*2.1.8 A flexible and dynamic tool*

The SE-SD tool is both flexible and adaptable. The tool's flexibility is manifested in the choice of SEI skills that are to be associated with a given course, in the links drawn between these skills and the course materials, in the number of assignments chosen from the selection offered and in the variety of these assignments. The tool offers further flexibility in terms of feedbacks and evaluations: instructors can limit themselves to the two formal evaluations (intermediate and final) that are provided as part of the tool, but may choose to provide additional informal and more frequent feedbacks. Furthermore, additional skills to those offered in the model can be added, consistent with the principles embedded in the tool: designing developmental activities and assignments that would support knowledge acquisition and enhance the understanding of these skills, determining the relevance of the added skill to a particular course, and identifying starting points and goals for each of the participants.

Taken together, these features of the SE-SD allow healthcare education systems to include social–emotional development as a strategic plan for preparing students and workers for a changing professional reality.

#### **2.2 Inculcating the model: methodological considerations**

Skill-development processes often follow a sequence of stages that have been recognized to contribute to effective development (e.g. [31, 41, 47]). These include: preparation (gaining students' commitment, identifying needs, and jointly designing a development program); action (implementing the program – introduction and development); and evaluation. In the case of the SE-SD tool and healthcare education settings, these stages have been adapted to meet the specific requirements of various healthcare professions (**Figure 2**).

#### *2.2.1 Preparation*

The preparation stage begins with the selection of an SEI skill to be developed during a given course. This skill, selected by the course instructor from a list of social–emotional skills offered in the tool (**Figure 1**), is chosen based on its degree of relevance to the course material and its suitability in terms of the students' academic level.

#### **Figure 2.**

*Process of model implementation.*

The course instructor then plans how to integrate the skill into the course material. For example, if integrated into a course that focuses on patient-caregiver relationships, the instructor may decide to discuss empathy as part of a segment that examines how to deliver difficult news to patients.

Lastly, the course instructor goes over the SE-SD assignment list and chooses assignments that correspond to the selected skill.

When a three-year process is involved, these steps are followed in group discussions where faculty members jointly decide on the skills to be introduced each year and the classes they most fit.

#### *2.2.2 Action*

The action stage includes two parts, introduction and development.

#### *2.2.2.1 Introduction*

This part of the action stage is designed to highlight the relevance and importance of SEI to the students and to promote motivation to participate in the EI development process. The course instructor begins by introducing the concept of social–emotional skills to the students, highlights the relevance of these skills to the course and notes their importance to students' overall growth and future careers in the 21st century.

Following these introductory remarks, the SE-SD model and tool are presented and the methods by which the development process will be incorporated into the course, both during class and by means of home assignments and their evaluation, are explained. The instructor notes the order by which the assignments are to be completed, the corresponding time frames, and the formative evaluation method by which they would be assessed.

#### *2.2.2.2 Development*

The development part of the action stage relies on individual home assignments that students are asked to carry out throughout the entire course. Students are instructed to complete the assignments in a pre-determined order and can only access subsequent assignments after completing the previous ones. In line with the

structure of the SE-SD tool, the assignments include three hierarchical segments: Theoretical background, Exploration, and Practice.


### *2.2.3 Evaluation*

Finally, during the evaluation segment, students are provided with feedbacks and formative assessments that can help them further develop their social– emotional skills. These feedbacks and evaluations are provided by their course instructors at two points in time during each course: mid-term (which coincides with the goal-setting stage of the development process) and at the end of the course (after all assignments have been completed). These feedbacks are accompanied by self-evaluations.

As noted above, participant students are evaluated based on their level of commitment, efforts and engagement in the development process (as opposed to the level of development that has been achieved); their level of understanding of the targeted EI skill; and the level of personal and professional reflectiveness they demonstrate throughout the entire course.

Furthermore, beyond the mid-term and end-of-term evaluations, instructors can choose to provide additional evaluations and feedbacks in the course of the program, in accordance with available time resources.
