One-of-a-kind medical student elective celebrates its 20th anniversary
One-of-a-kind medical student elective celebrates its 20th anniversary
Embracing Community & Humanity
Eighteen years ago, it took only three days for a group of medical students to teach me why I belonged in medicine. The experience provided me with more insight into myself and others than my entire four years of medical school. At a small retreat center, tucked away in a redwood forest in California, my heart and mind burst open to a new way of being in community with other physicians-in-training. The Circle of Healers medical student retreat resuscitated my spirit and restored my faith in medicine.
Organized by other senior medical students, the retreat provided an emotional safe space to drop my defensive armor, embrace vulnerability, and express myself fully and authentically. Listening to the stories and experiences of my fellow students validated that we were a united group of like-minded people who desired change, both within ourselves and externally, through our personal relationships and medical work. The main takeaway was that healthcare could be changed through the power of community and by embracing our humanity. The dynamic changed from the usual "i/me/my" within medical training's cut-throat atmosphere to the powerful "We/Our/Ours" in the conscious space of true unity. The experience healed us on many levels and imparted collective strength for the remainder of our medical school journeys.
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| Building at the Quaker Center, Ben Lomond, CA. Photo courtesy of HEART. |
20 years of HEART in Medical Education
While Circle of Healers no longer exists, the same exact spirit has lived on for twenty years through its sister program, HEART-IM (Humanistic Elective in Activism, Reflective Transformation, and Integrative Medicine), a one-month medical student elective. The American Medical Student Association (AMSA) offers HEART annually to twenty-five selected fourth-year medical students. The in-person program is held at the Quaker Center in Ben Lomond, California, where participants stay in communal lodging and cook meals together.
Due to the pandemic, the elective has gone entirely virtual for 2020 and 2021. Each year, the students pay a discounted tuition fee to attend, and The University of New Mexico issues medical education credit.
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| Healing in Nature: Students gain a new perspective, hiking through the enormous redwood trees on the grounds. Photo courtesy of HEART. |
Besides student tuition, the elective is primarily funded by grants and private donations. "Most years have faced formidable economic challenges," writes Dr. Nunely, a past attendee and previous AMSA national director. "Any consideration of the project is best to recognize the scores of mostly anonymous people and organizations who have donated time and money to help the project sustain, often just at budget." Dr. Wendy Kohatsu, a lead faculty member, credits donors who gave generously in past years to support HEART and notes the Quaker Center has gifted HEART a special rate to house the elective each year. (See end of article for more information on donating.)
Why HEART? The ART of Medicine
Arguably, the thought of communal living, self-reflection, and learning about Integrative Medicine ventures far into uncomfortable territory for many of us who functioned in the "left brain" realm throughout our medical education. Our doctor scientist training shaped our minds to be (rightfully) objective in evaluating medical evidence to determine how likely our patients would benefit from a treatment.
That being said, where do we train our hearts to love our patients and colleagues? Where do we train our minds and spirits to be resilient in the face of inevitable adversity? Where do we train to become tireless leaders and advocates for healthcare reform? To think these things should, "just come naturally to us" is unacceptable and not backed by evidence.
Enter "right brain" training and what is termed, the Art of Medicine: Compassion and empathy can be cultivated. Resilience can be taught and strengthened. Emotional intelligence can be developed for the majority of people. While some people are "natural born" leaders and empaths, most of us have to learn the "soft skills" and try our best to apply them consciously, every single day.
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| Balancing the left and right brain hemispheres-the true heart & art of medicine, IMHealth.blog, created with Canva |
Consider a 2013 cross-sectional survey study of the first eight HEART cohorts, where the majority of respondents recognized the elective provided education in the following required medical competencies:
- Patient Care
- Interpersonal and communication skills
- Professionalism
The study further outlines HEART educational objectives in more detail. Looking at the categories, it's clear this elective does take a deep dive into the "soft skills" territory that most medical training programs only touch on.
