Clinical and Health Affairs
Teaching the Art of Healing
By Jennifer Pearson, M.D.
Abstract
The Healer’s Art is a course based on the work of Rachel Naomi Remen, M.D., that is designed to explore the art of medicine with medical students. It has been offered as an elective to second-year medical students at the University of Minnesota Medical School’s Duluth campus since 2003. The course leads students into dialogue about what, beyond science and technology, they as physicians will be able to offer patients. It also encourages participating faculty members to rediscover their passion for medicine. This article describes the course, the reasons for its creation, and the lessons students and faculty take away from it.
A group of second-year medical students and their faculty mentors sit in chairs or on the living room floor of a historic Duluth mansion. They have come to explore their own paths within medicine and to listen to the thoughts and stories of others.
The purpose of the evening gathering is to explore the art, rather than the science, of medicine. Although the science gives form to the profession and is certainly imperative to learn, understand, and use, the art of what physicians do—how they interact with people—is equally as important to their work.
For the last six years, second-year medical students at the University of Minnesota Medical School’s Duluth campus have taken part in this elective course called the Healer’s Art. The curriculum, which was pioneered by Rachel Naomi Remen, M.D., in 1991 at the University of California San Francisco School of Medicine, is designed to help students discover things about themselves—and the practice of medicine—that will help them learn the art of medicine.
The course is designed to give students a chance to discuss topics that often aren’t covered in medical school—the importance of listening, dealing with grief and loss, how to handle situations in which they as physicians may not have an answer, and how to continue to find meaning and fulfillment in their work. Approximately 60 medical schools in the United States and elsewhere have incorporated their own version of the Healer’s Art into their offerings. On the Duluth campus, we have taught the course since 2003, and students have received it enthusiastically.
I became familiar with Dr. Remen and her work shortly after I joined the faculty on the University of Minnesota Duluth campus in 2001. I had received her book Kitchen Table Wisdom as a gift several years earlier and felt it articulated well what I was thinking as I worked on the frontlines of family medicine: That science and technology were critical to the practice of medicine, but equally important was that patients be heard and cared for in a way that supported the whole self. By recognizing and supporting the wholeness and uniqueness of each individual, we as physicians could open a door to make healing possible. The heart of Dr. Remen’s message was that independent of any disease state, healing is possible for anyone and everyone.
The art of medicine is a somewhat nebulous concept that many hear about during medical training but never have the opportunity to learn or explore directly. Recognizing the need for a course addressing this important part of medical practice, I began communicating with Dr. Remen and her colleagues at the Institute for the Study of Health and Illness in California. In May of 2003, along with a dozen other faculty members from medical schools throughout the United States and Canada, I took part in a faculty development workshop she ran at the Commonweal Retreat Center in California. The goal of the four-day workshop was to take the Healer’s Art course ourselves, gain an understanding of its goals and objectives, and begin developing ways to replicate the course within our home academic institutions. The time spent with Remen and her colleagues proved to be an intensive period of deep personal and professional exploration as well as a time to practice facilitating this approach to learning. As we listened to the waves crash onto the rugged California shore, we learned firsthand the strength of the model. We also rediscovered the notion that it is not our expertise but our humanity that facilitates healing.
Teaching the Essence of Healing
One of the primary goals of the Healer’s Art, as articulated by Dr. Remen, is to explore foundational elements of professionalism.1 Certainly, professionalism encompasses technical, intellectual, and cognitive competencies; but the Healer’s Art course targets other aspects of professionalism such as the importance of calling on our values as we relate to others as well as our need for emotional intelligence. These latter components of professionalism are sometimes difficult to address in the standard medical school curriculum.
In developing the course for Duluth students, I wanted it to achieve two objectives. The first was to have students explore the essence of healing—what, beyond science and technology, they have to offer patients and others. The second was to help them stay connected to the meaning of their work in order to avoid burnout.
