The term ‘leisure reading’, often referred to as ‘pleasure reading’ and ‘voluntary reading’, is considered reading for enjoyment and something outside the curriculum. According to Clark and Rambold (2006), ‘reading for pleasure refers to reading that we do of our own free will, anticipating the satisfaction that we will get from the act of reading’. In leisure reading, reading materials are generally selected according to individual preferences without external influences. Leisure reading allows people to engage in reading, which gives them a sense of fulfilment (Clark & Rambold, 2006). Amidst a busy and tiresome academic schedule, a short break for leisure reading can provide many important benefits for medical students (Watson, 2016).

Novels, fiction, short stories, poetry, and drama are commonly available leisure reading materials. These leisure reading materials belong to different genres of literature such as realistic fiction, fantasy, mystery, romance, thriller, horror, adventure, biography, autobiography, true history and historical fiction, philosophy, religion, comedy, tragedy, poetry, personal development, news and folklore.

Different studies worldwide have investigated the benefits of leisure reading for various communities, age groups, and other social categories. This paper aims to understand the benefits of leisure reading for medical students through the available literature. Further, this study explored the initiatives of medical libraries to promote leisure reading based on literature. The study is a scoping review to gather all possible literature relevant to the objectives.

According to Rosenblatt’s theory (as cited in Damico et al., 2014), reading is an interactive process, and pleasure reading does not merely deal with decoding texts but involves readers’ cognitive and emotional responses. Readers can gain a more whole and meaningful experience when they enjoy the work they read. Damico et al. (2014) further mention that readers’ sociocultural experiences and backgrounds can influence the enjoyment they gain from reading. They further stated that the enjoyment gained through pleasure reading triggers readers to read more complex text forms and helps them get closer to their cultural identities.

Deci and Ryan (1985) formulated a theory called self-determination. This theory suggests that human motivation is controlled or driven by three basic psychological needs: autonomy, competence and relatedness. This theory applies to different phenomena where human cognition is involved. Concerning pleasure reading, ‘autonomy’ can be described as the ‘ability to select whatever reading material preferred by the reader’. When readers have autonomy, their reading texts relates more to their life experiences. ‘Competence’ relevant to pleasure reading can be described as innovative ideas gained, interpretation of texts, and confidence gained while reading. ‘Relatedness’ deals with the similarity between experiences gained through reading and the external environment.

Krashen’s Input Hypothesis (Ponniah & Krashen, 2008) is another foundational theory supporting the voluntary reading concept. According to Krashen’s concept of free voluntary reading, people who read different types of texts out of their personal interest and their own free will tend to gain considerable general knowledge and reading skills, leading to greater understanding. This refers to reading not confined to the borders of formal reading of educational material. Krashen’s framework can be a foundation for understanding the benefits gained by medical students through leisure reading.

Another theory related to leisure reading is the Theory of Mind (Premack & Woodruff, 1978). According to the Theory of Mind (ToM), humans and animals have developed the ability within themselves to understand others’ intentions and thoughts. These thoughts and intentions are not visible outwardly—they are unseen traits. ToM helps people and animals to predict what others do under certain circumstances. According to ToM, when people engage in leisure reading, the reader can identify the minds of different characters in the book. Neuroscience and psychological aspects of leisure reading are linked closely with this theory.

Studies by Mar, Oatley, and Peterson (2009) and Kidd and Castano (2013) have shown that leisure reading improves empathy and social cognition by allowing readers to stimulate the characters that appear in books mentally. These are vital requirements for medical students who should develop empathy, an essential quality in patient care.

Evidence from previous studies on leisure reading related to tertiary education can be found across various study disciplines. Applegate et al. (2014) studied the willingness for leisure reading among students in the second year and above and future teachers in a large public university in the USA. Considering its benefits, the study revealed a need to promote enthusiasm for leisure reading, especially among future educators. Brookbank (2023) reports that promoting a culture of leisure reading in academic institutions can boost students’ personal and academic development. Gallik (1999) explored the relationship between leisure reading habits and academic achievement of university students. He found a significant positive correlation between the time students spend on leisure reading during vacations and the marks they scored. Hurst et al. (2017) examined how the academic success of university students is affected by leisure reading. The findings revealed that students who read leisure material regularly achieved higher academic performance.

