Effect of a Community Service-Learning Intervention on Medical Empathy and Clinical Self-Efficacy in Medical Students (ApS-MED-IZT)

Effect of a Community Service-Learning Intervention on Medical Empathy and Perceived Clinical Self-Efficacy in Fourth-Semester Medical Students at FES Iztacala, UNAM: A Quasi-Experimental Pre-Post Study

Medical empathy and clinical self-efficacy are key professional competencies that are difficult to develop through traditional classroom-based training alone. At the Faculty of Medicine of FES Iztacala (UNAM), the curriculum includes a community practice component in the Practica Clinica I module that is rarely implemented in practice, creating a gap between the formal and real curriculum.

This quasi-experimental pre-post study evaluates the effect of a structured Service-Learning (SL) intervention - a community anthropometry and somatometry assessment session conducted at a primary school - on medical empathy, perceived clinical self-efficacy, and clinical report performance in 35 fourth-semester medical students.

Medical empathy will be measured using the Jefferson Scale of Empathy, Student version (JSE-S), validated in Spanish for Latin American populations. Clinical self-efficacy will be measured using the Medical Self-Efficacy Scale (EAM), a 5-item Likert instrument developed by the principal investigator (Cronbach's alpha=0.818, McDonald's omega=0.862). Clinical performance will be assessed using a standardized 33-point rubric evaluated blindly by two independent faculty members, with inter-rater reliability calculated using the Intraclass Correlation Coefficient (ICC).

Children participating in the community session will receive a personalized health report with their anthropometric results and, if clinically relevant findings are detected, will be referred to the University Health Clinic (CUSI) at FES Iztacala at no cost.

Study Overview

• Status: Not yet recruiting
• Conditions: Medical Education
• Intervention / Treatment: Behavioral: Community Service-Learning Anthropometric Assessment

Detailed Description

BACKGROUND:

The Practica Clinica I module at FES Iztacala, UNAM, formally establishes three learning spaces: classroom, clinical, and community. However, systematic observation during the principal investigator's medical internship revealed that the community space is rarely operationalized, resulting in a significant gap between the formal and real curriculum. Students complete the module without real clinical contact with external patients, which limits the development of empathy and clinical self-efficacy.

THEORETICAL FRAMEWORK:

The intervention is grounded in Service-Learning pedagogy, Kolb's experiential learning cycle, Bandura's self-efficacy theory, and the medical empathy model by Hojat. The community activity at a primary school fulfills all constitutive elements of SL: a real community need (nutritional screening), structured learning objectives aligned with the curriculum, and mutual benefit for both students and the community.

INTERVENTION:

Participating medical students will conduct a full anthropometric and somatometric assessment of school-age children, including: weight, height, BMI calculation and interpretation using WHO/CDC reference tables, body circumferences (waist, hip, arm), body segments (armspan and others), and waist-hip ratio. Students will complete a simplified clinical history form and produce a written clinical report including findings interpretation and health recommendations. Each child's family will receive a sealed envelope with their personalized results. Children with clinically significant findings will be referred to CUSI (FES Iztacala).

MEASUREMENTS:

• Medical empathy: JSE-S (20 items, 7-point Likert, range 20-140), applied pre and post intervention. Used with permission from Thomas Jefferson University.
• Clinical self-efficacy: EAM (5 items, 5-point Likert, range 5-25), applied pre and post intervention.
• Clinical report performance: standardized rubric (7 dimensions, 33 points), applied blindly by two independent faculty members to both the pre-intervention report (classroom peer practice) and post-intervention report (community real patient). ICC will be calculated before proceeding with comparisons.

STATISTICAL ANALYSIS:

Shapiro-Wilk normality test on pre-post differences. Paired t-test or Wilcoxon signed-rank test depending on normality. Cohen's d for effect size. Bonferroni correction for three simultaneous primary hypotheses (adjusted alpha=0.017). Pearson or Spearman correlation for the secondary hypothesis. Software: JASP and G*Power.

ETHICAL CONSIDERATIONS:

The study poses minimal risk. Informed consent will be obtained from all medical students. Parental informed consent and children's assent will be obtained for all school-age participants. The study will be submitted for ethical review to the Ethics Committee of FES Iztacala (CEI-FES Iztacala) prior to data collection. The JSE-S is used with written permission from Thomas Jefferson University (April 2025).

