Developing empathy as a foundation of client-centred practice: evaluation of a university curriculum initiative

Empathy, emotional intelligence and interprofessional skills in healthcare education

According to the World Health Organization (WHO), health professionals maintain the health of citizens through evidence-based medicine and caring. Students enroled in health professional programmes are required to have successfully attained all core learning outcomes by reaching key milestones throughout the course of their studies, demonstrating they have developed the required graduate skills and attributes upon completion of the programme. While some of the knowledge, skills and competencies that make up these learning outcomes are very discipline specific, there are more general professional skills across all disciplines which are difficult to define, such as empathy, emotional intelligence and interprofessional skills. These are at the heart of all health professional programmes that once defined, can be mapped through curricula and further evaluated. Literature will be presented on these three professional skills: empathy, emotional intelligence, and interprofessional skills, based on studies that focussed primarily in health professional programmes and highlight some of the key findings and issues at undergraduate and postgraduate levels. The paper will present the need for these skills to be defined and then mapped through curricula so that students are better supported in their professional development. Empathy, emotional intelligence and interprofessional skills transcend the discipline specific skills and as such it is important that all educators consider how best these may be fostered. Efforts should also be made to further the integration of these professional skills within curricula to produce health professionals with an enhanced focus on person-centred care.

The feasibility and acceptability of a dementia care training program for registered dietitian nutritionists

There is a need for more Registered Dietitian Nutritionists (RDNs) trained to provide nutritional care to older adults with dementia who experience mealtime difficulties. The purpose of this single-arm, pre/post pilot study was to adapt a generalized dementia care curriculum to the learning needs of RDNs who work with individuals with dementia and to determine the feasibility and acceptability of the adapted program. Using an existing evidence-based dementia care curriculum, the research team identified learning objectives and content pertinent to the scope of RDNs. The adapted program was piloted with RDNs who work with older adults with dementia. Twenty-five RDNs registered for the training while 80% (20) attended the training and completed the post-training survey. All participants agreed that the module met the learning needs of RDNs who work with older adults with dementia, the two-hour workshop was a good use of their time, and the experience and skills gained would be useful in their work as an RDN. Implementation costs totaled $1,310. Based on the post-training feedback, the adapted program was deemed feasible and acceptable by RDN participants, who also expressed interest in using the module to train other caregivers on providing mealtime assistance to older adults with dementia.

The impact of face-to-face mental health consumer-led teaching on occupational therapy student empathy levels: Two group comparison design

INTRODUCTION

Australian and New Zealand accreditation standards for occupational therapy courses mandate consumer involvement in the design, delivery, and evaluation of courses. Consumer involvement in medical, dental, and nursing education has been evidenced as a factor for increasing student empathy. To date, there has been no known research on the impact of mental health consumer involvement on occupational therapy students' empathy. The aim of this study was to investigate if occupational therapy students who receive teaching from a mental health consumer demonstrate higher levels of empathy compared with students who receive teaching delivered by occupational therapy academics.

METHODS

Pre-post, quasi experimental, two group comparison design was used to measure second-year student empathy pre and post a consumer-led teaching tutorial. Students (N = 217) were randomised into two groups across three university campuses: 'teaching as usual group' (control) or 'consumer-led' group (experimental group). The Jefferson Scale of Empathy was used to measure student empathy.

RESULTS

N = 138 matched scales were returned. Little difference in empathy scales was detected between groups. The 'consumer-led' group increased for the empathy scale by 3.4(95% CI: 0.7,6.1, p = 0.014) but was not statistically significant compared to 1.3(95% CI: -1.0,3.5, p = 0.267) for the control group. Both groups scored highly on empathy.

CONCLUSION

This study found that occupational therapy students had pre-existing high levels of empathy. The challenge for future research is to identify appropriate ways to measure the impact of mental health consumer involvement on occupational therapy curriculum and students.

Empathy in occupational therapy students: a cross-sectional study at a Spanish university

INTRODUCTION

Empathy is an important interpersonal skill and a fundamental component in the professional-patient relationship, being the basis for implementing person-centred practice. In several studies, a decrease in empathy levels throughout training in medicine, nursing or dentistry, among others, has been shown. There are few studies on the occupational therapy branch of healthcare. The aim was to determine the degree of empathy perceived by students of occupational therapy at a Spanish university, as well as to analyse the differences between empathy levels according to the different degree courses and gender.

METHODS

A descriptive cross-sectional study was designed with a sample of 221 occupational therapy students from a Spanish university. The Davis Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy-Health Profession Student's Spanish version (JSPE-HPS-S) were used as outcome measures.

