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

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).

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