Kelly and Kneipp (2009) found that university students who engaged in leisure reading were creative thinkers compared to other students. MacAdam (1995) noted that the honours students in a university strongly preferred to read extra-curricular material for pleasure, and through an analysis, stated that leisure reading has a positive impact on the studies of university students. Martin-Chang et al. (2021) confirmed the positive effects of leisure reading on academic achievements, highlighting the significance of encouraging reading for pleasure among university students. Mahaffy (2009) examined how leisure reading affects academic accomplishment and found that students engaged in leisure reading have better grades. Mol and Bus (2011) explored the impact of exposure to literature on language and cognitive growth through a meta-analysis. They concluded that early and frequent reading involvement positively affects development. Above-mentioned papers collectively show how leisure reading has excreted a positive impact on the academic achievements of university students.

Nathanson, Pruslow and Levitt (2008) surveyed practising and aspiring teachers. They revealed that this group’s personal reading habits positively affected their teaching effectiveness. Salter and Brook (2007) investigated the reading preferences of library and information science professionals. They declared that many were passionate readers, but there was variability in reading frequency and preferences.

While the above-mentioned papers emphasise the importance of promoting leisure reading among university students belong to different study disciplines, this study investigates the effect of leisure reading on medical education.

What are the benefits of leisure reading for medical students, as reported by literature, and what are the evidence-based strategies medical libraries can implement to promote leisure reading habits among medical students?

A comprehensive literature search of electronic databases, including PubMed (MEDLINE), Google Scholar and JSTOR was conducted to identify relevant papers. No date limit was used. The Boolean operator OR was used to combine search terms of similar concepts: "pleasure reading", "leisure reading," "fun reading”, “recreational reading”, “free-choice reading”, “voluntary reading”, “personal reading”, “non-academic reading”, “informal reading”, “enjoyment reading’, “casual reading” and “light reading”. The results were combined with Boolean operator AND with the search terms of similar concepts combined with OR; “medical”, “medical student*”, “MBBS”, “MBBS student*”, “healthcare student*”, “medical School*”, “medical college*”, “medical facult*”, “medical librar*”. The links directed to related papers and reference lists were also checked to gather relevant papers. Further, the ‘Connected Papers’ platform was used to retrieve most relevant papers. A total number of 2355 documents were retrieved and were imported to the Zotero reference manager application. Forty-three (43) documents were removed as duplicates. The remaining number of 2312 documents were imported to Rayyan application. A double-blind peer review was conducted by two reviewers. Exclusion criteria were; scholarly papers about pleasure reading relevant to pre-school, elementary school and high school; scholarly papers about pleasure reading relevant to undergraduates who are not attached to medical schools, scholarly papers about curriculum-related reading; scholarly papers related to pleasure reading promotion and initiatives taken by non-medical libraries; scholarly papers written in languages other than English; scholarly papers which the full text content is not available. The inclusion criteria were scholarly papers about pleasure reading relevant to undergraduates attached to medical schools, faculties and colleges: leisure reading initiatives, scholarly papers on leisure reading promotion done by medical libraries; leisure reading initiatives by medical faculties. A majority of 2291 documents were excluded. Another one paper was excluded as the full-text content was not available. Only twenty (20) papers were selected for the review. The papers were reviewed focusing two key aspects relevant to the objectives as: benefits of leisure reading for medical students and evidence-based initiatives taken by medical libraries in pleasure reading among their undergraduate user community. Figure 1 shows the method of selection of sources of evidence according to PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) (Tricco et al.).

Thematic analysis was used to analyse the data, as mentioned by Braun and Clarke (2006). A total number of 20 scholarly papers were selected. Table 1 shows the complete set of papers selected for the study.

A total number of five (05) scholarly papers which discuss initiatives taken by medical libraries in promoting pleasure reading were identified. Table 2 shows the complete set of papers selected for the study.

