A Systematic Review of Compassion Training in Health Care.
To investigate the current state and quality of compassion education interventions offered to health care providers during training or practice, determine how the components of each education intervention map onto the domains of an empirically based clinical model of compassion, and identify the most common approaches to compassion education.
The MEDLINE, Embase, CINAHL Plus with Full Text, Sociological Abstracts, Web of Science, ERIC, and Education Research Complete databases were searched from inception to March 2020 in this systematic review. Studies that evaluated a compassion education intervention for health care providers or those in training to enhance compassion toward patients and/or families were included. A narrative synthesis of the included studies was performed. The components of each intervention were mapped onto the domains of compassion described in the Patient Compassion Model.
One hundred eight peer-reviewed publications describing 103 interventions were included. Modalities ranged from establishing curricula and interventions in clinical settings to programs that used humanities-based reflective practices, clinical simulation, role modeling, and contemplative practices, with many education interventions adopting a multimodal approach. Most interventions mapped to the virtuous response domain of the Patient Compassion Model; very few mapped to the other domains of this model.
Most interventions were limited as they focused on a single domain of compassion; did not adequately define compassion; were assessed exclusively by self-report; were devoid of a comparator/control group; and did not evaluate retention, sustainability, and translation to clinical practice over time. The authors suggest that compassion education interventions be grounded in an empirically based definition of compassion; use a competency-based approach; employ multimodal teaching methods that address the requisite attitudes, skills, behaviors, and knowledge within the multiple domains of compassion; evaluate learning over time; and incorporate patient, preceptor, and peer evaluations.
Compassion has been identified by patients as “a virtuous and intentional response to know a person, to discern their needs and ameliorate their suffering through relational understanding and action.” 1 Additionally, compassion is now recognized by medical professionals and health care providers as an essential feature of quality health care and a cornerstone of medical codes of ethics 2–4 and is arguably the greatest indicator of quality health care according to patients and family members. 5–10 The impact of compassion extends beyond patients’ perceptions, affecting symptom burden, 10–12 quality of life, 11 satisfaction with care, 9,10,13–15 health care provider–patient relationships, 16,17 patient disclosure and management of health issues, 16,18 and health care costs. 9,19 Further, among health care providers, compassion is associated with enhanced workplace well-being, job satisfaction, and retention. 10,18,20,21
Traditionally, contemporary health care provider training has undervalued the need to develop human aspects of medicine and care, such as compassion, empathy, respect, and interpersonal skills.
Since the Flexner Report in 1910, teaching, training, and practice within clinical medicine and nursing have been heavily grounded in a biomedical model, which explains and focuses on disease in scientific, pathologic, and physiologic terms. 24 More recently, due to the results and recommendations of system-wide health care reviews and surveys, 17,23,25–30 health care provider education is increasingly expected to embed aspects of compassion into the curriculum. 23,31
The challenges to developing compassion training programs are many, as compassion is a dynamic, individualized, and complex construct. 1,32,33 Further, compassion is mediated by the intrinsic qualities that learners possess before their health care training, which are cultivated through their family of origin, life experiences, spiritual traditions, personal suffering, and experiences of receiving and offering compassion. 1,31 Accordingly, compassion training programs must enable learners to develop the attitudes, knowledge, skills, and behaviors associated with compassion, while nurturing and sustaining the qualities of compassion that learners bring with them.
While the limitations of using conventional educational approaches to cultivate and sustain compassion are recognized, there is a lack of consensus on the teaching methods that are most effective for compassion education for health care providers. 22,34,35 As a prerequisite to developing effective compassion training programs for health care providers, the literature describing existing education interventions must be examined—an imperative step that, in spite of the array of reputed compassion training programs, has not been comprehensively conducted. One previous review concluded that curricula aimed at improving physician empathy and/or compassion were effective; however, this review was limited as it did not clearly differentiate between the constructs of empathy and compassion. 36
Establishing an empirical foundation of the literature will enable an evaluation of the performance of current compassion training programs and an understanding of the weaknesses that must be addressed in future studies and program development. The objectives of the present review were to: (1) perform a systematic review investigating the current state and quality of compassion education interventions (e.g., curricula, programs, workshops, rounds, professional development, lectures, seminars, rotations, training) offered to health care providers during training or practice, (2) determine how the components of each education intervention map onto the domains of an empirically based clinical model of compassion, 32 and (3) identify the most common approaches to compassion education.
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Published online: Academic Medicine, June 29, 2021.
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.
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