Authentic community as an educational strategy for advancing professionalism: a national evaluation of the Healer's Art course

The Power of Nursing: Person-Centered Self-Care Education for Student Nurses

The COVID 19 pandemic has had a tremendous impact on nursing and health care delivery systems. Recent research demonstrates a correlation between the stress of providing complex health care and the decline of nurse well-being. Investing in the well-being of nurses can benefit the entire health care system. Educational institutions can play a role in enhancing nurse well-being by incorporating holistic nursing education principles into the curriculum, including reflective practice methods to promote self-awareness and self-care. This may be challenging for some nursing programs, but the Power of Nursing course can help close this gap. This noncommercial course incorporates key elements of holistic nursing including authenticity, empathy, compassion, unconditional acceptance, and self-care; elements not always emphasized in a traditional curriculum. Power of Nursing, offered as an elective in nursing schools or part of nursing residency programs, provides attendees with tools and strategies to boost resilience, strengthen personal commitment to nursing, and increase well-being preparing them to thrive in any health care environment.

A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore

INTRODUCTION

Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore.

METHODS

A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used.

RESULTS

A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms.

CONCLUSION

The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.

Compassion and Empathy in Basic Medical Science Teaching: A Suggested Model

Medical school education typically consists of two main student bodies: medical students and biomedical graduate students. For both groups, compassion and empathy represent a major component of future professional roles. For medical students, this takes the form of the all-important doctor-patient relationship and adherence to the Hippocratic Oath. For biomedical students, future research and teaching are often driven by the opportunity to contribute to treatments to help pain and suffering for those in need. For both groups, such positive contributions further extend to families, who often suffer emotional distress watching the health struggles of a loved one. Given the key role that compassion and empathy play here, including them as part of student educational development is important. Such focus, however, is limited - especially during the initial academic classroom years - with most time here dedicated to the learning of facts and foundational material. Given its importance in the future professional roles of these students, we posit that more can be done to introduce and reinforce the concept of compassion and empathy during the initial didactic course years. Modest but viable options exist for the introduction of these concepts as a part of basic teaching that will provide additional reinforcement of this all-important sensitivity for others. Here we present a model providing suggestions and recommendations for the integration of compassion and empathy in otherwise basic scientific teaching, and in a way that also includes progressive equality positions on social issues. While the focus here is medical school education since it represents this author’s expertise as well as a field where young trainees graduate to professional careers requiring compassion, it can potentially be applied to many other disciplines.

A Scoping Review of Professional Identity Formation in Undergraduate Medical Education

BACKGROUND

Professional identity formation (PIF) in medical students is a multifactorial phenomenon, shaped by ways that clinical and non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations. The relationship between students' evolving professional identity and self-identity or personhood remains ill-defined, making it challenging for medical schools to support PIF systematically and strategically. Primarily, to capture prevailing literature on PIF in medical school education, and secondarily, to ascertain how PIF influences on medical students may be viewed through the lens of the ring theory of personhood (RToP) and to identify ways that medical schools support PIF.

METHODS

A systematic scoping review was conducted using the systematic evidence-based approach. Articles published between 1 January 2000 and 1 July 2020 related to PIF in medical students were searched using PubMed, Embase, PsycINFO, ERIC and Scopus. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. Concurrent thematic and directed content analyses were used to evaluate the data.

RESULTS

A total of 10443 abstracts were identified, 272 full-text articles evaluated, and 76 articles included. Thematic and directed content analyses revealed similar themes and categories as follows: characteristics of PIF in relation to professionalism, role of socialization in PIF, PIF enablers and barriers, and medical school approaches to supporting PIF.

DISCUSSION

PIF involves iterative construction, deconstruction and inculcation of professional beliefs, values and behaviours into a pre-existent identity. Through the lens of RToP, factors were elucidated that promote or hinder students' identity development on individual, relational or societal levels. If inadequately or inappropriately supported, enabling factors become barriers to PIF. Medical schools employ an all-encompassing approach to support PIF, illuminating the need for distinct and deliberate longitudinal monitoring and mentoring to foster students' balanced integration of personal and professional identities over time.

Coping with the Practice of Medicine: Religion, Spirituality, and Other Personal Strategies

With the increasing demands on the practice of medicine, this qualitative study asked residents and their faculty (n = 44) to reflect on how they cope with their work. They provided written reflections to questions about successful and disappointing patient experiences, as well as describing their personal, religious, or spiritual practices. Key themes included connecting with family and friends, learning from their mistakes, using cognitive behavioral tools, and engaging with their spirituality and religiosity. One third specifically mentioned they used prayer and/or meditation. We contextualized selected quotes with their level of spiritual well-being, religiosity, and burnout.

Loss of Meaning at Work Associated with Burnout Risk in Academic Medicine

OBJECTIVES

Meaning at work has been proposed as one of the key drivers of professional burnout in healthcare, but few studies have simultaneously measured this relation.

