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The University of Lancashire’s Person Before the Patient project places first-year medical students in care homes for four weeks to learn through conversations with residents. Student reflections describe gains in listening and empathy, but the project did not formally measure empathy or establish lasting effects.
The University of Lancashire has made a four-week care-home placement part of first-year medical training, asking students to learn about residents through conversation rather than diagnosis. Reflections from participants describe practicing listening, adapting communication and empathy, but the project did not formally measure empathy or show whether any changes persist.
The project, called The Person Before the Patient, was piloted in 2023–24 and became compulsory for first-year medical students in 2024–25. It operates across 11 care homes. Students meet residents who may be living with dementia, frailty or long-term conditions, with the aim of learning about their interests and experiences rather than assessing medical needs.
Students may begin with prepared questions, but residents decide what to share and how the conversation develops. One student wrote that they learned to listen more and let the resident lead, as well as to tolerate pauses while someone searched for words. The student also described paying closer attention to facial expressions and gestures.
Of 281 students who completed the placement, 157 voluntarily submitted written reflections for the project. Those accounts offer evidence of what responding students felt they learned; they are not a formal measure of empathy or proof of changes in later clinical practice. The project’s account also notes that respondents may have viewed the experience more positively than students who did not submit reflections.
Listening Beyond the Clinical Checklist
Medical training requires communication with people experiencing illness, but students can learn to focus heavily on symptoms and assessment. A placement built around residents’ lives offers practice in hearing people at their own pace and responding to what they choose to discuss. Those skills may be especially useful when a person has hearing loss or memory difficulties.
The project’s author connects this approach to concerns about empathy during medical training. Research on whether empathy declines is mixed. A 2023 review of 16 studies identified heavy workloads and poor role models as factors that may encourage emotional detachment, part of what is sometimes called the hidden curriculum: lessons students absorb from clinical environments in addition to formal teaching.
Still, positive student accounts do not establish that conversation placements improve care. An evaluation of the UK Time for Dementia program found gains in knowledge and attitudes among students who visited people with dementia and their families, but no significant difference in measured empathy compared with other students. The Lancashire project’s reflections are a reason to study the approach further, not a result that settles its effectiveness.
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How the Placement Was Designed
The placement introduces students to residents before their conversations are centered on clinical assessment. That differs from simulated consultations, in which actors play patients and students practice set communication tasks. The project’s account says direct conversations can require students to adjust when residents do not give the predictable answers they may expect.
Other research offers relevant but limited comparisons. An Australian study of 61 fifth-year students found that five-day care-home placements improved dementia knowledge and attitudes toward working with older people, although some students questioned the educational value. A New Zealand analysis of reflections from five students examined hands-on personal care rather than conversation; some accounts described residents as problems to manage after difficult encounters. The project author cites this as a reason to support reflection on discomfort, while recognizing the studies concern different kinds of placements.
Communication guidance from the UK National Institute for Health and Care Excellence recommends adapting communication to a person’s needs and taking account of their history and preferences. The care-home project also raises the importance of residents’ choice: they should decide whether to participate and what they wish to share, rather than having their lives treated only as teaching material.
“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
What the Reflections Cannot Show
The project did not formally assess empathy, and the written reflections capture students’ immediate self-reports, not independently measured changes. Because only 157 of 281 students chose to submit reflections, their views may not represent everyone who took part.
It is also unclear whether the experience changes how students communicate once they enter clinical settings or whether any effects last. The source account says a fuller evaluation would need to follow students over time. It does not provide a detailed assessment of resident outcomes or the views of residents who chose not to participate.
Residents’ consent and control are central questions for any such program. Some participating homes involved residents in discussions about hosting students and, with staff, how placement funding would be used. However, the available account does not give figures on participation, resident feedback or how consistently those decisions were shared across all 11 homes.
Evaluating Longer-Term Effects
The next evidentiary step would be a longer-term evaluation that assesses students beyond their immediate reflections and follows them into clinical training. It would need to measure outcomes directly and account for students who do not submit feedback, rather than treating written accounts as proof of lasting change.
Further reporting or evaluation could also clarify what residents themselves gain, how they choose whether to take part, and how their feedback shapes the placements. Care-home managers have reported that many residents enjoy the visits and look forward to students returning, but the source account does not provide a formal resident-outcome study. Until further findings are available, the project is best understood as an educational approach with promising student accounts and unconfirmed long-term effects.
Key Questions
What do medical students do during the placement?
They spend four weeks in a care home, learning about residents’ interests and experiences through conversation rather than conducting medical assessments.
Which students take part?
The University of Lancashire made the placement compulsory for its first-year medical students in the 2024–25 academic year. It was piloted the year before.
Has the project shown that students become more empathetic?
No formal empathy measure was used. Some students described learning about empathy in their reflections, but those self-reports do not establish lasting changes or effects on clinical behavior.
Do residents choose whether to participate?
The project account says residents should be able to choose whether to take part and what to share. Some participating homes included residents in discussions about hosting students, though the account does not detail how this worked across every home.
Source: rss
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