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Review

The Impact of Empathy and Perspective-Taking on Medical Student Satisfaction and Performance: A Meta-Ethnography and Proposed Bow-Tie Model

by
Chao Tian Tang
1,*,
Lucas Jun Hao Lim
2,
Haoming Tang
3,
Gaytri Gupta
3,
Isabelle Chiao Han Sung
3 and
Chaoyan Dong
4
1
Department of Psychiatry, Sengkang General Hospital, 110 Sengkang E Way, Singapore 544886, Singapore
2
Department of Mood and Anxiety, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore
3
Duke-National University of Singapore Medical School, 8 College Rd, Singapore 169857, Singapore
4
Education Office, Sengkang General Hospital, 110 Sengkang E Way, Singapore 544886, Singapore
*
Author to whom correspondence should be addressed.
Int. Med. Educ. 2025, 4(4), 43; https://doi.org/10.3390/ime4040043
Submission received: 12 September 2025 / Revised: 8 October 2025 / Accepted: 20 October 2025 / Published: 23 October 2025
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Abstract

Background: Empathy and perspective-taking are, respectively, associated with improved healthcare and educational outcomes. However, numerous studies show that medical students are experiencing a significant decline in self-reported empathy. We aim to examine the impact of empathy and perspective-taking on medical student satisfaction and performance. Methods: Qualitative evidence synthesis was performed using a meta-ethnography approach. Six electronic bibliographic databases were searched for papers published during 2000–2021, including those exploring empathy or perspective-taking in medical education concerning medical student satisfaction and performance and involving medical students. The Critical Appraisal Skills Programme was used to appraise the quality of each included paper critically. Results: In total, 851 articles were identified, and 15 studies were included. Six third-order constructs were synthesized and integrated via a “Bow-Tie” model. This included blending humanism in clinical skills with personal experiences, vicarious learning, challenging pre-conceived notions, curricular and pedagogical inculcation, collective expressions of empathy with secure catharsis, and multi-stakeholder perspectives and involvement. Conclusion: This Bow-Tie model provides a novel framework that integrates the contextual factors to better understand the roles of empathy and perspective-taking in medical education. This aids the planning of interventions, such as in the medical humanities to achieve the desired outcomes.

1. Introduction

There is significant empirical research that provides evidence of the importance of empathy to healthcare outcomes and the success of healthcare delivery [1,2,3,4]. Contemporary expectations of the medical profession designate empathy as a key professional attribute, and is widely acknowledged as one of the cornerstones of the physician–patient relationship [5,6,7]. It has been observed in several studies that medical students experience a decline in self-reported empathy as they progress through the course of their medical education, with concerns about the future of compassion in healthcare and the quality of medical education [8,9,10,11]. This consideration proves to be particularly relevant with the experience of the COVID-19 pandemic, where perceptions of empathy were altered due to changes in the format of patient contact, increased isolation and remote learning, as well as anxiety and distress from personal health concerns [12].
While the exact definition of empathy is elusive, empathy can be conceptualized as encompassing both an affective process, such as the sharing of another person’s emotional state, and a cognitive process, such as recognizing the source of that emotional state [13]. On the other hand, perspective-taking requires a more cognitive process of understanding another’s thoughts, beliefs, intentions and emotions, coupled with the ability to possess and abstractly represent another person’s mental state [13]. In healthcare, perspective-taking can lead to deeper empathy [14]. However, one can apply perspective-taking in patient care without necessarily feeling and showing empathy under stressful and emergent situations. This is further supported by research in neuroscience, where empathy and perspective-taking have been associated with distinct underlying neural networks and variances in the relation of these networks to the respective behavioral indices [15].
Several reviews suggest that empathy can be improved in medical students with interventions introduced to teach students about empathy and perspective-taking [16,17,18]. For example, perspective-taking exercises by medical students have been associated with enhanced patient satisfaction and effective clinical communication [19]. Medical student satisfaction, and the impact of this on their academic performance, has been studied through a range of pedagogical approaches [20,21,22,23,24]. Reviews have also explored the relationship between burnout and empathy in medical students [9,25,26]. Personal satisfaction in medical students was correlated to a higher level of perspective-taking in one study, while another cross-sectional study indicated that students with higher empathy and low burnout possess higher rates of life satisfaction [25,27].
However, to our knowledge, no one has aggregated the relationship between empathy and perspective-taking with students’ performance and satisfaction qualitatively which are key parameters for medical students. Via a meta-ethnographic approach, we aim to qualitatively examine the impact of empathy and perspective-taking on medical student satisfaction and performance.

