Impact of a fictional reading intervention on empathy development in student pharmacists

Comparing Narrative and Visual Arts for Empathy Enhancement in Nursing Postgraduate Education: A Mixed Method Study

BACKGROUND

Traditional empathy teaching methods fall short in addressing the heightened empathy demands of in-service postgraduate nurses. Art-based approaches offer potential solutions.

METHOD

We adopted a mixed method study with a quasi-experimental design. Two groups of in-service postgraduate nurses participated in narrative (n = 14) and visual (n = 13) arts interventions. Participants underwent four 45-minute sessions, including theory lectures and art-based interventions. Pre- and postcourse questionnaires assessed empathy and psychological capital.

RESULTS

The narrative arts group showed increased resilience (t = -2.775, p = .016) and secondary traumatic stress (t = -2.320, p = .037) postcourse. The visual arts group showed enhanced compassion satisfaction (t = -3.431, p = .005). Qualitative analysis identified two themes: empathy among participants and the benefits and challenges of the curriculum.

CONCLUSION

Incorporating both narrative and visual arts into nursing education could enhance empathy and well-being. Narrative arts enhanced resilience but increased secondary traumatic stress. Visual arts improved compassion satisfaction and offered a calming experience. [J Contin Educ Nurs. 2025;56(2):78-84.].

Pharmacists' empathy after a postgraduate course in narrative medicine: an observational study

BACKGROUND

Narrative medicine is a recent cross-disciplinary approach which through aesthetic activities such as reading fiction and creative writing aims to encourage empathy, reflection, professionalism, and trustworthiness in the encounter between patients and health care professionals.

AIM

The aim of this study was to evaluate changes in level of empathy after a postgraduate course in narrative medicine among pharmacists conducting medication counselling.

METHOD

During 2020-2021, three courses in narrative medicine among pharmacists with the aim to enhance empathy were held in Odense, Denmark. The primary outcome was the pharmacists' self-reported level of empathy before and after the course measured with Jefferson Scale of Empathy (JSE), which is a validated 20 item scale with higher scores indicating higher levels of cognitive empathy.

RESULTS

A total of 33 community and hospital pharmacists participated in the three courses. The pharmacists' median age was 41 years, 91% were female, 76% were working in community pharmacy, and 47% were, according to themselves, rare readers. The pharmacists completed the JSE scale before and after the course. A statistically significant increase was found in mean total JSE score from 109.9 ± 17.1 before the course to 115.7 ± 14.6 after the course (p = 0.0362).

CONCLUSION

Following the course in narrative medicine the level of empathy for the pharmacists according to JSE was enhanced. We recommend that future studies also use patient-reported outcomes to explore if the self-experienced enhanced empathy among pharmacists affects the patients' experience of their encounters.

Curricular Assessment Blueprint and Needs Analysis for the Social, Administrative, and Behavioral Foundational Sciences

OBJECTIVES

The objective of this integrative review is to analyze conceptual topics, applied content, teaching and learning strategies, and assessment methods within social, administrative, and behavioral sciences (SAS) syllabi and literature. The goal is to evaluate opportunities for enhancing the adoption and implementation of Curricular Outcomes and Entrustable Professional Activities 2022. Recommendations to better inform curriculum and assessment planning efforts are presented for programs and faculty seeking to optimize the integration of SAS content.

FINDINGS

Our search yielded 69 SAS-related syllabi from the American Association of Colleges of Pharmacy Connect repository and 296 publications from pharmacy journals focused on education. Most SAS literature was published in the didactic setting, which represents an opportunity to interweave and apply SAS knowledge concepts through the experiential, cocurricular, and interprofessional settings. In the future, it would be prudent to thoughtfully design assessment measures that encompass both summative and formative evaluations. The literature findings offer valuable insights and examples regarding content, teaching strategies, and assessment methods. These findings can serve as a practical framework, providing ideas and guidance for programs and faculty aiming to enhance the integration of SAS content into their curricula.

SUMMARY

In response to the recent guidelines from Curricular Outcomes and Entrustable Professional Activities 2022 and the release of the Accreditation Council for Pharmacy Education Standards 2025, programs and faculty have the responsibility to thoughtfully revise and improve the delivery and assessment of SAS content. The intentional integration of SAS knowledge, skills, and attitudes should be guided by a collaborative effort to develop pharmacists who deliver effective person-centered care and are well-equipped to navigate the complexities of health care.

Use and effectiveness of the arts for enhancing healthcare students' empathy skills: A mixed methods systematic review

OBJECTIVE

To identify, critically appraise and synthesise evidence of the use and effectiveness of the arts for enhancing pre-registration/prelicensure healthcare students' empathy skills.

