Based on evaluations from nearly 500 students from 22 medical schools across the country, the Healer’s Art course appears to successfully engage students in a discovery process that helps them identify defining values and qualities of professionalism. The themes that emerge from their narratives replicate many of the professional qualities called for in directives from professional organizations. Interactional safety, which is deliberately built into the course design, appears to be central to the reported outcomes. In legitimizing humanistic elements of professionalism and creating a mutually respectful, safe community, the course enables students to explore the underlying values, meaning, and intention of their work. Students reported that few, if any, such educational opportunities existed within their required curricula. Despite the many hours students spend together in school, most traditional curricula are unable to evoke the sort of safe, professional community that allows the professional values shared by the student group and faculty to be articulated and validated. In filling the curricular gap, the Healer’s Art encouraged students to engage personally with the concept of professionalism and find their place within it.
The Healer’s Art appears to help students commit (or recommit) personally to basic values that underlie the practice of medicine, including compassion, empathy, integrity, and service. Nationally feasible and widely adopted, the course appears to offer one answer to ubiquitous calls to promote foundational and humanistic elements of medical professionalism.30
Moreover, the Healer’s Art is an intentionally affirmative approach that focuses on supporting and promoting professional values and character, not simply avoiding deficiency or misconduct.
In addressing the three evaluation questions about learning, personal and professional insights, and course utility, “creating an authentic community” emerged as a common theme for two of the three questions. The fact that students’ responses to question 2 (insights gained from the course) and question 3 (course utility) overlapped supports the conclusion that the Healer’s Art offers a setting and perspective that is uncommon in the required curriculum. Although the two evaluation questions do ask about related concepts, the emergence of community as a central theme is especially notable given that the course offers no didactic teaching on the concept of community.
Many of the findings in our analysis mirror struggles commonly identified in medical student professional development. As students become physicians, they must reconcile a number of issues: what it means to them personally to be a physician and how this corresponds with professional standards and traditions, what is the place of healing and emotion amidst the promise of science and cure, and what are the implications of growing professional expertise on a trainee’s human relationship with patients. As students are enculturated into the profession of medicine, the statement “we are people just like our patients” is both a simplistic aphorism and a fundamental challenge for professional development. Undeniably, medical education does make students different, but what curricular experiences enable a student to hold fast to the empathic principle that “my medical education makes me no different from the people I care for”?
As has been suggested by social learning theory,17,18
our study provides some empiric evidence that understanding and affiliating with the core elements of professionalism may require the lived experience of sharing personal stories, experiences, and values within a safe community of inquiry. The Healer’s Art appears to create a “community of practice” as defined by Wenger.17
Students learn as they interact with one another; the community thus created becomes a living curriculum. The Healer’s Art community of practice appears to impact learning in all three of Wenger’s domains: internally (learning skills such as listening through participation in a community of learners); externally (connecting student experience to actual practice through participation in a broader community with faculty facilitators); and, potentially, lifetime learning (through developing habits of reflection, self awareness, and commitment to values).
Whereas some educators might be concerned that the personal involvement and shared vulnerability possible within the Healer’s Art exposes students to the potential risk of emotional distress, the organization and principles of the course are designed to support and honor students’ individual experiences and character.
Our study has some potential limitations. The generalizability of conclusions drawn from student evaluations of an elective course is inherently limited. Students evaluated here are self-selected, and this may bias the results towards fitting closely with the beliefs underlying the course. However, the Healer’s Art does have a widespread appeal to students and faculty and a consistently beneficial outcome reported across a wide variety of schools nationally.26
Although the course was developed and taught by Dr. Remen at one school, successful training of faculty and international dissemination of the course shows that it can be effectively replicated and taught by a wide variety of faculty across a wide spectrum of institutions.
No information is available about enrolled students who did not return evaluations. These students represented a small minority of enrolled students and, in our view, their inclusion would be unlikely to impact our findings. As our data are based on course evaluations, it is possible that students reported back what they believed their faculty wished to hear. This type of response bias is offset by the fact that the course uses a discovery model and allows students to uncover what is true for them. Whereas the course has well-defined educational objectives, didactic instruction is limited and students are encouraged to discern the meaning in their own experience. Additionally, common themes emerged across 22 different schools in varied settings and institutional cultures. The analysis may have missed or misinterpreted some themes because two of the raters were also course faculty. However, one of the raters (JW) who is an accomplished qualitative researcher with no preexisting exposure to the course came to the same conclusions as the faculty raters.
Finally, little is known about the potential of the Healer’s Art to change student attitudes, rather than support and develop existing ones. We argue that supporting positive professional commitments is an important end in itself. Whereas most students reported using things they had learned in the Healer’s Art in both their personal life and professional work,26
our study did not verify that behavior actually changed. As this was a cross-sectional evaluation, it is not known whether the Healer’s Art influenced students’ professional behavior and developmental maturity1
or “immunized” students from some of the negative influences of medical training.10,30
Future studies will examine the effect of exposure to the Healer’s Art on such longitudinal outcomes.
In 2006–2007, the Healer’s Art was offered in 53 medical schools in the United States and Canada as well as Slovenia and Israel. Whereas the course is an elective, a few schools plan to experiment with requiring the course for all students. Regardless of whether the Healer’s Art course can or should be adopted into the required curriculum, it will always remain true that self-discovery requires personal learning-readiness. There does appear to be a large community of medical students ready to explore and embrace the foundational values of medical professionalism and affiliate themselves with the lineage of our profession.