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Presentation – PD Working Group Meeting

Today I gave a presentation on our recently launched Compassion training for healthcare workers course with lead educator Debbie Ling at our PD Working Group Meeting. It was a great collaborative presentation. Debbie spoke about her lived professional experience in healthcare and compassion as well the identified need for this type of training for healthcare workers, while I spoke about how we teamed-up on the design, development and delivery of the course.

Dr Debbie Ling is a Lecturer in the Department of Social Work at Monash University and key contributor to the Monash Centre for Consciousness and Contemplative Studies. Debbie’s research focuses on compassion, common humanity and prosocial behaviour.

Debbie’s PhD investigated the relationship between common humanity and compassion in healthcare. She developed, trialled and evaluated a compassion training intervention in 2017 which has attracted international interest. Debbie sits on the Australian Compassion Council, Charter for Compassion Australia. Debbie is also a social worker at Epworth HealthCare and in private practice.

In the Compassion training for healthcare workers course, participants make their way through four weeks self paced online content that covers what compassion is, the science underpinning it, how to transform empathy into compassion to avoid empathic distress, barriers to compassion, how common humanity can strengthen universal unbiased compassion and strategies so that compassion can be sustained in daily life.

The key pitch is that compassion is known to benefit the patient but research now shows that compassion is a positive state of mind, increasing the wellbeing of the giver and protecting against burnout.

Compassion improves healthcare worker wellbeing, benefits the patient and creates more compassionate workplaces.

Debbie has over 20 years experience in healthcare working as a social worker. Familiarity with target customer group i.e other health professionals. It’s a common problem for healthcare workers to get burnout. They need to know the difference between compassion and empathic distress.

Debbie has been regularly presenting on compassion training to healthcare workers since 2017. Had already market tested part of the training and got survey feedback from hundreds of healthcare workers.

Demand for compassion training spiked up in 2020/2021 due to Turning Point promoting a compassion training workshop Australia-wide – difficult to meet this demand. This was Debbie’s inspiration to scale the training.

Compassion is a concerned response to another’s suffering combined with a desire to alleviate the suffering of the other. Compassion has been mentioned for centuries. It is considered a virtue across cultures and is the foundation of healthcare.

Increased interest in compassion and compassion training in last 10 years. Books like “Compassionomics” published by American doctors Stephen Trzeciak and Anthony Mazzarelli in 2019 detailing the scientific evidence that compassion benefits patients’ physical and mental health, improves healthcare worker resilience and improves organisation performance.

Research now shows that compassion enhances healthcare worker wellbeing, is a positive mind state and is an antidote to burnout. The term “compassion fatigue” is considered to be incorrectly named. It is actually ‘empathic distress fatigue’ that leads to burnout.

Compassion training has taken off in healthcare in USA over the last decade. Also big in UK where NHS had a 3 year “Compassion in Practice” policy from 2013-2016.

Big driver behind compassion training is fMRI research showing the difference between compassion and empathy. Compassion is protective against burnout. Major USA research institutes developed compassion training courses in 2008 e.g. Stanford and Emory. Values-based healthcare is big in the USA. It’s inevitable that compassion training was going to come to Australia.

It’s important for Monash to get in first and be the leader in Australia. Debbie had solid understanding of the healthcare market and competitors courses. Specific intention to create a course that could be commercially successful in both domestic and international markets.

Here at the Centre, we worked with Debbie and Craig Hassed and Richard Chambers from Monash Centre for Consciousness and Contemplative Studies to produce a practical course for healthcare professionals and anyone working in community and social service roles.

Over the four weeks of the course, participants will learn strategies to enhance compassion, avoid empathic distress, improve their own wellbeing and create more caring and compassionate workplaces. Participants will need to commit around 3 hours per week to make their way through the course material and sample the compassion exercises.

The course’s explicit aim is to give healthcare workers bitesize tools and techniques they can then go away and practice – the course is designed especially to relate to an authentic healthcare workers experience. Its direct applicability has really strengthened the course. Many participants have commented how practical and useful the course is.

Debbie found the biggest challenge was shifting from “lecturing” to providing a training course where participants take away new skills they can apply straight away.

The course design process was highly collaborative, where the storyboards were refined over a series of iterations. Our focus was to design a course to get healthcare workers to apply their learning in practice was a crucial factor in the success of the course. We thought of a “Fridge Magnet” approach which helped us focus discrete ideas and pull out easy take aways for participants e.g. 3 C’s and Five Moments of Compassion.

Throughout the course, carefully curated high quality related links were gently offered to participants where they could “Find out more”, if it was of interest to them. These were not just isolated links, but contained a brief explanation e.g., “Watch this 5 min youtube by world famous neuroscientist Tania Singer on the difference between compassion and empathy”.

This extra-touch made it easy for participants to quickly identify the value of the resource.

A handful of key themes run through the course e.g. difference between compassion and empathic distress, worker needs to heighten their self-awareness to help themselves, common humanity – focus on how everyone wants similar things.

When thinking of how to best present this learning, Debbie modelled specifically off Craig Hassed’s approach of still being the expert but being relatable, real and encouraging. This is a real shift away from the “academic on a pedestal” approach that can happen. Debbie also practiced being fluent in the line of logic so she could ad lib comfortably on the videos and in interviews.

