Melody of genes: design and implementation of an interdisciplinary medical humanities course to enhance empathy, humanistic literacy, and professional identity in Chinese medical students

Abstract

Background

Medical humanities education is recognized as essential for fostering empathy, professional identity, and humanistic literacy in future physicians. However, in China, existing medical humanities courses often lack effective interdisciplinary integration, rely primarily on passive lectures delivered by humanities faculty with limited clinical connection. There is an urgent need for evidence-based interdisciplinary curricula to cultivate medical students’ empathy, humanistic literacy, and professional identity.

Methods

We developed and implemented an interdisciplinary medical humanities course “Melody of Genes”, which employs a student-centered flipped‑classroom, discussion‑based model co-taught by medical and arts instructors. A single-group post-course observational study was conducted over three rounds (2022–2024), enrolling 113 medical undergraduates. Quantitative data were collected using an anonymous post‑course questionnaire (Cronbach’s α = 0.821), and qualitative data from students’ written reflections and final reports were analyzed using thematic analysis.

Results

Of 109 valid respondents (96.5% response rate), 101 (92.7%) reported perceived improvements in humanistic and philosophical literacy; 91 (83.5%) reported enhanced self-learning ability and critical thinking; and 92 (84.4%) reported increased empathy for patients and stronger professional identity as future physicians. Thematic analysis revealed that students valued the interdisciplinary discussions, the integration of real-clinical perspectives, and the opportunity for reflective writing.

Conclusions

An interdisciplinary medical humanities course using co-teaching, flipped classroom, and formative assessment is feasible and associated with positive self‑perceived improvements in empathy, humanistic literacy, and professional identity among Chinese medical undergraduates. These findings offer a replicable model for the construction and innovation of medical humanities curriculum in Chinese medical education.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09823-2.

Introduction

Medical humanities education plays an irreplaceable role in cultivating medical students’ empathy for patients, as well as improving their professional identity and communication ability [1, 2]. Studies have shown that medical humanities education can improve medical students’ empathy for patients and can promote students’ deep understanding and experience of human nature and humanity; promote reflective thinking and contemplative skills, which are essential for thoughtful medical decision-making and personal health; and effectively reduce doctor‒patient conflicts and job burnout [3, 4]. Medical humanities education has been included in the International Standard of Undergraduate Medical Education of the World Medical Federation and has become an indispensable part of medical education [5].

The mode of medical education in China is similar to that of most European countries, such as the United Kingdom, where students enter medical colleges directly through the college entrance examination after graduating from high school for professional study. Most medical undergraduates take separate examinations for liberal arts and science subjects in their first year of high school and no longer continue to study liberal arts courses such as history, geography, and politics in the remaining two years of high school. Therefore, the humanistic foundation of Chinese medical undergraduates is relatively weak, leading to a general lack of appreciation for humanistic education [6].

In recent years, Chinese medical colleges have begun to focus on the construction of medical humanities courses, but many problems remain. Not only is the proportion of class hours of relevant courses seriously insufficient, but more importantly, the contents of the courses are relatively rigid; most of the instructors are engaged in non-medical humanities majors and do not know much about medicine, and there is a large gap between the teaching content and clinical practice; the form of teaching is mainly based on instructors teaching theoretical knowledge, and students lack in-depth thinking and discussion and often lack interest in such courses. In addition, course assessment is based mainly on theoretical examinations, and there is a lack of effective evaluation mechanisms in all stages of medical students’ education; thus, students generally do not attach importance to humanities education and consider it “useless” [7, 8]. Medical humanities education is far from achieving the expected goal, and there is an urgent need for high-quality curriculum construction.

In this context, medical specialist instructors from Tianjin Medical University cooperated with a liberal arts instructor from Tianjin Normal University to create an innovative general course titled “Melody of Genes”, which is an integrated medical humanities curriculum with arts integration. This study aims to explore the following research questions: ① How do medical students perceive the interdisciplinary medical humanities course “Melody of Genes”? ② Can participation in the course improve students’ self-reported empathy, humanistic literacy, and critical thinking? ③ How effective is the flipped classroom and discussion-based teaching model in this interdisciplinary medical humanities curriculum? This study analyses and summarizes the teaching design and practice of this course for the three rounds of teaching, hoping to provide a reference for the construction and optimization of medical humanities courses.

In this paper, “medical humanities” refers to the interdisciplinary field that integrates humanities disciplines (e.g., philosophy, history, ethics, literature) and arts-based approaches into medical education to foster empathy, reflective practice, and humanistic literacy. When we use “arts” or “humanities” separately, we refer specifically to artistic practices or humanistic disciplines as distinct components of this broader field.

Literature review

Current status and challenges of medical humanities education

The role and importance of integrating humanities into medical education has been recognized for a long time. Humanities education promotes students’ deep understanding of human nature and humanity, promotes reflective thinking, and contributes to the reduction of doctor-patient conflicts and professional burnout [1]. However, the extent to which humanities are included in medical curricula and how they are taught across medical schools worldwide remain highly variable. A review by Isaac found that humanities content in the medical curriculum and the teaching of humanities continue to remain unstandardized, and what constitutes medical humanities is unclear as there are several understandings of the field [9]. The benefits and value of including humanities in the training of doctors—both short-term and long-term—remain unresolved and continue to be debated [9]. Similarly, a meta-review by Coronado-Vázquez et al. evaluated the expected learning outcomes of medical humanities subjects in medical studies curricula and concluded that humanities learning outcomes are part of the necessary knowledge for good clinical practice, yet noted significant heterogeneity in the teaching of medical humanities, both in terms of content and formal level [10].

A scoping review by Carr et al. examined how health humanities are used in health professions education and how such curricula are evaluated [11]. It was found that reported health humanities curricula focused on developing students’ capacity for perspective, reflexivity, self-reflection, and person-centered approaches to communication, but learning outcomes were not consistently described, identifying a limited capacity to compare health humanities curricula across programs. The authors called for a set of clearly stated generic capabilities or outcomes from learning in health humanities as a helpful next step for benchmarking, clarification, and comparison of evaluation strategies [11].

