Medical student experiences of the flows of compassion in medical education: a systematic review and meta-aggregation

PURPOSE: Compassion is crucial for effective, patient-centered care, but its development in medical education is challenging due to its complexity, with explicit and implicit teaching approaches. A qualitative synthesis is needed to explore nuances and foster sustainable compassion in medical students. This review aims to investigate perceptions and experiences of the flows of compassion (from others, for others, and self-compassion) in medical education. METHOD: For this qualitative systematic review and meta-aggregation, systematic searches were conducted using 7 major databases for studies published before July 5, 2024 (search date). Studies reporting qualitative data on the perceptions and experiences of medical students, educators, clinicians, or other relevant knowledge users with compassion in medical education were considered eligible. Two independent reviewers performed all screening as well as quality appraisal, data extraction, and certainty of evidence assessments for included studies with multiple relevant results. Meta-aggregation was guided by the Joanna Briggs Institute approach, forming categories from extracted results and synthesized findings overall. RESULTS: In total, 151 studies were included, from which extracted qualitative results were grouped into 30 categories, making 12 synthesized findings. Structured training and positive role modeling enhance compassionate care, whereas barriers such as burnout, negative role models, and restrictive clinical cultures hinder compassion. CONCLUSIONS: Formal and hidden curricula must integrate longitudinal compassion education, from assessments and clerkship instruction to faculty development, to foster compassion in medical education. Integrating both cultural and structural changes in medical education may enhance the flows of compassion.