Compassion Training Sticks: New Study Shows How Clinicians Put Caring Into Practice

Compassion sits at the heart of healthcare. Patients expect it, providers want to deliver it, and decades of clinical experience suggest it shapes the quality of care in profound ways. Yet healthcare providers routinely report struggling to express compassion within the pressures of modern health systems, and most receive little or no formal training in how to do it. A new study published in BMC Medical Education offers a detailed look at what happens when clinicians and senior leaders are actually taught the skills of compassion—and then followed up nine months later to see whether those lessons survived contact with the real world.

The research, led by Shane Sinclair of the University of Calgary’s Faculty of Nursing and Compassion Research Lab, with colleagues including Swati Dhingra, Shelley Raffin Bouchal, Amanda Roze des Ordons, Daranne Harris, and Cara MacInnis, examined the implementation of a program called EnACT—short for Evidence-informed, Competency-based, and Accredited, Compassion Training. The program was delivered to healthcare providers and senior leaders across two long-term care and hospice settings. Rather than asking participants simply whether they liked the course, the team interviewed twenty-one participants nine months after training to investigate how, and whether, the knowledge, skills, and resources from EnACT had been woven into daily clinical practice and workplace culture.

The methodological backbone of the study is the Knowledge to Action Cycle developed by Graham and colleagues, a widely used framework in implementation science that maps the journey of knowledge from the classroom to the bedside. The interview guide was prospectively designed to probe participants’ experiences across six stages of knowledge implementation: adapting knowledge to the local context; assessing barriers and facilitators to knowledge use; selecting, tailoring, and implementing interventions; monitoring knowledge use; evaluating outcomes; and sustaining knowledge use. The team then conducted a theoretically informed thematic analysis using Braun and Clarke’s original framework, a rigorous approach to identifying patterns across qualitative interview data.

The findings are striking in their consistency. Participants were highly satisfied with the EnACT program and described it as practical, clinically relevant, evidence-based, impactful, and malleable enough to fit both their personal practice and their workplaces. This matters because the study’s authors point out that existing compassion training programs have long struggled with limitations around transferability, feasibility, clinical relevance, validity, and sustainability. In other words, many programs teach compassion in ways that do not survive the transition to demanding clinical environments. EnACT was explicitly designed to close those gaps, and the nine-month follow-up suggests that design paid off.

The qualitative analysis identified themes that mapped neatly onto the six adapted Knowledge-to-Action stages. In the first theme, learners described adapting the training’s learnings to their own clinical practice and care culture—deciding for themselves what was valuable, useful, and appropriate for their particular setting. In the second, participants identified the contextual barriers and facilitators they encountered when trying to implement what they had learned, from the rhythm of frontline work to the attitudes of the surrounding team. The third theme captured their experiences of the specific interventions and knowledge products built into the EnACT curriculum, which were designed to mitigate those barriers and help learners execute their plans.

Those resources are worth noting in detail, because they reveal how concretely the program approaches its subject. The EnACT toolkit includes a Compassion Compass, a Compassion and Me poster, Compassion Checkpoints, a Compassionate Care Plan, a postcard reminder, a Commitment to Change exercise, and a workbook and journal for weekly reflection. Participants also completed a SWOT analysis—an assessment of strengths, weaknesses, opportunities, and threats—to help them tailor the training to their own circumstances. The Commitment to Change component asked each learner to identify three specific practice changes they intended to make after the program, and the follow-up interviews asked directly about the challenges and success factors involved in implementing them.

The fourth and fifth themes concerned monitoring and evaluation. Learners reported changes in their attitudes, knowledge, and practice over the course of the program and afterward, and they reflected on the impact of the training at multiple levels: on patients, on coworkers, and on the organization as a whole. This multi-level framing is significant. Compassion is often framed as a purely individual attribute, something a clinician either has or lacks. The EnACT framework treats it instead as something that operates within a system, shaped by unit culture, organizational structures, and leadership behavior as much as by personal disposition.

That systemic view culminates in the sixth theme, sustaining knowledge use, and in the study’s central conclusion. Across all six themes, participants identified the key strengths of the EnACT program as its brief format, interdisciplinary character, evidence base, clinical relevance, and multi-modal approach. These features, the authors report, enhanced and sustained learners’ knowledge, attitudes, and skills related to compassion while also addressing systemic barriers to operationalizing compassion in professional practice. The engagement of senior leaders proved essential, as did the integration of learner resources designed to sustain learning over time and the inclusion of content aimed squarely at broader organizational and workplace barriers to compassion.

The study’s design deserves attention for those unfamiliar with qualitative implementation research. Ethics approval was granted by the Conjoint Health Research Ethics Board at the University of Calgary, and all participants provided informed consent. The semi-structured interviews were guided by a formal appendix that paired each Knowledge-to-Action component with its definition and corresponding questions, ensuring that the analysis remained anchored to the framework rather than drifting into anecdote. The funding came from the Canadian Institutes of Health Research, and Sinclair holds the Cross Canada Chair in Compassionate Care, signaling institutional commitment to the field. A Patient and Family Advisory Council also guided the program’s development, keeping the curriculum tethered to the perspectives of those who receive care.

What the study ultimately demonstrates is that compassion can be taught, applied, and sustained—but only if the surrounding system cooperates. A brief, evidence-based, accredited curriculum that gives learners concrete tools and asks them to commit to specific changes appears capable of moving compassion from an abstract ideal to an operational skill. But the authors’ conclusion is clear that individual training alone is not enough: sustaining compassionate care over time required leadership engagement, durable learner resources, and explicit attention to the organizational barriers that grind down even the most well-intentioned clinicians. For a healthcare world increasingly concerned with burnout and the erosion of the human connection at the center of medicine, that finding may be the most important takeaway of all. Compassion, it turns out, is not just a feeling to be summoned but a competency to be built, implemented, and protected—one system at a time.

Subject of Research: Implementation of a compassion training program by healthcare providers in clinical practice

Article Title: Knowledge to action: a qualitative analysis of learners’ experiences of applying the knowledge, skills, and resources of a compassion training program into practice

Article References: Knowledge to action: a qualitative analysis of learners’ experiences of applying the knowledge, skills, and resources of a compassion training program into practice. (n.d.). https://doi.org/10.1186/s12909-026-10631-x

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10631-x

Keywords: compassion training, healthcare education, knowledge translation, qualitative research, EnACT, medical education, hospice care, long-term care, implementation science, compassionate care, nursing, organizational barriers