Empirical evidence on arts- and humanities-based interventions for empathy

The effectiveness of arts-based interventions in enhancing empathy among healthcare students has been systematically examined in recent years. A systematic review by Levett-Jones et al. synthesized evidence from 20 studies across 12 countries [12] and found that arts interventions generally have a positive effect on healthcare students’ empathy levels and enable a nuanced conceptual understanding of empathy. Visual arts were the most common approach, followed by film, drama, literature, creative writing, music, poetry, and photography. Importantly, it was identified that arts modalities used as a stimulus for active learning and supported with facilitated group-based discussion and/or reflection tend to be most effective [12].

A critical systematic review by Mojarrad et al. specifically examined the pedagogical mechanisms through which arts-based interventions—theatre, poetry, and narrative medicine—support empathy development in healthcare learners [13]. Theatre interventions, emphasizing embodied learning, showed patterns of large empathy effects, poetry interventions focusing on reflective practice showed moderate effects, and one study of narrative medicine demonstrated sustained gains at two-year follow-up [13]. Furthermore, a systematic review by Keenoo et al. examined the effects of arts and humanities interventions on medical learners and found that high-certainty evidence supporting improvements from interventions using literature, narrative writing, visual arts, and theatre [14]. Visual arts training significantly enhanced diagnostic observation, and reflective capacity and professional identity formation were strengthened by literature, narrative, and art-based methods [14].

A systematic review on the integration of digital and narrative medicine by Efthymiou (2025) found that narrative medicine nurtures empathy, communication, and professional identity formation among healthcare trainees, and that digital tools such as virtual reality simulations and e-portfolios reinforce these outcomes by providing immersive and reflective learning experiences [15].

The conceptualization and measurement of empathy in medical education

Empathy in patient care has been defined as a predominantly cognitive rather than an affective attribute—the ability to understand the patient’s inner experiences and perspectives and to communicate that understanding [16, 17]. A large multi-center cross-sectional study conducted across 11 Chinese medical universities with 10,576 medical students found that the mean empathy score of undergraduate medical students was 67.38 (standard deviation = 9.39) on the Jefferson Scale of Empathy Student-version [18]. Factors significantly associated with empathy included gender, university category, only child or not, self-perception of doctor-patient relationships, interest in medicine, and Kolb learning style. The study concluded that increasing manifest and hidden curricula on cultivating empathy may be needed among medical universities in China [18].

The Jefferson Scale of Empathy has been validated for the Chinese population. Wen et al. investigated the psychometric properties of the Chinese-Adapted Jefferson Scale of Empathy–Medical Student Version and found that it demonstrated robust psychometric properties consistent with the original English version, with satisfactory reliability and validity analyses, establishing its appropriateness for use in the Chinese population [19].

Medical humanities education in the Chinese context

The Chinese medical education system, similar to most European countries, has medical students enter directly from high school. Most medical undergraduates take separate examinations for liberal arts and science subjects in their first year of high school and no longer continue to study liberal arts courses. Consequently, the humanistic foundation of Chinese medical undergraduates is relatively weak [6, 8].

A national survey by Saffari et al. involving 904 medical students from 38 Chinese universities explored the associations between perceptions of medical humanities, burnout, and stress [20]. The study found that students’ perception of medical humanities was significantly influenced by years of medical school education, work burnout, and perceived stress. Work burnout was impacted by clinical clerkship experience, and perceived stress was influenced by the number of years in medical school. The study illuminated the complex relationship between medical education, burnout, stress, and students’ perception of medical humanities issues, underscoring the critical importance of balancing technical proficiency with humanistic values in medical training [20].

Efforts to integrate medical humanities into Chinese medical education have been emerging. Yang et al. conducted a pilot study of medical humanities courses in standardized residency training at a large comprehensive hospital in China, involving 118 residents from 18 different clinical specialties [21]. The study found that all post-course self-assessments showed significant improvement compared to pre-course assessments (P < 0.05), especially in communication skills and diagnostic processing ability, providing evidence that medical humanities courses are feasible and effective in the Chinese context [21]. However, the authors noted that medical humanities curricula are usually lacking during standardized training, and the proportion of class hours of relevant courses remains seriously insufficient.

Flipped classroom and discussion-based teaching models in medical humanities

Innovative pedagogical approaches have been explored to enhance medical humanities education. A study by Grossman et al. on flipped classroom in humanities education emphasized that empathy with patients is not only learned through reasoning but also through sensitivity, and that the dialogue between science and art in virtual environments is simultaneously a challenge and an opportunity, especially in traditional lecture-based curricula [22]. The authors developed a module based on narrative medicine in a virtual learning environment, finding that students engaged with the materials more readily than expected and that use of a virtual environment promoting the sharing of ideas and teamwork was an effective teaching strategy [22].

Research on flipped classroom approaches in Chinese medical humanities education has also shown promising results. A study examining the effectiveness of flipped classroom in a medical humanities English course found that the experimental group using O-PIRTAS flipped teaching demonstrated significant improvements in humanistic care ability, empathy, emotional intelligence, and supportive communication compared to the control group [23]. This suggests that flipped classroom models can be particularly effective for cultivating humanistic competencies in medical students.

Identifying the research gap

Taken together, the existing literature demonstrates that: (1) medical humanities education lacks standardization and robust evaluation frameworks globally [9, 11]; (2) arts-based interventions show promise for enhancing empathy, but most evidence comes from Western, high-income countries with small sample sizes and pre-post designs [12, 13]; (3) empathy can be reliably measured using validated instruments such as the Jefferson Scale of Empathy, which has been adapted for Chinese populations [18, 19]; (4) medical humanities education in China faces unique challenges due to the structure of pre-medical humanities training [6, 8], but emerging evidence suggests such courses can be effective [21]; and (5) flipped classroom approaches may enhance engagement and outcomes in medical humanities education [22, 23].

However, few studies have systematically reported on interdisciplinary medical humanities courses co-designed and co-taught by medical and arts faculty specifically for Chinese medical undergraduates. Even fewer have evaluated such courses using both quantitative and qualitative methods to assess self-perceived improvements in empathy, humanistic literacy, and professional identity within a flipped-classroom format. Furthermore, most existing studies in China have focused on course development rather than rigorous educational research. The present study aims to address these gaps by describing the design, implementation, and evaluation of an interdisciplinary medical humanities course—“Melody of Genes“—and reporting its associated outcomes among Chinese medical undergraduates.

