Talking medicine: a course in medical humanism--what do third-year medical students think?

The early 1990s sparked an interest in organized medicine to reclaim and re-evaluate how it promotes professionalism among physicians. The American Board of Internal Medicine (ABIM) launched Project Professionalism as a means to define and evaluate professionalism as a component of clinical competence. The course "Talking Medicine" was developed to create a series of small-group discussions on humanism and professionalism where students can reflect on the process of becoming a physician and share personally or ethically difficult and rewarding cases with each other. We asked students to define these concepts and use these definitions to spark small-group discussion.

"Talking Medicine" is predicated on the belief that humanism and professionalism come to students and others through understanding a number of core concepts and relationships complemented by self-reflection. "Talking Medicine" offers a consistent (every other week for ten weeks) opportunity to share experiences in small groups (six to eight students), facilitated by two preceptors, in a format driven by students' experiences. Although the focus is on students' experiences, readings are provided on basic topics and contexts in humanism and professionalism (e.g., end-of-life care, mistakes, spirituality in medicine, and boundaries between patients and doctors). Also, at the beginning of each internal medicine clerkship we asked students to define humanism and professionalism anonymously on sheets of paper to be handed to the preceptors.

"Talking Medicine" began in summer 2000. We hope to expand it to other institutions. We surveyed students and found 94% felt "very" or "somewhat" comfortable in the course. Seventy-three percent of students reported that the course increased their "connectedness" to classmates, and 61% favored its occurring during all rotations. Fifty-nine percent reported that their interest in caring for patients improved, and 53% reported their interest in internal medicine as a field improved. Answers to open-ended questions highlighted the importance of "Talking Medicine" as a forum to connect with others-both students and faculty. Despite this course's focus during an internal medicine clerkship, students see a broader definition of professionalism than the ABIM; the student's definitions were similar in many ways to the Group of Educational Affairs definition of professionalism. Third-year medical students focus more on tolerance of difference (e.g., race, socioeconomic status, and varying health beliefs), and the importance of collegiality and collaboration in the new environment of patient care. Their vantage point early in training allows them to look critically at the profession they are joining and view its shortcomings and strengths. Future work is needed that focuses on how these definitions change as students' progress through fourth year, into residency, and finally continuing medical education. Nevertheless, we suggest that "Talking Medicine" may be most effective in helping classmates connect to and learn from each other, thereby setting a foundation for changes in how they interact with patients.