The importance of empathy and compassion in healthcare cannot be overstated. In healthcare, empathy and compassion both refer to the same two key components: understanding other perspectives and acting to relieve suffering. This can apply to both patients and colleagues. In this knowledge article, I refer to empathy and compassion interchangeably.

Empathy strengthens doctor-patient relationships, boosts patient outcomes and satisfaction, increases professional satisfaction, improves clinical competence, and reduces potential burnout among healthcare professionals (Byrne et al., 2024; Malenfant et al., 2022; Winter et al.,  2020). Despite these benefits, empathy remains poorly nurtured in medical education and postgraduation training (Zhou et al., 2021).

Leaders who practice compassion are often perceived as more effective (Sinclair et al., 2021).. They are better able to inspire and motivate their teams, leading to higher levels of engagement and performance among healthcare providers. This type of leadership is associated with enhanced problem-solving and decision-making capabilities within healthcare teams (Östergård et al., 2023).

In this knowledge article, I provide a brief summary of recent evidence of compassion training for healthcare professionals, specifically focusing on systematic reviews and scoping reviews. I also refer to Byrne et als 2024 umbrella review encompassing 25 reviews of this topic (Byrne et al., 2024).

Impact of compassion training

Recent reviews have reported positive effects of various empathy-enhancing interventions aimed at healthcare students and professionals (Bas-Sarmiento et al., 2020; Boshra et al., 2022; Lajante et  al., 2023; Malenfant et al., 2022; Menezes et al., 2021; Patel et al., 2019;  Pearson et al., 2007; Sinclair et al., 2021; Winter et al., 2020; Zhou et al.,  2021). In Byrne’s umbrella review, qualitative findings included improved self-awareness, perspective-taking, and motivation to engage empathetically. Quantitative findings included positive effects at the learning level (Kirkpatrick Level 2) with moderate to large effect sizes. Small improvements or uncertain effects were found at the behaviour (Kirkpatrick Level 3) and patient outcome levels (Kirkpatrick Level 4). Limited studies included long-term follow-up, and those that did showed mixed results, with some indicating a decline in empathy over time (Byrne et al., 2024; Winter et al., 2020).

Educational methods

Most curricula in included reviews used multiple training methodologies, such as a combination of didactic teaching, small-group discussions, reflection and practical components.

Experiential interventions which involve practical, hands-on experiences and reflective practice, such as simulation, role-playing and real patient interactions, were found to be more effective than traditional didactic approaches in enhancing empathy (Bas-Sarmiento et al., 2020; Boshra et al., 2022; Byrne et  al., 2024; Menezes et al., 2021; Patel et al., 2019; Sinclair et al., 2021;  Zhou et al., 2021). These methods also increased students' understanding of patients' perspectives and knowledge retention. Face-to-face interventions were noted to be beneficial (Byrne et al., 2024).

Both short and long-duration interventions were effective, though longer interventions showed better results in some reviews (Menezes et al., 2021; Winter et al., 2020). Follow-up training was crucial for sustained behavior change (Byrne et al., 2024).

Having access to compassionate mentors and role models who can demonstrate and teach compassionate behaviors was found to be a powerful enabler (Malenfant et al., 2022). Other components of successful programmes included repeated practice, personalised feedback, guided reflection, and opportunities for perspective taking (Byrne et al., 2024).

Educational content

Compassion training programmes need to be comprehensive and tailored to the diverse learning and specialty needs of specific healthcare providers and organisations (Byrne et al., 2024; Sinclair et al., 2021).

Content relating to communication skills was associated with higher-level outcomes (Winter et al., 2020; Zhou et al., 2021). Reflective practice was found to promote insights into behaviours and attitudes, promoting self-awareness and emotional intelligence (Byrne et al., 2024; Malenfant et al., 2022; Sinclair et al.,  2021). This process can lead to a more profound and genuine expression of compassion. Mindfulness training was also associated with higher level outcomes in two reviews (Menezes et al., 2021; Zhou et al., 2021).

Limitations

In many of these reviews, substantial heterogeneity was found across individual included studies and many studies were at high or unclear risk of bias. The overall quality of evidence of individual studies was often low. Most studies used self-reported measures of empathy. As a result, there was a lack of reviews reporting higher Kirkpatrick level outcomes (behaviour and patient outcomes). There is a general lack of evidence for the efficacy of various assessment tools in measuring empathy (Winter et al., 2020; Zhou et al., 2021). Higher quality studies, with medium and long-term follow up, predefined core outcomes, and objective and valdiated measures are recommended for future research on this topic.