Theoretical framework

This study is grounded in a well-established conceptualization of empathy in medical education. We adopt the cognitive-affective model of empathy, which distinguishes between two core dimensions: cognitive empathy—the ability to understand a patient’s perspective, emotions, and internal states; affective empathy—the capacity to share or resonate with a patient’s emotional experience [24, 25]. This dual-dimension model has been widely used in medical education research and is operationalized in validated instruments such as the Jefferson Scale of Empathy [26].

In this study, empathy is defined as: the predominantly cognitive ability to comprehend the patient’s inner experiences and perspectives, combined with an affective resonance that motivates compassionate action, and to communicate that understanding effectively [1].

The course “Melody of Genes” was designed to target both dimensions of empathy through specific pedagogical strategies:

Cognitive empathy development

Pre-class videos and online resources provide factual knowledge about disease mechanisms, clinical features, and patient experiences. In-class discussions guided by instructors encourage students to analyze medical cases from multiple perspectives—philosophical, psychological, social, and cultural. The final reflective report requires students to explore the humanistic dimensions of a medical topic, fostering perspective-taking.

Affective empathy development

Exposure to patient stories, historical narratives of illness (e.g., plague, syphilis), and artistic representations of suffering (e.g., music, literature, visual arts) is intended to evoke emotional resonance. Small-group discussions and online extended discussions provide a safe space for students to share personal experiences related to body image, death, illness, or caregiving, thereby nurturing affective empathy.

Integration of cognitive and affective empathy

The flipped-classroom discussion format explicitly asks students to connect factual medical knowledge with humanistic reflection. For example, in the topic Eve’s confusion (Obesity and Aesthetics), students first learn the physiological and epidemiological facts about obesity, then discuss body anxiety, aesthetic diversity, and the social stigma of obesity—linking cognitive understanding to affective resonance.

This theoretical framework provides a rationale for why an interdisciplinary medical humanities course—using arts, history, and philosophy as stimuli for structured discussion and reflection—could plausibly influence students’ self-perceived empathy. The framework also guided the selection of questionnaire items measuring empathy and professional identity, and informed the thematic analysis of students’ written reflections [27].

Methods

Study design and methodological orientation

This study adopted a quantitative-dominant, qualitative-supportive program evaluation design situated within the pragmatic research paradigm [28]. The primary aim was to assess the feasibility, acceptability, and self-perceived outcomes of a novel interdisciplinary medical humanities course, rather than to infer causality or compare intervention effects.

A single-group, post-course only descriptive study was conducted. No pre-course measurements, control group, or randomization were used, consistent with the exploratory nature of this curriculum evaluation. The study was carried out over three rounds of course implementation from the fall semester of 2022 to 2024. Quantitative data were analyzed descriptively; qualitative data from written reflections and final reports were analyzed using thematic content analysis [27].

This design aligns with recommendations for initial evaluation of innovative educational interventions where establishing feasibility and student perceptions precedes more rigorous controlled studies [29].

Participants, rationale for course and institution selection

The course was open to all undergraduate students from medical-related majors at Tianjin Medical University, across all grades. A total of 113 students enrolled in the three rounds. All participants completed the post-course questionnaire voluntarily and anonymously.

Tianjin Medical University was selected as the study site because it represents a typical Chinese medical university with a strong emphasis on biomedical sciences and a limited number of medical humanities electives. Prior to 2022, the university offered only lecture-based humanities courses taught by non-medical faculty, with no interdisciplinary or discussion-based formats. The “Melody of Genes” course was the first elective at this university that deliberately integrated medical and arts faculty in co-design and co-teaching. This unique context made it suitable for an initial evaluation to inform future interdisciplinary medical humanities curriculum development in similar Chinese medical schools.

Course design and implementation

Teaching team

The course was co-designed and co-taught by an interdisciplinary team including a medical instructor from Tianjin Medical University, a clinical instructor from Tianjin Medical University General Hospital, and an arts instructor from Tianjin Normal University [30]. The medical instructor is responsible for designing the medical content, ensuring scientific accuracy, and leading discussions on disease mechanisms and clinical relevance. The arts instructor contributes to the selection of artistic and humanistic materials, facilitates discussions on aesthetics, history, and cultural context, and helps students connect medical topics with artistic expression. The clinical instructor provides real-world clinical perspectives, shares patient stories, and guides students in reflecting on empathy and professional identity. This collaborative teaching model ensures that the course integrates medical knowledge with humanistic inquiry effectively.

Teaching objectives

The course integrates the methods, concepts and contents of the humanities and social sciences and reflects distinct interdisciplinary characteristics [31]. It aims to guide students to think about the humanistic and philosophical issues behind medicine, understand the inseparable connection between medicine and medical humanities, and improve the empathy and comprehensive quality of medical students. Unlike medical specialty courses, this course focuses more on the cultivation of knowledge ability and the achievement of ability goals. The teaching objectives of the course are as follows:

① Knowledge objective

Students understand basic knowledge of human physiology, anatomy, genetics, and infectious diseases, and their connections with medical humanities.

② Capability objectives

Students explore relationships between medicine, human thought, civilization, and art; develop professional identity; deepen understanding of disease; enhance empathy for patients; and improve humanistic and philosophical literacy, including ethical thinking and reflective ability.

Curriculum structure and topics

The course consisted of 16 class hours (8 sessions × 2 class hours), with a maximum enrollment of 40 students per round. Since the teaching objects are multigrade and multimajor students with different knowledge bases, this course selected the medical content that students are most interested in as the discussion topics. Eight interdisciplinary topics were developed covering anatomy, genetics, physiology, and infectious diseases, as shown in Table 1.

Table 1.

