Cultivating caring practices in US clinical learning environments: a multi-site qualitative exploration of actions, barriers, and strategies

PURPOSE: Health care professionals perceive caring as fundamental to their practice, viewing it as both a calling and a virtue. Yet, the literature on caring underscores a crisis of genuine commitment to caring and a growing need to foster caring values and actions within clinical learning environments. This study aimed to explore caring actions; examine perceived systemic, institutional, and individual barriers and facilitators to caring in health care; and identify multilevel strategies to promote caring behaviors in the clinical learning environment. METHOD: Researchers conducted 15 focus groups with 50 participants across six medical schools in the United States, including physicians, residents, medical students, nurses, administrative staff, and patients. A general inductive qualitative approach was used to explore the complexities and contradictions in caring values, strategies, and actions. Data were collected and analyzed from April 2021 to October 2023. RESULTS: Results revealed actions that promote patient-centered care (eg,, caring gestures, trust-building), support health care teams (eg,, recognizing good work), nurture learners (eg,, promoting reflection through feedback), and enhance individual well-being (eg,, taking personal time). Participants also identified barriers to caring across individual (eg,, burnout and exhaustion, cultural and language barriers, lack of self-care), institutional (eg,, lack of institutional support, limited time, protocols and processes), and systemic (profit-driven health care, systemic pressures, health disparities, administrative burdens) levels in the clinical learning environment. CONCLUSIONS: Caring within clinical learning environments is not merely an individual concern, but an interaction among systemic, institutional, and individual dimensions that impact and can conflict with one another. Findings can inform the development of structured frameworks that effectively integrate caring values into medical curricula, promoting the education of health care professionals who are both clinically competent and committed to the compassionate care of patients, co-workers, learners, and themselves.