The results of this study show an improvement in the cognitive dimension of empathy in nursing students and the affective dimension of empathy of TECA in physiotherapy ones. In addition, total perceived EI end emotional clarity dimensions showed better scores in both nursing/physiotherapy students and in emotional repair (TMMS-24) in nursing degree, at post-intervention. Finally, an overall improvement in cognitive (perspective-taking) and emotional dimension (personal distress) of empathy (IRI) was founded among occupational therapy students after an academic coaching intervention.
Literature about the use of academic coaching in health sciences is still limited in comparison to fields such as sports, music, business and even medicine [10, 27]. To our knowledge, no previous studies have analysed, the effect of academic coaching on self-perception of EI and empathy among students of health sciences in the three disciplines studied herein. The literature review reveals that, at present, researchers are questioning whether the traditional methods of teaching and learning are capable of preparing health sciences students effectively and adequately for their future clinical placements [14, 15, 17, 18]. In this line, we have observed that the scientific evidence proposes numerous alternative approaches to teaching, in addition to coaching, with a view to improving learning outcomes among students of health sciences and other disciplines. Occasionally, however, the results of these approaches are contradictory.
On the one hand, there are studies that demonstrate the effectiveness of these new methodologies, such as conducted by Ward et al. [7] with physiotherapy students. They explored how a new approach to learning, using a virtual cultural simulation experience and guided reflection, significantly improved students’ intrapersonal cultural empathy and their level of satisfaction with the learning experience. In a recent study conducted by Martín et al. [28] with students from a university where classes are taught online, the authors suggested that educational coaching offers an efficient and effective means of helping students to achieve success in their university studies. In the study by Bas-Sarmiento et al. [1], nursing students were given empathy training via methodologies directly related to coaching, such as simulation through role-playing, behaviour assay, flipped classroom and reflective writing. The results of the study indicated that the training was effective in improving the students’ levels of empathy. Similarly, the quasi-experimental prospective study conducted by Fortune et al. [29] also adopted a new teaching methodology, in combination with coaching, to implement a training programme for physiotherapy and occupational therapy students involving the use of motivational interviews. The results showed that the training improved the levels of confidence and empathy in both groups of students. In this line, Mueller et al. [30] analysed the impact of an online evidence-based course on empathy, resilience and work engagement, which was attended by physiotherapy students during their clinical placements. The results of the study suggested that online capacity-building can have a positive impact on empathy, resilience and work engagement among physiotherapy students, and that it could also be applied to other health sciences degrees. Also, the pre-post quasi-experimental study of Romano et al. [31], that assess the impact of a health coaching program in 25 nursing students in Italy, showed statistically significant improvement in the students’ perception of their own stress management skills after the intervention, so the health coaching intervention could improve performance of nursing students [31].
However, other studies do not support the effectiveness of these new methodologies so conclusively. In this line a randomised controlled trial conducted in Germany with students of medicine, measured the improvement in the students’ empathy levels after they had completed a training programme involving simulated patients [9]. Their results were compared with a control group, the experimental group showed significantly higher levels of empathy when they were scored by the patients and experts, but no significant differences were observed between the groups in their self-assessment of rich their attitudes towards empathy [9]. Likewise, an experimental study was conducted with second-year physiotherapy students in which the effectiveness of two educational approaches – self-directed learning and traditional instruction – were compared in terms of the level of knowledge acquisition, optimism, hope and resilience, among other variables. No significant differences were found between the groups for any of these variables, and the authors concluded that more and longer-term research was needed in order to determine whether students benefited from self-directed learning [32].
With regard to the results, we obtained for the TECA, we have not found any published studies that used the same test on a similar sample. The scores for the nursing students were mid-range, in terms of their overall scores as well as those for the different subscales. Physiotherapy and occupational therapy students recorded higher overall scores in TECA’s subscales, with the exception of the Empathic Stress subscale, where the scores were average. However, it should be noted that a high score in the Empathic Stress subscale indicates a certain tendency to become over-involved in the problems of others, consequently, a lower score would indicate a more suitable level of emotional involvement in interpersonal relationships [22].