2. Materials and Methods

The meta-ethnography methodology allowed for us to select, analyze, and interpret qualitative information to increase our understanding of empathy and perspective-taking in medical education in order to arrive at new insights on the impact these factors have on medical student satisfaction and performance [28,29]. It was conducted in accordance with the protocol published on PROSPERO (reference identification CRD42022300278). Noblit and Hare’s approach to meta-ethnographies was used to synthesize the data [30].
Chao Tian (CT) and Lucas (LL) searched six major databases, with the results shown in Table 1. These databases included a wide range of the literature, given the increasingly multidisciplinary and interdisciplinary nature of medical education [31]. These studies were from 2000 to 2021, published in English, involved medical students, and had a significant qualitative component. We excluded non-medical professions, studies not in English, and purely quantitative studies. The search strategies are shown in Annex S1 in the Supplementary Material. A total of 851 studies were identified using the database search and were exported to Covidence.
Gaytri (G.Y.) and Isabelle (I.B.) screened the studies and discussed all discrepancies, with C.T. making the final decision if no agreement could be reached. The process is shown in the PRISMA flow diagram in Figure 1.
Search Strategy and Screening
C.T. extracted the study characteristics, including the authors, publication date, study aims, study design, type of activity, description of experiences, attitudes or perceptions of empathy, perspective-taking, satisfaction, and performance. L.L. cross-checked the accuracy of the extracted data. The Critical Appraisal Skills Programme (CASP) checklist was used to appraise the quality of each included paper. G.Y. and I.B. independently assessed the quality of each study, where any disagreement was resolved through discussion with C.T.. C.T., L.L., Haoming (H.M.), G.Y., and I.B. read the papers several times. Key concepts, metaphors, phrases, and ideas were subsequently extracted, and NVivo software (NVivo Qualitative Data Analysis Software 12) was used to code the findings by C.T. and H.M. The descriptions of empathy, perspective-taking, and their impact on students’ satisfaction and performance were extracted from each paper. The information was identified as either the participants’ exact words extracted from the article (first-order constructs) or the researchers’ interpretation extracted from the papers (second-order constructs). The studies were then reviewed again in conjunction with the extracted information, with NVivo being used to track the conceptual development and the coding process by allowing for the authors to return to the primary studies.
Translation and synthesis
Individual concepts and components were then determined by comparing the themes and concepts, keeping an open mind for emerging themes in the reciprocal translational process. There was an active process of looking for differences across the studies to determine any conflicting concepts to ensure a rigorous refutational translation process. Alternative postulations, explanations, and concerns from these processes were examined prior to the next stage. New key concepts and metaphors that pervaded across studies that provided a new understanding of the phenomena were developed, known as third-order constructs.
C.T., L.L., and H.M. then developed an overarching model that linked the translations and authors’ interpretations where alternative interpretations were considered. A lines-of-argument synthesis was then conducted to integrate the similarities and differences among the models to generate a new interpretive context, which was configured into a simplified conceptual model of the impact of empathy and perspective-taking on medical student satisfaction and performance to illustrate our findings.

3. Results

We divide the themes into two broad categories, including medical-student-focused efforts and those driven by the medical education ecosystem where the Bow-Tie Model is illustrated in Figure 2.

