Empathy, the quality that makes us feel understood and cared for, can be learned and encouraged through the thoughtful design of curriculum, technologies and structures.

The Empathy Effect

Empathy, a cornerstone of high-quality clinical care, has been defined in numerous ways across healthcare disciplines and conceptual studies. Lori Thuente, PhD, RN, captures its essence through her own experience as a patient.

“I was in the pre-op room, being prepped for a bilateral mastectomy. I had cancer. I was having a simultaneous mastectomy and reconstruction. Everybody’s running around. It’s super chaotic. And I’m lying there, quietly panicking to myself. The only person who came over to comfort me was the plastic surgeon. He sat down and held my hand and said, ‘You know, I’m gonna do the best job that I can. I’m happy to wait with you here until you go into the OR.’ He really had that skill of comfort. He understood that it was terrifying.”

The founding chair for the MSN for Entry into Nursing Practice (MENP) program, Dr. Thuente is the driving force behind the College of Nursing’s Dr. Scholl Foundation Empathy Lab, which allows students to embody a variety of disease states and patient diagnoses through virtual reality (VR) and adaptive equipment.

“Our students can literally walk in the patient’s shoes,” Dr. Thuente said. “They learn to understand from different perspectives — the family, the patient, the caregiver — not just the diagnosis, but the physical, mental and emotional responses that the patient and family experience with the disease.”

A VR immersive experience takes the learner along a journey through Alzheimer’s disease as lived by “Beatriz.” Here, Beatriz’s family is forced to confront the reality of her condition. Photo provided by Embodied Labs.

Studies cite immersive learning as a highly effective way to build empathy. Strap on one of the Empathy Lab’s specially programmed VR headsets, and you suddenly become Beatriz, a woman with mid-stage Alzheimer’s disease:

You are lost in the grocery store. A young clerk tries to help, but you can’t make sense of what he’s saying. Then it’s Easter Sunday. Your kids and your grandkids arrive for dinner, stunned to find you still in your housecoat, cutting potatoes. No roast lamb in the oven. No fish soup on the stove. They gather around you and start arguing among themselves.

In a subsequent module, Beatriz requires round-the-clock care by a certified nursing assistant. Her daughter and grandson move in. A family care plan meeting is held.

MENP students participate in empathy simulation for each of their nine clinical rotations. Pre- and post-test surveys and narrative reflections are revealing.

Ameera Minhas, CHP ’24, CON ’25, writes: “I like how the CNA allows the daughter to relax, be herself, and take care of Beatriz at the same time. This shows that not only does the patient suffer, but family members suffer as well — seeing their loved ones go through this — and require rest.”

Ms. Minhas notes that even though Beatriz is fully dependent, she “is still Beatriz and enjoys doing what she loves most.” Despite their neurological state, Ms. Minhas writes, Alzheimer’s patients “are still individuals, human beings, who require love, care and compassion.”

“What we know is empathy training changes the care our students provide,” Dr. Thuente said. “They’re showing an increased understanding of patients’ actions and behaviors as well as their caregivers’ behaviors. They’re reflecting on how they will give care in ways that show increased patience and communication. They’re learning how to offer autonomy, and how not to take a patient’s behavior personally.”

The Evidence for Empathy

It’s well-documented that empathy — understanding and sharing the feelings of another person and acting on that understanding in a therapeutic way — improves the physical and mental well-being of patients. When a provider fails to demonstrate empathy, studies show, patients are less satisfied and clinical outcomes suffer. When clinicians lack empathy or the ability to convey it, it may be a reflection of their own need.

A 2021 study of healthcare providers in Texas found that clinician distress “interferes with the capacity to provide empathetic patient care, whereas well-being enhances empathy.” The paper suggests that “optimizing one’s resilience could deepen empathy.”

“You can’t really have empathy for others until you yourself feel grateful and mindful.”

Meredith “Misty” Fils, MS, PA-C, assistant professor in the PA Department, said self-care is crucial for the empathetic clinician.

“I know self-care is a term that gets bandied about, but for me it means taking time for introspection and self-reflection — being grounded,” Ms. Fils said. “It’s more than just waking up and putting boots on the ground. You can’t really have empathy for others until you yourself feel grateful and mindful.”