In order to best fulfill the first objective, we help students understand that as future physicians one of the most important things they can do for their patients is to listen to them. Each patient, each life, each story is unique, and listening validates the individual, strengthens their sense of self, and opens the door to healing. By listening to their stories, thoughts, and feelings, physicians can better understand each patient’s unique needs and manage their medical problems in ways that are most appropriate to them. We believe that by allowing students to experience the power of listening, they will better be able to use those skills in their practice in order to promote healing.
To fulfill the second objective of the course—to avoid burnout, we remind students of the reason they went into medicine and encourage them to focus on what made them want to become physicians in the first place. The cynicism, ethical erosion, and decline in empathy that arise when physicians are burned out sharply contrasts with the idealism and good intentions that bring most students through the doors of medical schools. For many physicians, this transformation starts in medical school, as they drive themselves to learn vast amounts about science and technology. As they become overwhelmed by all that they have to do, they forget the things that drew them to the profession. This pattern can continue as they begin to practice, leading them to feel disconnected from their sense of purpose and increasingly less satisfied and fulfilled.
No doubt, many factors contribute to burnout. Many who are involved with the Healer’s Art curriculum believe that staying connected to the art of practice fortifies medical students and young physicians for meeting the challenges inherent in the profession. We encourage students to stay focused on their reasons for going into medicine and to talk with colleagues about what brought them to the profession in order to sustain their enthusiasm and prevent burnout.
On the Shores of Lake Superior
Our Healer’s Art course in Duluth consists of five sessions over eight weeks. Readings are suggested prior to each session to prompt thought and discussion; nothing beyond participation is required to pass the course. At least part of the evening sessions are spent in a large group, with participants sharing their thoughts on various topics and taking part in exercises such as making drawings or using visual imagery to further develop ideas. From there, smaller groups consisting of one physician faculty member and five students further explore each topic.
The discussions are confidential, as we want to create an environment in which students feel they can talk about things they may not feel comfortable discussing in class. The topics range from self—who we are as people and how we ended up on this path, to how we deal with the ups and downs of life both as individuals and as future and practicing physicians, to the mystery and awe we feel when we cannot explain certain experiences or happenings, to the importance of service in the lives of physicians. Faculty members share their own stories and perspectives, and encourage students to further explore various topics. No two small-group experiences are the same, and no faculty roles are scripted; rather, each group is a reflection of the participants and the thoughts and stories they share.
Because this course is an elective, between a third and three-quarters of second-year students have chosen to take part each year. Physician faculty have included both academic and community physicians from a range of specialties. To be a member of the faculty, one must be willing to listen, offer perspective, and share experiences.
Students who took part in the Healer’s Art course earlier this year wrote the following when asked about what they took away from it: “It’s a clarification or a rekindling of something already in me.” “It’s differentiation between caring and healing.” “It made me remember why I chose to go into medicine—why I love serving others.” And, “It taught us how to unwind and take care of the stresses we have now and will continue to face.” Others wrote that the course taught them “that self discovery can help in understanding others,” “to stop, think, and listen when I think I know it all,” and to “never forget the journey and each life you touch, the lives that touch you, and the hills and valleys along the way.”
Participating faculty, myself included, often express similar sentiments. We describe it as a “rekindling” of that which we get distracted from in our lives as teachers and practicing physicians. For many of us, being able to step back and reconnect with what brought us to medicine is transformative and invigorating.
Staying Connected
Medical schools do a paramount job of teaching science. But practicing medicine involves much more than tending to the physical body. During this time of increasing challenges for individual physicians and the medical profession as a whole, it is especially important that young physicians stay connected to the reasons why they chose to do what they do. They need to see service as the core of the profession and remember that they will affect the lives of real people. The Healer’s Art course is designed to keep them in touch with those realities as they move from the lecture halls of medical school to the exam rooms of clinics. It is designed to help them understand that the healer’s art is what will earn them the honor of being called “doctor.” MM
Jennifer Pearson is an assistant clinical professor in the department of family medicine and director of the Healer’s Art course at the University of Minnesota Medical School, Duluth Campus.
Reference
1. Rabow MW, Wrubel J, Remen RN. Authentic community as an educational strategy for advancing professionalism: a national evaluation of the Healer’s Art course. J Gen Intern Med. 2007;22(10):1422-8.