Abstract
BACKGROUND: Compassionate behavior plays a crucial role in medicine by fostering patient-doctor relationships, enhancing adherence, and improving care quality. While partly innate, compassion can be significantly enhanced through structured educational interventions. Despite recent efforts to integrate compassion into medical curricula, methodological challenges persist, especially in understanding how different environments influence skill expression and development. This study aims to assess the effectiveness of traditional clinical clerkships versus simulation-based training in cultivating compassion skills among medical students. METHODS: This retrospective longitudinal study evaluated the professional behavior and cognitive skills of 133 medical students at Humanitas University, Milan, Italy, over a three-year period from 2021 to 2024. The curriculum emphasizes problem-based learning and professional development through hospital clerkships and simulation-based training. Compassion was assessed quarterly using a standardized scorecard and continuously evaluated via a learning management system, simulation scenarios and objective structured clinical examinations (OSCEs). RESULTS: In the initial assessment, compassion scores showed no significant difference between the two settings (clerkship: 3.25 ± 0.73, simulation: 3.30 ± 0.69, p = 0.45). Over subsequent evaluations taking place in the following two years, the differences remained non-significant (p = 0.39, p = 0.22) until a notable divergence was observed in later assessments, particularly in the final evaluation at the end of 5th year study (clerkship: 3.54 ± 0.78, simulation: 3.23 ± 1.18, p = 0.023). Clerkship students demonstrated a significant increase in compassion scores over time (+ 0.29, p = 0.023), benefiting from immersive patient interactions that deepened their compassionate behavior. In contrast, simulation scores peaked slightly but not significantly in Year 4 before returning to initial levels (-0.07, 95% CI [-0.24, 0.11]), highlighting the challenge of sustaining compassionate behaviors without ongoing real-world practice. CONCLUSION: This study emphasizes the crucial role of deliberate curriculum design in medical education. While simulation-based training offers controlled environments, it incompletely replicates the emotional depth of real patient interactions crucial for sustaining compassion. Integrating compassion-focused training into medical curricula is essential for nurturing compassionate healthcare professionals, urging immediate action to enhance compassion in medical education. TRIAL REGISTRATION: Not applicable. No health intervention has been proposed, and it's a purely retrospective analysis on an educational methodology.