METHODS

In this cross-sectional analysis of 1637 individuals at the University of Arkansas for Medical Sciences, burnout was measured using the Copenhagen Burnout Inventory work-related subscale.

RESULTS

Meaningful work was measured using items adapted from the Work as Meaning Inventory. The prevalence of work-related burnout increased with each level of diminished meaning at work. From the highest ("always") to the lowest ("never") level of meaning at work, the prevalence of burnout was: 13, 26, 57, 84, and 94%, respectively.

CONCLUSIONS

Work-related burnout was inversely proportional to reported meaning at work in an academic medical center.

A Systematic Review of Mental Health-Improving Interventions in Veterinary Students

Literature over the past 5 years has demonstrated that veterinary students globally are experiencing poor mental health. This has detrimental consequences for their emotional well-being and physical health, as well as implications for their future careers. Considering this issue, a systematic review was devised to investigate what interventions were being used, and what effect they had, in veterinary students. The review process involved a search of five databases, from which 161 records were retrieved. Following this, the screening process revealed seven articles eligible for appraisal. These studies investigated seven different interventions, six being cohort-level workshops/courses and one being a collation of several individual strategies. All seven studies reported that the interventions were effective to some degree in improving the mental health of their participants. However, the lack of repeat interventions and control groups limited the external validity of each intervention. A comparison to the research in medical students is briefly discussed. Three of the appraised articles were recommended for further investigation.

Requiring the Healer's Art Curriculum to Promote Professional Identity Formation Among Medical Students

The Healer's Art curriculum (HART) is one of the best-known educational strategies to support medical student professional identity formation. HART has been widely used as an elective curriculum. We evaluated students' experience with HART when the curriculum was required. All one hundred eleven members of the class of 2019 University of New Mexico School of Medicine students were required to enroll in HART. We surveyed the students before and after the course to assess its self-reported impact on key elements of professional identity formation such as empathy towards patients and peers, commitment to service, and burnout. A majority of students (n=53 of 92, 57.6%) reported positive effects of the course on their empathy towards other students. This finding was significantly associated with self-reported willingness to have elected the course had it not been required. One-half of respondents (n=46 of 92, 50.0%) reported positive effects on their empathy towards future patients. At least one-quarter to one-third of respondents reported positive influences on commitment to service, conceptions about being a physician, and self-perceived burnout. Students report benefits on their professional identity formation after participating in a required course on humanism. Empathy-building among peers is one valuable outcome of such curricula.

Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990-2019

Introduction: Professionalism is an evolving, socioculturally informed multidimensional construct that influences doctor-patient relationships, patient satisfaction and care outcomes. However, despite its clinical significance there is little consistency in how professionalism is nurtured amongst medical students. To address this gap a systemic scoping review of nurturing professionalism in medical schools, is proposed.Methods: Levac's framework and the PRISMA-P 2015 checklist underpinned a 6-stage systematic review protocol. Concurrent use of Braun and Clarke's approach to thematic analysis and directed content analysis was used to identify the key elements in nurturing professionalism.Results: 13921 abstracts were identified from six databases, 854 full-text articles reviewed, and 162 full-text included articles were included. The 4 themes identified through thematic analysis are consistent with findings of the directed content analysis. These were the definition of professionalism, the approaches, content, barriers and enablers to teaching professionalism.Conclusion: Informed by a viable definition of professionalism and clear milestones nurturing professionalism nurturing professionalism begins with culturally appropriate training in clinical competence, humanistic qualities and reflective capacity. This process requires effective evaluations of professional identity formation, and the impact of the learning environment underlining the need for longitudinal assessments of the training process.

Best Practice in Supporting Professional Identity Formation: Use of a Professional Reasoning Framework

Professional identity and professionalism education are increasingly important to veterinary education, but many of the concepts remain intangible to veterinary students, and engagement is a persistent challenge. While whole-curriculum integration is recommended for a successful professional studies program, this is complicated by clinical faculty's discomfort with the content. Where professional studies education is centered around professional identity formation, a key element of this is the multi-perspective nature of veterinary work, with the veterinarian negotiating the needs of multiple stakeholders in animal care. Constructing teaching around a framework of professional reasoning, which incorporates the negotiation of different stakeholder needs, ethical decision making, communication, teamwork, and outcome monitoring, offers the potential to make professional identity a concept more visible to students in veterinary work, and guides students in the contextualization of taught material. A framework is presented for veterinary professional reasoning that signposts wider curriculum content and helps illustrate where material such as veterinary business studies, animal welfare, the human-animal bond, and professional responsibility, as well as attributes such as empathy and compassion, all integrate in the decisions and actions of the veterinary professional. The aims of this framework are to support students' engagement in professional studies teaching and help them use workplace learning experiences to construct an appropriate professional identity for competence and resilience in the clinic. For faculty involved in curriculum design and clinical teaching, the framework provides a tool to support the integration of professional identity concepts across the extended curriculum.

