Physician Healer Scholarly Concentration

How does one take a sick baby off life support and place him in the arms of his overwhelmed mother to die? How does one tell a mother of two young children that she has advanced and untreatable cancer? How does one try to make a positive difference in the life of a 58 year old with diabetes who cannot afford the medications prescribed? How does one sleep after seeing the family in the emergency department devastated in a car accident?

The faculty in the Physician Healer Scholarly Concentration walk these questions daily and want our future physicians to learn this walk in a kinder way than we were trained. Some things cannot and should not be reduced to the cognitive and technical aspects of medicine.

But where do we train our learners how to walk this path without turning off our hearts? How do we train them to meet the heartache in front of them... and then see the next patient?

Resilience needs to be taught before the protective walls of our psyche are needed, not after. Learning to walk the path of caring takes an equanimity that simply cannot be taught in lecture halls nor in the midst of clinical rotations requiring pre-rounding, rounding, academic questions and patient care demands.

The Physician Healer Scholarly Concentration entails 6 months of training integrated across the four years of medical school. It is by far the most extensive and in-depth training being offered across the country. It focuses on helping them embody the heart that drew them to medicine, and we hope it will provide a resilience that will serve them throughout the demands of this career.

In 2010, the Carnegie Institute published a report (Educating Physicians: A Call for Reform of Medical School and Residency) which analyzes physician training in the 100 years since the 1910 Flexner Report. Their report is divided into four areas of recommendations:

• Reevaluation of the curriculum with standardization of learning outcomes and Individualization of the learning process
• Integration of formal knowledge and clinical experience with earlier clinical experience for students and more basic science/best evidence for residents
• Development of habits of inquiry and innovation at all levels of training
• Focus on Professional Identity Formation which is defined as skills in Self-awareness, Interpersonal communication skills, and Acculturation

The Physician Healer Scholarly Concentration addresses the Professional Identity Formation component of the Carnegie report. This Scholarly Concentration is an opportunity for students to learn how to find balance within their calling to be of service and the intellectual, emotional, and physical demands of a career in medicine.

• Implement a four year Physician Healer Scholarly Concentration in the undergraduate medical education at UTMB
• Create a culture of awareness of Healing Concepts throughout the curriculum, and questions such as:
  • "What is suffering?"
  • "What is healing?"
  • "Can one heal into death?"
  • "What is a healer?", or
  • "What is a healing presence?"
• Evaluate aspects of this new program for greater inclusion within the current curriculum and within the upcoming TIME curriculum (students in 8/16)

• Recognize paradigms of education and practice
• Technocratic/Humanistic/Holistic
• Demonstrate abilities in Self-reflection and career direction
• Evaluate own view of body/mind/spirit relationship
• Evaluate role in healing encounters/healthcare environment
• Create map for career-life balance
• Demonstrate communication skills with oneself, with colleagues and with patients
• With self-reflection, recognize one's inner critic and it's utility
• Communicate effectively across cultural backgrounds
• Insight to emotion and human response to manage interactions
• Recognize one's impact on others (in conversations, in silence, in behaviors, in intention, and in one's role as a physician)

The Physician Healer Concentration (PHC) is a four-year journey designed to help students explore the human side of medicine, develop meaningful connections with patients and colleagues, and cultivate the skills and habits that support a fulfilling career in medicine.

Throughout all four years, students participate in monthly small-group dinner meetings with faculty mentors. These intimate gatherings provide a space to reflect on the experience of becoming a physician, explore challenging topics in medicine, build community with peers, and learn from faculty experiences.

Students engage with selected readings and brief reflective writing assignments throughout the four years, connecting the ideas they encounter to their own experiences and developing their professional identity as physicians.

Small-group topics evolve with students' experiences and needs throughout medical school and may include stress awareness and management, self-compassion, personal values, communication, cognitive behavioral strategies (CBT), gratitude, mindfulness, resilience, professional identity, relationships, boundaries, meaning and purpose, and navigating the challenges of medical training.

Between the first and second years of medical school, students participate in a 7-week preceptorship that combines clinical experiences with classroom and small-group learning.

Students gain clinical exposure through focused patient encounters, where they have the opportunity to practice PHC skills in real-world settings. The experience also includes learning and practice in Mindfulness-Based Stress Reduction (MBSR), communication skills, wellness, and developing the capacity to be present with the suffering of others.

Together, these experiences allow students to begin integrating the principles of the PHC into their developing clinical identity.

During the MS3 and MS4 years, students concurrently participate in White Coat Conversations, continuing the PHC emphasis on reflection, communication, connection, and professional identity as students transition into the clinical years.

Students also continue meeting in their same PHC small groups for monthly dinner sessions, maintaining the relationships and community they have built throughout the program while creating a consistent space for reflection during the clinical years.

During either the third or fourth year, students may complete a one-month asynchronous reading elective focused on the humanities and the practice of medicine.

Students read three books and complete reflective essays exploring themes such as empathy, illness, healing, identity, relationships, and the meaning of being a physician. The flexible, virtual format allows students to engage with the material at their own pace while continuing their clinical responsibilities.

In the fourth year, students complete a one-month BSHS capstone immersion experience.

The capstone offers students an opportunity to integrate what they have learned throughout the PHC and reflect on how their experiences will shape the kind of physician they hope to become. It focuses particularly on the transition to residency, revisiting core PHC topics while also providing opportunities to explore new topics that are especially relevant as students prepare to enter the next stage of their medical careers.

Across four years, these experiences create a continuous thread of reflection, connection, mentorship, and growth, from the classroom and small-group discussions to the clinical setting and beyond.

The goal is not simply to teach students how to be physicians, but to help them thoughtfully consider what kind of physicians they want to become.