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Vital Signs

Putting relationships at the center of medical education

By Rosemary Lunardini

It sure wasn't your run-of-the-mill, speaker-at-a-lectern professional meeting. As the official program got under way, deans and faculty members from nine medical schools engaged in animated conversation, told stories, shared their feelings, and got to know each other—and themselves—a lot better. They also learned how to practice "appreciative inquiry" by framing questions in positive rather than negative terms.

Concept: The attendees had been invited to Indiana University School of Medicine for what was billed as an immersion conference on relationship-centered care (RCC). An outgrowth of a movement known as patientcentered care, RCC expands on that concept. Its basic premise is that patient care is affected by a physician's relationships not only with patients and their families, but also with other healthcare professionals and with the community at large.

Medical students learn how to conduct themselves in an organizational culture largely by means of what's come to be called the "hidden curriculum"—the attitudes and values that get transmitted outside official classes. Dartmouth's Dr. Joseph O'Donnell, senior advising dean at DMS and one of the attendees at the conference, wants to shed a lot more light on the process. He sees a gulf between what students are taught officially about professionalism, human values, and conduct and what they actually see and learn in the medical setting.

The conference came on the heels of DMS's preparations for a reaccreditation site visit last year, in which all aspects of medical education were evaluated.

Lack: The School had learned from a student-run survey that below the surface, students feel surprisingly high levels of loneliness, isolation, and inadequacy and a lack of approachable role models. DMS is known for having a collegial and supportive atmosphere and a humanistic faculty and student body, so administrators were surprised by these findings. O'Donnell was determined to respond—to become "the best in the world" at caring for those who study and work within its walls.

Students say they don't know "who to go to," says O'Donnell. "There's no place for them to show vulnerability." This is not unusual for medical students at other schools, but O'Donnell knew Dartmouth could do better.

The meeting in Indiana could have been called a physician-heal-thyself session, since one precept of RCC is that caregivers need to themselves experience self-knowledge, appreciation, a sense of belonging, and values in their own lives before they can transmit these qualities to students, each other, and their patients.

The DMS team brought to the meeting ideas gleaned from many years of experience working with students. Those who joined O'Donnell in Indiana were Dr. Lori Arviso Alvord, associate dean of student and multicultural affairs at DMS; Sue Ann Hennessy, assistant dean of student affairs at DMS; Tommy Woon, associate dean of pluralism and leadership at Dartmouth College; and Dr. Nan Cochran, an associate professor of medicine who has worked on RCC efforts with O'Donnell.

The challenge of implementing RCC is a huge one, yet success is measured in small, human ways. The DMS team returned to campus with ideas they hope to implement soon. They range from the broad and formal—for example, to get the whole School to adopt the values of RCC —to the informal and personal—to show joy in their work, to show empathy everywhere, to know each other better, to say thank you.

The team has decided to use three new student societies, formed to foster cooperation across all four years, to carry the RCC message. O'Donnell and the other mentors of these societies hope that will give students the "feel-safe place" they lacked. "Bringing RCC into the societies," O'Donnell says, "brings more connectedness to each other and to the School. . . . We've got our feet in the water, but we have to go a little deeper."

Lessons: Armed with stories, poems, and life lessons, the Indiana conferees summed up their experiences by writing about the difference this unusual conference had made in their commitments to each other and to their profession.

One wrote this: "I sat and looked at the microphone at the end of the meeting, flooded with thoughts and feelings. Joe just used the word 'ripple waves' as I felt this flood. Tom talked about bringing our whole self into life and our work life. . . . I have been a reflective and emotional person, I guess forever. In my professional life I have adopted a 'quiet' life. . . . Often I tell myself I am satisfied with my quiet accomplishments, but in some ways the concept over the past few days has made me realize that I can take my 'quiet' skills and inject them into the culture of medicine . . . take the risk and hope that I can leave an impact that will be 'heard.'"

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