Mapping the humanistic care ecosystem in medical education: development and validation of a novel multidimensional...

Deficiencies in medical humanistic care contribute to poor therapeutic relationships and clinical conflicts. Existing assessment tools are fragmented, lacking a comprehensive framework to systematically evaluate the multidimensional ecosystem of humanistic education in medicine. Thus, this study developed and validated the Humanistic Care Scale for Medical Education (HCS-ME) to address this gap.

An initial 68-item pool was generated from a literature review. Following expert review, a 60-item scale assessing five dimensions grounded in an ecosystem framework of medical education was tested, including student literacy, faculty modeling, curriculum, campus environment and professional cognition. 738 medical undergraduates completed the HCS-ME at baseline, while psychometric properties were evaluated using data from 433 after quality control. Among them, 50 students underwent the follow-up evaluation four weeks afterwards.

The HCS-ME demonstrated excellent internal consistency (Cronbach's α = 0.982), split-half reliability (r = 0.956) and test-retest reliability (r = 0.29 ~ 0.54 for each subscale). The factor structure of the HCS-ME fits well with the factor model (χ²/df = 2.245, χ² = 3817.010, df = 1700, P < 0.001; CFI = 0.909; TLI = 0.905; RMSEA = 0.054). A key finding identified students from single-partner households as scoring significantly lower across all dimensions.

HCS-ME is a novel tool with good validity and reliability for holistically assessing medical humanistic care education. It provides a practical instrument for identifying educational gaps, informing targeted interventions, and guiding curriculum and policy reform to ultimately foster a more humanistic healthcare workforce.