Teaching topics and arrangement of the “Melody of Genes” course

No.	Topic	Core Content	Teaching Format
1	Medicine and Art (human anatomy and vitruvian man)	Ice-breaking, course introduction, connections between anatomy and artistic representation, student discussion, instructor summary	2 class hours offline
2	Eve’s Confusion (obesity and aesthetics)	Obesity physiology, prevalence in China, health risks of extreme thinness, aesthetic history, body anxiety	1 h online + 1 h offline
3	Mystery of Longevity (telomeres and views of life and death)	Telomere biology, aging mechanisms, philosophical and cultural views of life and death	1 h online + 1 h offline
4	The Great Imitator (syphilis and music)	Clinical features of syphilis, historical influence, connections between disease and musical works	1 h online + 1 h offline
5	Deadly Gift from Animals (the plague and the black death)	Plague epidemiology, pathology, historical pandemics, art and literature records	1 h online + 1 h offline
6	Sacred Feminine (female physiology and social status)	Female reproductive health, gender stigma, social status, cultural perceptions	1 h online + 1 h offline
7	Religion and Disease (prions and national art)	Prion diseases, cultural and religious practices, traditional art and ritual contexts	1 h online + 1 h offline
8	Hand of God (heredity and aesthetics)	Genetics of phenotypic traits, hereditary diversity, cultural views of aesthetics	2 class hours offline

1 class hour = 45 min

Topics were selected to bridge medical science with medical humanities discourse while incorporating culturally relevant themes for Chinese medical students. While some themes draw on Western art and history, such as Medicine and art (Human Anatomy and Vitruvian Man) and The great imitator (Syphilis and music), they were chosen for their universal relevance and ability to stimulate cross-cultural dialogue. The teaching team also intentionally incorporated topics with strong cultural and social resonance in China, such as “Female physiology and social status” and “Heredity and aesthetics,” to ensure local relevance and student engagement. The mix of Western and Eastern perspectives was designed to encourage students to think critically about the global and cultural dimensions of medicine, while also reflecting the interdisciplinary nature of the course.

Distinctiveness from existing medical humanities courses in China

This course differs from typical medical humanities offerings mainly in Chinese medical education in three key aspects:

① Interdisciplinary co-teaching

Unlike most courses that are taught solely by humanities faculty [7], “Melody of Genes” is co-designed and co-taught by medical scientists, clinical instructors, and an arts educator. This ensures that medical content remains scientifically accurate and clinically relevant while humanities perspectives are naturally integrated rather than superficially added.

② Flipped-classroom discussion model

Traditional medical humanities courses in China predominantly rely on passive lectures with limited student interaction [8]. Our course uses pre-class video learning followed by in-class guided discussions, requiring active participation from every student.

③ Formative assessment focused on reflection

Conventional courses often use theoretical examinations as the sole assessment method. Our course emphasizes in-class discussion performance (50% of grade) and a reflective final report (40%), aligning assessment with the goal of cultivating critical thinking and humanistic literacy rather than rote memorization.

These distinctive features position the course as an innovative model for medical humanities education in China.

Teaching strategies

The curriculum employed a student-centered, flipped-classroom model that blended online and offline learning activities [32]. In the first class, the instructors introduce the teaching objectives, implementation measures and assessment methods of the course in detail, lecture on the first topic and guide students to discuss it so that they can fully understand the course requirements and actively think about the connection between medicine and the medical humanities.

For the next six course topics, students first watch the teaching videos from the online course platform to gain a preliminary understanding of the medical and humanistic knowledge involved in the topic, and then all the students enter the classroom and discuss medical and humanistic issues related to the topic. In this process, the instructors propose enlightening questions and provide explanations, guide the students to discuss the profound connection between medicine and medical humanities, and summarize the results after the discussion. The last class involves offline teaching. After the theme lectures and discussions are over, the instructors assign the final class report and organize students to give feedback on the course and put forward opinions and suggestions.

Pre-class: enabling students to understand medical knowledge related to the topic and think actively by watching course videos

Before the class started, the teaching team had built an online course on the Chinese University MOOC platform, recorded the video as the main speaker and uploaded it to the online platform. At present, 8 themes have been built, with two videos approximately 15 min long for each theme. In the video, the teaching team interspersed with explaining medical humanities-related knowledge, asking questions, and guiding students to think proactively.

The theme Eve’s confusion (Obesity and Aesthetics), which explores obesity and aesthetics, is taken as an example. In the video, medical instructors introduced the diagnostic criteria for overweight and obesity and the changes in and regional distribution of obesity around the world, especially in China. Obesity increases the risk of multiple diseases, the mechanism of diet drugs, and the adverse effects of low weight on health. The arts instructor introduced historical changes in aesthetics in China and around the world, the desire for “thinness” and anorexia, and the diversity of aesthetics. At the end of the video, several questions are raised: how to maintain a healthy body shape correctly for a long time, how to treat “body anxiety”, whether everyone must pursue beauty, and how to treat the functionality and “beauty” attributes of the body. After watching the video, students can think about the topic and find more information to enrich their understanding of the topic.

In-class: guiding students to think about the deep connection between medicine and humanities through free discussion

After completing the video, the students enter the classroom and discuss the topic under the guidance of the instructors. All the students can express their views freely on the questions raised in the video or the topics they are interested in and carry out discussions. To ensure the enrichment of the discussion in this section, each student selects at least one topic independently in the first class and takes the initiative to express their own views in the discussion stage. Instructors play a guiding role, actively encourage students to speak, train students’ ability to raise questions and take the initiative to think, and focus on cultivating students’ speculative spirit and humanistic and philosophical literacy.

Since each discussion topic is relatively independent and covers various aspects of medicine, students can think deeply about the inseparable connection between medicine and medical humanities and art through the study and discussion of the 8 topics and establish the concepts of medical humanities and critical consciousness. Taking the theme of Eve’s confusion (Obesity and Aesthetics) as an example, in addition to expressing their opinions and discussing the issues raised in the video, students often combine their own or others’ experiences of weight loss or body anxiety. Through class discussions and instructors’ guidance, the study of this topic helps establish a correct view of the body, health and aesthetics.

