Clinical empathy has multiple benefits for patient care [1] and practitioner health and well-being [2]. Empathy is usually considered to be a multidimensional construct incorporating affective, cognitive, behavioral, and moral components [3]. A recent systematic review of empathy definitions identified 6 components of empathy: exploring, understanding, shared understanding, feeling, therapeutic action, and maintaining boundaries [4]. These components overlap with the 2002 definition of clinical empathy in health care by Mercer and Reynolds [5]: the ability to understand the patient’s situation, perspective, and feelings; communicate that understanding to them; and act on it in a helpful and therapeutic way.

Empathy is central to health care education [6] and is recognized internationally as a professional competency expected of medical students and physicians [6-8]. However, despite its importance, empathy appears to decline during medical school [9,10]. While there is no consensus on the most effective means of teaching empathy [11-14], a systematic review of 26 trials demonstrated that empathy can be taught [14] and that specific sustainable interventions integrated into the curriculum are likely to be most effective [13].

There is current evidence suggesting that empathy can decline in students during the transition from preclinical to clinical-based education [9,10]. Some studies report that an undue focus on biomedical knowledge [15,16] often detached from the lived patient experience in the preclinical years contributes to this [16]. Other studies suggest that involving patients and their stories more consistently could help boost empathy [17-19], promote human attributes [18], support a focus on the psychosocial aspects of illness [19], encourage active learning [20], and enhance knowledge construction and clinical reasoning [21]. Despite the potential to benefit medical students, patients and their stories are rarely involved to support learning in the biomedical science–focused curriculum.

Historically, patients have been used, often unethically, in lecture theaters as “passive props” to illustrate pathophysiology [22]. This is reflective of an outdated, paternalistic era of medicine [22,23]. With a move toward patient partnerships [24], patients’ roles in medical education have become increasingly active [22], with patients and educators keen to find new, innovative ways to support patient involvement in medical education [25]. To address the lack of patient participation in the biomedical science curriculum, we developed, implemented, and evaluated a curriculum component that aims to promote empathy by involving real patients in lecture-style teaching for biomedical- and clinical-focused modules.

Our research questions were as follows: (1) What benefits to learning and engagement do students report when patients contribute to biomedical and clinical science lectures? (2) Does the inclusion of real patients and their stories in lectures during the early-year biomedical, clinical, and social science curriculum have the potential to enhance student empathy?

The General Medical Council emphasizes that medical students should cultivate a person-centered approach throughout their training, recognizing that placing patients at the center of care is fundamental to safe and ethical practice [27]. Educators and curriculum developers advocate for the integration of the biopsychosocial model (a framework for understanding health and illness that highlights interactions among biological, psychological, and social factors) throughout the early years, not as an adjunct but woven into teaching. This encourages students to learn a holistic approach to patient care [28] and holistic reasoning alongside biomedical sciences [29]. Medical students highlight that early exposure to psychosocial narratives enhances empathy, communication, and understanding of illness, particularly in the context of chronic and complex conditions [30]. Finally, patients recognize the importance of using a biopsychosocial lens from the outset to support person-centered values in future health care professionals [31].

Leicester Medical School (LMS) describes its curriculum as integrated, patient focused, and with “teaching and learning based around patients and their needs” [32]. However, with notable exceptions [33], an audit of the curriculum (unpublished) revealed that most year 1 and 2 modules are biomedical and clinical science–based and use the lecture theater setting, which is devoid of exposure to real patients.

Ethics approval for this evaluation was obtained from the Medicine and Biological Sciences Research Ethics Committee at the University of Leicester (42549-rw205-ls:medicine). There was no potential harm to participants. Any personal information that could directly identify participants will be removed or coded before study data are shared. Despite these measures, anonymity was not guaranteed. All patients were given a participant information leaflet and asked to give their consent for the lecture to be filmed. Participants were not offered compensation.