3.1. Medical-Student-Focused Efforts

3.1.1. Theme 1: Blending Humanism in Clinical Skills with Personal Experiences

By taking time to sit down and to learn from patients, peers, and other professionals, students were “re-sensitized to the humanistic side of medicine”, learned to “treat the patient, not the condition”, and to “never give in to the cynical and hopeless nature that plagues our profession” [32,33]. Students were able to reconcile the difference in expectations at the start of treatment and the reality of the uncertainties of the outcomes by concluding that they were able to “at least” provide “hope and comfort them (patients) (…) in the times when they needed it most” [32]. This facilitated the development of a new skillset in addition to the standard clinical skills they had, focusing on the training for empathy and a humanistic touch throughout a patient’s journey instead of only mechanically incorporating clinical knowledge. To achieve this, narrative medicine training has provided an excellent opportunity for students who may become “burnout and numb to the humanistic side of medicine” [32]. For example, instead of putting all the focus on the newborn child, students were able to probe how a mother was doing and feeling after a Caesarean section, empathizing with and developing more cognizance of the social and environmental determinants of the mother’s health [34]. In this aspect, students perceived the patients as “more than an illness” and performed better overall by focusing on aspects that they had never noticed before [35,36].
Empathy developed through such experiences “shielded” students from the often overwhelming demands in their medical curriculum and helped them to resist “the urge to dehumanize” patients “to a record simply” with satisfaction derived from the reminders about their initial motivation to pursue medicine to become competent physicians who can “find a delicate balance and work with their patients” [32,36,37]. Perspective-taking through book club discussions allowed for the students to become less judgmental and to understand the multitude of issues that affect diverse patient populations [38]. Students were “applying these insights into their professional lives” and appreciated how the discussion helped them readily apply what they had learned in the clinical setting [38].

3.1.2. Theme 2: Vicarious Learning

Patient interaction provided a valuable medium for students to develop and refine their communication skills vicariously. By talking to patients, students learned to “listen and attend closely to the narrative and … receive and value different perspectives”, thus making them a “better listener and provider”, with reminders that it was “overwhelming” when loaded with information and jargon they did not understand [34,39]. Students also learned to recognize obstacles and to reduce conflicts of perspective [40,41]. Clinical scenarios where students wore melanoma tattoos and listened to patients’ accounts of their illness ignited emotions such as “fear and (…) anxiety”. This allowed for the students to learn about life with melanoma, “appreciate [cancer] patients as people”, and understand complex the reality that “real patients with melanoma cannot wash their cancer away” [33].
In addition, students can vicariously learn about the social and psychological aspects in formulating clinical management skills through taking the perspective and empathizing with a patient’s lifestyle, social support system, and socioeconomic status. Students shared how they better understood “the financial impact of the illness”, “social stigma [of the illness]”, and the impact of “disability” on the home environment and associated “barriers” through such interactions [41]. Going beyond the usual clinical setting for students, for example, home visits for patients with chronic illnesses, had a satisfying “emotional impact” that gave students “motivation to change and develop as humanistic physicians” [36].

3.1.3. Theme 3: Collective Expressions of Empathy with Secure Catharsis

Students found much satisfaction in having an empathetic, collegiate environment surrounded by their peers in a safe space, where they felt more “allowed to be” themselves, to “take risks”, and to “come to grips with something”, which provided significant catharsis [37,39]. One student said, “Thank you for allowing it to be a safe environment where tears were welcomed and not rejected” [37]. Narrative training allowed for the students to be situated in a “non-competitive” space where there was ample opportunity to express themselves and engage in perspective-taking from different angles [38,39]. On the other hand, the satisfaction level notably decreased when these strategies failed to match students’ expectations, as they were not as willing to take risks in front of others by approaching difficult and unfamiliar topics [37,39].
During narrative training, the relationships among students transformed from “colleagues” to more personal ones, where they shared vulnerable personal experiences that were “very empowering” and accentuated the commonality of a shared identity [37]. Students indicated they “have so few opportunities to talk about the patient experiences” because the existing medical curriculum did not facilitate sharing patients’ stories [37]. In addition to clarifying their initial goals of pursuing medicine, some students grasped their sense of selfhood in the process of “writing it out” in the journey with their narratives, which in turn enabled them to develop concepts of how they should deliver medical care as they matured to become competent clinical practitioners [32,39].

3.1.4. Theme 4: Challenging Pre-Conceived Notions

Prior biases and “assumptions” by medical students can cloud performance and impact satisfaction in medical education [42]. Experiences with empathy and perspective-taking via interaction with the clinical services and medical education allowed for them to clarify some of the engraved presumptions of how things should have turned out to be for a specific group of the population via “adopting the perspective of” or “picturing” a patient [36]. The realization of the complexity of these experiences allowed for them to reciprocate and share constructive feedback for valuable clinical learning and performance [38,42]. From “walking into it thinking” they “knew everything about it”, they learned to “adjust” their attitude to being more open and receptive and to learn from each other through a discussion of their transformative ideas [33,36,39,42].

