Open research questions in Empathy and Medical Education
66 unresolved questions extracted from the limitations and future-work sections of 2,134 Empathy and Medical Education papers in our library. Each links back to the study that raised it.
What the literature leaves open
Future research might explore the predictive validity of the SPM in new contexts such as virtual environments (e. However, it remains to be seen to what extent these identified components will be important within more specific situations. Also worth mentioning are prospective findings from the subsidiary measures that were listed in Section 3 but have not been analysed yet.
The main limitation of this study is that the sample is not repre- sentative of the studied population. The findings may only be valid for the studied population in terms of trends. The sample included both medical specialists and residents, who were analyzed as a single group due to shared clinical functions and sample size considerations. Future studies with balanced subgroup samples should examine potential differences in empathy and resil- ience across levels of professional training.
Evaluation of the relationship between resilience and empathy in medical professionals using structural equation modeling · 2026 · DOIThere is no systematic evaluation methodology described for assessing whether the LitMed track achieves its stated goals of helping students reflect on their experiences and maintain meaning-making capacity.
The first half of the 20 th century was a period of uncertainties in medical sciences, lack of standardised practice, the absence of guidelines for the treatment of various diseases, and, sometimes, scarcity of ethical guidelines in healthcare research or medical practice.
The paper discusses how narrative anxieties about subjectivity, objectivity, and truth manifest in medical critiques of narrative but does not specify which medical specialties, institutional settings, or types of ethical cases (e.g., end-of-life, resource allocation, informed consent) demonstrate these anxieties most acutely.
Clinical ethicists are characterized as story-makers who synthesize multiple narrative perspectives, but the paper provides no framework for evaluating which narrative elements, voices, or perspectives clinical ethicists should prioritize, weight, or omit when constructing ethical recommendations from narrative polyphony.
The paper asserts that narrative premises shape ethical perception and reasoning but does not examine how different narrative structures (biographical, sequential, fragmentary, non-linear) within patient or caregiver accounts differentially influence clinical ethical decision-making or moral deliberation in specific medical conditions.
The distinction between the 'internal perspective' (experiential insight from lived experience) and 'external perspective' (moral conclusions drawn from experience) in narrative evidence is theoretically developed but lacks specification of how this distinction should be operationalized when evaluating conflicting narratives from multiple stakeholders in complex ethics consultations.
The paper discusses narrative charitability and narrative humility as postures for receiving narrative accounts in medical ethics but provides no empirical validation of whether training clinicians and ethicists in these specific narrative practices actually improves their recognition of narrative fallibility or reduces dismissal of patient first-person accounts.
The paper identifies that expectations for rational scrutiny in narrative ethics could perpetrate hermeneutic injustice depending on how standards for rational scrutiny are identified and applied, but does not specify which populations, clinical contexts, or narrative forms are most vulnerable to this injustice or provide concrete methodologies for designing scrutiny standards that avoid this harm.
Despite the inevitability of not knowing in biomedicine, however, there is relatively little academic discussion about how physicians are socialized to address ignorance, how clinicians experience gaps in knowledge as practitioners, or the various forms that not knowing takes in professional health-care practice and education.
The authors propose that new metaphors with explanatory roles similar to 'soul' or 'spirits' could enhance subjunctive medicine without undermining biomedical naturalism, but do not specify criteria for evaluating which cultural metaphors are therapeutically effective or how to prevent these from being perceived as ideologically incompatible with biomedicine.
The paper claims subjunctive medicine reduces reliance on shared history between clinicians and patients, but provides no empirical evidence comparing patient outcomes or interpersonal understanding in consultations with continuous versus episodic provider-patient relationships within multidisciplinary healthcare teams.
While the authors propose subjunctive medicine as applicable across specialties but particularly useful in primary care, geriatrics, psychiatry, and clinical psychology, they provide no guidance on how the framework must be modified or adapted for lower-resource settings, interdisciplinary team structures, or brief clinical encounters typical of modern distributed healthcare.
The paper argues that a societal recognition of subjunctivity would enable medical pluralism without ideological tension, yet lacks concrete mechanisms or empirical frameworks for measuring how clinicians and healthcare systems should transition from the current dominance of indicative 'sincere' orientation to appreciating subjunctive modes in practice.
The authors propose that subjunctive medicine requires incorporation of stories, metaphors, narratives and myths into medical consultations but do not specify operationalized protocols, training curricula, or fidelity measures for implementing these narrative elements within the demarcated context of healing rituals in contemporary biomedical settings.
The paper identifies chronic illness management, multimorbidity, polypharmacy, medically unexplained symptoms, and mental health as conditions where subjunctive medicine is likely most useful, but provides no empirical validation or comparative outcome measures across these specific conditions to determine differential effectiveness.