Cultivating a way of being and doing: Individual strategies for physician well-being and resilience

The practice of medicine is rewarding on many levels, but demands of the work can result in mental and emotional exhaustion, self-isolation, burnout, depression, suicidal ideation and tragically, completed suicide. It is critical to have effective strategies to address the unique stressors of a medical career, mitigate burnout, and buffer the physiologic toll of chronic stress. Using Zwack and Schweitzer's widely published description of approaches to maintaining resilience and approaches to wellness, we have organized these strategies into three broad domains relevant to medical practice: (1) gratification (connection and communication, meaning and purpose); (2) resilience building practices (self-reflection, time for oneself, self-compassion, spirituality); and (3) useful attitudes (acceptance, flexibility, self-awareness). Several techniques are described including mindfulness-based stress reduction, narrative medicine, skillful communication, and practices in self-compassion, gratitude, and spirituality. The focus of the work is to introduce a spectrum of resilience strategies for individual consideration that can be tailored and combined to meet a physician's changing needs over the course of medical training and practice.

A self-report of the Healer's art by junior doctors: does the course have a lasting influence on personal experience of humanism, self-nurturing skills and medical counterculture?

BACKGROUND

Healer's Art (HA) is a voluntary course offered during medical school. The course aims to address the growing loss of meaning and commitment experienced by doctors through the exploration of compassion, empathy and awe in medicine, and early exposure to a supportive community of practice. This project aimed to evaluate the potential influence of HA on junior doctor graduates.

METHODS

Junior doctors who had undertaken HA during their medical studies were interviewed. A thematic analysis was performed on the results of these semi-structured interviews.

RESULTS

Ten junior doctors who had undertaken the HA course participated in interviews. All interviewees described the HA as a positive and enlightening experience in their medical education. The thematic analysis identified four major themes: developing empathy in the doctor-patient journey, self-care and self-awareness, the creation of a supportive community, and coping with the challenging medical culture.

CONCLUSIONS

HA provides experiential learning that enables participants to explore humanistic medicine. Self-selected junior doctors recall the course as a positive experience, and perceive themselves to be continuing to employ the techniques from HA in the healthcare setting. The concepts taught in the HA course appear to have a lasting personal impact on some junior doctors, who identify the course as influencing their self-reported positive patient-doctor relationships and supportive relationships with medical peers.

Preventing physician burnout: satisfaction or something more?

Physician burnout and depression have been recognized as serious international problems and the secondary costs of poor physician mental health are substantial. Interventions to address this problem can be split into two categories: those focusing on the individual, and those addressing the work environment. Individual-focused programs often include instruction in mindfulness, nutrition, and exercise, while those in the work environment have focused largely on stressors such as administrative burden, electronic health records, and productivity pressures.

The recent IJHPR article entitled “Burnout and intentions to quit the practice among community pediatricians: Associations with specific professional activities”, by Grosman et al., offers an additional path to address burnout and well-being in pediatricians through increasing of hours in more satisfying professional activities. While “satisfaction” was the metric in this study, what lay at the root of that satisfaction may be deeper and more profound. What the study does not measure is that the less-burned out physicians who felt greater satisfaction may have also felt a greater sense of meaning in their lives.

Grossman et al. rightly urge health care managers to encourage diversification of the pediatrician’s job by enabling greater engagement in the identified ‘anti- burnout’ professional activities, however more can and should be done. Physicians themselves should take an active role in both the seeking of, and connection to, meaning. Burnout and frustration, understandably, may have led some doctors to possess a sense of cynicism that has obscured meaning in their lives. If physicians cannot find a path to meaning on their own, they should seek colleague partners, coaches, or therapists to assist. Physicians can advocate for programs to reduce work-force stressors, but they can also advocate for formal programs such as Healers Arts programs, Schwartz rounds, and narrative medicine programs to help reconnect to meaning in their daily clinical work. Brief courses in cognitive behavioral techniques may also help in combating problematic mindsets endemic in medicine such as negativity bias, maladaptive perfectionism, and pessimistic explanatory style. With effort, a growth mindset, and when needed, guidance and some reinforcement, these negative and toxic mindsets can diminish; they can fade, and further open physicians to the healing power of meaning.

Is research on professional identity formation biased? Early insights from a scoping review and metasynthesis

OBJECTIVE

Despite a recent surge in literature identifying professional identity formation (PIF) as a key process in physician development, the empiric study of PIF in medicine remains in its infancy. To gain insight about PIF, the authors examined the medical literature and that of two other helping professions.