• Study Type: Interventional
• Enrollment (Estimated): 35
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Mexico
  • Mexico City
    • Tlalnepantla, Mexico City, Mexico, 54090
      • Facultad de Estudios Superiores Iztacala, UNAM

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Enrolled in the fourth semester of the Medico Cirujano (MD) program at FES Iztacala, UNAM
• Registered in the Practica Clinica I module during the study period
• Signed informed consent prior to any data collection
• Present at both pre-intervention and post-intervention measurement sessions

Exclusion Criteria:

• Previous enrollment in the Practica Clinica I module
• Prior documented clinical experience outside the university setting (internships, clinical rotations in other programs)
• Absence from the community intervention session for any reason
• Failure to complete at least one of the three measurement instruments at either time point

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Service-Learning Community Intervention; Fourth-semester medical students participate in a structured Service-Learning activity at a primary school, conducting anthropometric and somatometric assessments of school-age children. Measurements include weight, height, BMI, body circumferences, and body segments. Students complete a simplified clinical history and produce a written clinical report with findings interpretation and health recommendations.

Behavioral: Community Service-Learning Anthropometric Assessment; A single-session community Service-Learning activity conducted at Escuela Primaria Jesus Garcia (C.T. 15DPR1779L). Medical students perform weight, height, BMI, body circumferences (waist, hip, arm), body segments, and waist-hip ratio measurements on consenting school children. Students complete a simplified clinical history form and produce a written clinical report including anthropometric data, interpretation using WHO/CDC reference tables, relevant findings, and health recommendations. Each participating child's family receives a sealed personalized results envelope. Students with clinically significant findings are referred to CUSI (FES Iztacala). Duration: one full day. Supervised by faculty members from FES Iztacala.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Medical Empathy Score (JSE-S)	Change from baseline in total score on the Jefferson Scale of Empathy, Student version (JSE-S). Scale range: 20-140. Higher scores indicate greater empathy. Used with permission from Thomas Jefferson University.	Baseline and 5 weeks
Change in Perceived Clinical Self-Efficacy Score (EAM)	Change from baseline in total score on the Medical Self-Efficacy Scale (EAM), a 5-item Likert instrument (range 5-25) developed by the principal investigator. Cronbach's alpha=0.818, McDonald's omega=0.862.	Baseline and 5 weeks
Change in Clinical Report Performance Score (Standardized Rubric)	Change in total score on a 7-dimension, 33-point standardized rubric evaluating the clinical anthropometry report. Dimensions: basic anthropometric measurements, body circumferences, body segments, use of reference values, clinical interpretation, recommendations, and report structure. Evaluated blindly by two independent faculty members. Inter-rater reliability assessed with ICC (two-way absolute agreement model).	Baseline and 5 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation Between Change in Empathy and Change in Clinical Self-Efficacy	Pearson or Spearman correlation coefficient between the change score (post minus pre) in JSE-S and the change score (post minus pre) in EAM.	5 weeks

Collaborators and Investigators

• Sponsor: Luis Angel Flores Sagrero
• Collaborators: Universidad Nacional Autonoma de Mexico

Publications and helpful links

General Publications

• Abreu-Hernández LF, León-Bórquez R. Una agenda para el cambio de la educación médica en México. Horizonte 2030. Investigación Educ Med. 2022;11(42):2-10.

Study record dates

Study Major Dates

• Study Start (Estimated): April 8, 2026
• Primary Completion (Estimated): May 13, 2026
• Study Completion (Estimated): May 27, 2026

Study Registration Dates

• First Submitted: April 3, 2026
• First Submitted That Met QC Criteria: April 9, 2026
• First Posted (Actual): April 14, 2026

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 9, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: medical education; quasi-experimental; Jefferson Scale of Empathy; service-learning; medical empathy; clinical self-efficacy; pediatric health screening; undergraduate medical education
• Other Study ID Numbers: FES-IZT-PC1-2025-001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared publicly to protect participant confidentiality, in compliance with the ethical approval conditions of the CEI-FES Iztacala and the informed consent agreements. Aggregated results will be reported in publications and/or the thesis document.

Drug and device information, study documents

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