The Influence of Poverty Simulations on Dental Students' Empathy

Poverty simulations are frequently embedded in the curriculum of health professions training programs to enhance student attitudes toward poverty or to enhance student empathy. These outcomes are often not clearly distinguished, and empathy is rarely measured in a rigorous way. The purpose of this exploratory study was to measure changes in empathy following a poverty simulation, to compare them to changes in attitudes, and to explore whether personal experience of financial insecurity was associated with either.

Third year dental students (N = 169) participated in a poverty simulation and completed anonymous surveys at three points: baseline, post-simulation, and at 2-month follow-up. At baseline, students reported personal experience with financial insecurity. At all three points, students completed a 20-item poverty attitudes measure and the Interpersonal Reactivity Index, measuring empathy.

Compared to baseline, empathy was lower immediately after the poverty simulation (M = -1.78; p = 0.003) and 2 months later (M = -2.37; p < 0.001). Poverty attitude scores were higher immediately after the simulation (M = 9.40; p < 0.001) and 2 months later (M = 7.93; p < 0.001). Personal financial insecurity was not associated with empathy and was modestly associated only with baseline poverty attitudes (r = 0.16; p < 0.05). Although empathy and poverty attitudes were not associated at baseline, baseline empathy predicted poverty attitudes at post-simulation (r = 0.47; p < 0.001) and follow-up (r = 0.39; p < 0.001).

Poverty simulations may result in a decline in participant empathy, even if these simulations improve attitudes toward poverty. Empathy and attitudes are distinct constructs, and if enhancing empathy is the goal, then alternatives to poverty simulations may be more effective.