change in TAS-20 total score and subscale scores (Difficulty Identifying Feelings, Difficulty Describing Feelings, Externally Oriented Thinking). Higher scores indicate higher alexithymia.	Baseline (T0) and end of course (T1, approximately 14 weeks)
Scenario-Based Empathy Skills Total Score and Rubric Subscores (Change)	Change in total empathy skills score derived from responses to study-developed scenarios scored with a rubric based on Dökmen's staged empathy classification; includes rubric subscores/levels if applicable.	Baseline (T0) and end of course (T1, approximately 14 weeks)
Jefferson Scale of Empathy S(tudent)-Version	JSE-S is a self-administered 20-item questionnaire scored on a 7-point Likert scale (1=strongly disagree to 7=strongly agree). Total score is the sum of item scores (range 20-140); higher scores indicate higher empathy.	Baseline (T0) and end of course (T1, approximately 14 weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Association Between Change in TAS-20 and Change in Empathy Score	Correlation/association between ΔTAS-20 (T1-T0) and ΔEmpathy (T1-T0) (Pearson or Spearman depending on distribution).	From baseline (T0) to end of course (T1, approximately 14 weeks)
Jefferson Scale of Empathy - Student Version (JSE-S) Subscale/Factor Scores (Change)	Change in JSE-S factor/subscale scores (e.g., Perspective Taking, Compassionate Care, Standing in Patient's Shoes; if applicable per scoring approach used). Higher scores indicate higher empathy.	Baseline (T0) and end of course (T1, approximately 14 weeks)
Association Between JSE-S Score and Scenario-Based Empathy Skills Score (Convergent Validity)	Correlation/association between JSE-S total score and Scenario-Based Empathy Skills total score at T0 and at T1 (Pearson or Spearman depending on distribution), and/or association between change scores (ΔJSE-S vs ΔScenario score).	Baseline (T0) and end of course (T1, approximately 14 weeks)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reflective Journal Themes (Intervention Group Only)	De-identified reflective journals collected after sessions will be analyzed using thematic/content analysis to contextualize and deepen interpretation of quantitative findings.	After each session during the course period (approximately 14 weeks); analyzed after T1

Collaborators and Investigators

• Sponsor: Çanakkale Onsekiz Mart University
• Investigators: Study Chair: Mustafa Onur Yurdal, PhD, Canakkale Onsekiz Mart University

Publications and helpful links

General Publications

• Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale- I. J Psychosom Res. 1994;38(1):23-32. PMID: 8126686. doi: 10.1016/0022-3999(94)90005-1. Law M, Kwong W, Friesen F, Veinot P, Ng SL. The current landscape of television and movies in medical education. Perspect Med Educ. 2015;4(5):218-224. doi: 10.1007/s40037-015-0205-9. Lumlertgul N, Kijpaisalratana N, Pityaratstian N, Wangsaturaka D. Cinemeducation: A pilot student project using movies to help students learn medical professionalism. Med Teach. 2009;31(7):e327-e332. PMID: 19811142. doi: 10.1080/01421590802637941. Rueb M, Siebeck M, Rehfuess EA, Pfadenhauer LM. Cinemeducation in medicine: a mixed methods study on students' motivations and benefits. BMC Med Educ. 2022;22:172. doi: 10.1186/s12909-022-03240-x. Salajegheh M, Sohrabpour AA, Mohammadi E. Exploring medical students' perceptions of empathy after cinemeducation based on Lev Vygotsky's theory. BMC Med Educ. 2024;24:94. doi: 10.1186/s12909-024-05084-z.

Helpful Links

• Course Syllabus

Study record dates

Study Major Dates

• Study Start (Estimated): February 16, 2026
• Primary Completion (Estimated): June 20, 2026
• Study Completion (Estimated): August 30, 2026

Study Registration Dates

• First Submitted: February 3, 2026
• First Submitted That Met QC Criteria: February 3, 2026
• First Posted (Actual): February 10, 2026

Study Record Updates

• Last Update Posted (Actual): February 25, 2026
• Last Update Submitted That Met QC Criteria: February 23, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Narrative medicine; Film-based education; Cinema in medical education; CineMedicine; Social justice education
• Additional Relevant MeSH Terms: Behavioral Symptoms; Behavior; Communication; Narration; Affective Symptoms; Narrative Medicine
• Other Study ID Numbers: 2025-YÖNP-0418

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: De-identified individual participant data (IPD) underlying the results reported in publications (e.g., TAS-20 total/subscale scores and scenario-based empathy scores at T0 and T1) will be made available to qualified researchers upon reasonable request. Data will be shared after publication of the primary results, for up to 5 years. Requests will be reviewed by the study team and may require a data use agreement. Shared datasets will be de-identified and will not include direct identifiers; access will be limited to the minimum necessary to protect participant confidentiality.

Drug and device information, study documents

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