title: The application of heterogeneous cluster grouping to reflective writing for medical humanities literature study to enhance students' empathy, critical thinking, and reflective writing.
abstract: BACKGROUND
  To facilitate interdisciplinary collaboration and to make connections between patients' diseases and their social/cultural contexts, the study examined whether the use of heterogeneous cluster grouping in reflective writing for medical humanities literature acquisition could have positive effects on medical university students in terms of empathy, critical thinking, and reflective writing.
  
  
  METHODS
  A 15-week quasi-experimental design was conducted to investigate the learning outcomes. After conducting cluster algorithms, heterogeneous learning clusters (experimental group; n = 43) and non-heterogeneous learning clusters (control group; n = 43) were derived for a medical humanities literature study. Before and after the intervention, an Empathy Scale in Patient Care (ES-PC), a critical thinking disposition assessment (CTDA-R), and a reflective writing test were administered to both groups.
  
  
  RESULTS
  The findings showed that on the empathy scale, significant differences in the "behavioral empathy," "affective empathy," and overall sections existed between the post-test mean scores of the experimental group and those of the control group, but such differences did not exist in "intelligent empathy." Regarding critical thinking, there were significant differences in "systematicity and analyticity," "skepticism and well-informed," "maturity and skepticism," and overall sections. As for reflective writing, significant differences existed in "ideas," "voice and point of view," "critical thinking and representation," "depth of reflection on personal growth," and overall sections, but not in "focus and context structure" and "language and conventions."
  
  
  CONCLUSIONS
  This study outlined an alternative for using heterogeneous cluster grouping in reflective writing about medical humanities literature to facilitate interdisciplinary cooperation to provide more humanizing medical care.
authors: Department of Health Services Administration, Chung Shan Medical University, Taichung, Taiwan.|Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors: Hung-Chang
authors: HC
authors: Liao
authors: Department of Applied Foreign Languages, Chung Shan Medical University, 110, Sec. 1, Jian-Koa N. Road, Taichung, 402, Taiwan. yhuei@csmu.edu.tw.|Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan. yhuei@csmu.edu.tw.
authors: Ya-Huei
authors: YH
authors: Wang
mesh_terms: D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004645:Empathy; D006809:Humanities / Q000193:education*; D006801:Humans; D008091:Literature; D010817:Physician-Patient Relations; D015397:Program Evaluation; D013337:Students, Medical / Q000523:psychology*; D013850:Thinking; D014956:Writing
keywords: Critical thinking; Empathy; Heterogeneous grouping; Medical humanities literature study; Reflective writing