METHODS

The authors conducted a scoping review and qualitative metasynthesis of PIF in medicine, nursing and counselling/psychology. For the scoping review, four databases were searched using a combination of keywords to identify empiric studies on PIF in trainees. After a two-step screening process, thematic analysis was used to conduct the metasynthesis on screened articles.

RESULTS

A total of 7451 titles and abstracts were screened; 92 studies were included in the scoping review. Saturation was reached in the qualitative metasynthesis after reviewing 29 articles.

CONCLUSION

The metasynthesis revealed three inter-related PIF themes across the helping professions: the importance of clinical experience, the role of trainees' expectations of what a helping professional is or should be, and the impact of broader professional culture and systems on PIF. Upon reflection, most striking was that only 10 of the 92 articles examined trainee's sociocultural data, such as race, ethnicity, gender, sexual orientation, age and socio-economic status, in a robust way and included them in their analysis and interpretation. This raises the question of whether conceptions of PIF suffer from sociocultural bias, thereby disadvantaging trainees from diverse populations and preserving the status quo of an historically white, male medical culture.

The Healer's Art: Remembering Our Professional Lineage in Community through the Cultivation of Individual Core Values

This article was migrated. The article was marked as recommended. Introduction: There is both patient and provider dissatisfaction with the climate of healthcare delivery. Upon review, this is found to be at least in part attributable to the mechanization of health care, which often involves more computer interaction than hands-on care. Despite rising costs, the physical exam is replaced by lab tests and radiologic studies, generating more cost. The time-honored respect for a carefully obtained history from the patient is replaced by a computer check-box template. The humanity of both physician and patient are marginalized, with increased potential for both diagnostic and therapeutic compromise. Though access to medical information about disease is possible with bioinformatics, artificial intelligence cannot substitute for analysis by an informed, attentive, and properly educated physician. The process of healing must begin with the first patient visit - and the presence of an informed, compassionate, and fully attentive physician. Objective: To describe the history of medical educators' grappling with this problem through 3 landmark articles over a 100-year period. To illustrate the challenges of the climate of medical education. To offer some educational strategies (with examples of successful programs) to teach physicians using the Humanities. To illustrate that the art and science of medicine are synergistic, not dichotomous. Methods: Two educational theories ripe for use: Chickering and the Discovery Model, and Osler's recommended bedside reading list, exemplary programs that are being used currently (and over the last 25-plus years) to emphasize the importance of both the science and the practice of medicine in an effort to optimize the medical climate. Conclusion: The problem of physician burnout and patient dissatisfaction is being addressed in the medical literature, by regulatory societies devoted to physician wellness and by medical educators. This is nevertheless a challenge given the current electronic climate (with bioinformatics and artificial intelligence) and revenue-focused agendas of practice management business people. Results: With an awareness of the need for emphasis on the humanities coupled with an historical perspective over the last 100 years, a spirit of hope can be provided to both physician and patient from the lineage of the medical profession, which also is a legacy for our medical students.

The Healer's Art (HART): Veterinary Students Connecting with Self, Peers, and the Profession

This case study sought to understand veterinary students' perceptions and experiences of the Healer's Art (HART) elective to support well-being and resilience. Students' "mindful attention" was assessed using the MAAS-State scale. Course evaluations and written materials for course exercises (artifacts) across the 2012-2015 cohorts of Colorado State University's HART veterinary students (n=99) were analyzed for themes using a grounded theory approach, followed by thematic comparison with analyses of HART medical student participants. HART veterinary students described identity/self-expression and spontaneity/freedom as being unwelcome in the veterinary curriculum, whereas HART medical students described spirituality as unwelcome. HART veterinary students identified issues of "competition" and "having no time," which were at odds with their descriptions of not competing and having the time to connect with self and peers within their HART small groups. HART veterinary students shared that the course practices of nonjudgment, generous listening, and presence (i.e., mindfulness practices) helped them build relationships with peers. Although not statistically significant, MAAS pre-/post-scores trended in the positive direction. HART provides opportunities for students to connect with self and foster bonds with peers and the profession, factors that are positively associated with resilience and wellness.

Enhancing student perspectives of humanism in medicine: reflections from the Kalaupapa service learning project

BACKGROUND

Service learning is endorsed by the Liaison Committee on Medical Education (LCME) as an integral part of U.S. medical school curricula for future physicians. Service learning has been shown to help physicians in training rediscover the altruistic reasons for pursuing medicine and has the potential to enhance students' perspectives of humanism in medicine. The Kalaupapa service learning project is a unique collaboration between disadvantaged post-baccalaureate students with an underserved rural community. This study was conducted to determine whether the Kalaupapa service learning curricula enhanced student perspectives of humanism in medicine at an early stage of their medical training.

METHOD

Program participants between 2008 and 2014 (n = 41) completed written reflections following the conclusion of the service learning project. Four prompts guided student responses. Reflections were thematically analyzed. Once all essays were read, team members compared their findings to condense or expand themes and assess levels of agreement.

