Evidence map›Paper›PMID 40211287›Full record

ArticleBMC medical education2025

Cultivating compassion in care: evaluating a compassion-training intervention and exploring barriers to compassionate care in postgraduate medical education in Pakistan: a mixed-methods study.

Marib Ghulam Rasool Malik, Sana Saeed, Bisma Aziz, Shahzil Abdur Rehman Malik, Syed Ahsan Ali, Fareed Shaikh, Shahzadi Resham, Amna Subhan Butt, Qamar Riaz

Abstract read
In one paragraph

Article in BMC medical education, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Marib Ghulam Rasool MalikDean's Clinical Research Fellowship, Aga Khan University, Karachi, Pakistan.
Sana SaeedDepartment of Educational Development, Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. sana.saeed@aku.edu.
Bisma AzizDean's Clinical Research Fellowship, Aga Khan University, Karachi, Pakistan.
Shahzil Abdur Rehman MalikMedical College, Aga Khan University Medical College, Karachi, Pakistan.
Syed Ahsan AliDepartment of Medicine, Aga Khan University, Karachi, Pakistan.
Fareed ShaikhDepartment of Surgery, Aga Khan University, Karachi, Pakistan.
Shahzadi ReshamDepartment of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Amna Subhan ButtDepartment of Medicine, Aga Khan University, Karachi, Pakistan.
Qamar RiazPostgraduate Medical Education, Aga Khan University, Karachi, Pakistan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCompassionate patient care is essential for improving patient outcomes and enhancing healthcare experience. However, in lower-middle-income countries (LMICs) like Pakistan, systemic barriers and a lack of structured curricula hinder its consistent delivery. This study evaluates a targeted compassion-training intervention for residents in a tertiary care hospital and explores barriers to its implementation. Given shared challenges like resource constraints, high patient loads, and gaps in formal training, these findings have broader implications for integrating structured compassion-based education across LMICs.

methodsThis quasi-experimental mixed-methods study was conducted with first-year residents over a one-year period (November 2023 - October 2024). A 4-hour compassion-training session was delivered to develop compassion as a clinical competency. Quantitative data on satisfaction and self-reported compassion competence were collected using the Sinclair Compassion Questionnaire-Healthcare Provider Competence Self-Assessment (SCQ-HCPCSA) and analyzed via paired t-tests. Qualitative data from focused group discussions (FGDs) exploring barriers and facilitators underwent thematic analysis.

results204 residents participated. Baseline compassion competence was 4.03 ± 0.54, with no demographic variations (p > 0.05). Participants rated sessions highly for interest (4.54 ± 0.65), relevance (4.50 ± 0.82), and interactivity (4.68 ± 0.61). Post-training, compassion competence significantly improved to 4.58 ± 0.47 (p < 0.001), with all SCQ-HCPCSA items showing significant improvements (p < 0.001). Qualitative findings revealed key barriers to practicing compassionate care, including time constraints, high workloads, and compassion fatigue, particularly in high-pressure specialties like surgery and intensive care. Institutional factors like documentation inefficiencies, financial pressures, and hierarchical workplace culture also limit compassionate care delivery. Culturally specific challenges emerged, including language barriers, differences in patient expectations, and perceptions of compassion as a transactional service in a largely out-of-pocket healthcare system. Facilitators of compassionate care included interdisciplinary collaboration, supportive senior staff, and effective communication strategies.

conclusionsTargeted compassion-training interventions can enhance compassionate care among physicians. To ensure long-term impact, postgraduate medical education programs should formally integrate structured curricula, alongside institutional policy reforms that reduce administrative burdens and promote interdisciplinary collaboration. Future studies should explore long-term retention of training effects and assess scalability of similar curricula across diverse healthcare settings, particularly in other lower-middle-income countries.

trial registrationNot applicable.

Indexed as

Education, Medical, GraduateEmpathyInternship and ResidencyAdultClinical CompetenceCurriculumFemaleHumansMalePakistanSurveys and QuestionnairesCompassionate careCurriculumEmpathySimulation-based learning

Identifiers

PMID40211287
PMCPMC11987440

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.