Facilitators and barriers to developing emotional intelligence during clinical training in healthcare settings: a mixed methods study of clinical pastoral education students

Emotional intelligence (EI), the capacity to perceive, use, understand, and manage emotions, is essential for healthcare chaplains supporting individuals experiencing spiritual and emotional distress. Clinical Pastoral Education (CPE), clinical training required for healthcare chaplains, serves as a key learning environment for developing EI. While research indicates that EI increases during CPE, student perspectives on what facilitates or hinders their EI growth remain underexplored. This study examined CPE students’ perceptions of facilitators and barriers to EI development during their clinical training. A concurrent mixed methods design analyzed data from 196 CPE students across 29 ACPE-accredited centers in 15 U.S. states. Surveys collected quantitative data on the perceived usefulness of curricular elements and qualitative open-ended responses to questions about facilitators and barriers to EI development. Data were analyzed in parallel using descriptive statistics and thematic analysis of 1,464 free-text statements, and findings were integrated through narrative weaving. Most participants (77.0%) reported their CPE programs included learning activities explicitly designed to foster EI. Four themes reflected students’ perceptions of what helped them develop EI: clinical practice experiences, group-based learning, reflective learning, and relational supervision and mentorship. Participants also identified learning about diversity, inclusion, and equity as facilitating their growth. Participants rated their clinical practice experiences (98.0%), verbatim case discussions (96.9%), and individual supervision/consultation (94.9%) as somewhat or very useful for increasing EI. Barrier themes included intrapersonal factors, interpersonal dynamics, structural challenges, and contextual factors. Participants identified CPE’s action-reflection learning model, grounded in supervised clinical experience and small-group learning, as supporting their EI development. They described trust, safety, time, and energy as necessary conditions for engaging with their own and others’ emotions. Their accounts suggest they experienced EI development as a relational process unfolding through interactions with patients, peers, educators, and themselves. Reported barriers, from personal fears to institutional pressures, indicate EI development occurs within, and may be shaped by, broader systems of clinical training and healthcare delivery. This reading invites viewing EI development not solely as an individual responsibility but also as a collective effort involving supportive relationships, organizational culture, openness to diversity, adequate resources, and institutional commitment.