RESULTS

Emerging themes of resilience and unity were prominent throughout the student reflections. Students expressed respect and empathy for the patients' struggles and strengths, as well as those of their peers. The experience also reinforced students' commitment to service, particularly to populations in rural and underserved communities. Students also gained a deeper understanding of the patient experience and also of themselves as future physicians.

CONCLUSION

To identify and address underserved and rural patients' health care needs, training programs must prepare an altruistic health care workforce that embraces the humanistic element of medicine. The Kalaupapa service learning project is a potential curricular model that can be used to enhance students' awareness and perspectives of humanism in medicine.

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

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.

A Methodological Review of the Assessment of Humanism in Medical Students

BACKGROUND

Humanism is a complex construct that defies simplistic measurement. How educators measure humanism shapes understanding and implications for learners. This systematic review sought to address the following questions: How do medical educators assess humanism in medical students, and how does the measurement impact the understanding of humanism in undergraduate medical education (UME)?

METHOD

Using the IECARES (integrity, excellence, compassion, altruism, respect, empathy, and service) Gold Foundation framework, a search of English literature databases from 2000 to 2013 on assessment of humanism in medical students revealed more than 900 articles, of which 155 met criteria for analysis. Using descriptive statistics, articles and assessments were analyzed for construct measured, study design, assessment method, instrument type, perspective/source of assessment, student level, validity evidence, and national context.

RESULTS

Of 202 assessments reported in 155 articles, 162 (80%) used surveys; 164 (81%) used student self-reports. One hundred nine articles (70%) included only one humanism construct. Empathy was the most prevalent construct present in 96 (62%); 49 (51%) of those used a single instrument. One hundred fifteen (74%) used exclusively quantitative data; only 48 (31%) used a longitudinal design. Construct underrepresentation was identified as a threat to validity in half of the assessments. Articles included 34 countries; 87 (56%) were from North America.

CONCLUSIONS

Assessment of humanism in UME incorporates a limited scope of a complex construct, often relying on single quantitative measures from self-reported survey instruments. This highlights the need for multiple methods, perspectives, and longitudinal designs to strengthen the validity of humanism assessments.

Humanism and professionalism education for pediatric hematology-oncology fellows: A model for pediatric subspecialty training

BACKGROUND

Humanism and professionalism are virtues intrinsic to the practice of medicine, for which we lack a standard, evidence-based approach for teaching and evaluation. Pediatric hematology-oncology (PHO) fellowship training brings new and significant stressors, making it an attractive setting for innovation in humanism and professionalism training.

PROCEDURE

We electronically surveyed a national sample of PHO fellows to identify fellows' educational needs in humanism and professionalism. Next, we developed a case-based, faculty-facilitated discussion curriculum to teach this content within pilot fellowship programs. We assessed whether fellowships would decide to offer the curriculum, feasibility of administering the curriculum, and satisfaction of fellow and faculty participants.

RESULTS

Surveys were completed by 187 fellows (35%). A minority (29%) reported that their training program offers a formal curriculum in humanism and/or professionalism. A majority desires more formal teaching on balancing clinical practice and research (85%), coping with death/dying (85%), bereavement (78%), balancing work and personal life (75%), navigating challenging relationships with patients (74%), and depression/burn out (71%). These six topics were condensed into four case-based modules, which proved feasible to deliver at all pilot sites. Ten fellowship programs agreed to administer the novel curriculum. The majority (90%) of responding fellows and faculty reported the sessions touched on issues important for training, stimulated reflective communication, and were valuable.

CONCLUSIONS

Pediatric hematology-oncology fellows identify numerous gaps in their training related to humanism and professionalism. This curriculum offers an opportunity to systematically address these educational needs and can serve as a model for wider implementation. Pediatr Blood Cancer 2015;62:335-340. © 2014 Wiley Periodicals, Inc.

Twelve tips on teaching and learning humanism in medical education

BACKGROUND

The teaching of humanistic values is recognized as an essential component of medical education and continuing professional development of physicians. The application of humanistic values in medical care can benefit medical students, clinicians and patients.

AIMS

This article presents 12 tips on fostering humanistic values in medical education.

METHOD

The authors reviewed the literature and present 12 practical tips that are relevant to contemporary practices.

RESULTS

The tips can be used in teaching and sustaining humanistic values in medical education.

CONCLUSIONS

Humanistic values can be incorporated in formal preclinical environments, the transition into clinical settings, medical curricula and clinical clerkships. Additionally, steps can be taken so that medical educators and institutions promote and sustain humanistic values.

