Background: Research evidence over the past 20 years has established that doctors' ability to empathize with their patients is a crucial component of effective health care. Consequently, teaching and reinforcing empathy has entered undergraduate medical education curricula; however, there have been mixed results in terms of its effectiveness. While there is evidence that empathy fluctuates during undergraduate medical training, there has been very little longitudinal research looking at medical students' empathy levels over their full course of study. The aim of the current study was to investigate whether medical students' empathy changed during their 5-year MBBS degree. Methods: Students completed the medical student version of the Jefferson Scale of Physician Empathy (JSPE) at the start of Year 1 and then near the end of Years 2, 3, 4, and 5 during 2009–2015. Total empathy score for students who had completed the JSPE in all 5 years of medical training was compared over time using nonparametrical statistical analysis. Results: Results indicated that medical students' empathy varies with empathy being highest at the start of the medical course in Year 1, declining to a low in Year 3 and then rising again in Years 4 and 5. There was a tendency for female students to have higher empathy scores compared to male students in each of the 5 years, with scores significantly different in Years 2, 3, and 4. However, there were no differences in empathy scores according to the students' age. Discussion: The decline in empathy in the early years of undergraduate medical training is a concern. Medical educators should teach and reinforce empathy during early years of undergraduate medical training in a sustainable way to guard against declining empathy levels. Specific interventions targeted at increasing empathy in male students might be warranted in the future.

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Purpose: The purpose of this study is to examine the impact of an interprofessional education (IPE) clinical experience for medical and physical therapy students on students' comfort levels and attitudes toward patients with disabilities. Methods: Forty students were recruited for this study, 20 from the College of Medicine and 20 from the Doctor of Physical Therapy Program at University of Central Florida with 10 students from each program self-selected into a control group or an experimental group. The experimental group attended an IPE clinical experience that included an encounter with a patient with a disability. Students completed standardized inventories on their perceptions of difficult rehabilitation situations, comfort levels, and attitudes prior to, and immediately following, the clinical experience. The control group completed the same standardized assessments. Results: Using the rehabilitation situations inventory (RSI) statistically significant changes in scores from the pre- to the post-intervention (P < 0.001) were observed. In addition, a statistically significant (P < 0.05) improvement in comfort levels was found in five of the six RSI subscales which include staff–staff interactions, families, motivation/adherence, aggression, and sexual situations. Attitudes toward disabled persons (ATDP) and interactions with disabled persons (IDP) failed to find statistically significant changes in respondent scores due to the intervention (P > 0.05). Conclusion: Both medical and physical therapy students reported increased comfort in dealing with rehabilitation situations after attending the IPE clinical experience. This supports the use of clinical encounters with individuals with disabilities as component of education on treating patients with disabilities.

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Background: After nearly four decades of testing an innovative model for training health workers for marginalized communities, the evidence base for the impact of University of the Philippines Manila-School of Health Sciences (UPM-SHS) medical program needs to address important gaps. Has it succeeded in contributing toward socially accountable medical education where medical schools will be evaluated in terms of their contribution to society's health outcomes? To answer this question, this study examined human resources for health (HRH) inequity in the Philippines and reviewed the medical school's performance in terms of addressing HRH distribution. Methods: The evaluation of the school's performance was done through two phases. Phase 1 involved generating HRH inequity metrics for the Philippines through secondary data. Phase 2 involved gathering primary data and generating performance metrics for UPM-SHS. Results: We found challenges that UPM-SHS needs to address based on the analysis of its student admissions from 1976 to 2011: targeting the right underserved communities, especially at the municipal level; addressing issues of high leakage and undercoverage rates in the program; ensuring mechanisms for return service are in place at the community level; and tracking and measuring program outputs and impact on community health outcomes. Discussion: Given this study on the performance of UPM-SHS to produce a broad range of health workforce to address the needs of marginalized communities in the Philippines and in similarly situated countries, there is a need to reassess its HRH development strategy. If it wants to build a critical mass of transformational health leaders to meet the needs of poor communities as part of its social accountability mandate, it needs to accelerate this development process.

