Compassionate Communication Training Rebuilds Connection in a High-Stress Health Care Culture

Story by:

• Susanne Clara Bard- [email protected]

Topics covered:

• Education
• Health care
• Physician burnout
• Compassion

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The average emergency room wait time in the U.S. is 2 hours and 40 minutes. As an emergency medicine physician, Rachna Subramony, MD, empathizes with patients in the waiting room who may already be coping with stress, anxiety and pain. Dealing with high patient loads, life-threatening trauma, and unpredictability can also take a toll on clinicians.

" It can be very disheartening for physicians to meet a patient and hear 'I've been waiting for hours, what do you mean I have to be here another few hours for my CAT scan?'" said Subramony, an assistant clinical professor of emergency medicine atUniversity of California San Diego School of Medicine. "And it's very easy for the doctors to get defensive. But the patient is not blaming you, they simply need to vent."

Studiesshow that building long-term trust with patients is associated with improved health outcomes. Despite their brief encounters, Subramony wanted to do more to connect meaningfully with her patients, and to help her fellow providers do the same. That's why, in 2023, she participated in the UC San Diego Health: Sanford Compassionate Communication Academy Fellowship.

The 60-hour training, spread across four months of in-person and virtual sessions, was designed to address the "compassion crisis" in U.S. health care: a lack of emotional connection between providers and patients fueled by heavy workloads, provider burnout, and a slough of societal factors.

Nearly half of all Americans believe the U.S. health care system and health care providers lack compassion, according to "Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference," a 2019 book frequently referenced during the fellowship. At the same time, researchalso indicates that compassion for oneself and for others is associated with less clinician burnout. This isn't trivial: a 2025 Medscape surveyfound that nearly half of physicians feel burned out and nearly a quarter report suffering from depression. And female physicians are at an especially high risk of suicide, according to a recent UC San Diego study.

The fellowship is offered twice a year to several dozen UC San Diego-affiliated physicians, nurses and advanced practice providers. In addition, several teaching artists - including actors, stage directors and designers, visual artists and dancers - serve as fellows, helping foster meaningful collaboration between the arts and medicine. Their unique perspectives allow medical professionals to recognize their communication blind spots. And by training alongside clinicians, the artists gain insights into the challenges faced by the profession and how their craft can be adapted to health care settings to build interdisciplinary teams of educators.

"This is really tough stuff to teach healthcare providers," said Kaplan-Liss. "Theater and improvisation helps them get out of their heads and experiment with ways of connecting in a safe environment using the part of the brain that allows us to connect and communicate with compassion."

One of the first exercises asks fellows to recall their own most memorable interaction with a physician. Overwhelmingly, their answers mirror those of patients, focusing less on the provider's credentials and more on their ability to listen and make them feel heard, according to Kaplan-Liss."What people sometimes call soft skills. And in fact, they are the most important skills."

These skills can't be gleaned from textbooks; they need to be practiced. Fellows are encouraged to be vulnerable as they build trust with one another. In one foundational exercise, "the rant," they share something they feel extremely passionate or upset about while another fellow listens without judgment.

"I listen, and then I say, 'Why don't we call a few people and see if we can find someone to walk your dog?' or 'We have chargers. Why don't we charge the phone for you? This way you can prioritize your health.'"

The fellowship has shown Subramony that making a meaningful connection with patients in the emergency department is possible, despite the limited time they have together.

"If we look at the literature, a compassionate interaction only takes 40 seconds to develop," she said. "My goal with every patient is to learn something about them that is not their chief complaint. The fellowship created a toolkit for me to shift my perspective and see things from the patient's perspective."

Connecting in the clinic

For pediatric orthopedic surgeon Maya Pring, MD, a 2025 fellow, the experience has helped her slow down with patients. As chief of staff elect at Rady Children's Hospital as well asclinical professor in the Department of Orthopaedic Surgery at UC San Diego School of Medicine, she often feels rushed.

Kaplan-Liss and Lantz-Gefroh have worked together to transform how health providers communicate for more than 15 years. Kaplan-Liss, who has had a chronic condition since she was a teenager, has been on the receiving end of both good and poor communication as a patient. This has impacted pivotal choices she and her family have made about her care over the years. Initially a journalist, she later became a physician with a passion for improving provider communication.

"Everybody assumes medical students are taught how to communicate with compassion," she said. " And at the time we started, that was really not the case."

In 2011, she and Lantz-Gefroh created a curriculum at the  Alan Alda Center for Communicating Science at Stony Brook University, training more than 15,000 scientists and medical professionals improvisation skills to help them tell the story of their research. They eventually expanded the curriculum to include different forms of arts and humanities for other universities and medical schools. In 2021, the opportunity to expand the curriculum into a longer, more comprehensive fellowship arose when Kaplan-Liss was asked to head up the new Center for Compassionate Communication at the Sanford Institute for Empathy and Compassion, bringing Lantz-Gefroh with her.

"Coming to UC San Diego gave us the opportunity to do what we thought was so important: this longitudinal learning experience," said Kaplan-Liss. "Physicians are freed up from their busy lives to actually spend time learning skills to add to their tool belt. We're like unicorns, there weren't many people doing what we do. We wanted to train others to do it."

"We provide assistance to create as much of a ripple effect as possible with the fellowship curriculum within their department or their division,"said Gary Buckholz, MD, professor of medicine at UC San Diego School of Medicine and  director of the affiliate faculty program. Buckholz, a palliative care physician, was part of the fellowship's first cohort in 2022.

" I spent so much of my career creating space during very fragile times for patients and loved ones that I neglected to create space for myself so that I could fill my cup and continue to give," he said. "That was a key learning point for me during the pilot program. And now I have the gift of continuing to share that with current and future fellows."

Another 2022 fellow, Ami Doshi, MD, is a clinical professor of pediatrics at UC San Diego School of Medicine. She also serves as vice chair of faculty development and wellness for the Department of Pediatrics, charged with creating programs and cultivating an environment that promotes the wellness of her colleagues.

For Subramony, the fellowship has been an important tool for getting to the root of burnout in the emergency department.

"As a director of wellness for the emergency department, this is such a passion of mine," said Subramony, who works with other wellness directors to help faculty connect with compassion. "I've had providers tell me how much happier they are at the end of a shift after developing that meaningful connection with the patient."

"UC San Diego is leading the way with the fellowship curriculum and with the train-the-trainer program, and it absolutely is a model that could extend to other institutions and programs," said Buckholz.

Measuring the impact

The fellowship directors partnered with Amy Vatne Bintliff,  Ph.D., an associate teaching professor, and Becca Levine, a doctoral student, both in the Department of Education Studies at UC San Diego, to evaluate the impact of the fellowship on clinicians and to provide an evidence base for their innovative approach. The researchers collected field notes and conducted in-depth interviews with the fellows, which were published in Academic Medicine(see sidebar).

" An educational intervention like this one aims to help medical professionals tap into the compassion they already have, and  into the reasons they entered the medical field in the first place," said Levine.

Subramony agrees. "Early in my career, I was very much focused on the science of medicine, making sure that I did not make medical errors and seeing as many patients as possible," she said. "That is still a priority, but I've come to learn that the art of medicine is just as important, if not even more important in the long run: developing that connection with a patient and meeting them where they are because we're all humans, we're all individuals."

More than 85 health care professionals and artists have graduated from the Sanford Compassionate Communication Academy to date. Applicationsfor the fellowship are accepted on a rolling basis. The Center for Compassionate Communication also offers a two-day workshop, Lead With Compassion, which covers some of the same curriculum as the fellowship and is open to health care professionals, medical educators and teaching artists from within and beyond UC San Diego.