A medical student elective promoting humanism, communication skills, complementary and alternative medicine and physician self-care: an evaluation of the HEART program

OBJECTIVE

In 2002 the American Medical Student Association (AMSA) created a fourth-year medical student elective known as the Humanistic Elective in alternative medicine, Activism, and Reflective Transformation (HEART) that provided the opportunity for students to explore humanism in medicine, self-care, complementary and alternative medicine modalities, communication, activism, and community building in a four-week immersion experience. The educational effects of this elective, and whether it has met its stated goals, are unknown.

METHOD

The authors conducted a web-based, cross-sectional survey of the first eight cohorts of HEART graduates in 2010. Survey questions assessed respondents' demographics and perspectives on the educational impact of the elective. Descriptive statistics were used to characterize the sample and qualitative analyses were guided by grounded theory.

RESULTS

Of 168 eligible alumni, 122 (73%) completed the survey. The majority were female (70%), age ≤35 (77%) years, and trained in primary care specialties (66%). Half were attendings in practice. The majority of respondents felt the elective taught professionalism (89%) and communication skills (92%) well or very well. The majority highly agreed that the elective helped them better cope with stress during residency training (80%), taught them self-care skills (75%), and improved their ability to empathize and connect with patients (71%). Qualitative analysis of the personal and professional impact of the elective identified twelve common themes with self-discovery, self-care, and collegial development/community most frequently cited.

CONCLUSIONS

The majority of HEART graduates endorse learning important skills and benefiting from the experience both personally and professionally. Aspects of the HEART curriculum may help training programs teach professionalism and improve trainee well-being.

Attitudes of Pakistani and Pakistani heritage medical students regarding professionalism at a medical college in Karachi, Pakistan

BACKGROUND

An increased interest in professionalism has been reported in the field of medical education due to concerns regarding deterioration of humanism and professional values in the teaching and practice of medicine. The primary aim of this study was to assess attitudes of Pakistani and Pakistani heritage students at a medical college in Pakistan about important elements of professionalism that an ideal medical doctor should possess. A further objective of the study was to determine students' preferred ways of learning professionalism.

METHODS

A written survey was distributed to undergraduate medical students at a public sector medical college at Karachi, Pakistan in 2011. Using the Penn State College of Medicine (PSCOM) Professionalism Questionnaire, attitudes of medical students of semester 1, 5, and 8 regarding professionalism were assessed anonymously.

RESULTS

The mean age of the students was 21.11 ± 2.72 years. Forty-three percent of the respondents were male. Forty percent of the students held Pakistani citizenship. Thirty-five percent students were US citizens with Pakistani parents and twenty-five percent were Pakistani heritage students that had dual citizenships. No significant differences in the elements of professionalism (Accountability, Altruism, Duty, Excellence, Honesty & Integrity and Respect) mean scores or in the overall mean score of professionalism among the various classes were found. The total overall Cronbach alpha value for all elements of the professionalism in the selected classes was above 0.9. The most preferred methods for learning professionalism were role modeling by faculty, case based scenarios and role plays.

CONCLUSION

The students rated all the attributes of professionalism as important and there was no difference across the study years. The overall internal consistency of each element of professionalism was high in different classes. Faculty role models, case based scenarios and role plays may be used to teach professionalism. As a great majority of students were having a Pakistani heritage rather than complete Pakistani born and bred background, hence findings of the survey may not be taken as representative of typical Pakistani medical students.

Fostering professional formation in residency: development and evaluation of the "forum" seminar series

BACKGROUND

Residency training is a critical time for physicians' professional formation. However, few structured interventions exist to support residents in this transformative process of integrating personal and professional values, a process that is essential to physician identity formation and preservation of core values such as service and compassion.

PURPOSES

The authors created a seminar series, the "Forum," to support resident professional formation and address the hidden curriculum as part of a larger intervention to support self-directed learning skills such as goal setting and reflection.

METHODS

Ninety-minute sessions with senior residents and faculty held every other month include opportunities for individual reflection, small- and large-group discussion, and brief didactic components focused on skills such as teaching and leadership. The qualitative program evaluation included analyses of individual semistructured interviews with resident and faculty participants from 2008 to 2011 and of notes recorded by an observer during the 1st year's sessions.

RESULTS

Residents appreciated the focus on relevant issues, presence of faculty, opportunities for reflection and interactivity, and inclusion of practical skills. Effects attributed to the Forum included gaining practical skills, feeling a deeper connection to one another and a sense of community, and recognizing progress in their own professional development and growth. Elements described in the literature as essential to professional formation, including encouraging reflection, use of narrative, role modeling, addressing the hidden curriculum, and fostering an authentic community, were recognized by participants as integral to the Forum's success.

CONCLUSIONS

A group forum for reflection and discussion with peers and role models, tailored to local needs, offers an effective structure to foster professional formation in residency.

Teaching in relationship: the impact on faculty of teaching "the Healer's Art"

BACKGROUND

Medical teachers report both positive and negative experiences, but these impacts are not well understood. In particular, the experience of faculty in relationship-centered education is unknown.

