In Reply to Kim

We thank Dr. Kim for her comments on our article. I understand the author’s letter to say that social empathy must be grounded in experience. There is indeed evidence suggesting that students who have direct contact with patients in need, or with communities suffering from disadvantage and inequity, are more committed to those individuals and those communities.1 So I agree wholeheartedly with the intent of the author’s message. Until institutions provide ample, longitudinal, and substantive opportunities to serve, we as educators have not realized the full potential of our social mission. Empathy is what I call “groomed proximity.” That is, while empathy requires close contact to activate emotion and understanding, it must be nurtured to achieve the desired commitment. There are many ways to enhance direct experience, including fostering within the medical culture the values that underpin social responsibility. Empathy is malleable, and there are very good studies demonstrating this.2 We have observed firsthand the importance of creating a culture of empathy because we are more exposed than ever to a cultural narrative that can sway our beliefs, sometimes to the detriment of specific groups, but sometimes with heartening results. According to a recent study, for example, narrative-formatted stories “produce more compassion toward the individuals in the story, more favorable attitudes toward the group, more beneficial behavioral intentions, and more information-seeking behavior.”3 So I think it’s safe to say that it takes a village to ensure the solidity of social justice initiatives. Some of us envision a theoretical framework, some think up objectives and competencies, others replace the old portraits of middle-aged white men lining our hallways with images of women and people of color. Still others go out into the trenches and fight the good fight. There are many ways to make inroads, but I agree with Dr. Kim that direct experience is essential if not sufficient for change. Caroline Wellbery, MDProfessor, Department of Family Medicine, Georgetown University School of Medicine, Washington, DC; [email protected]; ORCID: https://orcid.org/0000-0002-5785-0378.