The paper proposes that literature and poetry should be integrated into broader societal discussions about death, dying, serious illness, and spirituality, but does not specify how medical humanities curricula incorporating literary analysis should be structured, assessed, or implemented to measurably shift institutional cultures of silence around end-of-life spiritual care.
The case study of medical student J. illustrates that religious literature ('Footprints in the Sand') mitigates burnout and supports physician wellbeing during moral injury, but the paper lacks systematic data on which specific religious literary texts or secular spiritual literature most effectively support physician resilience across different medical specialties and training stages.
The paper asserts that poetry transcends time and space to allow emotional connection to spirituality, drawing on Bakhtin's observation about social processes unfolding across centuries, but lacks empirical evidence comparing how different literary genres (poetry versus prose medical narratives) affect physician capacity to recognize spiritual dimensions of patient suffering across diverse cultural and religious contexts.
While the paper discusses how Holub's juxtaposition of medical terminology and poetic language unsettles readers and prompts spiritual inquiry, there is no systematic analysis of which specific medical poetic techniques (technical terminology embedding, metaphorical disease descriptions, narrative structure) most effectively trigger intuitive understanding versus emotional resonance in medical students or practicing physicians.
The paper argues that poetry can help doctors recognize when silence is better than words in medical contexts, but provides no empirical measurement of how poetry training affects physician communication patterns or patient outcomes in end-of-life care scenarios. Future research should quantify changes in physician-patient interactions and communication quality following structured poetry-based medical humanities curricula.
A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform ‘medical activities,’ what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate.
Photography certainly had to contend with competing models from both science and the arts in the nineteenth century, and as Sheehan acknowledges, this issue remained an open question, which did not prevent commercial portrait photographers from engaging “in fantasies of competition with” the American medical profession (p.
Doctored: The Medicine of Photography in Nineteenth-Century America by Tanya Sheehan (review) · 2015 · DOIThe paper notes opportunities for early, sensitive conversations with patients and families about illness nature, disease natural history, and treatment benefits/risks in the context of Advanced Health Care Directives, but provides no standardized communication framework or validated assessment tools for measuring quality or outcomes of these discussions.
Most-cited papers in Empathy and Medical Education
- THE NATURE OF SUFFERING AND THE GOALS OF MEDICINE · New England Journal of Medicine · 1982 · 1,333 citations
- ‘Healthcare Heroes’: problems with media focus on heroism from healthcare workers during the COVID-19 pandemic · Journal of Medical Ethics · 2020 · 200 citations
- Sociological interpretations of professionalism · Medical Education · 2009 · 153 citations
- Grappling with complexity: Medical students’ reflective writings about challenging patient encounters as a window into professional identity formation · Medical Teacher · 2018 · 94 citations
- Basic empathy: Developing the concept of empathy from the ground up · International Journal of Nursing Studies · 2020 · 80 citations
- The need for empathetic healthcare systems · Journal of Medical Ethics · 2020 · 78 citations
- Editorial: A Call to Action for an Antiracist Clinical Science · Journal of Clinical Child & Adolescent Psychology · 2021 · 78 citations
- Physician Empathy and Chronic Pain Outcomes · JAMA Network Open · 2024 · 77 citations
- <i>Medical Teacher</i>’s first ChatGPT’s referencing hallucinations: Lessons for editors, reviewers, and teachers · Medical Teacher · 2023 · 74 citations
- Katie Eriksson’s caring theories. Part 1. The caritative caring theory, the multidimensional health theory and the theory of human suffering · Scandinavian Journal of Caring Sciences · 2021 · 68 citations
Most recent work
- Collaborative research in the medical humanities: The case for transdisciplinarity · History of the Human Sciences · 2026
- Experiential music therapy in cultivating medial humanistic qualities for medical education: a qualitative analysis based on experiential learning theory · BMC Medical Education · 2026
- The Art of Poetry, in Medicine · JAMA · 2026
- The role of narrative medicine in cultivating professional competencies: a mediation analysis of empathy among medical students · BMC Medical Education · 2026
- Humanistic care competency among standardized residency training physicians and refresher doctor in prenatal ultrasound: current status and influencing factors · Frontiers in Medicine · 2026
- Practical Wisdom Through Narratives as Told by Medical Students and Physicians. · Southern Medical Journal · 2026
- Beyond anger: a surgeon’s reflection when empathy became the strongest surgical tool · Annals of Medicine & Surgery · 2026
- When stories become care: mapping literary exposure to empathy and resilience in medical students and doctors through the lens of narrative medicine · Frontiers in Medicine · 2026
- Healing beyond the physical: Ethical approaches to emotional support in post-stroke recovery · African Journal of Disability · 2026
- Designing for impact: a game-based approach to teaching health inequality in community care · British Journal of General Practice · 2026
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