PURPOSES

We sought to assess the benefits to teachers of the Healer's Art, a popular international medical school elective course.

METHODS

We performed quantitative and qualitative analyses of course evaluations completed by 2009-10 Healer's Art faculty from 17 schools.

RESULTS

Ninety-nine of 117 faculty (84.6%) completed the evaluation. No differences in quantitative responses based on gender, specialty, medical school, or year of graduation were observed. Respondents were likely or very likely to agree that the course was useful, positively impacted clinical work and teaching, and increased overall commitment to teaching. In describing the benefits of teaching in the Healer's Art, faculty emphasized four themes: Personal Response to Medicine, Professional Growth, Greater Connection, and Greater Empathy and Respect for Students.

CONCLUSIONS

Healer's Art faculty report personal and professional benefits, as well as increased commitment to teaching and to a relationship-centered educational process.

Teaching professionalism in medical education: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25

INTRODUCTION

We undertook a systematic review to identify the best evidence for how professionalism in medicine should be taught.

METHODS

Eligible studies included any articles published between 1999 and 2009 inclusive. We reviewed papers presenting viewpoints and opinions as well as empirical research. We performed a comparative and thematic synthesis on all papers meeting inclusion criteria in order to capture the best available evidence on how to teach professionalism.

RESULTS

We identified 217 papers on how to teach professionalism. Of these, we determined 43 to be best evidence. Few studies provided comprehensive evaluation or assessment data demonstrating success. As yet, there has not emerged a unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum.

DISCUSSION

Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in current teaching programmes, and are widely held to be the most effective techniques for developing professionalism. While it is generally held that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory.

Expressing one's feelings and listening to others increases emotional intelligence: a pilot study of Asian medical students

BACKGROUND

There has been considerable interest in Emotional Intelligence (EI) in undergraduate medical education, with respect to student selection and admissions, health and well-being and academic performance. EI is a significant component of the physician-patient relationship. The emotional well-being of the physician is, therefore, a significant component in patient care. The aim is to examine the measurement of TEIQue-SF in Asian medical students and to explore how the practice of listening to the feelings of others and expressing one's own feelings influences an individual's EI, set in the context of the emotional well-being of a medical practitioner.

METHODS

A group of 183 international undergraduate medical students attended a half-day workshop (WS) about mental-health and well-being. They completed a self-reported measure of EI on three occasions, pre- and post-workshop, and a 1-year follow-up.

RESULT

The reliability of TEIQue-SF was high and the reliabilities of its four factors were acceptable. There were strong correlations between the TEIQue-SF and personality traits. A paired t-test indicated significant positive changes after the WS for all students (n=181, p=.014), male students (n=78, p=.015) and non-Japanese students (n=112, p=.007), but a repeated measures analysis showed that one year post-workshop there were significant positive changes for all students (n=55, p=.034), female students (n=31, p=.007), especially Japanese female students (n=13, p=.023). Moreover, 80% of the students reported that they were more attentive listeners, and 60% agreed that they were more confident in dealing with emotional issues, both within themselves and in others, as a result of the workshop.

CONCLUSION

This study found the measurement of TEIQue-SF is appropriate and reliable to use for Asian medical students. The mental health workshop was helpful to develop medical students' EI but showed different results for gender and nationality. The immediate impact on the emotional awareness of individuals was particularly significant for male students and the non-Japanese group. The impact over the long term was notable for the significant increase in EI for females and Japanese. Japanese female students were more conscious about emotionality. Emotion-driven communication exercises might strongly influence the development of students' EI over a year.

Perspective: the negativity bias, medical education, and the culture of academic medicine: why culture change is hard

Despite ongoing efforts to improve working conditions, address well-being of faculty and students, and promote professionalism, many still feel the culture of academic medicine is problematic. Depression and burnout persist among physicians and trainees. The authors propose that culture change is so challenging in part because of an evolutionary construct known as the negativity bias that is reinforced serially in medical education. The negativity bias drives people to attend to and be more greatly affected by the negative aspects of experience. Some common teaching methods such as simulations, pimping, and instruction in clinical reasoning inadvertently reinforce the negativity bias and thereby enhance physicians' focus on the negative. Here, the authors examine the concept of negativity bias in the context of academic medicine, arguing that culture is affected by serially emphasizing the inherent bias to recognize and remember the negative. They explore the potential role of practices rooted in positive psychology as powerful tools to counteract the negativity bias and aid in achieving desired culture change.

Using movies to teach professionalism to medical students

BACKGROUND

Professionalism topics are usually not covered as a separate lesson within formal curriculum, but in subtler and less officially recognized educational activities, which makes them difficult to teach and assess. Interactive methods (e.g. movies) could be efficient teaching methods but are rarely studied. The aims of this study were: 1) to test the relevance and usefulness of movies in teaching professionalism to fourth year medical students and, 2) to assess the impact of this teaching method on students' attitudes towards some professionalism topics.

