Training for compassionate care delivery when using digital health technology: a scoping review of primary care education
DOI:
https://doi.org/10.36834/beg1ew59Abstract
Background: Rapid integration of digital technologies, including electronic health records, virtual care, and artificial intelligence, has transformed primary care practice. While these technologies may improve efficiency and care access, they also introduce challenges to delivering compassionate care. While training programs increasingly emphasize digital competencies, it remains unclear how compassionate care is addressed in education for primary care providers using these technologies. This scoping review aimed to map existing literature on how digital health technologies influence compassionate care in primary care education.
Methods: A scoping review was conducted to map the current evidence. Articles were searched across seven databases, and included peer-reviewed articles published in English, between 2015-2025. Data were extracted on study characteristics, educational interventions and outcomes. Analysis of educational outcomes was guided by Kirkpatrick’s framework.
Results: Fourteen studies were included. Most (92.9%) employed quantitative methodology. Family medicine learners were the primary audience for the educational interventions in 85.7% of studies. Training primarily focused on using electronic health records and virtual care, with no identified studies addressing AI. Educational approaches included workshops, simulations, role play, and observed clinical encounters. No studies explicitly addressed compassionate care; instead, they focused on related concepts such as communication skills, patient-centered care, and rapport building. Outcomes largely assessed participants’ reactions to training and short-term learning gains, including changes in knowledge, skills or attitudes.
Conclusion: Interventions focused mainly on communication and technical skills, without explicitly addressing compassion, highlighting a gap in compassionate care education and training. As digital technologies become more embedded in primary care, intentional curricular strategies are needed to ensure that compassionate care remains central.
References
1. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457-502. https://doi.org/10.1111/j.1468-0009.2005.00409.x
2. Rosser W. Sustaining the 4 principles of family medicine in Canada. Can Fam Physician. 2006;52(10):1191-2, 1196-7.
3. Seppälä EM, Simon-Thomas E, Brown SL, et al. The Oxford handbook of compassion science. Oxford: Oxford University Press; 2017. https://doi.org/10.1093/oxfordhb/9780190464684.001.0001
4. Wiljer D, Strudwick G, Crawford A. Caring in a digital age: exploring the interface of humans and machines in the provision of compassionate healthcare. In: Without compassion, there is no healthcare: leading with care in a technological age. 2020. p. 33-57. https://doi.org/10.1515/9780228004615-005
5. Ghasempour M, Ghafourifard M, Purabdollah M, et al. Barriers and facilitators to compassionate care from the perspective of healthcare providers: a systematic review and qualitative meta-synthesis. Nurs Ethics. 2025;32:9697330251374399. https://doi.org/10.1177/09697330251374399
6. Sinclair S, Kondejewski J, Jaggi P, et al. What is the state of compassion education? A systematic review of compassion training in health care. Acad Med. 2021;96(7):1057-1070. https://doi.org/10.1097/ACM.0000000000004114
7. Malenfant S, Jaggi P, Hayden KA, et al. Compassion in healthcare: an updated scoping review of the literature. BMC Palliat Care. 2022;21(1):80. https://doi.org/10.1186/s12904-022-00942-3
8. De Vera K, Challa P, Liu RH, et al. Virtual primary care implementation during COVID-19 in high-income countries: a scoping review. Telemed J E Health. 2022;28(7):920-931. https://doi.org/10.1089/tmj.2021.0377
9. Stovel RG, Dubois D, Chan TM, et al. Virtual care in CanMEDS 2025. Can Med Educ J. 2023;14(1):22-26. https://doi.org/10.36834/cmej.75439
10. Car J, Ong QC, Erlikh Fox T, et al. The digital health competencies in medical education framework: an international consensus statement based on a Delphi study. JAMA Netw Open. 2025;8(1):e2453131.