3.2. Medical Education Ecosystem Driven

3.2.1. Theme 5: Curricular and Pedagogical Inculcation

Operationalizing empathy through both verbal and nonverbal communication techniques such as posture, voice, and eye contact has been integrated into the curriculum, providing students with new perspectives and satisfactory “heavy lingering experiences” [43,44]. Novel experiences and new perspectives enrich students’ understanding of different perspectives, where “communicating with others with empathy” helped with gaining “new perspectives” [43,45]. Formal mentorship via consistent modelling, including a focus on empathetic patient-centeredness, was a key component where, for example, an “ED resident (…) would squat next to the bedside of every patient so he would be on eye level” [46]. Empathy and perspective-taking using literature served as a useful pedagogical tool and assisted in “professional” performance, for example, the “skill to understand others’ perspectives” [38]. Simulation exercises allowed for students to have a “greater appreciation for the barriers that patients face” and “new reflections on how diseases persistently and relentlessly infiltrate significant aspects of a patient’s life” [33,45]. These experiences elicited emotions and perspectives beyond biomedical and technical dimensions, and helped students improve professional performance and develop compassion as future physicians [33].

3.2.2. Theme 6: Multi-Stakeholder Perspectives and Involvement

Exploring multi-stakeholder perspectives such as caregivers allowed for the students to gain new perspectives that were both satisfying and enriched different aspects of clinical skill performance. Students realized that there was much more benefit and value after incorporating caregivers into the decision-making process, bringing “latent perceived generalizations (…) to the fore”, where it was “worth it” to listen to their input to achieve a more satisfactory learning outcome [34,42]. Specific encouragement by a clinical chief to be patient-centered with caregivers in the rounds allowed for “extreme” gratitude by the caregiver “for having been included as part of the care team” and was deemed by some students to be the “most memorable and rewarding experiences of medical school thus far” [34].
However, accepting a different perspective from patients was not all comfortable at the start: students needed to challenge themselves to step out of their comfort zone, and the tension created in the process was what prompted them to consider diverse opinions and adjust their thinking [34,36,41,43]. Often, this process started with the realization that they made the assumptions prematurely because of such cognitive heuristics that assisted with the decision-making process before [36,42,43]. One such important transformation was that students learned a new experience of empathy, not only by “putting myself in someone else’s shoes”, but also “to communicate with and care for him or her based on the in-depth understanding of the person’s life”; this process left them with an indelible impression of how to proceed to form meaning relationships with others by “seeing things through patient’s eyes” [40,43,46].

3.2.3. Specific Details

Annex S2 summarizes the 15 studies used in this meta-ethnography. Annex S3 summarizes the second- and third-order constructs, with illustrative first-order constructs. The quality appraisal based on the CASP tool is summarized in Annex S4.