The results and discussion identify all five (05) themes as benefits of leisure reading for medical students and are discussed based on similarities, differences of studies, and potential avenues for future research. Further, the initiatives medical libraries have taken to promote leisure reading among their users are discussed based on the five (05) papers identified.

The scholarly papers studied identified literature as an effective tool to cultivate empathy within a medical student. This scoping review detected multiple studies indicating similar findings showcasing literature as a tool for inculcating empathy in medical students, although they have used different approaches and methodologies.

For example, Calman (1988) and McLellan and Jones (1996) showed that integrating well-organized structured small-group discussions on literature into the curriculum helps medical students to develop their emotional intelligence as they focus on moral and ethical dilemmas.

On the other hand, Hampshire and Avery (2001) highlights the self-initiated reading experiences of students who read illness-related literature and how it triggered empathy in their minds. It is an example of self-directed approach without external inputs. A similar approach for a self-directed reading experience is described by Johnson (2016) which also discusses enhanced empathy.

On the other hand, Hampshire and Avery (2001) highlight the self-initiated reading experiences of students who read illness-related literature and how it triggered empathy in their minds. It is an example of a self-directed approach without external inputs. Johnson (2016) described a similar approach for a self-directed reading experience that discusses enhanced empathy. However, it is unclear which approach is more effective in inculcating empathy in medical students: structured small group discussions or self-directed approach.

Watson (2016) and Van Oosbree (2023) reveal survey findings on the effect of leisure reading developing empathy towards patients. However, neither study has considered controlling factors (confounding variables) such as personal experience for various illnesses and pre-exposure to literature. This makes it difficult to conclude whether the students who are naturally good readers and have read since childhood develop empathy towards patients or whether the novel reading approach they developed after entering the universities has made them more empathetic towards patients. Therefore, future studies must have proper control over confounding variables, enabling us to identify the pure impact of literature on the development of empathy in medical students.

Calman et al. (1988) and Mc Ateer and Murray (2003) have found that introducing literature courses to medical students encourages them to think more deeply about ethical dilemmas related to patient care. Jacobson et al. (2016) have shown that writing reflections on literature improves the analytical skills of medical students. However, Watson (2016) and Fan et al. (2010) have reported that medical students who read fiction voluntarily also develop strong cognitive abilities even without guided reading programmes.

According to McLellan and Jones (1996) and Jones (1999), fiction narrating ethical dilemmas provide an opportunity for medical students to think more about such difficult scenarios before facing them in reality. Hampshire and Avery (2001) has found that students who engage in reading fiction about patients achieve a broader view on real-life problems of patients and gain more confidence in ethical decision making. However, Beveridge (2003) and Fan et al. (2010) suggest that psychiatry students benefit more from reading literature because mental health care involves complex issues. However, no research has been conducted so far about different types of literature genres that have higher effects on different specialties in the field of medicine or whether a general approach works for all specialties. Hence, this is a potential avenue for future research.

According to Hodgson and Thomson (2000) and Piccoli et al. (2003), fiction improves students’ awareness of different cultures and makes them more sensitive to various patient needs. However, Shankar et al. (2008) and Watson (2016) have stated that medical students who read on their own learn more to adjust to different cultural settings than those who read only the required specified texts to complete their assignments.

Based on the findings mentioned above, a question arises as to whether medical students gain cultural awareness properly if leisure reading activities are assigned to them in their curriculum or whether they gain cultural awareness by voluntary reading. Future studies must compare these two settings, and the weight of cultural awareness gained.

Shankar et al. (2008) and Watson (2016) found that medical students who read fiction have lower stress levels than students who do not read fiction. Fan et al. (2010) found that a literature course introduced to medical students has contributed to elevating their emotional intelligence. Viqar et al. (2018) provided evidence of a significant drop in stress levels in medical students regularly engaged in leisure reading.

Nevertheless, literature-based stress relief will be ineffective for all medical students as there are many other stress-relieving modes, such as music, movies, and exercise. More research is necessary to understand the percentage of students who enjoy literature over other stress-relieving modes in the present context.