11. Patel S, Pelletier-Bui A, Smith S, et al. Curricula for empathy and compassion training in medical education: a systematic review. PLoS One. 2019;14(8):e0221412. https://doi.org/10.1371/journal.pone.0221412
12. Ebm C, Sarti R, Panico P, et al. Enhancing compassion in medical education: a comparative study of the efficacy of clinical clerkships versus simulation-based training methodologies. BMC Med Educ. 2025;25(1):181. https://doi.org/10.1186/s12909-025-06687-w
13. Sinclair S, McClement S, Raffin-Bouchal S, et al. Compassion in health care: an empirical model. J Pain Symptom Manage. 2016;51(2):193-203. https://doi.org/10.1016/j.jpainsymman.2015.10.009
14. Wiljer D, Charow R, Zhang M, et al. Enabling digital compassion in digital health environments: modified eDelphi study to identify interprofessional competencies and technology attributes. J Med Internet Res. 2025;27:e66547. https://doi.org/10.2196/66547
15. Ndayishimiye C, Lopes H, Middleton J. A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery. Health Technol. 2023;13(2):273-284. https://doi.org/10.1007/s12553-023-00725-7
16. Campbell K, Greenfield G, Li E, et al. The impact of virtual consultations on the quality of primary care: systematic review. J Med Internet Res. 2023;25:e48920. https://doi.org/10.2196/48920
17. Agarwal P, Fletcher GG, Ramamoorthi K, et al. Uses of virtual care in primary care: scoping review. J Med Internet Res. 2025;27:e55007. https://doi.org/10.2196/55007
18. Andreadis K, Muellers K, Ancker JS, et al. Telemedicine impact on the patient-provider relationship in primary care during the COVID-19 pandemic. Med Care. 2023;61(Suppl 1):S83-S88. https://doi.org/10.1097/MLR.0000000000001808
19. Amano A, Brown-Johnson CG, Winget M, et al. Perspectives on the intersection of electronic health records and health care team communication, function, and well-being. JAMA Netw Open. 2023;6(5):e2313178. https://doi.org/10.1001/jamanetworkopen.2023.13178
20. Street RL Jr, Liu L, Farber NJ, et al. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. Patient Educ Couns. 2014;96(3):315-319. https://doi.org/10.1016/j.pec.2014.05.004
21. Duggan MJ, Gervase J, Schoenbaum A, et al. Clinician experiences with ambient scribe technology to assist with documentation burden and efficiency. JAMA Netw Open. 2025;8(2):e2460637. https://doi.org/10.1001/jamanetworkopen.2024.60637
22. Ghatnekar S, Faletsky A, Nambudiri VE. Digital scribe utility and barriers to implementation in clinical practice: a scoping review. Health Technol. 2021;11(4):803-809. https://doi.org/10.1007/s12553-021-00568-0
23. Howcroft A, Bennett-Weston A, Khan A, et al. AI chatbots versus human healthcare professionals: a systematic review and meta-analysis of empathy in patient care. Br Med Bull. 2025;156(1). https://doi.org/10.1093/bmb/ldaf017
24. Gordon HS, Solanki P, Bokhour BG, et al. "I'm not feeling like I'm part of the conversation": patients' perspectives on communicating in clinical video telehealth visits. J Gen Intern Med. 2020;35:1751-1758. https://doi.org/10.1007/s11606-020-05673-w
25. Agarwal P, Lall R, Girdhari R. Artificial intelligence scribes in primary care. CMAJ. 2024;196(30):E1042-E1042. https://doi.org/10.1503/cmaj.240363
26. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. https://doi.org/10.1080/1364557032000119616
27. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. https://doi.org/10.1186/1748-5908-5-69
28. Elma A, Jeyabalan V, Wilson E, Apramian T, Myers J, Sirianni G. Compassionate primary care training and practice in the digital technology sphere: a scoping review protocol. Can Med Educ J. 2025;16(6):54-8. https://doi.org/10.21125/iceri.2025.1189
29. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. https://doi.org/10.7326/M18-0850
30. WONCA Europe. The European definition of general practice/family medicine. Barcelona (ES): World Health Organization; 2023.
