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.