Post-class: promotion of students’ knowledge systematization and continuous learning via instructors’ supplements and online resources

During the topic discussion, the instructors guide and ask questions in time to ensure the breadth and depth of the discussion. After the students’ discussion, the instructors supplement the core but not discuss knowledge of the topic and the relationship between medicine and humanities, make detailed comments, summarize the discussion among all the students in the class, and propose deeper questions for students to think about after class. On the online course platform, instructors uploaded online resources, reference books and audio and video materials related to the course theme for students to watch and learn after class. Instructors and students can ask questions and discuss them on the platform. During the process of discussion for each topic, instructors observe the improvement in students’ attitudes and abilities and urge students to continue to improve.

The last topic of the course, The hand of God (Heredity and aesthetics), is all offline teaching. In this class, the teaching team introduces the theme, asks questions, organizes students’ discussions and summarizes them. Afterwards, the final report for the course is assigned, requiring each student to choose a topic on the basis of their major, search for literature, write their own views, and complete a written report of no less than 2000 words. Finally, the students are asked for feedback on the entire course.

Assessment and evaluation

Since the main teaching goal of this course is to guide students to think about the profound connection between medicine and humanities, and improve their humanistic and philosophical literacy, the assessment should focus not only on students’ mastery of professional knowledge but also on whether students can actively think and learn and whether they have the attitude toward and ability to engage in critical thinking and humanistic care. Therefore, it is more reasonable to adopt formative evaluation.

The score evaluation of this course consists of 4 components: online video completion and class attendance (5%), in-class discussion performance (50%), final thematic report (40%), and course feedback summary (5%). The score evaluation of the final report is quantified in three main aspects: demonstration of humanistic literacy, empathy, and critical thinking (40%); depth and systematic understanding of the topic (40%); academic writing quality, appropriate length, and rigorous references (20%). The instructors introduce the scoring criteria in detail, which is helpful for students to understand and achieve the course objectives. During the discussion for each topic, the instructors observe the performance of each student for score evaluation and pay attention to the continuous progress of the students, which is reflected in the score.

Data collection

Three sources of data were collected:

① Anonymous post-course questionnaire

Instrument development

The questionnaire was developed by the teaching team based on the course’s learning objectives (see Sect. "Teaching objectives". Given the exploratory nature of this curriculum evaluation, the team designed a brief, targeted instrument to capture students’ self-perceived improvements across four key domains: (a) knowledge of medical humanities and related history, (b) humanistic and philosophical literacy, (c) self-learning ability and critical thinking, and (d) empathy for patients and professional identity. The questionnaire consisted of three sections: Section Two (5 items) assessed perceptions of teaching methods, Section Three (5 items) measured self-perceived learning outcomes (the primary outcomes reported in this study), and Section Four (2 items plus an open-ended question) assessed overall satisfaction and collected qualitative feedback. Only Section Three items were used for the quantitative outcome analysis reported in this paper.

Item mapping to learning outcomes. The five Section Three items correspond directly to the course’s capability objectives:

Item Q1: “Through the study of this course, my knowledge of medical-related humanities and history has increased significantly.”

Item Q2: “The course prompts me to think about the relationship between medicine and humanities and arts for the first time.”

Item Q3: “The course helps to improve my humanistic and philosophical literacy.”

Item Q4: “Through the study of this course, my abilities of self-learning and critical thinking have been improved.”

Item Q5: “The course helps to enhance my empathy for patients and professional identity with doctors.”

Each item was rated on a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). For reporting, responses of “agree” or “strongly agree” were combined as “positive endorsement.”

Content validity

The initial 7-item pool was reviewed by three independent experts: two medical education researchers and one medical humanities scholar from two universities. They rated each item for relevance, clarity, and alignment with the course objectives using a 4-point scale (1 = not relevant, 4 = highly relevant). Based on their feedback, two redundant items were removed. The scale-level content validity index (S-CVI) for the final 5 items was 0.92 (based on the proportion of items rated 3 or 4 by all experts), exceeding the recommended threshold of 0.80 [33]. Items were also pilot-tested with 15 students from a previous elective course (not part of the study sample) to check for clarity and comprehension; minor wording adjustments were made based on their feedback.

Reliability

Internal consistency of the 5-item outcome scale was assessed using Cronbach’s alpha. The overall α was 0.821, indicating acceptable reliability for a brief scale [34]. Item-total correlations ranged from 0.58 to 0.74.

Construct validity considerations

Because each of the five items represents a conceptually distinct learning outcome (knowledge, reflection, humanistic literacy, critical thinking, empathy/professional identity), the scale was not designed as a unidimensional instrument. An exploratory factor analysis would not be appropriate given the single-item-per-domain structure. Instead, content validity was prioritized, and the item-level results are reported separately for each outcome, consistent with program evaluation approaches where distinct competencies are measured by individual indicators [35].

Limitations acknowledged

Single-item measures may not fully capture multidimensional constructs such as empathy or critical thinking. However, for an initial course evaluation with time constraints, single items are acceptable as global self-perceived indicators [36]. Future studies should employ validated multi-item scales such as the Jefferson Scale of Empathy [26].

The questionnaire was administered online via the course platform after the final class session in each of the three rounds. Students were informed that participation was voluntary, responses were anonymous, and non-participation would not affect their course grades. The response rate was 96.5% (109/113).

② Written student feedback and reflective summaries

submitted at the end of the course as part of the course feedback summary component (5% of grade). Students were asked to write at least 200 words reflecting on what they learned and how the course influenced their thinking about medicine, patients, and themselves.

③ Final thematic reports

prepared by each student, based on self-selected topics linking medicine and humanities (40% of grade). Reports ranged from 2000 to 3500 words and included references to literature.

Data analysis

Quantitative data from the five outcome items of the post-course questionnaire were analyzed using descriptive statistics (frequencies and percentages) with SPSS 27.0 software. No inferential statistical tests were applied due to the single-group, post-course only design. Qualitative data, including students’ written feedback, reflective summaries, and thematic content from final reports and online discussion boards, were analyzed using thematic content analysis [27]. This process involved familiarization with the data, generating initial codes, searching for themes, reviewing themes, and defining and naming themes to identify key patterns in students’ learning experiences and perceived outcomes.

Results

Student participation and classroom engagement

The course has been delivered for three rounds since the fall semester of 2022, with a total enrollment of 113 students. Under the guidance and encouragement of the interdisciplinary teaching team, most students actively participated in in-class discussions. The classroom atmosphere was lively, and students were able to analyze medical issues from medical humanities perspectives (philosophy, ethics, society, arts).