In the results obtained for the TMMS-24, both the overall scores and those of the subscales demonstrated adequate levels of perceived EI following the intervention, for all three groups (Attention: 22 ≥ x ≤ 35; Clarity and Repair: 24 ≥ x ≤ 35). We observed also a significant improvement in the overall test scores for nursing and physiotherapy students after the intervention. In line with our results, Yoong et al., in 2023 showed that EI improved significantly in nursing students who had participated in a palliative and end-of-life simulation program [32]. However, there were no such changes for the occupational therapy students. In contrast, Polonio-López et al. [34], in which study the TMMS-24 was used to measure the EI of occupational therapy students before and after they carried out their clinical placements, demonstrated that a program centred on “practical training” the students improved their attention to feelings, their emotional clarity and the regulation of their emotions related to EI. In this respect, a number of studies have analysed the relationship between the levels of EI in health sciences students and their ability to pursue a professional career in the future. In this line, Andonian et al. [35] conducted a study with occupational therapy students from 36 universities in the United States. The authors concluded that the students’ levels of EI improved when they were able to undertake clinical placements, which in turn correlated positively with improved communication and intervention skills. Brown et al. [36] examined the question of whether the EI and personality traits of occupational therapy students were predictors of their teamwork skills. The results showed that the variables of emotional reasoning, emotional self-management, emotional management of others and the personality traits of extroversion and emotional stability were significant predictors of the students’ teamwork skills. Similarly, another study [37] explored changes in EI among physiotherapy, occupational therapy and speech therapy students using the Emotional Quotient Inventory 2.0 (EQ-i 2.0), before and after they carried out their clinical placements. The results showed a significant reduction in assertiveness, while the rest of the scores showed no significant increases.
With regard to IRI, if we compare the results we obtained for the health sciences students with the results of the study conducted by Jiang et al. [38] in China with students from other university degree programmes, such as the arts, science and engineering, in which the authors measured empathy using the same scale, we can see that empathy levels as recorded in the IRI are much higher for the health sciences students (as observed in our results) compared to students from other disciplines, where the total average score for the scale was 37.73 points. These findings concur with the study conducted by Holmes et al. [11] which notes that, over the last 30 years, there has been a reduction in the empathy levels of university students in general, although the levels remain higher in health sciences students than in students from other disciplines. The study also highlights the observation that the empathy levels of these students lessen as they progress further into their studies. In this respect, Mueller et al. [30] affirm that academic staff in the physiotherapy field have observed a constant increase in students’ emotional distress and, in general, students of healthcare-related subjects often experience fatigue and a loss of empathy. Moreover, the situation worsens as they progress further into their studies. In the study conducted by Ogino et al. [39] with nursing professionals, the participants obtained a significantly lower score on the Fantasy subscale of the IRI compared to the control group. These lower scores indicated that the nurses had a greater tendency, in comparison to the control group, to adopt a more realistic view, which helped them to care for patients practically and efficiently regardless of their emotional state. In our study, which was conducted with students, the scores for this specific subscale of the IRI were lower for the nursing students than those from other disciplines; moreover, these scores became lower still after the coaching intervention.
Our results for the IRI are also supported by those of the study conducted by Ardenghi et al. [40] with students of medicine, in which the IRI scores are very similar to those recorded in our study and fall within similar ranges. All of these results can help us to highlight the importance of conducting tests and trials to assess empathy and EI, and the importance of taking specific steps to develop these skills, with particular reference (as we explored in our study) to health sciences students prior to the commencement of their clinical practice.
