TL;DR
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The University of Lancashire’s Person Before the Patient project places first-year medical students in care homes to talk with residents about their lives, rather than conduct medical assessments. Student reflections describe learning to listen and adapt, but the project did not formally measure empathy or establish whether any changes last.
The University of Lancashire made its Person Before the Patient care-home placement compulsory for first-year medical students in 2024/25, giving them four weeks to learn about residents through conversation rather than medical assessment. Reflections from participating students describe practicing patient listening and adjusting how they communicate, but the project did not formally measure whether empathy improved or whether any reported learning lasts.
Developed at the university and piloted in 2023/24, the project now operates across 11 care homes. Students meet residents, some of whom live with dementia, frailty or long-term conditions. Their task is to learn about residents’ interests and experiences, not to take medical histories or make diagnoses. The report’s author says students may arrive with prepared questions but need to follow what residents choose to share.
One student wrote that they had to listen more and let the resident lead instead of relying on prepared questions. The student also described learning to tolerate silence while a resident searched for words, and to pay more attention to facial expressions and gestures. These approaches can help communication when someone has hearing loss or memory difficulties, the report says.
The author reviewed written reflections from 157 of 281 students who took part. The responses were voluntary, and the author says they show what respondents felt they learned—not a measured change in empathy or clinical practice. Because students who chose to write reflections may have viewed the placement more positively, the accounts cannot establish how all participants experienced it.
Listening Before Clinical Assessment
The placement addresses a tension in medical education: students need to learn clinical skills while also attending to the person behind a diagnosis. Conversation with residents gives students practice responding to someone’s own pace, preferences and story before encounters become centered on assessment. That experience may be relevant in later care, particularly when communication needs adapting, but the report does not show that it changes clinical behavior.
The format also gives residents a role beyond being the subject of a lesson. The report says residents should be able to choose whether to take part and what they share. In some homes, residents discussed hosting students and, with staff, how placement funding would be used. Care-home managers reported that many residents enjoy the visits and look forward to students returning. Those reports are not a formal evaluation of benefits to residents.
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How the Placement Was Designed
The project is presented against concern that empathy may be difficult to develop and sustain during medical training. The report notes that research on empathy trends is mixed: some studies suggest it declines, particularly as students enter clinical settings. A proposed factor is the “hidden curriculum”—attitudes absorbed from clinical environments alongside formal teaching. A 2023 review of 16 studies identified heavy workloads and poor role models among influences that may contribute to emotional detachment.
Other programs offer useful but limited comparisons. An Australian study of 61 fifth-year medical students found a five-day care-home placement improved dementia knowledge and attitudes toward working with older people, though some students questioned its educational value. A UK evaluation of the Time for Dementia program found improvements in knowledge and attitudes among students visiting people with dementia and their families, but no significant difference in measured empathy against other students. The report also cites a review finding little evidence that gains from long-term empathy training persist.
The author says the Lancashire program introduces care-home conversations earlier, before students’ interactions are focused on clinical assessment. The report cites NICE dementia guidance recommending that communication be adapted to people’s needs and that their histories and preferences be considered.
“I also learned to become comfortable with periods of silence while residents searched for the words they wanted to use.”
— A first-year medical student reflecting on the placement
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Whether Learning Lasts
The project’s written reflections do not establish that students became more empathetic, retained any learning or changed how they later treated patients. The author says empathy was not formally measured, and participation in the reflections was voluntary. It is also unclear how residents themselves assessed the experience: the report relays care-home managers’ observations that many residents enjoy visits but does not provide a formal resident-outcome evaluation.
The wider evidence cited does not settle the question. Some studies report gains in knowledge and attitudes, while the Time for Dementia evaluation found no significant difference in measured empathy. The report also notes limited evidence that empathy-training effects persist. It therefore presents students’ accounts as an encouraging starting point, not proof of lasting impact.
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Evaluating Students Over Time
The report says a fuller evaluation would follow students over time, including after they begin clinical training, rather than relying on immediate reflections. Such work would need to assess empathy and clinical behavior directly and account for students who do not volunteer written responses. The source does not give a timetable for that evaluation or describe a planned next study.
For participating care homes, the report says residents should retain choice over whether to meet students and what to discuss. Further assessment could also clarify how residents view the visits and whether the placement offers benefits beyond the managers’ reported observations. Until then, the confirmed development is the university’s early conversation-based placement; its long-term educational and resident effects remain unestablished.
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Key Questions
What do medical students do during the placement?
Students visit a care home for a four-week placement and talk with residents about their interests and experiences. They are not there to take medical histories or make diagnoses.
Where and when did the program begin?
The University of Lancashire piloted the Person Before the Patient project in 2023/24. It became compulsory for first-year medical students in 2024/25 and operates across 11 care homes.
Did the project prove that students became more empathetic?
No. Some students described feeling they had learned empathy, but the project did not formally measure empathy or establish lasting changes in students’ attitudes or clinical behavior.
What did students say they learned?
Reflections described listening more, letting residents guide conversations, allowing time for silence and noticing nonverbal cues. These are students’ reported experiences, not independently measured outcomes.
Do residents benefit from the visits?
Care-home managers reported that many residents enjoy the visits and look forward to students returning. The report does not provide a formal evaluation of resident outcomes and says residents should be able to choose whether and what to share.
Source: rss
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