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The Healer's Art: professionalism, service and mission

2005; Wiley; Volume: 39; Issue: 11 Linguagem: Inglês

10.1111/j.1365-2929.2005.02296.x

1365-2923

Rachel Naomi Remen, Michael W. Rabow,

Education and Critical Thinking Development

Context and setting Under the influence of a hidden curriculum that often runs counter to humanistic values, students tend to adopt a professional stance that devalues the service impulse that brought many of them into medicine. The Healer's Art is an elective course in values education for Year 1 and 2 medical students that was developed in 1992 at the University of California, San Francisco (UCSF) and is currently taught at 33 schools in the USA and Canada. Why the idea was necessary Professionalism consists of more than expertise, technical competencies and ethics. It includes other meaningful but non-cognitive dimensions, such as values, service commitment, mission and the ability to establish a healing relationship. Instilling and strengthening professionalism may require a different educational approach than teaching professional expertise. While there are many calls to promote professionalism and student well-being, few educational strategies to address these deeper elements of professionalism have been evaluated or proven feasible nationally. What was done The Healer's Art includes 5 3-hour modules: Discovering and Nurturing your Wholeness; Sharing Loss and Honouring Grief (2 sessions); Beyond Analysis: Allowing Awe in Medicine; and Care of the Soul. Each module includes a brief faculty presentation and a guided reflection on personal experiences. Students then work in small groups of 4–5 students and 1 faculty doctor to share and examine what was discovered in the reflection. Students and faculty share as equals. Small groups agree on guidelines of interaction and confidentiality that allow each group member to feel heard, respected and safe. The Healer's Art is based on 4 educational concepts: medical education is a moral trajectory, and the curriculum not only informs but also transforms learners; meaning and values are antecedent of professionalism and professional commitment; values learning requires content to be engaged experientially using an interactive discovery model; and learners already know more than they realise about healing and the doctor−patient relationship. In sharing their stories, students and faculty directly experience basic principles of service and the healing relationship: safety, authentic listening and presence; intimacy, respect and trust; compassion and empathy; community, and commitment. Evaluation of results and impact The Healer's Art has attracted an average of 44% of the UCSF Year 1 class annually since 1992. The course is now offered at 33 medical schools in the USA and Canada. In 2003–04, standardised evaluations were collected from 23 of the 25 schools participating at the time, with 489 of 680 students (72.0%) and 88 of 174 faculty (50.1%) responding. Students rated the quality of the course highly (4.47 on a 5-point scale). Both students and faculty reported that the course provided important content not available elsewhere in the curriculum (4.59 and 4.76, respectively). Students and faculty reported using content from the course both professionally (65.7% and 75.0%, respectively) and personally (73.3% and 79.5%, respectively). There were no statistically significant differences in evaluations of either the uniqueness or utility of the course based on student age, year in school, gender or medical school. Further evaluation of the course's short- and longterm impact is ongoing.