To the best of our knowledge, this paper is among the first to describe the design, implementation, and evaluation of a wide-reaching educational strategy that integrates real patients to promote empathy across the biomedical, clinical, and social science components of the medical school curriculum. We recognize that similar initiatives may be underway elsewhere and would welcome engagement with others working in this area. Students overwhelmingly reported that the inclusion of patients in science-based lectures helped elicit feelings of empathy and agreed that the intervention benefitted their engagement with teaching and learning.

Overall, our findings broadly support those of previous studies in this area. A systematic review of 49 studies reported that patient involvement in education in medical school can improve student understanding of person-centered care [44] and, therefore, empathy [45]. However, none of the studies included in this review described the introduction of real patients in lecture-based pathophysiology teaching. Other studies have identified that students value interactions with patients, reporting finding real patient encounters to be authentic and instructive [46], and that patients can help link theory with reality, enhance learning [46], and improve learning satisfaction [47]. Our evaluation adds to a growing body of evidence on the advantages of including real patients across the spectrum of medical education and in more innovative ways [19,47]. Specifically, it is rare to introduce real patients in lectures focused primarily on pathophysiology teaching.

A strength of this evaluation is that it describes the development and delivery of a wide-reaching curriculum component. Our response rate to the postintervention survey was high, especially given the frequent requests that medical students receive to complete evaluations or participate in research [48,49]. Our findings identify that this addition to the curriculum is feasible and sustainable. There are some limitations to this evaluation. First, concerns were raised about the generalizability of our findings. This was a single-site evaluation for first- and second-year medical students. There are additional resources required to develop and implement this strategy across multiple sites, including the potential additional work required from faculty. To mitigate this, medical schools are required to promote a person-centered approach to health care throughout their programs [27], so lecturers already often include videos or vignettes (which must be identified and integrated into the lecture). There is also a cost associated with setting up the system of including patients in the lecture theaters. Our comprehensive standard operating procedure minimizes the set up and organizational resources required for future educators who wish to implement our curriculum component. We also note that our medical school has a patient involvement group who were happy to contribute to the delivery of this initiative. In addition, we worked with primary care colleagues at LMS to identify and recruit patients in general practice. Many medical schools have similar patient groups and networks that could be similarly helpful. Second, it was beyond the scope of this evaluation to formally explore patient experiences; however, we acknowledge that the patient experience does need exploring. We are currently conducting research to better understand the patient perspective when presenting in lectures, including any potential harms. A third limitation was that our evaluation did not describe the 4 types of evaluation by Kirkpatrick and Kirkpatrick [50], whose outcomes of hierarchy evaluate training methods at four levels: (1) reaction of the learner, (2) the degree to which the learning takes place, (3) how well the learning is assimilated into the learner’s practice or behavior, and (4) the degree to which the learning outcomes are met as a result of the training. We did not assess actual learning or changes to behavior or practice as a result of the intervention. Finally, while lectures are mandatory at LMS, there is no record of attendance kept, and it was not possible to identify whether students who completed the evaluation attended all or just some of the lectures hosting patients.

Involving patients in early-year teaching of biomedical and clinical science offers students a meaningful and motivating way to connect theoretical knowledge with real-world clinical practice. Patients from primary care settings provide ideal contexts for this intervention, offering a diverse range of experiences with conditions, chronic disease management, and preventative care. These real-life contexts not only illustrate the application of science but highlight the complexity and continuity of health care. Students will also begin to develop a broader understanding of the health care system, including social determinants of health and the realities of delivering care in community settings, right from the start of their training. There are inherent challenges, as already discussed, with inviting patients to attend lectures. However, there are many potential benefits to students in terms of fostering empathy toward patients, enhancing engagement with learning, and increasing awareness of the psychological and social aspects of health and illness. A future focus on the long-term impact on empathy and whether this intervention can help halt or reverse the documented decline in medical student empathy [9,10] during training is needed.

Integrating real patients and their stories into biomedical and clinical science lecture-based teaching is a novel application. The introduction to real patients throughout the early-year biomedical, clinical, and social science curriculum was well received by students. It can support engagement with learning and promote feelings of empathy in students, with the potential to mitigate the risk of decline in empathy among medical students.