Conclusion

The findings from these articles underscore the importance of empathy in healthcare and the effectiveness of various empathy-enhancing interventions. However, the heterogeneity of interventions and the low methodological quality of individual studies in existing literature make it difficult to draw definitive conclusions on best practices for interventions and the precise outcome effect size. Use of adult learning and behavior change principles (debriefing, feedback, self-reflection, experiential learning) was found to be most effective in producing desired outcomes. Experiential and immersive experiences, along with patient-involved education, were found to be particularly effective. Long-term interventions and role-modelling were also associated with greater impact. Content related to communication and self-reflection showed the strongest association with positive outcomes. While empathy-enhancing interventions can be effective, further high-quality trials are needed, especially those that include patient-led outcome assessments and evaluate long-term sustainability.

References

Bas-Sarmiento,  P., Fernández-Gutiérrez, M., Baena-Baños, M., Correro-Bermejo, A.,  Soler-Martins, P. S., & de la Torre-Moyano, S. (2020). Empathy training in  health sciences: A systematic review. Nurse Education in Practice, 44.  https://doi.org/10.1016/J.NEPR.2020.102739

Boshra, M., Lee,  A., Kim, I., Malek-Adamian, E., Yau, M., & Ladonna, K. A. (2022). Canadian  Medical Education Journal Revue canadienne de l’éducation médicale When  patients teach students empathy: A systematic review of interventions for  promoting medical student empathy Quand les patients enseignent l’empathie aux  étudiants : une revue systématique des interventions visant à promouvoir  l’empathie chez les étudiants en médecine. 13(6), 2022.  https://doi.org/10.36834/cmej.73058

Byrne, M.,  Campos, C., Daly, S., Lok, B., & Miles, A. (2024). The current state of  empathy, compassion and person-centred communication training in healthcare:  An umbrella review. Patient Education and Counseling, 119,  108063. https://doi.org/10.1016/J.PEC.2023.108063

Lajante, M.,  Prete, M. Del, Sasseville, B., Rouleau, G., Gagnon, M. P., & Pelletier, N.  (2023). Empathy training for service employees: A mixed-methods systematic  review. PLOS ONE, 18(8).  https://doi.org/10.1371/JOURNAL.PONE.0289793

Malenfant, S.,  Jaggi, P., Hayden, K. A., & Sinclair, S. (2022). Compassion in healthcare:  an updated scoping review of the literature. BMC Palliative Care, 21(1),  1–28. https://doi.org/10.1186/S12904-022-00942-3/FIGURES/2

Menezes, P.,  Guraya, S. Y., & Guraya, S. S. (2021). A Systematic Review of Educational  Interventions and Their Impact on Empathy and Compassion of Undergraduate  Medical Students. Frontiers in Medicine, 8, 758377.  https://doi.org/10.3389/FMED.2021.758377/FULL

Östergård, K.,  Kuha, S., & Kanste, O. (2023). Health-care leaders’ and professionals’  experiences and perceptions of compassionate leadership: A mixed-methods  systematic review. Leadership in Health Services.  https://doi.org/10.1108/LHS-06-2023-0043

Patel, S.,  Pelletier-Bui, A., Smith, S., Roberts, M. B., Kilgannon, H., Trzeciak, S.,  & Roberts, B. W. (2019). Curricula for empathy and compassion training in  medical education: A systematic review. PLoS ONE, 14(8).  https://doi.org/10.1371/JOURNAL.PONE.0221412

Pearson, A.,  Laschinger, H., Porritt, K., Jordan, Z., Tucker, D., & Long, L. (2007).  Comprehensive systematic review of evidence on developing and sustaining  nursing leadership that fosters a healthy work environment in healthcare. International  Journal of Evidence-Based Healthcare, 5(2), 208–253.  https://doi.org/10.1111/J.1479-6988.2007.00065.X

Sinclair, S.,  Kondejewski, J., Jaggi, P., Roze des Ordons, A. L., Kassam, A., Hayden, K. A.,  Harris, D., & Hack, T. F. (2021). What works for whom in compassion  training programs offered to practicing healthcare providers: a realist  review. BMC Medical Education, 21(1), 1–17.  https://doi.org/10.1186/S12909-021-02863-W/TABLES/3

Winter, R., Issa,  E., Roberts, N., Norman, R. I., & Howick, J. (2020). Assessing the effect  of empathy-enhancing interventions in health education and training: a  systematic review of randomised controlled trials. BMJ Open, 10(9),  e036471. https://doi.org/10.1136/BMJOPEN-2019-036471

Zhou, Y. C., Tan,  S. R., Tan, C. G. H., Ng, M. S. P., Lim, K. H., Tan, L. H. E., Ong, Y. T.,  Cheong, C. W. S., Chin, A. M. C., Chiam, M., Chia, E. W. Y., Lim, C., Wijaya,  L., Chowdhury, A. R., Kwek, J. W., Fong, W., Somasundaram, N., Ong, E. K.,  Mason, S., & Krishna, L. K. R. (2021). A systematic scoping review of  approaches to teaching and assessing empathy in medicine. BMC Medical  Education 2021 21:1, 21(1), 1–15.  https://doi.org/10.1186/S12909-021-02697-6