For example, during discussions of the topic Medicine and Art (Human Anatomy and Vitruvian Man), students linked human anatomical structures to artistic principles such as the golden ratio, and connected artistic expression with anatomical accuracy, as seen in da Vinci’s anatomical drawings and the Mona Lisa. Students also shared views on life, death, and body donation, triggering in-depth exchanges. Throughout all topics, students showed growing willingness to express independent opinions and engage in critical dialogue.

Online platform interaction and resource construction

Due to limited in-class time, discussions were extended online via the course platform. The students continued to have lively discussions in the course discussion board and combined the online learning resources and video and audio materials provided by the instructors, as well as the relevant literature and information retrieved by the students themselves, to further expand the depth and breadth of the discussion. At present, 176 discussion threads have been initiated by instructors and students.

Through two years of collaborative construction, the online platform now provides 25 video resources, 48 audio resources, and 33 extended reading materials. Many students voluntarily contributed supplementary resources, which were reviewed and uploaded by instructors to enrich the course. The online platform supported sustained reflection and expanded the depth and breadth of learning beyond face‑to‑face sessions. Instructors also gained much inspiration from students’ online discussions and constantly improved course teaching.

Student performance in final reports

In the final report, students freely choose topics based on their majors, explore relevant humanistic elements from medical issues and provide in-depth explanations. The topics of the students’ reports are rich and diverse, including the impacts of medicine on people’s consciousness and behavior, such as the adverse impact of overdiagnosis and overtreatment of thyroid cancer on patients’ mental state. There are thoughts about the relationships between the advances in medicine and major historical events, such as war promoting the development of orthopedics and neurosurgery. There are also thoughts on the impacts of humanistic cognition on the development of medicine. For example, the development of disciplines such as palliative medicine, hospice care, and euthanasia reflects humanistic care and cognition of life and death.

Students demonstrated strong ability in literature retrieval, independent thinking, and critical analysis. Most reports provided deep insights into the interactions between medicine and society, revealing self-perceived improvements in critical thinking and humanistic awareness.

Quantitative questionnaire results

An anonymous questionnaire was administered after each round. The Cronbach’s α coefficient was 0.821, indicating good reliability. A total of 113 questionnaires were sent out, and 109 valid questionnaires were returned, representing a valid response rate of 96.5%.

Results show that 95 students (87.2%) reported increased knowledge of medical humanities and related history; 97 students (89.0%) stated that the course prompted their first systematic reflection on the connections between medicine and medical humanities; 101 students (92.7%) reported perceived improvements in humanistic and philosophical literacy; 91 students (83.5%) reported perceived enhancements in self-learning ability and critical thinking; and 92 students (84.4%) reported increased self-perceived empathy for patients and stronger professional identity as future physicians. Overall, student feedback was highly positive, with frequent comments describing the course as “enlightening,” “innovative,” “interesting,” and deserving more class hours.

Additional instructional design details, including the full course syllabus and sample discussion prompts, are provided in Appendix 1. An anonymized sample student final report excerpt is provided in Appendix 2.

Connection between learning outcomes and instructional design

To understand why students reported perceived improvements in empathy, humanistic literacy, and critical thinking, we analyzed their written feedback (the questionnaire and end-of-course reflective summaries) in relation to specific course design elements. Below we summarize how each major instructional component was associated with student-reported outcomes.

Thematic selection and empathy promotion

The eight interdisciplinary topics (Table 1) were selected based on two design principles: (a) each topic connects a core medical concept with a humanistic or artistic dimension that has clear resonance with students’ lived experiences or cultural context; (b) each topic includes a “humanistic tension point”—an aspect where medical facts interact with social values, ethical dilemmas, or personal identity. For example, Eve’s confusion (Obesity and Aesthetics) juxtaposes epidemiological data on obesity with social pressures around body image. In written feedback, 47 students explicitly mentioned this topic as “eye-opening” and “personally relevant.” One student wrote: “I never realized how much my view of my own body was shaped by social media and aesthetic standards. Discussing the health risks of extreme thinness made me rethink what ‘healthy’ really means.” Another student commented on The great imitator (Syphilis and music): “Learning about how syphilis affected famous musicians’ lives and work helped me see disease not just as a biological process but as something that shapes human creativity and suffering. This deepened my empathy for patients with chronic illnesses.”

Flipped-classroom discussion structure and reflective thinking

The course employed a three-phase discussion structure (pre-class video, in-class guided discussion, post-class online extension) designed to scaffold reflective thinking. Pre-class videos provided factual medical knowledge and raised open-ended questions (e.g., “How should we balance the desire for thinness with health?”). In-class discussions required each student to speak at least once, with instructors posing follow-up “why” and “how” questions. Online discussion boards extended the conversation with additional resources.

Analysis of student feedback indicated that this structure was effective in promoting critical thinking. One student noted: “The online video gave me the basic facts, so when we met in class we could focus on discussing the human side—like why some people develop eating disorders or how to talk to patients about weight without shaming them.” Another wrote: “I was shy at first, but because everyone had to speak, I gradually became more confident. Reading others’ comments online also gave me new perspectives.” Of 109 respondents, 83 (76.1%) commented positively about the discussion format in their open-ended feedback.

Reflective final report as a mechanism for integrating humanities and medicine

The final report required students to select a topic linking medicine and humanities, search literature, and write a 2000-word reflective analysis. This assignment was designed to consolidate learning and promote deeper integration of cognitive and affective empathy. Students’ reports covered diverse topics (see Sect. "Course design and implementation"). In their feedback, several students noted that the process of writing the report helped them internalize the course themes. One student wrote: “Writing about the history of plague made me realize how fear and stigma affect patients even today. I will remember this when I treat infectious disease patients.” Another commented: “Choosing my own topic—palliative care and dignity—forced me to think deeply about what I really believe about death and suffering. This is not something I ever discussed in my regular medical classes.”

Summary of design-outcome links

Table 2 summarizes the instructional design elements and their associated student-perceived outcomes based on thematic analysis of written feedback.

Table 2.

