Integrating Humanism into the Medical School Experience
Newark and New Brunswick communities reap health care benefits from students’ service learning
‘If you take humanism to heart and bring it to your interaction with patients, amazing things happen. As a profession, we’ve made progress in teaching humanism to students, and that will, hopefully, impact how they will do their jobs.’– Dorian Wilson, NJMS liver transplant surgeon and director, Healthcare Foundation Center for Humanism and Medicine
Every other Wednesday afternoon, students from Rutgers New Jersey Medical School (NJMS) visit The Apostle House, a nearby Newark shelter. There they meet with single mothers and share information to prevent a host of medical and mental health conditions from cervical cancer and influenza to depression, nutritional deficiencies and the threat of domestic violence.
For most of the women, these conversations are the first time anyone has ever talked to them about how they can help themselves, says Janki Shah, a fourth-year medical student who created the program, the Women’s Health Literacy Project, two years ago.
“I wanted to set up a system that could be passed on after I graduated,” said Shah, who developed the initiative as part of her fellowship project for the medical school’s Healthcare Foundation Center for Humanism and Medicine.
The 24-year-old aspiring physician will get her wish. The project will be one of many options in 2015 when service learning is expanded as a school requirement for first-year students. Although many students are already engaged in such efforts, the requirement will be rolled out to all classes in subsequent years.
To fulfill service learning requirements, students will devote a number of hours annually to activities that address health risk factors in the community – such as blood pressure and diabetes screenings – and promote healthy behavior.
“It’s extremely important for every student to understand the needs of the communities they eventually will serve,” says Maria Soto-Greene, vice dean of NJMS who also oversees service learning activities. Noting that NJMS’ Student Family Health Care Center is the oldest student -run clinic in the country, Soto-Greene said community service and diversity have long been key foundational principles for NJMS.
Service learning has become an increasingly visible component of the medical school experience in the past 20 years as a way to develop more compassionate physicians. The new requirement will encourage med students to develop as humanists as well as skilled diagnosticians and care providers.
Faculty and students at Rutgers New Jersey Medical School in Newark and Rutgers Robert Wood Johnson Medical School (RWJMS) in New Brunswick have aggressively embraced it. The future physicians are being challenged to help underserved populations, conveying medical and wellness guidance in an easy-to-comprehend manner in new or existing programs that demonstrate empathy and compassion.
“If you take humanism to heart and bring it to your interaction with patients, amazing things happen,” says Dorian Wilson, liver transplant surgeon and director of the humanism center at NJMS since its founding in 2004. “As a profession, we’ve made progress in teaching humanism to students, and that will, hopefully, impact how they will do their jobs.”
Each year, Wilson invites four or five new students to become fellows of the humanism center supported by the Healthcare Foundation of New Jersey and Joseph L. Muscarelle. The fellows, who receive an annual $10,000 stipend, are chosen based on their prior experiences and the likelihood that they will enhance the center’s mission by developing and implementing sustainable activities that promote patient respect and dignity.
Similarly, students at Robert Wood Johnson Medical School participate in a wide range of projects to support greater New Brunswick’s underserved residents, primarily through the school’s HIPHOP initiative (Homeless and Indigent Population Health Outreach Project) established in 1994. HIPHOP coordinates both the Promise Clinic, the student-run primary care center within the Eric B. Chandler Health Center, serving referred clients of Elijah’s Promise, Inc. (Soup Kitchen), and the Community Health Initiative, which provides community-based organizations with volunteers, health literacy education and health workshops on topics such as sexually transmitted infections, drug and alcohol abuse and healthy eating.
“These activities help raise students’ awareness of cultural differences,” says Susan Giordano, HIPHOP’s program coordinator. “They learn you can’t generalize about patients, that they are all individuals.”
Developing “humanist” physicians was the impetus behind RWJMS changing its admissions process five years ago, when it became one of the first and only U.S. medical schools to do away with the traditional, one-on-one interview lasting an hour or longer. Now, potential students are rated by six admissions committee members on how well they respond to problem scenarios in each of their six, 10-minute “mini interviews.”
Scenarios are designed to elicit responses that convey the applicants’ competencies in integrity and ethics, reliability and dependability, service orientation, sensitivity to diversity, resilience and adaptability, team work and desire to learn.
“We believe that the way applicants say that they would behave in a given situation, or how they have behaved, is a better predictor of future performance as a physician than a traditional interview,” says Carol A. Terregino, RWJMS senior associate dean for education and chair of the admissions committee. “It’s more reliable to have multiple observations made on the personal characteristics of more applicants.”
Internal assessments indicate the humanism-focused efforts are achieving their goal – enhancing students’ thinking about how they treat and communicate with their patients – while fueling a desire from the populations who are benefitting for increased services.
“A lot of what we need to be effective physicians may be what we learned from our parents about following the Golden Rule,” Wilson says. “As we develop a deeper perspective about the humanistic practice of medicine, our greater appreciation for empathy will lead us to a more patient-centered medicine and our patients will derive additional benefit in kind.”