DESIGN

A systematic review of mixed methods literature.

DATA SOURCES

A search of six electronic databases was conducted.

REVIEW METHODS

Articles describing English language, peer-reviewed, primary research studies reporting empathy as an outcome of an arts-based intervention with pre-registration/prelicensure healthcare students (years 1-7) and published between 2000 and 2024 were eligible for inclusion. The JBI Manual for Evidence Synthesis guided the review and a convergent segregated methodology was used to synthesise the results. Methodological rigour of included studies was examined using the Mixed Methods Appraisal Tool.

RESULTS

Twenty studies from 12 countries described the use of the arts to develop empathy, with visual arts being the most common approach (n = 8). Other modalities included film, drama, digital stories, literature, creative writing, music, poetry, photography and dance. Studies included nursing, medicine and dental, pharmacy and/or health sciences students. Ten studies used quantitative methods, three qualitative, and seven used mixed methods designs. Of the studies that presented pre-post outcome measures, nine reported significant gains in empathy scores at post-test and two reported non-significant gains in empathy. In eight studies, empathy scores demonstrated a significant intervention effect with effect sizes ranging from moderate (d = 0.52) to large (d = 1.19). Findings from qualitative studies revealed that arts pedagogies support students to better understand the perspectives of people with a lived experience of suffering but that these approaches are sometimes perceived negatively by students.

CONCLUSIONS

Arts interventions generally have a positive effect on healthcare students' empathy levels and enable a nuanced conceptual understanding of empathy. Arts modalities used as a stimulus for active learning and supported with facilitated group-based discussion and/or reflection, tend to be most effective.

Empathy and Coping Strategies Predict Quality of Life in Japanese Healthcare Professionals

Burnout and secondary traumatic stress (STS), also referred to as compassion fatigue, are undeniable negative consequences experienced by healthcare professionals when working with patients. As frontline healthcare professionals are essential to communities, it is crucial to understand their mental health and how they cope with negative psychological responses. This study investigated the relationships between burnout, STS, compassion satisfaction, dispositional empathy, and stress management among Japanese healthcare professionals and students taking care of patients in clinical practice. The participants were 506 Japanese healthcare professionals and students (doctors, nurses, medical students, and nursing students) affiliated with Japanese Ministry of Defense Hospitals. The data were collected from March 2020 to May 2021. We assessed burnout, STS, and compassion satisfaction using the Professional Quality of Life Scale, dispositional empathy using the Interpersonal Reactivity Index, and coping with stress using the Coping Orientation to Problems Experienced Inventory (Brief-COPE). Exploratory factor analysis of the Brief-COPE yielded three factors: active coping; support-seeking; and indirect coping. Personal distress, a self-oriented emotional empathy index, was related to higher burnout and STS scores and lower compassion satisfaction. Empathic concern, an other-oriented emotional empathy index, was associated with lower burnout and higher compassion satisfaction. Active coping strategies were associated with lower burnout and higher compassion satisfaction, whereas indirect coping strategies were associated with higher burnout and STS scores. In a comparison of empathy in professional categories, nurses presented higher personal distress than nursing students, and medical doctors showed lower fantasy tendencies than medical students. These results imply the complex relationships between empathy, coping strategies, and psychological responses among healthcare professionals. Further longitudinal study is needed to explore these complex relationships and to develop more precise and effective psycho-educational interventions to prevent burnout and STS.

Activities to promote empathy for patients among pharmacy learners: A scoping review

BACKGROUND

Provider empathy has been shown to be directly linked to improved patient outcomes. The objective of this scoping review of the literature was to identify and describe learning activities that promote empathy for patients among pharmacy learners.

METHODS

This scoping review was conducted using the following inclusion criteria: publication in English, activities conducted in any academic pharmacy training program (professional degree program, experiential, residency, or fellowship), description of the learning activity(ies) provided, and focus on the experience of empathy/caring/compassion for patients, either human or animal. Articles were excluded if they focused only on skills such as empathic responding or if they did not describe the learning experience. All study designs other than reviews were included.

RESULTS

The scoping review revealed 89 full-text articles that met the inclusion criteria. Included studies demonstrated a wide variety of approaches to the design of learning experiences as well as methods of measurement of empathy. Various types of learning modalities have been used to develop empathy in pharmacy learners, with reflection being the most common. A large proportion of studies that assessed empathy development used quasi-experimental or qualitative designs and did not report tests of statistical significance, which would make it difficult to compare the effectiveness of the different learning activities.