The pilot nature of our study excluded key features of a pivotal clinical trial, including a large sample size, blinding of the intervention and a control group. As clinical implications, it is worth mentioning that adherence to the intervention was good (100%) completed the intervention and surveys; and we speculate that the lack of worsening post-intervention evidences the effectiveness of our training program. In addition, aspects of empathy and emotional intelligence have improved, which seems to indicate that coaching can play an important role in the success of students of health sciences. However, without control group, we can only speculate on what the outcome of the group will be without intervention. So, this study provides preliminary data to design a subsequent clinical trial. Our study design is in line with studies which we have mentioned previously that performance and pre-post study [7, 29, 33, 34] or not include a control group [32, 35,36,37,38, 40,41,42]. Also, in line with our results, a prospective single-arm intervention study conducted in 2019, which evaluated a program of two group and two private training sessions in first-year medical students, obtained good adherence since 37 of 39 (94.9%) completed the protocol [41]. A recent study that evaluated the opinions of different stakeholders (students, faculty members and educational mangers) about the practice of coaching showed that the perception about coaching practices in the three groups were positive and supportive of each other, so their results support the implementation of coaching in nursing education programs [42].
However, other studies have included a control group [20, 30, 31] or have carried out a randomized clinical trial [43]. Coaching is also used in health professionals, in this sense the study by Pollak et al. [20], 2020, with intervention through communication coaching to teach motivational interviews to palliative care clinicians, determined that compared to the control group, the intervention group showed higher motivational interviewing skills scores, higher communication skills, and better burnout scores. Thus, it appears that coaching can improve communication among palliative care clinicians [20]. Also, in this line, in a recent randomized clinical trial Pollak et al., 2023, analysed the effect of a coaching intervention to improve cardiologists’ communication with patients. Their results showed that the skills of expressing empathy and eliciting questions improved after the intervention in the coaching group, which could improve patients’ experience and understanding of the information [43].
Finally, we should also highlight the importance of training the academic staff and professionals who serve as the students’ clinical tutors, as they can directly influence the students’ acquisition of these skills. In our study we have considered up to four control variables that can influence the development of the training program (the training medium, the number of training sessions, the duration of the training program and the demographics of the trainers). However, previous studies highlight the lack of consensus on these variables and therefore the need to carry out future studies where these aspects are analysed in depth [10, 14,15,16, 20, 25, 26]. They also highlight the need to include and check these variables when implementing a coaching program.
Limitation
This study has significant limitations. Firstly, we selected a convenience sample of health sciences students from nursing, physiotherapy and occupational therapy degrees, thus our results cannot be generalised to other degree programmes. Secondly, although our study’s pilot nature offers preliminary data regarding coaching efficacy, further studies are required including a large sample size and a control group with clinical trial desing to corroborate and verify our conclusions. Furthermore, because this was not a randomized study with a control group, the effects of coaching intervention cannot be separated from non-specific effects. In this sense, we have also not been able to blind the participants in the study or the coaches who conduct the sessions due to the nature of the intervention, although the coaches were blinded to outcome measures and baseline examination findings. Thirdly there are significant differences regarding the gender of our sample, as there were fewer male participants than female. We were therefore unable to break down the analysis according to gender. However, the proportion of male students in this study is similar to – and representative of – the proportion of male students enrolled in these three degrees at our university. Fourthly the short duration of coaching intervention makes it necessary for future research to evaluate the effects over a longer period, and to extend the follow-up period. Accordingly, caution is needed in extrapolating the results of our study. Consequently, we believe new studies should be conducted that include a higher number of male students and students from different universities. We have considered four control variables that can influence the development of the training program (the training medium, the number of training sessions, the duration of the training program and the demographics of the trainers), however, future studies where analyzing these aspects in depth are necessary. Lastly, there is still no consensus regarding the definition of empathy [44], which makes it a difficult quality to measure. Additionally, we used self-reported questionnaires to empathy and EI, which means the participants’ subjectivity, could affect the results. Also some students may have given socially acceptable responses that are not a true reflection of their empathy skills. However, we have used scales that were available in Spanish and measure empathy from a multi-dimensional perspective by incorporating both emotional and affective aspects, thereby offering a more complex approach to the subject.
