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The newspaper of The Johns Hopkins University February 6, 2006 | Vol. 35 No. 20
Nurturing the Caring Doctor

Associate Director John Flynn and Director David Kern in Billings' Osler Room, named for William Osler, who promoted a humanistic approach to health care.

Sound doctor-patient interactions are goal of Osler Center programs

By Greg Rienzi
The Gazette

Medical students can get so consumed by their chosen field, Sarah Clever says, that they can literally forget themselves. A student, for example, might lose sight of what led her to become a doctor in the first place, or fail to address his own physical and emotional needs.

To confront this issue, Clever, an assistant professor in General Internal Medicine at the School of Medicine, has offered to second-year students the Healer's Art, a five-session course intended to help them better understand their humanity and innate capacity as healers. Specifically, they learn tools of stress reduction, offer group support to colleagues and experience firsthand the power of listening — all skills they can use in their professional career.

"Through the exercises, the students will find acceptance for taking time for their own healing, and share moments of loss and pain. We hope that what students learn from this is just how important listening can be," she said. "When students get on the wards, it's reinforced on them just how much they don't know, or that they don't know anything, yet. But we want them to know that it's not true and that just by listening to somebody they can help them feel better."

The course, which was designed by nationally known educator and mind/body health pioneer Rachel Naomi Remen, has been used in more than 30 medical schools during the past decade, but it has never been subject to rigorous evaluation. So Clever and a colleague, Gail Geller, designed a research project to determine the outcomes.

The study was funded in part by a grant from the Osler Center for Clinical Excellence at Johns Hopkins, an initiative that seeks to train physicians in the basic elements of a sound doctor-patient relationship — like how to listen. Since its inception in 2002, the Osler Center has been dedicated to training a new generation of doctors who, in addition to applying sound clinical skills, can communicate effectively with patients and their families.

William Osler, Johns Hopkins' first physician in chief, set the gold standard in general medical practice and himself championed a humanistic approach to health care that valued the patient's insights and history. His 1892 authoritative textbook, The Principles and Practice of Medicine, emphasized ways to reach out to patients.

David Kern, director of the Osler Center and an associate professor in the Department of Medicine, said that the center's mission is to promote and develop all learning activities, like the Healer's Art, that further the Osler-inspired doctor-patient interaction.

"Bringing better care to the bedside is what this center is all about," Kern said.

The Osler Center endorses what it calls the "modern old-fashioned doctor model," a physician who can combine caring and empathy with the latest medical advancements.

Currently, the bulk of the center's activities involves providing grants for educational projects and then helping communicate the research to a national audience.

The programs that come out of the center help train doctors at all levels on patient-related issues. For example, one program has been developed to teach all Johns Hopkins medical students to blend communications skills, clinical reasoning and joint decision making in treating patients. In another center-funded project, internal medicine residents take a one-month in-depth course on communication skills and the psychosocial problems their patients are likely to encounter.

Last year, the center funded six projects, including one on enhancing a resident's communication skills in HIV prevention.

On Jan. 31, the Osler Center hosted an event that presented outcomes from three of the funded programs, including Clever's, which was titled "The Healer's Art: A Curriculum to Help Medical Students Identify, Strengthen and Cultivate the Human Dimensions of the Practice of Medicine."

To date, the Healer's Art has been offered here twice. While more sessions and a greater sample size are needed to determine any real conclusions as to the effectiveness of the training, Clever feels confident the experience will bear fruit. She says the Osler Center is a tremendous resource for Johns Hopkins faculty.

"The grant we received was vital," she said. "We had no other way we could perform this level of research, or provide the course in the first place."

Medical education has traditionally been extremely underfunded in the United States, Kern says, as most of the money given to medical schools goes toward research and clinical practice. He hopes education funding will now start to catch up.

"We don't give new treatments to patients without fully researching the efficacy of these treatments, but we give new information to doctors without looking into how best to communicate it," he says. "In our work here, we are trying to take what we already know and improve educational and training techniques."

Kern said that in the near future the center plans to host a seminar that highlights best practices. He also wants to be able to offer more grant funding, but additional donations are needed. The center currently receives the bulk of its funding through private philanthropic gifts, primarily grateful patients.

John Flynn, the center's associate director, said that the world recognizes Hopkins' stature in medical research and clinical care. It ranks first in federal research dollars, and for 15 straight years the hospital has topped U.S. News & World Report's annual rankings of America's Best Hospitals. While the School of Medicine is currently in the lead pack of medical schools, Flynn said the Osler Center's work will be part of the many educational efforts that are occurring right now to take the school even further to the forefront.

To learn more about the Osler Center and its educational grants, go to


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