Article:

The Physician Healer Track: Educating the Hearts and the Minds of Future Physicians

Era Buck, Travis Billingsley, Julie McKee, Gwyn Richardson, and Cara Geary. Medical Education Online, Volume 26, 2021- Issue 1. https://doi.org/10.1080/10872981.2020.1844394

Summary:

Thought leaders in medical education ("Med Ed") have been calling for a reform in Med Ed with explicit training in professional identity formation ("PIF") to promote the development of humanistic, compassionate physicians. The authors of this publication report their experience offering The Physician Healer Track (PHT), a 500-contact-hour curriculum integrated over 4 years, focusing on self-awareness, reflection, being-with-suffering, communication and professional identity development. The voluntary scholarly-concentration program comprises 4 years of monthly dinner meetings with faculty mentors, a two-month preceptorship in the first year, a one-month immersion course in MS4 and one elective. Training in mindfulness, cognitive behavioral therapy, nonviolent communication, motivational interviewing, spirituality in healthcare, wellness, equanimity, and 'being with suffering' is reinforced across all 4 years. Community building and reflection are integral to the training both in the monthly sessions and the immersion courses. Enrollment has grown from 26 students in the first year (11% of class) to a total of 258 students across the first 6 years (average of 20–26% of each class). In serial assessments, students report continued growth in personal development, professional development, and the ability to empathize. Offering PHT has resulted in the growth of training for medical residents, faculty, physical therapy students and the creation of a student healer association.

Interview:

 

REY: You mentioned "professional identity formation" (PIF) as an important aspect of medical education, could you elaborate on what the term means and why is it important?

CG: Professional Identity Formation is a psychological process resulting from socialization and education regarding the values, behaviors and attitudes of the profession. The individual incorporates a professional identity into their being. "Being a doctor" is different from working in a hospital or clinic – not separate necessarily but more foundational. In medicine it comprises a sense of duty, and an entry into the social contract of the profession. It includes habits, attitudes, relationships (and boundaries) and perception. This development is essential to being able to make difficult decisions in ambiguous circumstances (the day-to-day of medical practice) – a type of professional moral compass. It allows the physician to have internal guidance about a course of action consistent with the values of the profession.

REY: What prompted you to create a "Physician Healer Track" curriculum?

CG: This is a long story, but the Story originates in my first year of Neonatology Fellowship withdrawing babies from life support. Handing these babies to overwhelmed parents was overwhelming and not something that medical school or residency had prepared me for from a psycho-emotional-spiritual perspective. The breaking of bad news was also something that I had seen done poorly by caring people that simply had not developed skill sets for being-with-suffering. These experiences created a dissonance that I could not ignore, and this was the driving factor in redirecting my career away from basic science research. I started with teaching Mindfulness-Based Stress Reduction to employees and through a series of circumstances, an opportunity for a handful of us to create a 6-month Scholarly Concentration appeared and we jumped at the opportunity.

REY: What have been some of the challenges with creating such a curriculum and how were you able to overcome them?

CG: Entertainingly, one of the biggest challenges has been the program's popularity. We quickly filled and have continued to have 45-65 first year medical students enroll each year. Over 4 years, this became a massive organizational and administrative undertaking. Our medical school and donors have repeatedly recognized and supported the program and yet it remains a call of the heart for us to keep it up and running at the level that is optimal.

REY: Beyond medical school, there is certainly a role for such an experience during residency and/or fellowship. However, it seems to be a time-consuming commitment given all the hours required for preceptorship, reading assigned books, writing reflections, etc. How do you think such a curriculum could be implemented in residency/fellowship given the time-constraints?

CG: After 8 years of running this program, we are developing a better sense of what it is that we have created, and we have started calling this Healer Identity Formation. As we watch students mature and move through Residency with a skillset and an equanimity for 'Being-with-Suffering', I am coming to the belief that this should be an essential part of training. At the same time, it is a very specialized skill to teach. Many people learn these skills as life lessons as they interface with patients and the losses that life hands to all of us. But these skills and the basic understanding that it is possible to be a source of healing with our unconditional presence seems critical to practicing good medicine. How do we heal when nothing is left to diagnose or treat? What exactly does healing mean independent of our procedures, prescriptions, and knowledge base? I mention all of this to suggest that a quick 'drive-thru' approach to covering these topics is unlikely to succeed. We have tried more efficient approaches and found them to lack the quality and depth needed for transformation and understanding required to embody a 'healer pathway'. With that said, an intermediate approach that has had some success for our more senior resident & fellow trainees is for them to do a full month, mentored, independent study with one of our faculty.

REY: Finally, what advice would you give medical educators who are interested in creating a similar program at their own institutions, especially at a post-graduate medical education level?

CG: We are looking into starting a monthly virtual program with semi-annual in-person weekend retreats to help schools get something like this going. Beyond this, some advice might be to start small for the post-graduate level given the demands on everyone's time. Consider starting as a monthly book club and perhaps use James Hollis's, 'An Examined Life' as a launching point for faculty level endeavors. Having a 'tribe' in which safe conversations can happen without an expert in the room will require ground rules to be established as is exceptionally challenging without a skilled facilitator.