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

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.

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).