Fostering empathy and narrative competence through oral history videos in community-based medical education: a mixed-methods study

Empathy and narrative competence are essential components of patient-centered care and professional identity formation in medical education. However, empathy often declines during medical training, and conventional communication programs may foster performed rather than authentic empathy. Narrative medicine offers a promising framework for cultivating humanistic understanding in medical education. Central to this approach is narrative competence, defined as the ability to recognize, absorb, interpret, and act upon the stories of others. This study explored how viewing and discussing oral history videos of local older adults could foster empathy and narrative competence among medical students in a community-based educational context.

A convergent mixed-methods design with qualitative priority was employed. Twenty-seven fifth- and sixth-year medical students at Tottori University participated in a 60-minute session during their one-week community-based clinical placement. Participants viewed a 20-minute oral history video from a regional series featuring older residents' life stories, followed by a reflective group discussion. Empathy was assessed using the Japanese version of the Interpersonal Reactivity Index (IRI) before and after the session. Written reflections were thematically analyzed to explore experiential learning.

The total IRI score showed a small, non-significant increase (91.25 to 92.69; t = 0.82, p = 0.42, Cohen's d = 0.15). Thematic analysis identified nine categories, including recognizing the significance of listening to narratives, respecting individuality, recognizing patients' social and historical contexts, and reconsidering assumptions about older adults and patient care. Students described emotional resonance, reflective insight, and renewed awareness of patients' values and life histories.

Although quantitative measures revealed minimal change, qualitative findings suggested short-term reflective engagement with patients' life histories, values, and social contexts. Oral history-based narrative education may enrich community-based medical training by linking empathy, reflection, and narrative listening, and may offer a concise approach for supporting context-sensitive, patient-centered care.