Insisting on the Healer's Art: The Implications of Required Participation in a Medical School Course on Values and Humanism

Abstract

Theory: Elective courses, by definition, allow medical students to self-select for participation in the class. In a small-group learning setting, students uninterested or not ready for a particular learning topic might change the educational experience (“poison the well”) for those students most interested in the topic. It is not known how medical students required to take a course in humanism (that they otherwise would not have elected to take) might be impacted by the course or how their presence might affect students originally interested in the course. Hypotheses: Medical students in a required course on humanism and values in medicine will have different experiences based on whether a particular student might have or not have elected to enroll in the course. Students uninterested in taking a course in humanism and values, but required to enroll, will limit the benefit of the course for those students originally interested in participating. Method: In 2012, all 1st-year students at a U.S. medical school were required to take the Healer's Art, an elective on professional values and humanism offered at more than 90 other schools in the United States and internationally. Students completed pre/postcourse surveys assessing emotional exhaustion, work engagement, positive emotions, and cynicism. We analyzed differences between those who would have elected to take the course (Elective students) and those who would not have elected to take it (Required students). Results: Elective students did not differ from Required students in baseline demographic characteristics, emotional exhaustion, work engagement, or positive emotions. At baseline, Elective students did report feeling safer to talk openly, a greater sense of community, and higher levels of cynicism. Over time, there were no differences in course evaluations or outcomes between Elective and Required students. Conclusions: Required students do not differ greatly from those who would have elected to take Healer's Art, and all students appear to have similar experiences in the course.

Keywords:

• humanism
• emotional exhaustion
• cynicism

Acknowledgments

Dr. Lapedis is currently in the Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA. Dr. Feingold is the course director and Dr. Thomas the associate course director for the Healer's Art at Cooper Medical School at Rowan University. Dr. Rabow is a course faculty member at University of California, San Francisco (UCSF) and Director of the Center for the Study of the Healer's Art. Dr. Remen is the Founder and Director of the Healer's Art course and the UCSF course director.

Some of the research described in this article was presented at the Annual Education Day Conference, UCSF Academy of Medical Educators, April 21, 2014. The authors acknowledge the deep and sustained commitment and colleagueship of the Healer's Art course directors and faculty. Diane Duchesne, RN, CHPN, Associate Director of the Healer's Art, supports the national and international dissemination of the course, coordinates the community of course directors, and ensures the course's impeccably consistent quality. We are indebted to all these professionals for their generosity, their expertise, and their wisdom.

Funding

There was no funding obtained to support this research work. The international Healer's Art course itself is supported by gifts to the Institute for the Study of Health and Illness (ISHI) at Commonweal from private donors, and grants from the Flow Fund and a family foundation that prefers to remain anonymous. None of the funding agencies to ISHI had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript.