The benefits of compassion in healthcare are impressive and expansive – compassion is known to improve patient outcomes and experiences, enhance healthcare provider (HCP) well-being and job satisfaction, and even lower healthcare costs [1] [2]. It is therefore no surprise that patients, HCPs, policy makers, and healthcare institutions all wish to increase compassion in practice, so why is it still found to be lacking? And how can the underlying objective of improving compassion be achieved?
One way to increase compassion in healthcare systems would be through specific and targeted compassion training initiatives. Previously we discussed the controversial topic of whether compassion is teachable [See: Can compassion be taught?], and while we concluded that it is, the nuts and bolts of implementing compassion training in a feasible and effective manner are not so obvious or a simple feat. Compassion is a multi-faceted construct, dynamic in nature, and needs to be delivered in a personalized manner. Further, since HCP learners bring unique baselines of compassion [See: Cultivating Compassion] to the table, it is unlikely that a “one-size-fits-all” training program would be an effective approach. At the same time, while a learner-centred approach is essential, this does not imply that we need to reinvent the wheel in every instance of training compassion. So what could and should be the core content and teaching methods of compassion training? Let’s begin by looking at what current compassion education programs offer.
In our recent systematic review, we analyzed an array of studies to determine current approaches to compassion education [1]. While we found that most education interventions were developed for physicians and nurses in training (as opposed to practicing HCPs), and adopted a multimodal approach to training, these programs had some significant limitations. A couple major limitations of compassion education programs are the lack of a clear definition of compassion and the tendency to focus on a single domain of compassion – virtuous response – while neglecting other essential domains of compassion, such as seeking to understand, relational communication, relational space, and attending to needs [3]. Imagine a math class that exclusively instructed learners about addition without considering subtraction, division, or multiplication. This finite focus would greatly constrain the scope of the education and any applicability to solving practical or real-life problems. There is no doubt that virtuous response (the generation of compassionate qualities and feelings within learners) is important, but it is not the whole story.
Beyond this, a promising compassion education program should not just cover the multiple and dynamic facets of compassion, but also be taught through a multimodal approach to address requisite attitudes, skills, and knowledge of the learners. Just as a math class may use card games, reciting times tables, and counting manipulatives to crystallize students’ skills, compassion trainings could include clinical simulations, safe discussions spaces, role-modelling, patient panels, and contemplative or reflective learning opportunities [1][4]. Another limitation that we identified in our review was that most compassion programs measured outcomes of training exclusively using learner self-reports – a myopic approach that is liable to the same pitfalls as developing a model of compassion without including the perspectives of patients. Given the reciprocal and relational nature of compassion, garnering insight from patients, peers, and preceptors is paramount to evaluating learner competencies and the overall training program, including its perceived benefits.
While gaining competency through evidence informed and competency-based compassion training is essential, aspiring to master the topic or to become an expert, in the traditional sense, is likely a futile endeavour, counter productive, and antithetical to the topic itself. Compassion competency is a life-long endeavour. To sustain and grow in their compassion, learners require ongoing training opportunities, access to educational resources, and an organizational culture and clinical learning environment that tangibly supports the refinement of these skills over time, knowing that learners will either ‘use it, or lose it’. In addition to our review on the state of the science of compassion training, we also conducted a realist review focused on the contextual features of successful training programs – asking “what works for whom, how, and in what contexts” [4]. These contextual considerations to implementing a compassion training program move us beyond the curriculum, which is particularly important to ensuring the success of compassion training programs. Offering both online and in-person modalities of learning, reducing dissonance and isolation by training the whole staff, utilizing highly experienced and compassionate program facilitators who are knowledgeable about the specific healthcare context and topic, securing and sustaining senior management and institutional support, and utilizing a valid and reliable measure of compassion to evaluate the program itself are important practical details to making compassion training an ongoing success [4].
Finally, just as patients wouldn’t want the compassion they receive at the bedside to be contrived, scripted, or standardized, a uniform blanketed approach to learners and compassion training is unhelpful and contrary to the personalized nature of compassion itself. In the same way that compassion must be tailored to individual patients, compassion training calls for a learner-centred approach that recognizes variance in compassion aptitude and learning styles – it’s not “one size fits all”.
Photo by James Baldwin on Unsplash
Works Cited
[1] Sinclair, S., Kondejewski,J., Jaggi, P., Dennett, L., Roze, des O. A. L., & Hack, T. F. (2021). What is the state of compassion education? A systematic review of compassion training in health care. Academic Medicine : Journal of the Association of American Medical Colleges, 96(7), 1057–1070. https://doi.org/10.1097/ACM.0000000000004114
[2] Sinclair, S., Norris, J. M., McConnell, S. J., Chochinov, H. M., Hack, T. F., Hagen, N. A., McClement, S., & Raffin-Bouchal, S.R. (2016). Compassion: a scoping review of the healthcare literature. BMC Palliative Care, 15, 6–6. https://doi.org/10.1186/s12904-016-0080-0
[3] Sinclair, S., McClement, S., Raffin-Bouchal, S., Hack, T. F., Hagen, N. A., McConnell, S., & Chochinov,H. M. (2016). Compassion in Health Care: An Empirical Model. Journal of pain and symptom management, 51(2), 193–203. https://doi.org/10.1016/j.jpainsymman.2015.10.009
[4] Sinclair,S., Kondejewski, J., Jaggi, P., Roze des Ordons, A., Kassam, A., Hayden,A., Harris, D., Hack, TF. (2021). What works for whom in compassion training programs offered to practicing healthcare providers: A realist review. BMC Medical Education. 21(455). https://doi.org/10.1186/s12909-021-02863-w