Adopting this approach was crucial for establishing an appropriate tone for the course.

Having started on 7 March, the course is now in its third week. So far we’ve noticed a number of things about the participants.

Participants are engaging in the discussion forums, in response to their own experience to the content and comments made by other participants, too. Last week around 35 out of 112 participants have posted to the forums. This is most likely going to increase and can be attributed to Debbie’s a strong presence in the discussion forums.

It’s been so great to see how participants have been so willing to share their experiences of the course and relate it to their own professional experience as a healthcare worker.

We’ve also noticed how the course is opening up a lot of other opportunities e.g. requests to Debbie to meet with hospital leadership, present at hospital grand rounds, consult at policy level re: embedding compassion in healthcare at systems level etc, which is fantastic.

We’ve also done a head count. So far, 112 fully-paid participants joined us for the first run of the course, with a large number of enrolments originating from hospitals health-related government departments.

We know participants that take our professional development courses are incredibly busy and time poor. Understanding this informs the way we design the course and shape its content.

Downloadable materials and end of week summaries, which in this course we called ‘the essentials’ are designed to be printable and ready to use as a quick reference, much like a “fridge magnet” or “post-it note” stuck on your monitor that’s immediately available when you need it.

The course is designed to be social. That’s why we encourage talking in class!

With this social aspect in mind and the potential for varied responses to some of the compassion exercises, we’ve designed for opportunities for participant reflection and discussion – we gently invited participants to “Tell us how you went” and “Reflect and connect” with others.

This social interaction is further supported with more intensive educator engagement via text-based discussion forums as well as freshly minted feedback videos produced in response to participant activity and discussion throughout the week. In the fourth and final week of the course, participants are invited to attend a live Q&A event with the course educators – that’s coming up next week.

These varieties of modalities enable participants to ask clarifying questions and get feedback from other participants and the course educators, which is crucial – when you’re practising a new skill you want to know if you’re doing it right.

Again, thinking about our cohort we intentionally designed the course to have a modern feel. We wanted the participants learning experience to be calm, warm and welcoming.

Each week of the course is carefully chunked and sequenced to make it easy for participants to identify where they are in the course, navigate to where they want, and also track their progress – this enables them to dip in and out of their learning as need and then easily pick up where they left off.

We’ve designed for the learning to action-based and practical, encouraging participants and inviting them to actively engage in the READ, WATCH and DO.

Text-based content is often the most used method for delivering content in many learning experiences. In this course, we used text as well as diagrams and images to communicate key concepts to participants e.g., how compassion and empathic distress are different.

Using formatting to create emphasis and increase scannability of content is important to user experience, engagement and learning – examples of this in our approach is to use heading levels, short sentences, bold, call-outs and pull quotes to highlight key point, or even tabulated formatting when showing data-style content, and more.

Like many other courses, we used video to deliver content. Our videos generally featured Debbie presenting by herself, but also with course contributors Craig Hassed and Richard Chambers – videos featuring more than one presenter had a conversational and reflective style.

The use of video isn’t reduced only to pre-prepared and pre-recorded content that contributes to the course material. Video is also used in response to participant activity and plays a critical role in enabling educators and the course team to provide feedback to participants throughout the delivery of the course.

The affordances of video enable instructors to convey detailed and elaborate feedback as well as encouragement and praise to learners more so than written commentary (Henderson and Phillips, 2015) – there’s been a positive learner response to video-based feedback from the course educators, which is fantastic.

Because this course is all about developing skills that can then be applied to a professional practice, there are many opportunities to practise compassion exercises as listening and reflective activities.

These exercise often feature invitations for participants to “Give it a go” and to then tell us and other participants how they went – this is through guided discussion and reflection.

Participants are gently encouraged to contribute by reading and replying to discussions started by other participants, making sure they provide constructive feedback and commentary. These discussions are also managed by the course educator Debbie – these responses make the course extremely personal, attentive and intimate, much like a community of learners.

What are some possible next steps for the course and how might we cultivate a monash compassion universe of courses?

While nothing is confirmed, some ideas for cultivating a universe of complementary compassion courses could be to design a more generalist course for teachers, trainers and those in leadership roles – this could then be the origin course that connects other more discipline specific courses together, including this course designed especially for healthcare workers.

These could then be stacked together to form a pathway into other offerings by the School of Primary and Allied Health Care, the Monash Centre for Consciousness & Contemplative Studies, or even pathways into other on-campus or online offerings by Monash University.

Another idea could also be offered internally to Monash staff and students, with some localisation – let’s wait and see.

A huge thanks goes out to the lead educator Debbie Ling and course contributors Craig Hassed and Richard – without them it would not have been possible. A big thanks also goes out to all the course participants who joined us for the first run of the course.

Finally, thank you to Aron Shlonsky, Professor and Head, Social Work at the School of Primary and Allied Health Care and Jakob Hohwy, Director, Monash Centre for Consciousness & Contemplative Studies for the support.

That’s the end of this presentation. If you’d like to find out more about this course or other courses we’ve produced, please reach out to us.

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