The Skill Medicine Doesn’t Train: What New Compassion Research Reveals About 264 Surgeons and Anaesthetists

By Paul Larkin, Guest Author

Editor’s note: I’m delighted to welcome Paul Larkin as a guest author. Paul is a Compassionate Accountability Master Trainer and a valued member of Next Element’s global network of Compassionate Accountability experts. From his base in Melbourne, he brings Compassionate Accountability to doctors, specialists, trainees, and allied health workers across Australia and New Zealand. In this post, Paul shared what our Compassionate Accountability Assessment revealed across hundreds of those clinicians—and why it matters for patients, for teams, and for doctors themselves. —Nate Regier

This post summarizes a portion of the academic and applied research I conducted over the past several years, including data from 264 surgeons, anaesthetists, and surgical trainees in Australia and New Zealand who have completed Next Element’s Compassionate Accountability Assessment (CAA) as part of our workshops. Across 28 separate groups, one pattern shows up again and again.

Before addressing the data, it’s important to understand that the CAA doesn’t measure intention, because intention was never the issue. What we experienced, unequivocally, during all our trainings, is that every one of these healthcare professionals wanted the best for their patients and was committed to acting on it. Their commitment to patients was never in question.

Our workshops focused on the compassion skills that support that intention.

What we measured

The CAA measures a person’s own view regarding the presence of three compassion skills. It isn’t a profile of whether people are compassionate; it’s a snapshot of how they behave at a point in time. These are the non-technical skills that support clinical excellence and collaboration:

• Openness: emotional transparency, self-awareness, empathy, and a willingness to ask for and receive support.
• Resourcefulness: curiosity, creativity, problem-solving, collaboration, and rebounding from setbacks.
• Persistence: dependability, perseverance, consistency, and holding boundaries in healthy ways—including apologising when the boundary-crossing behavior is our own.

Each of these skills is needed to create interactions and cultures that support high-quality healthcare experiences, outcomes, and clinician wellbeing. Think of them as the three spokes of a wheel. When one is weaker than the others, interactions and the cultures they shape can become unstable, especially under stress.

What the data show

On a scale of 0 to 100, where 67 and above counts as high skill, the average scores were:

• Persistence: 74
• Resourcefulness: 68
• Openness: 66

Three findings stand out:

• Persistence was the strongest of the three skills in all 28 groups.
• Openness scored lower than Persistence in all 28 groups, by an average of 8 points (95% CI 7–9; p < 0.001).
• Openness also scored lower than Resourcefulness in 23 of 28 groups (p < 0.001), although that gap is smaller.

Openness is the only compassion skill that sits below the high-skill range and is significantly lower than the other skills.

Why an Openness gap isn’t surprising

Medicine selects for commitment, dedication, and persistence, then trains it hard. Long training, deferred rewards, high stakes, and the expectation that specialist doctors will hold it together all reinforce this dynamic. That’s a real strength, and patients benefit from it every day.

But it may come at a cost. Research is beginning to show that shifts in thinking that may diminish openness occur even before the first postgraduate year (PGY1), as trainees reorient to these demands.¹

Why the gap matters

Openness creates safety within teams and between clinicians and patients. In care, it shows up when a doctor:

• Invites and affirms the emotional experience of patients and peers: “How are you feeling about what’s going on?”
• Shares an appropriate emotion of their own: “I’m optimistic we can help.”
• Practises empathy in ways that support autonomy, curiosity, and accountability: “I can relate to how hard it is not knowing what to expect. It’s all new territory.”

When Persistence outpaces Openness, a clinician may end up pushing through alone: upholding standards and carrying the workload, but finding it harder to connect with others. The same determination that gets someone through a long operating list can make it harder to say “I’m not sure” or “I need help.”

Sometimes the cost is clinical. Without connection, a patient may not feel safe disclosing critical information, e.g., smoking before general anaesthetic, taking herbal supplements, or even a known allergy. This leaves the clinical picture incomplete.

Self-reported behaviour

These scores are a snapshot of how doctors reported their own behaviour. They don’t measure clinical ability, and they don’t show what the training changed. What stands out is how consistent the pattern is. It isn’t a reflection on individuals; it appears to reflect a training pathway that hasn’t actively trained and reinforced Openness.

There’s more at stake, too. Openness includes experiencing positive emotions. Clinicians who are less open to their own or others’ emotional experience may also be less likely to feel the positive emotional reward of partnering with patients to alleviate suffering, which can be a strong antidote to burnout. Research is ongoing, but appears to support this hypothesis.²

Building Openness

Openness is a skill, and like any skill, its strength reflects practice, clinical factors, and environment.³ Our workshops use the Compassionate Accountability® framework to help clinicians build Openness alongside the Persistence and Resourcefulness they already have. That means practising empathy, affirming emotional experiences, and sharing their own so that Openness can better inform Resourcefulness, and Persistence can be used in ways that foster cohesion and dignity.

The aim isn’t to produce doctors who are less determined. It’s to make sure their determination is guided by other skills, creating compassionate, accountable journeys for every person in healthcare.

About the author

Paul Larkin, M.App.Psy (Hons), LLB, is the founder of 700 Healthcare in Melbourne, Australia, and Next Element’s Compassionate Accountability Master Trainer for Oceania. A member of Next Element’s global network of Compassionate Accountability experts, Paul co-developed the Compassion Mindset for Healthcare curriculum with Next Element and led global development of the Compassionate Accountability for Healthcare course curriculum. His background spans legal practice, professional sports leadership, and non-technical skills development for clinicians. Learn more at 700 Healthcare.

A note on methods

This analysis includes only participants who accessed training through Continuing Professional Development (CPD) workshops. Participants who registered for public courses, or who took part through projects supporting organisational initiatives, are excluded.

Scores are self-assessed and drawn from group-level reports (28 workshops, 264 assessments). Average scores are weighted by group size. Comparisons treat each workshop as one unit (n = 28): p-values are from two-sided Wilcoxon signed-rank tests, and the confidence interval is for the mean paired difference across workshops.

References

[1]

Dahlin, M., Fjell, J., & Runeson, B. (2010). Factors at medical school and work related to exhaustion among physicians in their first postgraduate year. Nordic Journal of Psychiatry, 64(6), 402–408. https://doi.org/10.3109/08039481003759219

Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., Haramati, A., & Scheffer, C. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine, 86(8), 996–1009. https://doi.org/10.1097/ACM.0b013e318221e615

Singer-Chang, G., Dong, F., Seffinger, M., Nevins, N., Blumer, J., Musharbash, H., & Helf, S. (2020). Empathy in medicine self and other in medical education: Initial emotional intelligence trend analysis widens the lens around empathy and burnout. Journal of Osteopathic Medicine, 120(6), 388–394.

[2]

Román-Calderón, J. P., Krikorian, A., Ruiz, E., Romero, A. M., & Lemos, M. (2024). Compassion and self-compassion: Counterfactors of burnout in medical students and physicians. Psychological Reports, 127(3), 1032–1049. https://doi.org/10.1177/00332941221132995

Singer, T., & Klimecki, O. M. (2014). Empathy and compassion. Current Biology, 24(18), R875–R878. https://doi.org/10.1016/j.cub.2014.06.054

[3]

Fernando, A. T., III, & Consedine, N. S. (2014). Beyond compassion fatigue: The transactional model of physician compassion. Journal of Pain and Symptom Management, 48(2), 289–298.