Document Type (Journals)

Original Research


Clinical empathy has been identified as an essential skill for healthcare workers to provide quality healthcare. One teaching strategy for improving clinical empathy towards people with psychiatric disabilities is the Hearing Voices Simulation. This study used an explanatory sequential mixed methods design to evaluate change in clinical empathy among occupational therapy students after participating in the Hearing Voices Simulation. Participants (N=71) completed the Jefferson Scale of Empathy- Health Professions Student Version (JSE-HPS) prior to and following the simulation. A paired samples t-test compared whether the change in scale scores was equal to zero. Subsequently, focus groups were used to collect qualitative data. This study found that although already high at baseline, mean JSE-HPS scores increased significantly following the simulation experiences (p=.004). Four main themes emerged from the focus groups: 1) temporary discomfort, 2) improved understanding, 3) reformulating stigmatizing attitudes and sharing with others, and 4) planned changes for fieldwork and future clinical practice. Auditory simulations may increase occupational therapy students’ empathy. Occupational therapy programs may consider the Hearing Voices Simulation or other simulations for improving clinical empathy among students.


Molly Whitlow, PhD, MPH is an Assistant Professor at the University of Nebraska Medical Center's College of Allied Health Professions in the Division of Occupational Therapy Education. Her scholarly activity focuses on access to health services, social and structural determinants of health, and research methods and methodology.

Anna Carl, OTS is an occupational therapy student in Creighton University’s entry-level Doctor of Occupational Therapy program.

Dr. Andrea Thinnes, OTD, OTR/L is an Associate Professor at Creighton University’s School of Pharmacy and Health Professions. Her scholarly activity focuses on the development of empathy in occupational therapy students, interprofessional education experiences for health professions students and faculty, and expanding the critical role of occupational therapy with survivors of sex trafficking.

Declaration of Interest

The authors report no declarations of interests.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.