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Background: The Dundee Ready Education Environment Measure (DREEM) is used in the curricular development of future health professionals worldwide, but often without first locally testing its psychometric qualities, for example, construct validity and internal consistency. These characteristics are modified by different environments, but must be locally appropriate to obtain unequivocal and reliable conclusions about the strong and weak areas of a curriculum. Here, we report the results of the psychometric testing of DREEM results in our institution in Chile. Methods: All 1^st–5^th-year undergraduate medical students were asked to respond the DREEM questionnaire. The construct validity of the results was assessed by an exploratory factor analysis (EFA), and their internal consistency was assessed by Cronbach's α. The Institutional Review Board approved the study, and each student signed an informed consent. Results: A total of 304 (88%) eligible students, aged 22 ± 2 years, 46% of females, answered the questionnaire. The EFA determined four instead of the original DREEM's five subareas with clearly different item contents. The inner consistencies of the locally defined subareas of teaching, learning, teachers and organizational aspects, and self-perception surpassed the originals with Cronbach's α values of 0.79, 0.78, 0.77, and 0.82, respectively. Discussion: The optimal psychometric structure to accurately interpret our DREEM results differed from both the original and previous similar studies, including one from Chile. There are several potential explanations for these differences, but most importantly, they underline the need to first define the psychometric characteristics of the test results, to obtain accurate conclusions about the strengths and the weaknesses of a curriculum.

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Background: One of the health issues faced worldwide is the misdistribution of health practitioners resulting in a lack of physicians working in rural and remote areas. We identified the motivations of rural doctors and the personality that contribute to motivation to stay in rural communities. Methods: A qualitative phenomenological approach was used for which 35 rural general practitioners were interviewed in focus group discussion and one-to-one in-depth interview using a list of structured open-ended questions. Results: Family relationships and self-actualization play important roles in choosing a rural career. Personality also contributes to the decision to work as a rural doctor. We identified nine types of rural doctors, of which it is proposed that five could be encouraged and further developed in medical training. Discussion: The study results suggest that more attention should be devoted to developing certain characteristic in medical students. This would hopefully result in rural doctors gaining increased job satisfaction and being more likely to be retained for a longer duration in rural locations.

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Imparting a positive attitude toward social determinants of health among medical students has remained a challenge in medical education. This pedagogical exercise attempted to use a toxic tour with participant photography technique to impart environmental health education as part of the community medicine curriculum for medical students. In collaboration with a local environmental health nongovernmental organization, faculty from two medical colleges took a set of 13 medical students to Ennore thermal power plants as a part of a toxic tour to view the air and water pollution caused due to the operation of the power plants. The students were instructed to capture photographs of the environmental hazards using their mobile phone cameras and share them on a social media platform. Immediately after the tour, the students discussed their experiences with the faculty. Two weeks after the toxic tour, the students engaged in a focus group discussion in which they discussed their experiences, advantages, and disadvantages of the toxic tour and participant photography method and their attitudes toward environmental health. This pedagogical exercise led to the active engagement of the students with the environmental hazards in the area. They shared 70 photographs on the social media platform. In reflection, students described that they found the method very useful to actively engage with the environment, look for and find the hazards, revisit, and reflect on the photos, and use the photos to share the knowledge and experience. They also demonstrated a positive social determinants and public health attitude during the discussions. Participant photography technique during a toxic tour can impart affective domain of learning related to environmental health among medical students.

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Background: Although alcohol and tobacco are leading causes of mortality and morbidity, their use continues to be common. We hypothesized that awareness about this issue can be spread in a time-efficient way if health talks are conducted within hospital premises itself. Furthermore, this could potentially provide good experiential learning to medical students. Methods: In this longitudinal study, we implemented such an awareness activity and evaluated the outcome. Students who showed interest to volunteer were helped to develop an in-depth understanding of the issue, through detailed presentation and discussions. They conducted health talks near the wards, with patients and their relatives, after routine college hours. An iterative process was used to improve the health talk, based on self-reflection and formative feedback. A pre- and post-self-assessment of students regarding their knowledge and skills on this issue was obtained. A structured, anonymous questionnaire was administered to the audience before and after three of the educational talks. Results: In 29 days, our team of 24 students gave 21 health talks reaching out to 1090 rural people. Pre–post analysis of audience showed improvement in their awareness level and many developed the motivation to quit their addictions. Self-rating of students across all knowledge domains increased by at least 2 points (scale of 1–7) and across all skill domains, it increased by 3 points (P < 0.0001). Conclusion: This model of conducting health talks in hospital premises can enable us to spread health awareness effectively, in a time-efficient and cost-effective way. Furthermore, this model can prove to be a novel and effective academic tool for grooming medical students.

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