RESULTS

According to the results found, high level of empathy was found on all dimension of the IRI (69.84 (9.80)) and the JSPE-HPS-S (122 (94-140)). Although high levels of empathy among occupational therapy students are observed in all degree courses, no significant differences were found between them. Statistically significant differences and a moderate effect size (r) were found between the variables according to the gender of the participants, with females showing greater empathy in the overall scores of the IRI as well as in the JSPE-HPS-S (p=0.002, r=0.212; p=0.001, r=0.327, respectively).

CONCLUSIONS

Empathy is an essential competence for the development of quality occupational therapy practice. According to the results and although occupational therapy students showed high levels of empathy, it is important to pay attention to the evolution of empathy and to provide students with learning experiences that prevent its possible decline.

Plurality of perspective: Doctor-parents of deaf children in a low-to middle-income country

OBJECTIVES

Pediatric deafness is an important consideration in neurodevelopment. Early identification and intervention are major factors in seeing that deaf children reach their full potential. Often, it is the medical professionals who themselves have limited knowledge about hearing loss or the consequences of delayed language acquisition. These knowledge gaps can negatively influence the timeous and holistic care that children with hearing loss require. With a dual experiential expertise gained through both parenting children with disabling hearing loss and being medical doctors, the purpose of this study was to better understand the field of pediatric hearing loss through doctors' insights gained as parents.

STUDY DESIGN

Interpretative Phenomenological Analysis was the approach used for this qualitative enquiry. Five South African participants with children between the ages of two and ten years, were selected using purposive sampling and an in-depth semi-structured interview used as the data instrument. Thereafter, three levels of thematic analysis were conducted.

RESULTS

Generally, doctors have limited knowledge of pediatric deafness. Perceptions towards deafness are typically through a medical-model lens, while appreciation of Universal Newborn Hearing Screening is lacking. Through exploring the various gains of parenting a deaf child, participants acknowledged the power of the lived experience in changing their own practice as both parents and practitioners.

CONCLUSION

Doctors need to know more about pediatric deafness. The pathway of care from identification to intervention in South Africa needs revision. Exposure to the lived experience is a powerful means of enabling expert insights to influence such change in a practical and meaningful way.

Engaging persons with disabilities as community teachers for experiential learning in occupational therapy education

Background

Cultivating empathy towards persons with disabilities has been highlighted as an essential graduate attribute in the occupational therapy profession.

Purpose

With the aim to developing a more holistic understanding of disability, this project seeks to translate an experiential learning activity developed in Canada to the local Singaporean context. Small groups of two to three students were paired with a person with physical disability, known as a community teacher, for a series of visits to observe and participate in their self-care, productivity and leisure activities.

Method

A sequential explanatory mixed methods design was adopted with the administration of an adapted version of the Multidimensional Attitudes Scale Towards Persons with Disabilities on 51 first year occupational therapy students. Seventeen students participated in three focus group discussions at the end of the learning activity.

Findings: Comparison of pre- and post-scores using Wilcoxon signed-rank tests of all three subscales of the Multidimensional Attitudes Scale Towards Persons with Disabilities yielded significant improvements. The average score for Affect improved from 42.94 to 32.08, z = −5.43, P <  .001; for Cognition improved from 26.12 to 21.41, z = −4.20, P <  .001; for Behaviour improved from 23.78 to 20.65, z= −4.44, P <  .001. Effect sizes ranged from medium to large. Thematic analysis of focus groups led to the identification of four themes that explained these improvements.

Implications: Experiential learning can be effective in cultivating empathy and improving attitudes of occupational therapy students towards persons with disabilities. There is potential to expand this pedagogical approach to other health sciences disciplines.

Enhancing student occupational therapists' client-centred counselling skills

BACKGROUND

Client-centred practice is the cornerstone of the occupational therapy profession. However, there has been little focus on how to teach students to be client-centred practitioners while engaged in counselling.

PURPOSE

The purpose of this study was to examine the impact of the use of a client-completed rating scale on student occupational therapists' client-centred counselling skills.

METHOD

A time-series design was used to measure the changes in students' counselling skills over time. Demographic information was collected prior to time one. An online questionnaire was administered after study completion to explore students' experiences of using the Session Rating Scale.

FINDINGS

The impact of using the Session Rating Scale as a measure of students' client-centred counselling skills performance significantly improved over time. Most students valued using the rating scale and would recommend its use for future students.

IMPLICATIONS

The process of supporting students to learn how to engage clients in providing timely feedback and using this feedback to design treatment sets the stage for integration and application of client-centred practice.