31. Gliklich R, Leavy M, Dreyer N. Tools and technologies for registry interoperability. In: Registries for evaluating patient outcomes: a user's guide. Addendum 2. Rockville (MD): Agency for Healthcare Research and Quality; 2019. https://doi.org/10.23970/AHRQEPCREGISTRIES3ADDENDUM2
32. Jamieson T, Wallace R, Armstrong K, et al. Virtual care: a framework for a patient-centric system. Toronto (ON): Women's College Hospital Institute for Health Systems Solutions and Virtual Care; 2015.
33. Coiera E, Kocaballi B, Halamka J, et al. The digital scribe. NPJ Digit Med. 2018;1(1):58. https://doi.org/10.1038/s41746-018-0066-9
34. Wiljer D, Charow R, Costin H, et al. Defining compassion in the digital health age: protocol for a scoping review. BMJ Open. 2019;9(2):e026338. https://doi.org/10.1136/bmjopen-2018-026338
35. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288. https://doi.org/10.1177/1049732305276687
36. Yardley S, Dornan T. Kirkpatrick's levels and education 'evidence'. Med Educ. 2012;46(1):97-106. https://doi.org/10.1111/j.1365-2923.2011.04076.x
37. Skelly K, Shen W, Wilbur J, et al. A curriculum for teaching clinical efficiency focusing on specific communication skills while maximizing the electronic health record. MedEdPORTAL. 2020;16:10989. https://doi.org/10.15766/mep_2374-8265.10989
38. Antoun J, Saab B, Usta J, et al. Development of an assessment tool to measure communication skills among family medicine residents in the context of electronic medical record use. BMC Med Educ. 2023;23(1):245. https://doi.org/10.1186/s12909-023-04216-1
39. Barksdale S, Stark Taylor S, Criss S, et al. Improving patient health literacy during telehealth visits through remote teach-back methods training for family medicine residents: pilot 2-arm cluster, nonrandomized controlled trial. JMIR Form Res. 2023;7:e51541. https://doi.org/10.2196/51541
40. Greenhalgh T, Payne R, Hemmings N, et al. Training needs for staff providing remote services in general practice: a mixed-methods study. Br J Gen Pract. 2024;74(738):e17-e26. https://doi.org/10.3399/BJGP.2023.0251
41. Cantone RE, Palmer R, Dodson LG, et al. Insomnia telemedicine OSCE (TeleOSCE): a simulated standardized patient video-visit case for clerkship students. MedEdPORTAL. 2019;15:10867. https://doi.org/10.15766/mep_2374-8265.10867
42. Lee WW, Alkureishi ML, Isaacson JH, et al. Impact of a brief faculty training to improve patient-centered communication while using electronic health records. Patient Educ Couns. 2018;101(12):2156-2161. https://doi.org/10.1016/j.pec.2018.06.020
43. Lanier C, Dominicé Dao M, Hudelson P, et al. Learning to use electronic health records: can we stay patient-centered? A pre-post intervention study with family medicine residents. BMC Fam Pract. 2017;18(1):69. https://doi.org/10.1186/s12875-017-0640-2
44. Kim JG, Morris CG, Heidrich FE. A tool to assess family medicine residents' patient encounters using secure messaging. J Grad Med Educ. 2015;7(4):649-653. https://doi.org/10.4300/JGME-D-14-00558.1
45. Sieck CJ, Henriksen B, Scott S, et al. Training to improve patient-centered electronic health record (EHR) use. J Hosp Manag Health Policy. 2022;6. https://doi.org/10.21037/jhmhp-20-121
46. Särchen F, Springborn S, Mortsiefer A, et al. Patient care via video consultations: piloting and SWOT analysis of a family medicine digitally synchronous seminar for medical students. Int J Environ Res Public Health. 2022;19(15):8922. https://doi.org/10.3390/ijerph19158922
47. Sobral D, Rosenbaum M, Figueiredo-Braga M. Computer use in primary care and patient-physician communication. Patient Educ Couns. 2015;98(12):1568-1576. https://doi.org/10.1016/j.pec.2015.07.002
48. Phillips Z, Mitsumoto J, Fisher H, et al. Using unannounced standardized patients to assess clinician telehealth and communication skills at an urban student health center. J Adolesc Health. 2024;74(5):1033-1038. https://doi.org/10.1016/j.jadohealth.2024.01.014
49. Deming J, Horecki P, Brustad R, et al. A virtual communication workshop to increase confidence using telehealth modalities. WMJ. 2024;123(2):124-126.