4. Discussion

Our study developed a “Bow-Tie” conceptual model to explore the relationship between empathy and perspective-taking in medical education to the performance and satisfaction of medical students through our collective interpretation of primary qualitative studies. Previous studies explored different interventions, such as using arts and virtual reality to teach empathy, which showed an improvement in empathy through quantitative measures between the pre- and post-interventions, but these studies did not look into the exact contextual factors [47,48]. Our “Bow-Tie” model displays these concepts in a simple yet encompassing framework to include various contextual factors contributing to the outcomes of such interventions involving empathy and perspective-taking, fastened together with the key parameters of medical student satisfaction and performance. We illustrate this concept by integrating the medical student-focused efforts and the medical education ecosystem factors potentially mediating this relationship. Such contextual factors have been found to interact with one another and with the interventions to facilitate changes in clinical systems with important outcomes [49].
The development of humanistic skills is also key in forming the professional identity, which involves an active learning process, leading to profound respect for patients and a concern for their general welfare [50]. Narrative medicine is a central concept in several themes, including vicarious learning and the blending of humanism, where the inclusion of such concepts formally in the curriculum in a structured manner can aid the empowerment of students in optimizing their own identity formation as a clinician with the necessary professional and moral values. Our model proposes that empathy and perspective-taking can act as a buffer towards the dehumanization of medicine and facilitate the re-sensitization of the humanistic side of medicine towards developing such humanistic skills. This provides further clarification to the questions posed by another key meta-ethnography on qualitative experiences in medical education involving empathy, which found conceptual confusion around empathy and tension in medical education between distancing and connecting with patients with barriers, including an overemphasis on the biomedical aspects over the psycho-social aspects of the curriculum [51]. The multi-stakeholder perspective also holds true in other similar areas, where a recent study from Asia on professional identity formation revealed that personal, relational, and organizational factors influenced the development of the clinical educator identity [52]. For this study, the relational aspect was a vital enabler, while organizational culture was a strong barrier; however, in our study, organizational aspects such as curricular and pedagogical inculcation as part of the medical education ecosystem appeared to be more of an enabler [52].
Having a “safe space” in medical education has been discussed in the existing literature as being able to provide support through clerkship challenges and to assist students with appreciating patient experiences across the continuum of care, where modules that aim to create such resources have been well-received and improve attitudes towards a safe space [53,54]. Secondary qualitative analysis on the practice of human touch in healthcare professions generated the metaphor of “the waltz” in explaining how touch allows for the formation of strong relationships between patients and healthcare professionals, while dance steps help manage the risk that is inherent in such an intimate form of connection [55]. We postulate, with our model, that empathy has a role in mediating the advantages of such safe spaces by allowing for students to collectively empathize with their peers with the accentuation of a shared identity as medical students. This brings much satisfaction, as they too “waltz” through the joys and complexities of medical education. A mix of these concepts in medical education has been seen in the past, such as that seen in the Silent Mentor Program, which increased empathy levels in medical students [56]. This mentorship program contextualized and empowered the students’ capacity to empathize with surgical donors, bridging the division between hard sciences and soft humanities, which is in line with our findings as well, which also stress the importance of multi-stakeholder perspectives [56].

4.1. Strengths and Limitations

There are several strengths to our study. Using the CASP, the majority of studies included in the synthesis were rated to be of reasonable quality. This was based on grading strategies by consensus employed by existing published peer-reviewed systematic reviews [57,58,59]. All of the studies included in the review had a reasonable qualitative methodology, and almost all of the studies had a clear statement of the aims, with a corresponding research design suitable to address the aims of the research. Ethical issues were also taken into consideration satisfactorily in almost all of the studies, in addition to a clear statement of the findings in these studies. In addition, no authors had any strong stance on empathy and perspective-taking in medical education, as the impact on the domains affected was a novel question to all. Authors also acknowledged that their own experiences might influence the analysis and generation of conceptual frameworks where prior assumptions towards the research question were set aside. This allowed for authors to focus solely on the available data [60]. No funding or conflicts of interest were present for all authors regarding the research question.
One limitation of our review was that the data analysis was also not assessed to be adequately rigorous based on the CASP tool for qualitative studies in several studies. However, this limitation was partially mitigated through further meta-ethnographic analysis of the available data from primary studies to achieve new conceptual perspectives [61]. Another limitation was the lack of consideration of the relationship between the researchers and participants in several studies. In our meta-ethnography, we sought to address this given the diverse team of researchers involved in this study. Two authors (C.T. and L.L.) are psychiatrists who have completed undergraduate medical degrees and further training in psychiatry, and are currently adjunct medical school educators. Hence, while the both of them are outsiders, they also have insiders’ experiences given their experience as medical students [62,63]. Three authors (H.M., G.Y., and I.B.) are third-year medical students who are insiders [62,63]. Both groups acknowledged this and the potential pressures on each author given the related outcome, with active reflection on the impact on conceptual generation [64].

4.2. Future Implications

Given the increased focus on empathy in medical education, our findings bring important considerations for integrating empathy and perspective-taking interventions in medical school curriculums, student support systems, and the conceptualization of the medical student–patient relationship. There has been a renewed focus on medical humanities in many countries worldwide to promote patient-centered, empathic care by future physicians [65]. Our model aids medical education leadership teams in understanding the contextual factors that drive potential benefits. It also provides a framework for medical educators to adapt interventions in medical humanities to suit their cultural context and system demands. The failure to adapt such interventions to the individual requirements of each medical education system may have contributed to suggestions that interventions that directly support empathy development are ineffective and possibly detrimental to justice-oriented aims [66]. Given the cost of medical education interventions with scrutiny on tangible outcomes, our model conceptually links the key parameters of medical student satisfaction and performance directly with the espoused values underpinning the medical humanities, which supports the continued growth and viability of such programs [67,68]. Outcome measures such as the Jefferson Empathy Scale, which is a broadly used instrument developed to measure empathy in the context of health professions education and patient care, can be further refined to meet the needs of various systems and cultural nuances with regard to student satisfaction and performance.

