Effect of a Community Service-Learning Intervention on Medical Empathy and Clinical Self-Efficacy in Medical Students

Official title

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

Overview

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.

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).

Interventions

• 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

Primary outcome measures

• Change in Medical Empathy Score (JSE-S) [Time frame: Baseline and 5 weeks]
• Change in Perceived Clinical Self-Efficacy Score (EAM) [Time frame: Baseline and 5 weeks]
• Change in Clinical Report Performance Score (Standardized Rubric) [Time frame: Baseline and 5 weeks]

Secondary outcome measures (1)

• Correlation Between Change in Empathy and Change in Clinical Self-Efficacy [Time frame: 5 weeks]

Eligibility criteria

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

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Other

Study locations

Mexico · 1 center

• Facultad de Estudios Superiores Iztacala, UNAM — Tlalnepantla

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.

Identifiers

NCT: NCT07528521 · FES-IZT-PC1-2025-001

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