Medical student reflections on community-based observations of health: Empathy for marginalized populations and specialty choice

BACKGROUND: The PPACA stipulates community-based training for physicians and provides incentives to deliver care in underserved areas. If physicians are to be effective providers for underserved populations, training programs must cultivate understanding of barriers to health. Community-based experiences are critical to professional development, providing context and fostering understanding of the interplay between environment and patient health. Experiencing communities where patients live has potential to engender empathy – an attribute that declines during medical professionals' training, yet linked to patient satisfaction, health outcomes, and specialty choice. While there is debate whether empathy can be taught, exposure to community experiences has high face validity to mitigate empathy erosion and to shape understanding of patient context. Previous work on student empathy is limited by selection and self-report biases. METHODS: We employed grounded theory to examine student reflections (n=349) of a community experience to ascertain themes present in language used to describe marginalized communities. The specific aims were to characterize the underlying distribution of empathy, and to examine the relationship between expressed empathy and medical specialty choice. Students were grouped based on specialty choice (people-oriented versus patient-remote) and community volunteerism. Student writings provided textual data that was analyzed using NVivo 9. RESULTS: An underlying distribution of expressed empathy was established for a non-voluntary medical student population. Differential themes of empathy, judgment, and stereotyping were observed among student groups. DISCUSSION: These findings provide a qualitative understanding of empathy in a medical student population and have important implications for training physicians to work with underserved populations.