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| Infographic based on 2013 study by Dossett, et al. Designed by IMHealth.blog, via Canva |
Amazingly, a different group of fourth-year medical students plans the elective each year. The 2021 planning committee included Eileen Wang from Icahn School of Medicine at Mount Sinai. Wang, a soon-to-be OB/GYN resident, first heard about HEART through a former planner and participant who went to her medical school. Wang states the medical training process teaches little on how to become a healer. Reflecting on her HEART lessons, she concludes, "The healer sees the person, listens to their life experiences, and enables the person to help heal themselves." She writes:
"Part of that transformation from physician to healer (although this is definitely not a linear process) begins from within, including being able to take care of ourselves so we can better take care of others...and acknowledging that though we as doctors wield the powerful tools of biomedicine, we also do not know and cannot explain everything."
HEART's History Comes Full Circle
From Global One to HEART
One of the HEART faculty founders is Dr. Bill Manahan, a physician who graduated from one of the first Family Medicine residencies in the United States. Dr. Manahan's journey has taken him from the Peace Corps, practicing in an aboriginal hospital near Kuala Lumpur, Malaysia to completing his residency at the University of Oklahoma. During this time, a highly skilled chiropractor successfully treated him for a long-standing shoulder problem. Experiencing that "cure", firsthand, sparked Manahan's curiosity-both about the body's ability to heal and about the amazing abilities of many non-MD practitioners. After moving to Minnesota, he joined the American Holistic Medical Association (AHMA), a community he says, "was everything I wanted from medicine" and taught him more on how to treat the Whole patient (mind, body, & spirit). He served as AHMA president from 1990-1992 and continued to build a large network of holistic health providers within Minnesota.
At the turn of this century, Manahan met Pali Delevitt, a psychology PhD student who was championing global medicine education at Duke University. Delevitt linked Manahan to the medical collective who would create what would become HEART, originally designed as an elective for global health and activism in 2001. The first incarnation of the elective was accredited by the University of Florida and held in 2002 at the Institute of Noetic Sciences (IONS) in Petaluma, California. After two year at IONS, the four-week elective moved to Ben Lomond Quaker Center, and it has been held there annually since then. The year 2021 marks the 20th student cohort to complete HEART.
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| The circular walking labyrinth at the site in Ben Lomond, used for contemplation and walking meditation. Photo Courtesy of HEART. |
Dr. Mara Merritt was one of the original medical student planners for the elective, which was originally the Global Medicine Education Program (fondly nicknamed, "Global One") in 2002, then LIGHT (Living Integral Global Healing and Transformation) in 2003. Merritt joined AMSA's Humanistic Medicine action committee in 2000, where she was introduced to Pali Delevitt, who served as the project's primary mentor until 2004. Delevitt, who had prior medical student retreat planning experience, helped the ASMA student leaders organize their first Circle of Healers retreat in 2001 and worked with Merritt to secure grant finding for what would eventually become HEART.
The powerhouse group united key players, and an impressive list of core faculty mentors: Wayne Jonas, Al Niems, Bill Manahan, Wendy Kohatsu, Greg Plotnikoff, among many other respected who's who professionals in holistic and integrative medicine. Merritt describes Global One's atmosphere as "magical." She remembers sitting outdoors in a circle listening to her fellow students signing an playing a variety of musical instruments, amidst an ideal natural setting with "dappled sunlight." The end result produced more than any ordinary medical elective could--joyful lifelong memories and friendships. Merritt marvels at the love that transformed themselves and those around them, "That group was just so tight and connected on a deep soul level," she recalls. "That October we got together for our first reunion in Albuquerque," she says. "Two of the participants were hugging outside [the airport] when this total stranger came up and started hugging them, saying, 'I just had to be part of it, you two had such joy pouring out of you!' "
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| HEART students from the Northeast arrange a springtime meet up. Photo courtesy of HEART. |
In 2004, a group of five strong and talented ASMA leaders transformed the elective into a sustainable vision and settled on a permanent name, HEART. Merritt explains that the rebranded elective featured a different set of five medical student planners each year. Medical students were given full selection and leadership responsibility in planning and developing the four-week programming. The core faculty group taught and facilitated the elective at the students' request.