IMPLICATIONS

A variety of approaches have been used among pharmacy learners to develop empathy for patients. Due to the high level of variability in approaches, more rigorous studies are needed to assess the effectiveness of these learning activities.

Assessing the effect of empathy-enhancing interventions in health education and training: a systematic review of randomised controlled trials

OBJECTIVE

To estimate the effect of empathy interventions in health education and training from randomised controlled trials (RCTs).

METHODS

MEDLINE, PsycINFO, EMBASE, CINAHL and Cochrane databases were searched from inception to June 2019 for RCTs investigating the effect of empathy-enhancing interventions in medical and healthcare students and professionals. Studies measuring any aspect of 'clinical empathy' as a primary or secondary outcome were included. Two reviewers extracted data and assessed the risk of bias of eligible studies using the Cochrane Risk of Bias Tool. Random effects meta-analyses of the impact of empathy training on participants' empathy levels were performed.

RESULTS

Twenty-six trials were included, with 22 providing adequate data for meta-analysis. An overall moderate effect on participant empathy postintervention (standardised mean difference 0.52, 95% CI 0.36 to 0.67) was found. Heterogeneity across trial results was substantial (I²=63%). Data on sustainability of effect was provided by 11 trials and found a moderate effect size for improved empathy up until 12 weeks (0.69, 95% CI 0.23 to 1.15), and a small but statistically significant effect size for sustainability at 12 weeks and beyond (standardised mean difference 0.34, 95% CI 0.11 to 0.57). In total, 15 studies were considered to be either unclear or high risk of bias. The quality of evidence of included studies was low.

CONCLUSION

Findings suggest that empathy-enhancing interventions can be effective at cultivating and sustaining empathy with intervention specifics contributing to effectiveness. This review focuses on an important, growing area of medical education and provides guidance to those looking to develop effective interventions to enhance empathy in the healthcare setting. Further high-quality trials are needed that include patient-led outcome assessments and further evaluate the long-term sustainability of empathy training.

PROTOCOL REGISTRATION NUMBER

PROSPERO (CRD42019126843).

Using social media and focused learning activities to impact self-efficacy of empathy

BACKGROUND AND PURPOSE

Empathy is a component of emotional intelligence that is critical for healthcare professionals. Intentional learning activities utilizing social media platforms were developed to enhance student growth in self-efficacy of empathy and to assess how the incorporation of social media impacts pharmacy students' empathy and self-efficacy through self-reflection.

EDUCATIONAL ACTIVITY AND SETTING

Activities utilizing social media were implemented in a pharmacy skills lab course. This included following a social media story, focused classroom instruction, and writing personal reflections. Initial surveys assessed baseline empathy and self-efficacy. Post and "think back" surveys at the end of the semester re-assessed empathy and self-efficacy. Reflection assignments were designed to allow students to further self-reflect, and their responses provided qualitative data.

FINDINGS

Data was analyzed for 138 students in the fall semester of study year 1 (SY1) and 111 students in the fall semester of study year 2 (SY2). Overall, student empathy significantly decreased in both study years. However, student self-efficacy demonstrated a non-significant increase in SY1 and a significant increase in SY2. The "think-back" survey results demonstrated a significant increase in total self-efficacy for nine of the ten individual constructs. Qualitative findings supported perceived areas of growth.

SUMMARY

Although challenging to develop and assess empathy, social media can be an avenue for empathy skill development. This approach can easily be adapted by other schools of pharmacy and health professional programs to further develop self-efficacy regarding empathy.

Comparing Empathy Levels in Doctor of Pharmacy Students and Exemplary Pharmacist Preceptors

Objective. To determine how student pharmacists' empathy compares to that of exemplary pharmacist preceptors. Methods. First- through third-year Doctor of Pharmacy students and nominated preceptors demonstrating a model level of empathy in patient care were invited to take the Jefferson Scale of Empathy (JSE) and answer demographic questions. A comparison of total JSE scores was made between students and preceptors. Comparisons of total JSE scores were performed between male and female students, students with and without direct patient care experience, students with and without chronic care experience, and among students based on class year. A factor analysis was completed. Results. The response rate for students and preceptors was 70.3% (n=318) and 73.7% (n=14), respectively. No significant differences in median JSE scores were identified for any of the comparisons. Factor analysis revealed two factors as underlying constructs: "compassionate care" and "perspective taking." Seven of 20 items on the JSE had mean scores >6.0 (possible range 1-7). Conclusion. The majority of students had moderately high cognitive empathy not related to class year that was similar to that of exemplary pharmacist preceptors. A possible ceiling effect was found in several items on the JSE, potentially limiting its use for measuring changes in empathy longitudinally in students with baseline high empathy.