**2. The Social-Emotional Skill Development Tool (SE-SD)**

In order to integrate the development of social–emotional skills into existing academic and training curricula in a wide field of subjects, a unique Social– Emotional Skill Development tool (SE-SD) that is based on guidelines for effective practices in social–emotional development (e.g. [31, 32]) has been recently developed. This tool is highly suited for healthcare education systems, in particular in light of the above-noted time constraints and the challenges imposed by a predominantly cognitive focus [2, 33].

The SE-SD tool offers a broad perspective on the field of healthcare education and addresses the need for non-cognitive social–emotional skills in the field. In addition, it aims to complement and to work in synergy with existing training tools and to support other professional skills. It can be further viewed more broadly as a method and pedagogy for integrating the development of social–emotional skills in healthcare training. By doing so, it is expected to enable students to cope with a changing healthcare reality and thrive in it.

#### **2.1 The social-emotional skill development tool: underlying principles**

The SE-SD tool is based on eight underlying principles:

#### *2.1.1 An inclusive theoretical framework*

The theoretical framework at the basis of the SE-SD tool is the well-established Bar-On [11] model of Emotional–Social Intelligence. This framework, which addresses both behaviors and outcomes, has been noted to be especially suitable for educational settings [34, 35] and has been employed successfully in the medical arena [36–38]. It allows for a holistic and inclusive development approach that has been noted especially effective in SEI trainings [39]. Similar to the Bar-On framework and associated tool (EQ-i), the SE-SD tool includes ten skills, nine such as emotional self-awareness and expression, self-regulation, empathy and interpersonal relations, social responsibility, flexibility, stress-tolerance, optimism and selfregard from the original Bar-On model (**Figure 1**) [11], with the addition of Growth Mindset. All linked to different aspects of various healthcare professions [25]. The SE-SD skills are arranged in 4 major clusters: intrapersonal, inter-personal, adaptability and stress-management, to which the well-being indicator of the original model has been added.

#### **Figure 1.**

## *2.1.2 A wide variety of pedagogical methods*

In line with the inclusive model at its basis and the wide variety of social– emotional skills it includes, the SE-SD tool addresses a offers a wide range of development assignments and a wide range of methodical tools (such as dedicated articles, video clips, short interviews, reflective questions, real-life experimentation, etc.). This variability is in line with earlier studies where the successful development of social–emotional skills was noted to include both cognitive and emotional components and to require varied and experiential methods [40].

#### *2.1.3 A curriculum-integrated approach*

It has been widely acknowledged that SEI development cannot be achieved by means of a single workshop [41–44] and requires an extensive, routinised, longterm effort that provides time for learning, practicing and achieving development [31]. A curriculum integrated approach allows for such extensive and long-term development efforts as well as for offering a contextual, rather than isolated, experience.

In line with these findings, the SE-SD tool has been designed to be integrated into existing course materials. This integrated approach helps students and instructors overcome time constraints as well as highlights the links between the targeted SEI skills and different aspects of the profession, making the development relevant and meaningful. Integration is achieved through two parallel processes: by linking specific social–emotional skills with the general course material; and through home assignments that target SEI development, are self-paced and are completed and evaluated at different points in time throughout the entire course.

#### *2.1.4 A generic tool*

Social–emotional skills have been noted to be relevant across a wide range of roles and positions in the field of healthcare [17].

Accordingly, the SE-SD tool, and in particular the assignments associated with each skill, were structured in a more general manner and therefore can be easily applied to a variety of subjects in the academic curriculum and can be integrated into a variety of healthcare academic courses, disciplines and academic levels.

### *2.1.5 Modularity*

The SE-SD tool can be used in a modular and "spiral" manner in order to integrate a wide range of skills into different courses throughout the academic program. Such modularity is particularly suited to the development of social–emotional skills, a process noted to involve continuous and lifelong learning [45, 46] and in which links between skills exist [11]. Importantly, while the SE-SD tool can be used in isolation, as part of a single course or a number of courses, a multiyear, spiral SEI development program which corresponds with the desired graduate vision can enhance the overall effectiveness and sustainability of the SEI development process [31] and ultimately contribute to the quality of healthcare professionals.

The nature of healthcare studies supports such modularity as healthcare students may need to employ different SEI skills at different stages of their academic training (pre-clinical and clinical years for example).

Finally, assignments that form part of the SE-SD tool are constructed in a modular fashion, building up from theory to practice. This modular structure is built on the premise that theoretical knowledge provides a foundation for the development of SEI [44] and that effective social–emotional development should follow several steps: the acquisition of a theoretical basis; and an understanding of the concept of EI and the specific SEI skills as they are being targeted, achieved through theoretical assignments. These are followed by gaining understanding of the relevance of the targeted skills to the course material and to future practice through reflective assignments. Practical assignments then provide a step-by-step opportunity to develop and practice newly acquired skills. Ideally, these steps lead to changes in habits, attitudes and behaviors [31, 44].
