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

Abstract

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.

Keywords: Professionalism; communication skills; humanism; integrative medicine; medical education; self-care skills.

Figure 1

Frequency of graduates reporting lack of exposure to HEART curriculum core content areas in medical school and residency. Graduates were asked “how much exposure to the following subjects did you have as part of your medical school/residency curriculum?” and given three possible responses: none, some, extensive. Shown are the percent of HEART graduates reporting no training in humanism in medicine (e.g., narrative, the arts in medicine, medical humanities), activism and service (e.g., social justice, cultural humility, underserved populations), CAM, self-care (e.g., stress reduction techniques), and reflection (e.g., opportunities to reflect on medical education and life) during medical school (black bars) and residency (gray bars).

Figure 2

Frequency of graduates reporting that HEART taught the ACGME core competencies well or very well. Graduates were given a list of the ACGME core competencies and definitions(1) and asked, “How well did HEART teach explicitly or implicitly, these ACGME core competencies that residencies are required to teach?” Answer choices were presented as a 5 point likert scale with the following options: not at all, a little, somewhat, well, very well. Shown are the percentage of respondents rating “well” or “very well” in response to the question.