Poverty Simulation Improves Empathy and Attitudes Among Health Professions Students

Medical, nursing, dentistry and public health students at The University of Texas Health Science Center at Houston reported more empathetic attitudes toward people living in poverty after taking part in a three-hour immersive exercise known as the Community Action Poverty Simulation, according to a study published in BMC Medical Education. The findings suggest that a relatively brief, experience-based activity can shift how future health professionals think and feel about the non-medical forces that shape their patients’ health.

The rationale for the intervention rests on a widely cited statistic: research indicates that 80 percent of health outcomes are influenced by non-medical drivers of health, such as housing, income and food security. Yet the study’s authors note that health professions students often lack both understanding of and empathy for these factors, particularly poverty. To close that gap, UTHealth Houston implemented the simulation, in which participants navigate scenarios designed to deepen their understanding of what it is like to live with limited financial resources.

The study used an anonymous, unpaired pre-post survey design. Students completed questionnaires before and after the in-person activity, reporting on their emotional responses, their attitudes toward poverty, and their self-assessed knowledge and professional competence. Because the data were non-normally distributed and the samples were anonymous and unpaired, a design chosen to protect confidentiality, the researchers used the Mann–Whitney U test to compare responses between groups.

The results showed statistically significant improvements across attitudes, emotions and competencies. Participants reported reduced negative emotions, including frustration and ambivalence, when considering patients in poverty who do not follow treatment plans.

Attitudinal changes were equally pronounced. After the simulation, students were less likely to attribute poverty to personal responsibility and expressed greater support for social assistance and community service. Confidence also rose: participants reported increased belief in their ability to assess socioeconomic status, direct patients toward appropriate resources, and interact effectively with patients living in poverty. Every one of these reported changes reached the study’s reported threshold of p < 0.0001.

The experience resonated with students on its own terms as well. Overall, 98 percent of participants found the simulation worthwhile. The study’s hypothesis, that participants would demonstrate reduced negative emotions, more positive attitudes and enhanced professional competencies, was supported by the survey comparisons.

The authors conclude that the Community Action Poverty Simulation is an effective educational activity for health professions students, one that fosters more empathetic attitudes, reduces bias and negative emotional responses, and enhances the readiness of future clinicians to address non-medical drivers of health.

Some limitations of the design deserve emphasis. The surveys were anonymous and unpaired, meaning individual students’ before-and-after responses could not be linked, and the Mann–Whitney U test was used accordingly. Self-assessed knowledge and competence are subjective measures, and the study evaluated a single simulation at a single institution. The reported publication is an early-access, peer-reviewed accepted version carrying a permanent DOI, subject to further edits before the final version of record. Within those bounds, the study offers evidence that immersive poverty education can measurably change the attitudes and emotional responses of trainees who will one day care for patients whose health is shaped less by medicine than by the circumstances of their daily lives.

Subject of Research: The effect of a community action poverty simulation on empathy, attitudes and knowledge among interprofessional health professions students

Article Title: The impact of a community action poverty simulation (CAPS) on empathy, attitudes, and knowledge among interprofessional health professions students

Article References: Zhao, P., Majeethia, D. M., Wise, J. N., Gomez, A. P., Fernández, M. E., Alford, J., & Carapucci, T. T. (2026). The impact of a community action poverty simulation (CAPS) on empathy, attitudes, and knowledge among interprofessional health professions students. BMC Medical Education. https://doi.org/10.1186/s12909-026-10551-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10551-w

Keywords: poverty simulation, health professions education, empathy, interprofessional education, non-medical drivers of health, attitudes toward poverty, survey study, BMC Medical Education, UTHealth Houston, student competencies, impact, community