Compassionate care is an essential value in medicine and nursing 1,14,15,17, increasingly relevant in clinical practice 18, and one of the main indicators of healthcare quality 12. It impacts in patients' well-being, satisfaction, symptomatic distress, quality of life, therapeutic relationship, and communication. Furthermore, it influences therapeutic decisions and healthcare costs 2,18,36. Despite its acknowledged importance, offering compassionate care consistently remains a challenge within healthcare education and practice37.
Over the past decade, efforts have been made to develop policies and standards aimed at promoting compassionate care in healthcare institutions and systems, as well as in the training of healthcare personnel 29,38–40. Consequently, integrating compassionate care training into health sciences curricula has become imperative. 29.
The results of the evaluation of our programs indicate that both explicitly and implicitly offer some form of training in compassionate care. This offering is greater in nursing (47 vs. 32), which aligns with the historical consideration that compassion and care are the essence of nursing 26,41. However, an international study involving 1,323 nurses from 15 countries (including Colombia) found that only 11% of them believed that sufficient training related to compassionate care was offered, while 44% felt it was inadequate 42. Despite the recognition that healthcare personnel need to acquire competencies in compassionate care and that this requires training, there is still uncertainty about how to provide this type of training in health professions schools, leading to the development of various models and efforts to formalize it in curricula 17,26–28.
In the medicine program, we observe that the contents related to compassionate care declared in the syllabi are very scarce: only five out of 64 courses, accounting for 8%, while through the surveys, we identified 32 courses (50%). Similarly, about 50% of the teachers and less than 40% of the students and alumni indicated that the program included content related to compassionate care. Consequently, training in compassionate care tends to appear little and implicitly in our program, becoming part of a hidden curriculum 3.
Despite these non-technical skills being essential for clinical performance and development, when they remain hidden, they are not addressed and evaluated as much as technical skills 3,5,6, even though they constitute a desired, planned, and valuable content for professional practice 5,38. Thus, contents in health programs often disintegrate biomedical knowledge from human skills, emphasizing clinical competencies and neglecting soft skills such as compassion 43.
In the nursing program, we found that training in compassionate care is frequently declared in the program (25 courses, corresponding to 37%), and identified by participants in an additional 17, for a total of 42 courses (62%). These findings suggest that compassionate care appears repeatedly, across the program, and explicitly throughout the courses, although some components remain implicit. This is consistent with the universal consideration that compassion is a core value in nursing that permeates its education, enabling nurses to empathize with the patient's suffering and alleviate it 44,45. For example, a qualitative study conducted at a university in Colombia found that students believe there is a close relationship between care and compassion, determining their work and their development as good professionals 45.
However, when contrasting the information obtained from the programs with the perceptions of the survey participants, we found that 78% of teachers believe that content related to compassionate care is addressed in the training, while only 42% of students and 57% of alumni think so. This could reflect the need to make the teaching/learning and assessment processes related to compassionate care more intentional 3. In this regard, the literature has highlighted the importance of promoting compassion training to increase the quality of care, understanding that such training occurs mainly through experiential activities where students are exposed to situations of compassionate care with patients, family members, and teachers themselves, in practice environments that foster compassionate care and reflection on associated values 34,44–46. The literature also suggests the need to make compassionate care visible in the curriculum to protect students and professionals from the consequences that may arise from constant exposure to suffering, such as compassion fatigue, and burnout, among other issues related to their work 29,47,48.
Concerning specific contents, communication skills were the most addressed in both programs (four courses in medicine and 13 in nursing). Teamwork is taken up in two medicine courses and six nursing courses. It is also noteworthy that only one nursing course and none in medicine explicitly addresses self-care. While communication skills strengthen the therapeutic relationship and enable clinical work based on attention, care, empathy, and compassion, it is necessary to promote other competencies related to collaborative work, self-compassion, and self-care to strengthen relational aspects and reduce the negative consequences of care 12,28,31. Conversely, participants had difficulty identifying courses that emphasized the development of empathic skills, which are a prerequisite for compassionate care and a central element in the therapeutic relationship 48; Evidence shows how these skills tend to decline throughout professional training, requiring specific pedagogical strategies to maintain and promote them 49–51.
Teaching methodologies predominantly rely on traditional approaches such as lectures and clinical practices, despite evidence suggesting the effectiveness of experiential and reflective methods in promoting empathy and compassion52. The literature has shown that strategies using didactics, experiential activities, small group work, role-playing, and standardized patients are more effective in training empathy and compassion 48. Specifically, Schwartz rounds, which consist of regularly scheduled discussion spaces to discuss the emotional and social challenges of patient care, enable compassionate care and self-compassion, improvement of relational and communicative skills, and collaborative work 53. In summary, the recommendation is to use experiential, reflective, and participatory teaching methods to achieve meaningful learning about compassionate care 28,34,48,53,54.
When examining assessment strategies, we find that formative assessments are used as summative ones, although a large percentage of students and alumni claim that these contents are not evaluated or do not remember them being evaluated. Exams with closed or open-ended questions are more commonly used, occasionally supplemented by practical assessments. The evaluation of these non-technical skills is not done regularly in academic programs and involves significant challenges 3,29,38; however, it is convenient for students to recognize their knowledge, capacities, and weaknesses, and to become aware of their personal processes, favoring change and transcendence 55,56 This evaluation can take various forms, with self-assessment, feedback from teachers and peers, and discussions of strengths and areas for improvement being essential for learning 3,57.
The study findings shed light on the status of compassionate care training within the medicine and nursing programs, revealing both strengths and areas for improvement. It also provides evidence for further programs willing to improve compassionate care education.
In the medicine program, training in compassionate care predominantly appears implicitly within syllabi, consistent with the information provided by all participants. Conversely, in nursing, such training is mostly declared in the syllabi, which aligns with the results reported primarily by teachers but to a lesser extent by students and alumni. These findings are consistent with some reports in the literature, highlighting significant challenges for compassionate care training in undergraduate health sciences programs 29,42,48.
Communication and therapeutic relationship competencies emerge as the most addressed areas across both programs, with collaboration-related content being less prevalent. The scarcity of content related to self-care is notable, despite its importance for the well-being and mental health of future professionals 22,23,31. However, participants' perceptions in the surveys indicate ambiguous results, perhaps because these contents tend to be implicit. Achieving a better balance in the training of the mentioned aspects could contribute to the comprehensive development of competencies in students, promoting not only better therapeutic and teamwork relationships but also the development of competencies for personal well-being 21,31.
Finally, we also identified opportunities for improvement in teaching-learning methodologies and competency assessment. Recommendations emphasize the adoption of active, participatory strategies that facilitate interaction, reflection, and external feedback. Such approaches are crucial for promoting meaningful engagement with compassionate care concepts and fostering skill development among students. 25,53,55.