METHOD

This was an education study with qualitative data analysis in a group of eleven fourth year medical students from the Medical School of University Maribor who attended an elective four month course on professionalism. There were 8 (66.7%) female students in the group. The mean age of the students was 21.9 ± 0.9 years. The authors used students' written reports and oral presentations as the basis for qualitative analysis using thematic codes.

RESULTS

Students recognised the following dimensions in the movie: communication, empathy, doctors' personal interests and palliative care. It also made them think about their attitudes towards life, death and dying.

CONCLUSIONS

The controlled environment of movies successfully enables students to explore their values, beliefs, and attitudes towards features of professionalism without feeling that their personal integrity had been threatened. Interactive teaching methods could become an indispensible aid in teaching professionalism to new generations.

Professional formation: extending medicine's lineage of service into the next century

In his 1910 report on medical education, Flexner emphasized the importance of competency in basic sciences. Less widely recognized is that he also emphasized the necessity of liberal education. On the Flexner Report's 100th anniversary, medicine is challenged to realize Flexner's full vision for medical education to ensure that physicians are prepared to lead lives of compassion and service as well as to perform with technical proficiency. To meet the complex medical and social challenges of the next century, medical educators must continue to promote cognitive expertise while concurrently supporting "professional formation"-the moral and professional development of students, their ability to stay true to their personal service values and the core values of the profession, and the integration of their individual maturation with growth in clinical competency. The goal of professional formation is to anchor students to foundational principles while helping them navigate the inevitable moral conflicts in medical practice. The consequences of inadequate support for professional formation are profound, impacting individual learners, patients, the profession, and society at large. Among the many successful professional formation projects nationally, two long-standing programs are described in modest detail to identify common elements that might guide future developments elsewhere. Key elements include experiential and reflective processes, use of personal narratives, integration of self and expertise, and candid discussion within a safe community of learners. Committing to professional formation within medical education will require transformation of formal and informal curricula and will necessitate a rebalancing of attention and financial support within schools of medicine.

Heart of Pharmacy: a course exploring the psychosocial issues of patient care

OBJECTIVE

To implement and assess the impact of a course utilizing reflective learning to explore the complex, psychosocial human issues encountered in pharmacy practice.

DESIGN

A 1-credit-hour elective course, The Heart of Pharmacy, was offered to all pharmacy students. The course utilized both content and reflective techniques to produce a mutual exploratory learning experience for students, staff, and faculty members. Faculty and staff facilitators observed competencies and used a single group posttest design to assess students' attitudes. In year four, students' written reflections for each session were added and reviewed on a continuous basis throughout the course.

ASSESSMENT

Faculty and staff observations indicated that educational outcomes were achieved and student perceptions and evaluations of the course were highly positive. Three major themes were identified in the students' qualitative responses: a recognition of communal support among student and faculty colleagues; a grounding for personal growth and professional formation; a deeper insight into and experience with the role of the pharmacist as compassionate listener and caregiver.

CONCLUSION

Faculty observations of student competencies and students' perceptions of this course point to the need for pharmacy education to provide organized, structured reflective learning opportunities for students and faculty members to explore the deeper human issues of pharmacy practice and patient care.

Promise of professionalism: personal mission statements among a national cohort of medical students

PURPOSE

While historic medical oaths and numerous contemporary medical organizations offer guidelines for professionalism, the nature of the professional aspirations, commitments, and values of current medical students is not well known. We sought to provide a thematic catalogue of individual mission statements written by medical students nationally.

METHODS

In the Healer's Art elective course, students write a personal mission statement about their highest professional values. In 2006-2007, we randomly selected 100 student mission statements from 10 representative schools nationally. Three researchers coded content using a team-based qualitative approach and categorized the codes into major themes. Student mission statements were compared with classic medical oaths and contemporary professionalism guidelines.

RESULTS

The mission statements were similar across different schools. Three major themes emerged, comprised of codes identified in 20% or more of the mission statements. The first theme, professional skills, includes dealing with the negatives of training, listening and empathy, growth and development. The second theme, personal qualities, includes wholeness, humility, and constancy/perfectionism. The third theme, scope of professional practice, includes physician relationships, positive emotions, healing, service, spirituality, and balance. Unlike the content of classic oaths and contemporary professionalism statements, the students' statements dealt with fears, personal-professional balance, love, nonhierachical relationships, self-care, healing, and awe as key to being a physician.

CONCLUSIONS

In their personal mission statements, this national cohort of medical students described an expanded view of physicianhood that includes such elements as presence, love, and awe. Medical school curricula may require adaptation to support the personal aspirations of those now entering the profession.