50. Asan O, Kushner K, Montague E. Exploring residents' interactions with electronic health records in primary care encounters. Fam Med. 2015;47(9):722.
51. Grundland B, Kulasegaram K, Prucnal K, et al. Implementation and evaluation of an innovative virtual care curriculum. Med Educ. 2022;56(11):1133-1134. https://doi.org/10.1111/medu.14920
52. Bajra R, Srinivasan M, Torres EC, et al. Training future clinicians in telehealth competencies: outcomes of a telehealth curriculum and teleOSCEs at an academic medical center. Front Med (Lausanne). 2023;10:1222181. https://doi.org/10.3389/fmed.2023.1222181
53. Medical Council of Canada. Compassionate virtual care. Ottawa (ON): Medical Council of Canada; Available from: https://mcc.ca/examinations-assessments/resources-to-help-with-exam-prep/resources-for-compassionate-virtual-care/ [Accessed on Jun 22, 2026]
54. Brazelton T. STFM task force releases learning objectives for national telemedicine curriculum. Ann Fam Med. 2021;19(1):91. https://doi.org/10.1370/afm.2665
55. Wu K, Dang Nguyen M, Rouleau G, et al. Understanding how virtual care has shifted primary care interactions and patient experience: a qualitative analysis. J Telemed Telecare. 2025;31(1):73-81. https://doi.org/10.1177/1357633X231167905
56. Selick A, Durbin J, Hamdani Y, et al. Accessibility of virtual primary care for adults with intellectual and developmental disabilities during the COVID-19 pandemic: qualitative study. JMIR Form Res. 2022;6(8):e38916. https://doi.org/10.2196/38916
57. Kusmiat M. A comprehensive evaluation in medical curriculum using the Kirkpatrick hierarchical approach: a review and update. Med Res Arch. 2025;13(5). https://doi.org/10.18103/mra.v13i5.6557
58. Ratelle JT, Gallagher CN, Sawatsky AP, et al. The effect of bedside rounds on learning outcomes in medical education: a systematic review. Acad Med. 2022;97(6):923-930. https://doi.org/10.1097/ACM.0000000000004586
59. Baker L, Wright S, Mylopoulos M, et al. Aligning and applying the paradigms and practices of education. Acad Med. 2019;94(7):1060. https://doi.org/10.1097/ACM.0000000000002693
60. Samuel A, Konopasky A, Schuwirth LW, et al. Five principles for using educational theory: strategies for advancing health professions education research. Acad Med. 2020;95(4):518-522. https://doi.org/10.1097/ACM.0000000000003066
61. Battista A. Situated learning theory in health professions education research: a scoping review. Adv Health Sci Educ Theory Pract. 2020;25(2):483-509. https://doi.org/10.1007/s10459-019-09900-w
62. Yardley S, Teunissen PW, Dornan T. Experiential learning: AMEE guide No. 63. Med Teach. 2012;34(2):e102-e115. https://doi.org/10.3109/0142159X.2012.650741
63. Elma A, Jeyabalan V, Wilson E, et al. The use of digital health technologies in delivering compassionate primary care in training and practice: A scoping review. In: International Congress on Academic Medicine: 2026 medical education abstracts. Can Med Ed J. 2026. https://doi.org/10.36834/fv597x83
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Giovanna Sirianni, Asiana Elma, Vyshave Jeyabalan, Emma Wilson, Jeff Myers, Sarah Wright
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.
How to Cite