Instructional design elements and associated student outcomes

Design Element	Intended Mechanism	Student-Reported Outcome (example quote)
Interdisciplinary topics (e.g., obesity + aesthetics)	Create humanistic tension points to trigger reflection	“Helped me rethink body image and health”
Pre-class videos with questions	Provide cognitive foundation for discussion	“I came to class prepared and could focus on deeper issues”
Mandatory in-class discussion	Ensure active participation and perspective-taking	“I learned from hearing different viewpoints”
Online extended discussion	Sustain reflection and peer learning	“Reading others‘ posts gave me new ideas”
Reflective final report	Consolidate learning and personalize connections	“Writing made me connect medicine with my own values”

Theoretical framework integration

Returning to our theoretical framework (Sect. "Theoretical framework"), which adopted the cognitive-affective model of empathy [30, 31], we can interpret the findings as follows. The observed self-reported empathy gains likely reflect improvements in cognitive empathy—students’ enhanced ability to understand patients’ perspectives and the social/cultural dimensions of illness—facilitated by pre-class videos and structured in-class discussions. Meanwhile, student narratives about emotional resonance with patient stories (e.g., syphilis affecting musicians’ lives) suggest concurrent affective empathy development, stimulated by arts-based materials and personal sharing in discussion. The integration of both dimensions, as promoted by the flipped-classroom format, may explain why students reported not just understanding but also compassion. This interpretation supports Decety and Cowell’s [30] assertion that empathy is a multidimensional construct best cultivated through combined cognitive and affective pedagogical strategies.

Discussion

Summary of main findings

This study described the design, implementation, and evaluation of “Melody of Genes”, an interdisciplinary medical humanities course for Chinese medical undergraduates. Based on three rounds of teaching, the course was feasible and well-accepted, with 92.7% of students reporting perceived improvements in humanistic literacy, 84.4% reporting increased empathy and professional identity, and 83.5% reporting enhanced critical thinking. These self-perceived outcomes are consistent with findings from a scoping review by Carr et al. [11], where student satisfaction and perceived empathy gains were common but objective measures were often lacking. However, our findings extend prior work by providing concrete course design features (co-teaching, flipped classroom, formative assessment) that students explicitly linked to their reported outcomes (see Sect. "Connection between learning outcomes and instructional design").

Interdisciplinary co-teaching model

A key strength of this course is its interdisciplinary teaching team combining medical scientists, clinicians, and an arts educator. This collaboration ensured medical content was scientifically accurate while artistic and humanistic perspectives were integrated naturally. Our model aligns with recommendations from Carr et al. [11], who found that effective health humanities curricula require genuine interdisciplinary integration rather than separate teaching of medicine and humanities. Unlike many Chinese medical humanities courses that are taught solely by humanities faculty without clinical context [7], our co-teaching approach allowed students to hear real clinical narratives from a practicing intensivist (author KLX). This finding is consistent with a pilot study in China by Yang et al. [21], where resident training courses co-taught by clinical and humanities faculty showed significant post-course improvements in communication skills and diagnostic processing (P < 0.05). The added value of our model is the explicit inclusion of an arts educator, which enabled deeper exploration of aesthetic and historical dimensions rarely addressed in Chinese medical curricula—a gap identified in the national survey by Saffari et al. [20].

Flipped classroom and blended learning effectiveness

The flipped-classroom and blended learning strategy proved effective in promoting active engagement. Pre-class videos provided foundational knowledge, freeing class time for in-depth discussion. Online discussion boards extended learning beyond the classroom. Our findings are supported by a network meta-analysis by Zhang et al. [37], which identified flipped classroom as one of the most effective teaching strategies in medical education, particularly for outcomes related to critical thinking and problem-solving. More specifically, a study examining flipped classroom in a Chinese medical humanities English course found that the flipped model significantly improved empathy, emotional intelligence, and supportive communication compared to traditional lectures [23]. Our results extend this evidence to a fully interdisciplinary course co-taught by medical and arts faculty. However, unlike the controlled study by Huang et al. [23], our single-group design cannot isolate the flipped component’s independent effect—a limitation we acknowledge.

Formative assessment and reflective reports

The formative assessment system focused on discussion performance (50%) and reflective reports (40%) rather than traditional written examinations. A meta-review by Coronado-Vázquez et al. [10] found that humanities learning outcomes are part of necessary knowledge for good clinical practice, but assessment methods in most medical humanities courses remain underdeveloped, often relying on knowledge recall rather than reflection. Our approach addresses this gap by prioritizing process-oriented assessment. Student feedback indicated that knowing their discussion performance would be assessed motivated them to prepare and participate. Furthermore, the reflective final report—requiring literature search and personal connection to medical humanities topics—was cited by many students as the most valuable assignment (see Sect. "Reflective final report as a mechanism for integrating humanities and medicine"). This finding echoes the work of Huang et al. [38], who showed that narrative-based reflective writing promotes professional identity formation in Chinese medical trainees.

Empathy, professional identity, and comparison with existing evidence

The most important finding is that 84.4% of students self-reported increased empathy for patients and stronger professional identity. This proportion is comparable to or slightly higher than those reported in international reviews. A systematic review by Levett-Jones et al. [12] found that arts-based interventions generally had positive effects on healthcare students’ empathy, with post-test effect sizes ranging from moderate to large. Our descriptive percentage (84.4%) cannot be directly converted to an effect size, but it suggests a positive direction consistent with that literature.

However, direct comparison with existing studies is complicated by measurement differences. Most controlled trials use validated scales such as the Jefferson Scale of Empathy (JSE). A large multi-center study across 11 Chinese medical universities reported a mean JSE score of 67.38 (SD = 9.39) among undergraduate medical students [18], and the Chinese-adapted JSE has demonstrated robust psychometric properties [19]. Our study did not use JSE or a pre-post design, so we cannot claim objective empathy gains. This is a major limitation relative to studies that demonstrated significant JSE score improvements after humanities interventions.

