BackgroundCompassion is considered a fundamental human capacity instrumental to the creation of medicine and for patient-centered practice and innovations in healthcare. However, instead of nurturing and cultivating institutional compassion, many healthcare providers cite the health system itself as a direct barrier to standard care. The trend of compassion depletion begins with medical students and is often attributed to the culture of undergraduate medical training, where students experience an increased risk of depression, substance use, and suicidality.ObjectivesThis qualitative study aims to develop a more comprehensive understanding of compassion as it relates to undergraduate medical education. We used focus groups with key stakeholders in medical education to characterize beliefs about the nature of compassion and to identify perceived barriers and facilitators to compassion within their daily responsibilities as educators and students.MethodsResearchers conducted a series of virtual (Zoom) focus groups with stakeholders: Students (N = 14), Small Group Advisors (N = 11), and Medical Curriculum Leaders (N = 4). Transcripts were thematically analyzed using MAXQDA software.ResultsStudy participants described compassion as being more than empathy, demanding action, and capable of being cultivated. Stakeholders identified self-care, life experiences, and role models as facilitators. The consistently identified barriers to compassion were time constraints, culture, and burnout. Both medical students and those training them agreed on a general definition of compassion and that there are ways to cultivate more of it in their daily professional lives. They also agreed that undergraduate medical education – and the healthcare culture at large – does not deliberately foster compassion and may be directly contributing to its degradation by the content and pedagogies emphasized, the high rates of burnout and futility, and the overwhelming time constraints.DiscussionIntentional instruction in and cultivation of compassion during undergraduate medical education could provide a critical first step for undergirding the professional culture of healthcare with more resilience and warm-hearted concern. Our finding that medical students and those training them agree about what compassion is and that there are specific and actionable ways to cultivate more of it in their professional lives highlights key changes that will promote a more compassionate training environment conducive to the experience and expression of compassion.

Background: Depression is the largest source of global medical disability, highlighting the importance of translating and validating depression screening instruments to improve our understanding of differences in the prevalence of depression in divergent cultures around the world. The aim of this study was to translate and evaluate a widely used depression screening and diagnostic instrument, the Patient Health Questionnaire-9 (PHQ-9), for use with Tibetan populations. A secondary aim was to use the Tibetan-PHQ-9 (T-PHQ-9) to estimate the prevalence of depression symptoms in a population of Tibetan-speaking Buddhist monastic scholars engaging in a 6-year science curriculum in India, the Emory Tibet Science Initiative (ETSI).Methods: Three-hundred-eighty-four monastics (363 monks, 21 nuns) completed the T-PHQ-9. We computed measures of internal consistency and conducted factor analysis to evaluate scale performance. Following this, we evaluated the prevalence of depressive symptoms among the monastic population. We also conducted cognitive interviews with six monastics to explore their thought processes when completing the instrument and when thinking about depression symptoms.Results: The T-PHQ-9 had acceptable reliability and demonstrated a single-factor structure. While having low energy was the most commonly endorsed symptom, monastics did not have overall higher endorsement rates of other somatic symptoms when compared with endorsement rates of emotional symptoms. Over 10% of the monastics scored in the moderately severe to severe range and met criteria for major depressive disorder using standard diagnostic criteria cut-offs. First year monks had the highest mean score, and there was not a significant difference between monks and nuns. Cognitive interviews revealed some variation in the cognitive processes used to complete the instrument, particularly with symptoms related to energy and concentration.Conclusion: These preliminary findings indicate that the Tibetan PHQ-9 is a reliable instrument for assessing depressive symptoms, as evidenced by its ability to inform how symptoms are experienced, interpreted, and communicated among Buddhist monastics. Results from the cognitive interviews may be important for further refining the instrument.