Medical professionalism the nature of story and the story of nature

All human communities rely on healers to elaborate conceptions of health and wholeness, and apply their expertise for the benefit of individuals and societies. The process of "professionalizing" young doctors in medical schools allows society to train experts who are entrusted with developing the systems of knowledge, the institutions, and the relationships necessary to maintain and improve the health of human individuals and the community at large (Greaves, 2004, p. 67-69). Medical education in the United States has fallen under especially intense scrutiny in recent years for neglecting to explore, adapt, or contemporize the social contract that has long linked healers to their communities, and for failing to curtail the pessimism that runs rampant amongst medical students, diminishing their confidence and making them doubt their abilities to become professionals (Wagoner, 2000). Medical education has even been accused of destroying idealism and creating cynicism in its stead. As many have pointed out, the professionalism discourse currently conceived in our medical schools often seems more of a humanizing veneer of platitudes and abstract definitions than an operational ethos in students' lives. Too often, as students wend their way through medical school, a tacit professional socialization occurs, transferring sets of values, beliefs, and behaviors that may be altogether inconsistent with the avowed tenets of medical professionalism (Coulehan, 2000). Noble abstractions are uttered, commendable pronouncements are made, but because there is no sustained attempt to filter them through the cultural realities students face, they are not reinforced and are instead perceived as ivory-tower propaganda. In this chapter, we consider aspects of medical professionalism that deserve greater conceptual and practical emphasis in medical education and suggest how such ideas and behaviors may be integrated into a medical student's code of ethical responsibility. First we briefly adumbrate the philosophical framework for a curricular reform that reunites the disciplines of public health and medicine into a single complementary program of study that will recapture the balance of knowledge, values, and action that characterizes any healthy polity. Following this conceptual overview, we offer a brief summary of a highly effective elective course called 'The Healer's Art," developed by Dr. Rachel Naomi Remen at the University of California at San Francisco (UCSF) School of Medicine and successfully replicated in over 25 medical schools nationwide, 'The Healer's Art" is an innovative course predicated on the time-honored art of storytelling, which addresses the growing loss of meaning and commitment experienced by physicians who function under the stresses of the modern health care system (Remen, 2002). Because we find Remen's pedagogical approach in her micro-based course that is concerned with the patient-physician relationship to be exemplary, we will make an argument for employing her techniques at the macro-level of public health matters that concern communities. Next, we will present the plan for a radical curricular reform that is currently being undertaken at our own School of Medicine at Case Western Reserve University (CWRU) in Cleveland, Ohio. Finally, we will provide a detailed sketch of a course called 'The World of the Healer" that we propose to offer to fourth-year medical students at CWRU. Our course incorporates many of the same pedagogical principles used by Dr. Remen, particularly the notion that in human communities the most substantive learning takes place through the sharing of stories, and has the similar aim of broadening the horizons of our medical students as they begin to envision their future roles in health organizations. Later, as an appendix, we present the course syllabus in its entirety with the hope that it will lend insight into the creative approaches our institution is taking to nurture the professional growth of our students.