Based on Jerome M. Schneck’s study (1962), medical libraries can play a key role in promoting leisure reading to alleviate stress and enhance emotional well-being among healthcare professionals by maintaining collections that include medical biographies and autobiographies. Medical Libraries can support this initiative by recommending relevant literature, aiding book selection, and making leisure reading materials accessible to students.

According to Piccoli et al. (2003), Medical Libraries can take several initiatives to promote leisure reading among students. One of the main movements is committing a separate section in the library for non-medical books. This section must include literature such as novels, short stories, and non-fiction that touch on the essence of medicine, humanistic themes, medical ethics, patient-physician relationships and broader societal issues related to the medical context. Also, the libraries can organise seminars and interactive sessions to discuss literature. These materials can be promoted through book lists.

Dali and Dilevko (2006) investigates the under-utilisation of fiction in medical collections in academic health sciences libraries. The paper suggests methods for integrating fiction with non-fiction to improve the accessibility. It also proposes using the Literature, Arts, and Medicine Database (LAMD) to assign medical and health-related classification numbers and subject headings to the fiction titles available in a health sciences library. This method facilitates cataloguing and shelving fiction next to related non-fiction, making fiction more accessible to medical students.

According to Watson (2014), medical libraries can promote leisure reading by setting up separately dedicated ‘leisure reading sections’ within the library. These sections can offer students a range of materials such as novels, short stories, and non-fiction, focussing on medical as well as non-medical themes. Libraries can maintain and promote book lists that suit students’ interests, especially those related to medical humanities. Creating comfortable reading spaces with welcoming shelving and facilitating students’ book clubs can further encourage a culture of leisure reading.

A survey regarding the leisure reading habits of healthcare students conducted in a Canadian University analysed 213 responses from students from different fields, such as medicine, nursing, pharmacy and public health. Most students preferred print over digital leisure reading material. The respondents identified lack of time and fatigue as major barriers to leisure reading. They expressed willingness to support setting up a leisure reading collection within the health sciences library (Watson, 2016).

It is debatable whether medical libraries should promote leisure reading or make the leisure reading collection available exclusively for interested students. Future studies must investigate this argument to determine whether medical libraries should dedicate their resources and time to promote leisure reading.

This scoping review shows that leisure reading benefits medical students in five (05) constructive ways: (1) improving empathy, (2) critical thinking, (3) ethical decision-making, (4) cultural competence, and (5) stress management.

According to these findings, leisure reading is not an extra-curricular activity. It can be a strategic tool in medical education to improve medical students’ professional, emotional and thinking skills. These findings align with the expectations of medical humanities, which aim to build a well-rounded medical professional by equally developing knowledge and emotional competencies.

Today’s world observes the reality of a conflicting nature or the paradox of the scientific way of handling things and the medical profession with humane feelings. Worldwide, there is an increased concern about whether the medical profession is heading towards an inhumane nature. This scoping review emphasises that leisure reading or literature, can act as a bridge between the scientific rigour and the emotional intelligence of medical students. Literature helps medical students capture the humane side of clinical interventions by providing a more comprehensive picture of patient suffering.

Some medical schools have included the field of medical humanities in their curriculum. Under medical humanities, some medical schools have allowed students to follow literary courses, but not as compulsory activities (Hampshire and Avery, 2001; McLellan and Jones, 1996). Through this scoping review, we could not find information on the standardisation of literary courses and initiatives to monitor the effectiveness of such courses. Some medical educators who support the traditional curriculum argue that integrating such literary courses into medical school curricula is difficult as they are already overloaded with rigorous activities (Beveridge, 2003; Fan et al., 2010). These traditional medical educators argue that medical humanities courses are considered soft skills.

The gaps identified from the study:

According to the findings of this scoping review, there is limited evidence for medical libraries promoting leisure reading among their users. Medical libraries have taken a few initiatives, but these isolated efforts lack institutional backing.

Medical educators and medical libraries can make better decisions on leisure reading initiatives in medical schools by addressing these gaps. The medical library staff are obliged to collaborate with faculty members, especially with specialists in medical humanities, and research on the medical students’ reading habits. This scoping review provides clear evidence to prove that medical libraries have the potential to promote leisure reading among their users, but such efforts are untouched.

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