SEATTLE--A quiet revolution is brewing in medical education. It's not about cost containment or technological advances.
It's about staying human.
Which is why Dr. Len Hudson, one of the country's leading pulmonologists, leads monthly poetry discussions with the residents he supervises at Harborview Medical Center.
Why Tom McCormick, an ordained minister and head of counseling at the University of Washington medical school, teaches courses on spirituality, ethics, and "The Human Face of Medicine."
Why the medical school now offers a reflective-writing course to help students stay sane and grounded during their grueling training.
The writing course, Mind, Body & Pen, is the brainchild of second-year students Stephanie Cooper and Davis Wilkins, who began teaching it this winter. They also hope to launch a medical campus literary magazine, something a third of the nation's medical schools already have.
Their goal, says Cooper, is "to retain the human values and compassion that made us want to be doctors in the first place."
That's becoming a common refrain in medical education--a course correction, perhaps, in an era of high-tech medicine and managed care. Students are behind some of the changes, such as the spring cadaver ceremony held by UW anatomy students. Some students are trying to organize similar ceremonies for research animals.
"What I see around the country is an increase in attention to the issue of humanity in medicine," says Hudson, chief of pulmonary and critical care at Harborview and University medical centers.
A serious potter and arts advocate, Hudson brings poems once a month to the daily meetings where medical residents review their cases.
He says poetry sets the tone for discussions of tough issues, such as how to deliver bad news to a patient. And it has a wholeness, a unity, that's often missing in the fragmented nature of modern medicine.
Medical training has always been tough on the psyche. The hours are long. The work is rigorous and often emotionally draining.
|"What I see around the country is an increase in attention to the issue of humanity in medicine"|
"You often feel powerless in the face of terrible things happening to people," says Dr. Emily Transue, a chief resident in internal medicine and a faculty co-sponsor of Mind, Body & Pen.
"In the old days," she says, "you just lived through whatever brutality there was in medical training and went on."
The boot-camp mentality is changing as educators recognize that today's disillusioned student may become tomorrow's callous, burned-out doctor and that doctors can't embrace patients' humanity if they aren't whole people themselves.
The very definition of professionalism is being revisited. Humanistic competence, Hudson notes, is now one of the professional skills evaluated by the American Board of Internal Medicine.
"I remember being told when I was in training 30 years ago that you shouldn't get involved with your patient emotionally," Hudson says. "That didn't make any sense at all. What are we [becoming doctors] for?"
Dr. Erika Goldstein, who teaches basic clinical skills to first- and second-year medical students, sees medical schools moving toward an integrated curriculum that weaves humanistic training throughout all four years. She heads a committee that is weighing curriculum changes at UW medical school.
The school's three-year-old pilot program, the Bioethics Education Project, is also working to foster compassion, respect, and self-reflection in medical education, says project coordinator Kelly Edwards.
The easiest time to tackle these topics is when students are still in medical school and easy to corral. But the issues really hit home during residency, precisely when newly minted doctors are too overloaded to address them. That is why Hudson began weaving poetry into regular staff meetings.
Driven by haunting memories of her own residency more than 10 years ago, Dr. Deborah Kasman has taken a hiatus from family medicine to research the emotional experiences of residents at two Seattle-area hospitals.
One of her most devastating memories is the day an 11-year-old trauma victim was brought into the ER. As a third-year resident, Kasman was thrust in charge. Frantic at the responsibility, she led efforts to resuscitate the child, who had already died. Her devastating account, "When a Heart Stops," was published in the Annals of Internal Medicine in 1994.
"I came out of residency numb," Kasman says. "It took me three years to start feeling again."
One of the pioneers in humanistic medical education is Dr. Rachel Naomi Remen. Remen, 62, is a storyteller whose mind-body approach to medicine stems from her experiences as physician, teacher, therapist, and chronic patient.
Her inspirational best-seller, "Kitchen Table Wisdom," is used as a text at 18 medical schools. Says Remen: "Medical education is changing now very, very profoundly. Keep your eye on it."