Exploring the Development of Clinical Empathy among Chinese Medical Students: A Transition from Simulation-based Learning to Clerkship

Background: Little is known about how simulation-based learning and clinical clerkship—two key learning contexts—shape medical students’ interaction with simulated and actual patients and influence students’ clinical empathy. This study investigated the development of clinical empathy among medical students from simulation-based learning to clerkship in China. Methods: In a constructivist paradigm, this study employed an exploratory qualitative approach, adhering to the COREQ. Data were collected through semi-structured interviews with eight fifth-year medical students and observations of 26 instances among 16 fourth-year students in a six-station objective structured clinical examination. Thematic analysis was used to analyse the qualitative data. Results: In simulation-based learning, medical students focused on improving their clinical skills, seldom perceiving simulators as patients they might encounter in clinical settings, and pretended to show empathetic concern as needed. Furthermore, due to the lack of timely simulator feedback, medical students easily overlooked critical steps in clinical procedures. During clerkship, medical students experienced stronger emotional responses. Concern about potentially harming patients made students more cautious in procedural steps. Medical students gradually recognized patients’ uniqueness, becoming attuned to emotional cues and alleviating patient suffering by improving their clinical skills. Moreover, their perspective on patients shifted, enabling them to see patients as a whole to carry out medical procedures with empathetic concern. Conclusions: While simulation provides skill training, its procedural nature limits empathy development. Clerkship, in contrast, fosters medical students’ emotional engagement, individualized thinking, and flexible views of patients.