Nevertheless, the student-written feedback provides qualitative support for empathy enhancement. Students explicitly mentioned specific course topics (e.g., syphilis and music, obesity and aesthetics) as triggers for understanding patient suffering—a finding consistent with the pedagogical mechanisms identified by Mojarrad et al. [13], who found that arts modalities used as a stimulus for active group discussion were most effective for empathy development. Our findings also align with a national survey by Saffari et al. [20], which highlighted that Chinese medical students’ perception of medical humanities is associated with lower burnout and stress, underscoring the potential long-term value of such courses.

Global and local relevance of course themes

The course themes were selected to balance global perspectives and local cultural relevance. Topics such as female physiology and social status, heredity and aesthetics, and views on life and death were designed to resonate with Chinese students’ social backgrounds. Meanwhile, Western materials (e.g., Vitruvian Man, syphilis and music, the Black Death) encouraged cross-cultural thinking. This approach is supported by a narrative review by Smydra et al. [40], which emphasized that effective medical humanities curricula must be culturally contextualized. In the Chinese context, where medical education has been heavily influenced by Western biomedical models but retains unique cultural values (e.g., stigma around certain diseases), integrating both global and local content is particularly important [8]. Student feedback confirmed that topics like “female physiology and social status” generated particularly engaged discussions, suggesting that culturally resonant themes may enhance learning outcomes.

Comparison with existing medical humanities interventions in China and implications

Several recent studies have reported on medical humanities courses in Chinese medical schools, allowing preliminary comparisons. Chen et al. [7] described a volunteerism-based humanistic education program but did not report quantitative empathy outcomes. Li and Wu [8] analyzed the characteristics of medical humanities education in China, noting serious deficiencies in teaching hours and student engagement. Yang et al. [21] conducted a pilot study of medical humanities courses in resident training, finding significant pre-post improvements in communication skills (P < 0.05). Our study differs from Yang et al. in several ways: (a) our participants were undergraduates rather than residents; (b) our course was co-taught by an arts educator, whereas Yang et al. focused on clinical communication; (c) we used a post-course only design while Yang et al. used pre-post comparisons. Both studies support the feasibility of medical humanities courses in China, but our study provides more detailed qualitative feedback linking specific design elements to student outcomes. To our knowledge, this is the first study in China to explicitly describe and evaluate an interdisciplinary medical humanities course that integrates arts (music, visual arts, literature) into a flipped-classroom format with co-teaching by medical and arts faculty.

Taken together, the “Melody of Genes” model provides a replicable framework for medical humanities curriculum development in China. It addresses common problems documented in the literature: rigid content, disconnection from clinical reality, passive lectures, and student disinterest [7, 8]. The course demonstrates that interdisciplinary collaboration, flipped teaching, thematic discussion with humanistic tension points, and formative assessment can effectively improve the perceived quality of medical humanities education. However, as discussed in the limitations section, the evidence presented is self-perceived and descriptive; rigorous controlled studies using validated instruments such as the JSE [18, 19, 26] are needed to establish causal effects.

Limitations

While this study provides valuable insights, several limitations should be acknowledged when interpreting the results.

First, this study used a single-group, post-course only observational design without pre-test and post-test comparisons, validated measurement scales (e.g., the Jefferson Scale of Empathy), a control group, or inferential statistical analysis. Therefore, causal conclusions cannot be drawn. All reported improvements represent students’ self-perceived changes rather than objectively verified outcomes.

Second, the course was offered as a public elective course, which may introduce self-selection bias. Students who enrolled were likely to have greater initial interest in medical humanities and interdisciplinary learning. Thus, the high satisfaction and positive feedback may not be fully generalizable to the entire medical student population.

Third, the study was conducted at a single medical university in Tianjin, China. Institutional context, faculty resources, and student characteristics may differ across medical schools, which limits the generalizability of the model to other educational settings.

Fourth, the evaluation relied on self-reported questionnaires, written reflections, and final reports, without objective behavioral assessments or long-term follow-up. The sustained impact of the course on students’ clinical practice, communication skills, empathy performance, and professional development remains unclear.

Fifth, although the teaching team made efforts to guide discussions, individual differences in participation existed. Some quieter or less proactive students may have benefited less from group discussions, and no targeted strategies were formally evaluated for this subgroup.

Future studies should consider using validated assessment tools, pre–post and controlled designs, inferential statistics, longitudinal tracking, and multi-center implementation to generate more robust, objective, and generalizable evidence.

Conclusions

We designed, implemented, and evaluated “Melody of Genes,” an interdisciplinary undergraduate course that integrates medicine and medical humanities. Based on three rounds of teaching practice, this student-centered, flipped-classroom curriculum was feasible, well-accepted, and associated with positive self-perceived outcomes among medical students.

Students reported significant perceived improvements in humanistic and philosophical literacy, self-learning ability, critical thinking, empathy for patients, and professional identity. The course helped break down disciplinary barriers between medicine and medical humanities, encouraged deep reflection on the social, ethical, and cultural meanings of medicine, and fostered humanistic care awareness.

This interdisciplinary model provides a practical and replicable reference for the construction and innovation of medical humanities curricula in Chinese medical education [39, 40]. Future work will focus on optimizing teaching design, expanding course accessibility, developing open online resources, and conducting more rigorous, longitudinal, and multi-center evaluations. Ultimately, this course aims to support the cultivation of compassionate, reflective, and well-rounded physicians capable of delivering high-quality, human-centered medical care.

Authors' contributions

YC and ZY have made substantial contributions to the conception and the design of the work. YC, ZY, LZH and KLX contributed to the acquisition, analysis, and interpretation of data. YC wrote the main manuscript text and KLX revised it. YC contributed to funding acquisition. All authors reviewed the manuscript.

Funding

This study was supported by grants from the first batch of New Liberal Arts Research and Reform Practice Projects of Tianjin (BK11020318), Tianjin Philosophy and Social Science Planning Project (TJJYQN24-002), and Tianjin Higher Education Institution Graduate Education Reform Research Program (TJYG25096).

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the principles of the Declaration of Helsinki for research involving human participants. It was reviewed by the Ethics Committee of Tianjin Medical University. The committee waived the requirement for written informed consent because this study was a retrospective curriculum evaluation, all data were collected anonymously, and no identifiable personal information or sensitive health data were involved. All participants were informed that their feedback would be used for course improvement and research publication.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.