I was very nervous at the start of the placement because I have always struggled with starting conversations. The idea of speaking with someone much older than me and focusing on non-medical topics felt quite daunting. I was worried I wouldn’t know what to say or how to keep the conversation going.
For this first-year medical student, visiting a care home was daunting. There was no medical history to take or diagnosis to make. The task was to get to know an older resident through conversation.
Listening and showing compassion are core expectations of medical graduates. Yet empathy can be difficult to develop and sustain. Some studies suggest it declines during medical training, particularly when students enter clinical settings, although other research reports mixed findings.
One possible explanation is the “hidden curriculum”: attitudes students absorb from doctors and clinical environments alongside formal teaching. A 2023 review of 16 studies identified heavy workloads and poor role models among influences that may encourage emotional detachment.
Doctors need to manage their emotions in distressing situations. How can medical schools also encourage students to remain curious about the people experiencing illness?
Getting to know the person
At the University of Lancashire, I developed The Person Before the Patient project, a care-home placement piloted in 2023/24. It was made compulsory for first-year medical students in 2024/25.
The programme operates across 11 care homes. During four-week placements, students meet residents who may be living with dementia, frailty or long-term conditions. Rather than assess medical needs, they learn about residents’ interests and experiences.
An Australian study of 61 fifth-year medical students found that five-day care-home placements improved dementia knowledge and attitudes towards working with older people, although some students questioned their educational value.
Our programme introduces students earlier, before their conversations become focused on clinical assessment. They may arrive with prepared questions, expecting predictable answers. Instead, they must respond to what residents choose to share.
One student reflected:
I realised that I had to adapt my communication style. This meant listening more and allowing the resident to lead the conversation, rather than relying on prepared questions. I also learned to become comfortable with periods of silence while residents searched for the words they wanted to use.
The student also became more attentive to facial expressions and gestures. Such skills are useful when people experience hearing loss or memory difficulties. Nice guidance on dementia recommends adapting communication to people’s needs and considering their histories and preferences.
The placement gives students time to practise listening at a resident’s pace, something that can be harder during a busy clinical appointment.
Learning about empathy
Medical students often practise consultations with actors playing patients. These exercises develop communication skills, but can feel different from hearing someone describe their own life.
A New Zealand analysis of five students’ nursing-home reflections found that providing personal care sometimes helped students recognise residents as individuals. But encounters involving incontinence or frightening behaviour could leave students overwhelmed. In some accounts, they began describing residents as problems to manage rather than people to understand.
That small study examined hands-on caregiving, unlike our conversation-based placement. Nevertheless, it shows why students need support to reflect on difficult feelings instead of allowing discomfort to shape their attitudes towards patients.
One student on our placement wrote:
Being with the residents made me feel and understand what empathy actually is. Before this I feel I was ‘pretending’ to be empathetic with simulated patient in classes and exams.
The student went on to describe relating residents’ life experiences to their own family and feeling better able to empathise.
Of 281 students who undertook the placement, 157 voluntarily completed written reflections as part of a project with ethical approval. These accounts show what respondents felt they had learned. However, we did not formally measure empathy, and students who chose to respond may have felt more positively about the experience than those who did not.
A UK evaluation of the Time for Dementia programme found that students who regularly visited people with dementia and their families showed improvements in knowledge and attitudes, but no significant difference in measured empathy compared with other students. A review of long-term empathy training also found little evidence that gains persist.
For our programme, this means positive reflections are an encouraging starting point, but cannot establish lasting changes in empathy or clinical behaviour. A fuller evaluation would need to assess students over time, including after they begin clinical training, rather than relying on their immediate impressions.
What do residents gain?
Residents live in the homes where students learn, so they should be able to choose whether to take part and what they want to share. Otherwise, there is a risk of treating people’s lives as teaching material without giving them control over the encounter. Guidance from the National Institute for Health and Care Excellence emphasises residents’ involvement in choosing meaningful activities.
In some participating homes, residents took part in discussions about hosting students and, alongside staff, how placement funding would be used.
Care-home managers report that many residents enjoy the visits, look forward to students returning and become more socially engaged. These observations have not been independently evaluated.
An Australian study involving 28 residents found that healthcare student placements offered opportunities for social connection and enabled residents to contribute to students’ education.
Medical schools cannot remove the pressures future doctors will face. Spending time with older people without the demands of diagnosis or treatment may nevertheless help students see patients as people with lives beyond their medical needs.
Helen Rainford does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.