The Development of Client-Centredness in Student Occupational Therapists

Introduction:

While the occupational therapy profession emphasizes the importance of a client-centred approach, the student perspective on development of client-centredness has been absent in the research literature. The purpose of this grounded theory study was to gain an understanding of occupational therapy students' perceptions of the curricular and practice experiences that contributed to their client-centred development.

Method:

Study participants were recruited from three cohorts (n = 29) of an entry-level Canadian occupational therapy programme: students from two separate years of an occupational therapy programme, and graduates from the programme who were 1 year into practice. Researchers conducted six focus groups using a semi-structured interview guide; focus group transcripts were reviewed to develop a coding scheme. Emergent categories were collapsed to develop overarching themes.

Findings:

Six developmental themes were constructed: Internalizing client-centredness; Relationship building; Who is the client?; Systems influences; Academic/practice discrepancy; and Power and control. Each theme was of greater or lesser emphasis at different points, and participants revisited and expanded upon themes throughout their academic programme.

Conclusion:

Academic and placement educators can use the findings of the study to understand how student occupational therapists develop client-centredness. Educators can use this understanding to implement strategies to intentionally foster client-centred development in students at opportune times.

Improving client-centered brain injury rehabilitation through research-based theater

Traumatic brain injury often results in physical, behavioral, and cognitive impairments perceived by health care practitioners to limit or exclude clients' full participation in treatment decision making. We used qualitative methods to evaluate the short- and long-term impact of "After the Crash: A Play About Brain Injury," a research-based drama designed to teach client-centered care principles to brain injury rehabilitation staff. We conducted interviews and observations with staff of two inpatient neurorehabilitation units in Ontario, Canada. Findings demonstrate the effectiveness of the play in influencing practice through the avoidance of medical jargon to improve clients' understanding and participation in treatment; newfound appreciation for clients' needs for emotional expression and sexual intimacy; increased involvement of family caregivers; and avoidance of staff discussions as if clients were unaware. These findings suggest that research-based drama can effect reflexivity, empathy, and practice change to facilitate a client-centered culture of practice in brain injury rehabilitation.

Levels of empathy in undergraduate occupational therapy students

Empathy is an important attribute for occupational therapists in establishing rapport and in better understanding their clients. However, empathy can be compromised by high workloads, personal stressors and pressures to demonstrate efficacy. Occupational therapists also work with patients from a variety of diagnostic groups. The objective of this study was to determine the extent of empathy and attitudes towards clients amongst undergraduate occupational therapy students at one Australian University. A cross-sectional study was undertaken using a written survey of the Jefferson Scale of Physician Empathy (JSPE) and the Medical Condition Regard Scale. Overall, a strong level of empathy was reported amongst students. Four medical conditions that occupational therapists work with (stroke, cerebral palsy, traumatic brain injury and depression) were held in high regard. Substance abuse, however, was held in comparatively low regard. Overall, the year of study appeared to have no significant impact on the students' empathy. Despite having a lower reported empathy level than found in health professions from other studies using the JSPE, occupational therapy students were found to have a good level of empathy. Of concern, however, was the bias reported against the medical condition of substance abuse, highlighting that the there may be a need to reinforce that patients from this diagnostic group are equally deserving of quality care irrespective of their clinical condition. Recommendations for future research include completing a longitudinal study of occupational therapy students' empathy levels and investigating the empathy levels of occupational therapists working with different client groups. Limitations of the study include the convenience sampling of occupational therapy students enrolled at one university which limits the generalizability of the results to groups of participants with similar characteristics.

Graduates' Reflections on their Preparation for Practice

New graduates are the life blood of the occupational therapy profession. It is important that they are equipped to practise in the current health care environment and are confident about their professional contribution. This New Zealand study explored new graduates' perceptions of how well they had been prepared for practice, using three focus groups of graduates from one occupational therapy programme. The findings confirmed that the biggest issues for new graduates were searching for role clarity, inadequate supervision, an insufficient grasp of skills and uncertainty in team responsibility, underpinned by a lack of confidence. Conversely, they felt confident about their ability to research and find information in response to gaps in their knowledge.

This study demonstrates that learning how to ‘be’ an occupational therapist is as important as receiving formal supervision, and suggests that learning how to contextualise and reconstruct knowledge is essential in preparation for graduation. The stressful situations experienced in the first months of practice could be minimised through opportunities to learn how to repackage knowledge, observe role models and have supervision that provides confirmation of plans and bridges the theory-practice divide.