5. Conclusions

This meta-ethnography review allows us to delve into the complexities and the interplay between empathy and perspective-taking, which are vital components in developing a professional identity, with the key outcomes of medical student satisfaction and performance. Our model provides an innovative conceptual framework that combines the parameters above to allow for the continued development and vitality of interventions promoting empathy and perspective-taking in medical education. Further innovative interventions with a grounding in the medical humanities can be developed using this model involving critical reflection by the various stakeholders, including medical educationists and researchers, to cement the role of empathy and perspective-taking in medical education at a time of increasing burnout and perceived declining empathy in medical students.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ime4040043/s1, Annex S1: Search strategy; Annex S2: Summary of 15 studies utilised in the meta-ethnography; Annex S3: 3rd order constructs (in bold), 2nd order constructs illustrative first-order constructs; Annex S4: The Critical Appraisal Skills Programme tool for quality assessments of qualitative studies.

Author Contributions

C.T.T.: Conceptualization, Methodology, Software, Data Curation, Writing—Original Draft, Writing—Review and Editing, Project Administration, Formal analysis, Supervision, L.J.H.L.: Conceptualization, Methodology, Data Curation, Writing—Original Draft, Writing—Review and Editing, Project Administration, H.T.: Writing—Original Draft, Formal analysis, Software, Data Curation, G.G.: Writing—Original Draft, Formal analysis, Data Curation, I.C.H.S.: Writing—Original Draft, Formal analysis, Data Curation, C.D.: Writing—Review and Editing, Conceptualization, Supervision. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

All data is available via public sources.

Conflicts of Interest

The authors declare no conflicts of interest.

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Ime 04 00043 g001
Figure 1. PRISMA flow diagram for study selection.
Figure 1. PRISMA flow diagram for study selection.
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Figure 2. The “Bow-Tie” model: How empathy and perspective-taking in medical education can impact medical student satisfaction and performance.
Figure 2. The “Bow-Tie” model: How empathy and perspective-taking in medical education can impact medical student satisfaction and performance.
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Table 1. Databases and number of studies included for this study.
Table 1. Databases and number of studies included for this study.
DatabasesNumber of Studies
PubMed254
PsycINFO104
Cumulative Index to Nursing & Allied Health Literature (CINAHL)36
Web of Science229
Educational Resources Information Centre (ERIC)25
Embase203
Total851
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MDPI and ACS Style

Tang, C.T.; Lim, L.J.H.; Tang, H.; Gupta, G.; Sung, I.C.H.; Dong, C. The Impact of Empathy and Perspective-Taking on Medical Student Satisfaction and Performance: A Meta-Ethnography and Proposed Bow-Tie Model. Int. Med. Educ. 2025, 4, 43. https://doi.org/10.3390/ime4040043

AMA Style

Tang CT, Lim LJH, Tang H, Gupta G, Sung ICH, Dong C. The Impact of Empathy and Perspective-Taking on Medical Student Satisfaction and Performance: A Meta-Ethnography and Proposed Bow-Tie Model. International Medical Education. 2025; 4(4):43. https://doi.org/10.3390/ime4040043

Chicago/Turabian Style

Tang, Chao Tian, Lucas Jun Hao Lim, Haoming Tang, Gaytri Gupta, Isabelle Chiao Han Sung, and Chaoyan Dong. 2025. "The Impact of Empathy and Perspective-Taking on Medical Student Satisfaction and Performance: A Meta-Ethnography and Proposed Bow-Tie Model" International Medical Education 4, no. 4: 43. https://doi.org/10.3390/ime4040043

APA Style

Tang, C. T., Lim, L. J. H., Tang, H., Gupta, G., Sung, I. C. H., & Dong, C. (2025). The Impact of Empathy and Perspective-Taking on Medical Student Satisfaction and Performance: A Meta-Ethnography and Proposed Bow-Tie Model. International Medical Education, 4(4), 43. https://doi.org/10.3390/ime4040043

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