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PLoS One. 2019 Aug 22;14(8):e0221412. doi: 10.1371/journal.pone.0221412. eCollection 2019.

Curricula for empathy and compassion training in medical education: A systematic review.

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Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, United States of America.
Institutional Research and Outcomes Assessment, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States of America.
Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, United States of America.
Department of Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, United States of America.



Empathy and compassion are vital components of health care quality; however, physicians frequently miss opportunities for empathy and compassion in patient care. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective.


We searched CENTRAL, MEDLINE, EMBASE, and CINAHL using a previously published comprehensive search strategy. We screened reference lists of the articles meeting inclusion criteria to identify additional studies for potential inclusion. Study inclusion criteria were: (1) intervention arm in which subjects underwent an educational curriculum aimed at enhancing empathy and/or compassion; (2) clearly defined control arm in which subjects did not receive the curriculum; (3) curriculum was tested on physicians (or physicians-in-training); and (4) outcome measure assessing the effect of the curriculum on physician empathy and/or compassion. We performed a qualitative analysis to collate and tabulate effects of tested curricula according to recommended methodology from the Cochrane Handbook. We used the Cochrane Collaboration's tool for assessing risk of bias.


Fifty-two studies (total n = 5,316) met inclusion criteria. Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure. We identified the following key behaviors to be effective: (1) sitting (versus standing) during the interview; (2) detecting patients' non-verbal cues of emotion; (3) recognizing and responding to opportunities for compassion; (4) non-verbal communication of caring (e.g. eye contact); and (5) verbal statements of acknowledgement, validation, and support. These behaviors were found to improve patient perception of physician empathy and/or compassion.


Evidence suggests that training can enhance physician empathy and compassion. Training curricula should incorporate the specific behaviors identified in this report.

Conflict of interest statement

Dr. Trzeciak is the author of a book on compassion science entitled “Compassionomics”. No other authors have disclosures to report. We confirm that this does not alter our adherence to all PLOS ONE policies on sharing data and materials.

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