Ms. Fils and 70 of her PA students in January dove into laptop-based Empathy Lab modules that simulated sensory impairment — vision and hearing loss.

Members of the extended Â鶹ӰÒô community visit the Scholl Empathy Lab during a College of Nursing Open House.

“In their final reflections and evaluations, almost to a person, the students spoke about the power of that experience,” Ms. Fils said. “How they felt helpless, frustrated, angry and were grieving for what they had suddenly lost. For me, by the end of the module, I couldn’t see well enough to solve a simple math problem. At the root of empathy is the ability to look at something from someone else’s perspective. And the modules force you to do that.”

Cultivating Empathy and Identifying Structural Barriers

Teaching and learning around empathy takes place across Â鶹ӰÒô academic programs through simulations, interactions with standardized patients, community clinics, patient and provider panels, and other types of experiential learning.

P2H2, or “Principles of Professionalism, Health Care and Health Equity,” a longitudinal course for medical students, builds empathy and critical consciousness through small groups, as students listen to each other, to faculty, to near peers, and to patient panels and community voices.

“Most people, what they want from their provider is someone who listens,” said P2H2 instructor Hillary Mowbray, MD. “And yet listening is not a compensated part of medicine.”

“The lesson ... is how they can make a difference by really listening to patients and understanding the barriers to care that they face.”

Dr. Mowbray and Melissa Chen, MD, who created P2H2, are part of a growing chorus that includes Harvard Medical School, Intermountain Health, and Â鶹ӰÒô Trustee and author Stephen Klasko, MD, MBA. They believe that structural barriers have diminished clinician empathy and call for embedding empathy in the foundation and design of health systems.

“People who are making decisions about the structures of health care are not clinicians,” Dr. Chen said. “The delivery of health services has become a transaction that really limits the opportunity for empathy, and that is leading to burnout. Empathy is not rewarded. It is not incentivized.”

Â鶹ӰÒô’s student-driven Interprofessional Community Clinic (ICC), where students and faculty advisors care for uninsured patients, offers deep experience in the development of empathy.

“It’s an incredible place for putting empathy into action, and also just seeing the power that being an empathetic listener and clinician can have in other people’s lives,” said Ms. Fils, ICC assistant medical director.

Many ICC patients rely on community-based emergency shelters. A lack of resources means an inability to follow a treatment regimen. Serious vitamin deficiencies are common.

“A patient may receive a diagnosis that requires a special diet, but they’re living in a shelter or sometimes a motel room,” Ms. Fils said. “So students need to think about that and put themselves in that situation. How is talk about less-processed food and more leafy greens going to go over with this person? How are they going to feel? It’s a situation and a reality that students and clinicians alike have to acknowledge.

Simulator glasses mimic the effects of eye diseases, including glaucoma, cataracts and macular degeneration.

“It’s really powerful when we come out of the exam room and do the debrief,” she added. “Our students aren’t talking about learning that atorvastatin is the medicine of choice. That’s not the lesson that they take away, even though that’s important. The lesson that they take away is how they can make a difference by really listening to patients and understanding the barriers to care that they face.”

“There are lots of reasons that people can’t make good choices for themselves, or get the care that they need,” said Robin Dyer, MD, OTR, course director for HIPS 515, “Foundations for Interprofessional Practice,” where all first-year clinical students learn active listening as part of interprofessional healthcare teams. “It’s not usually because they intend to be non-compliant with their care plan. Maybe they’re scared. Maybe they don’t understand, or they’re in denial.”

In her former practice in internal medicine, Dr. Dyer learned that a new patient was the sole caregiver for her 18-year-old son, who had severe cerebral palsy.

“Her whole life was taking care of her son,” Dr. Dyer said. “So she didn’t get her medicine refilled and her diabetes was out of control. And she didn’t have much income. So it was a matter of working with the pharmaceutical companies to get her insulin.”

Another patient, uninsured, with debilitating rheumatoid arthritis, had to take two buses to appointments.

“I referred her to a rheumatologist, but she didn’t go,” Dr. Dyer said. “I remember that feeling, a kind of frustration. In a perfect world, everyone has access to the care they need and providers are able to deliver that care. The negative effect on the provider’s well-being comes from the frustration of not being able to meet those needs. But I’m a glass-half-full kind of optimist. I think we’re empowering our students to be the change that we all want to see.”