Flavor of HEART- Through the Years
Dr. Wendy Kohatsu, a Family Medicine physician and Integrative Medicine fellowship director in Santa Rosa has been on the HEART faculty from the beginning and reflects on the past twenty years, "We have had so many amazing students, faculty facilitators, and experiences year after year," she says. "Each year takes on its own flavor!" Speaking of flavor: Literally a food lover at HEART, Kohatsu combines her professional culinary skills and medical nutrition knowledge to teach fun classes on preparing healthy, delicious meals on a tight budget. She has worked with physicians-in-training for years to give them skills to then pass on this wellness information to their patients and communities. Kohatsu joyfully recalls being in the kitchen with her students, especially when it comes time to clean up. She says, "We have a dance party in the kitchen while we clean. That's my favorite part!"
Kohatsu is deeply appreciative of the many faculty who have led transformative programming at HEART over the years. She cites experiential workshops in self-care and cross-cultural medicine as memorable to her students, such as self-massage, Ayurveda, nature walks, and even shamanic journeying--unique experiences that only this one-of-a-kind elective provided. She excitedly remembers one year the group got to visit and cook for a community garden in Santa Cruz that grew food to feed the homeless community. Looking back, one of her all time favorite workshops was led by Rachel Naomi Remen who ran a Healer's Art session and sat fireside with the group.
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| Heart 2021 participants in a virtual small group breakout session. Photo courtesy of Eileen Wang and HEART. |
Virtual HEART-Creating Sacred Space
At the end of our interview, Dr. Kohatsu shared a touching video with me, created by the 2020 cohort, showing each student passing on a personal message or quote to their beloved friends. (You could seriously FEEL the love, and I could barely see the screen through my tears!) This example she provided emphasizes the sense of community and heart connections created within the virtual space these past two years. Kohatsu says, "This speaks to the resiliency and ingenuity of the students." 2021 planner, Eileen Wang, echoes this sentiment as well, "Everyone bonded quickly," she says, "and I think the reason we were able to do that, even on Zoom, is because everyone was so open and vulnerable, and because we were intentional about the topics and issues we wanted to cover." "We were able to discuss tough and emotional experiences with listening ears and open hearts and with the facilitation of incredible faculty."
Wang says the group kept in close contact after lecture hours through a chat app where they continued their socializing, posting photos of their pets, "guess-who" clues, and art or poetry that found beautiful. At the end of this year's elective, each received a lotus necklace in the mail, which symbolized their experience, and a token to connect them physically."It was an incredible space," she says, "and although we sorely missed being in-person in the redwoods, the connections were still palpable!"
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| The 2021 HEART online graduation in April, marking the 20th cohort. Photo courtesy of HEART. |
HEART's Legacy
My interviewees brought up the many spirited HEART reunions over the years, the extensive alumni network, and the continued bonds among the doctors that once shared a month of their lives together, early in their medical careers. The continued support gave past participants strength throughout the twists and turns of being a working physician, among other demanding life roles--mother, father, wife, husband, son, daughter, coach, entrepreneur, etc. Lifelong friendships and even romantic relationships sprung from the close community connections.
Dr. Manahan says that the experience they wanted to create for the students was to give them the opportunity "to truly examine the spirit, breath, and the soul of medicine." "The medical student learns to discover the balance between the scientific and humanistic sides of medical practice." He emphasizes that "the experience is truly transformative for every student, and I believe that every student would benefit from a similar elective."
One such experiential teaching from this year that Eileen Wang now carries forward (thanks to faculty member, Eran Magen) is the practice of listening to patients without judgement, interjection, advice, or bringing the focus to yourself. This simple, yet profound teaching stuck with her and instilled the wisdom "that just listening and being present for someone can be a healing form of mindfulness," she says, "even if I'm not actively 'doing' anything."
Dr. Bill Nunley, a past participant, sums up the soulful experience of HEART. He writes:
"Many people have reimagined their careers after HEART. Some of us at HEART can celebrate fully achieving a lifetime goal, some can rest and play a bit before making the next step into a meaningful career as a healer. Many of us simply are truly traumatized by training--academic struggles for the first time in our lives, the conflicting inspirations for becoming a 'doctor', grief from the donation of our twenties (or later) to science, biases in medicine, and being with the suffering of our patients and peers."
"HEART provides a space where some of us can see and be seen in a messy and wonderful way...almost all participants were cracked open a bit to see the humanity and love of healing that inspired them to choose medicine (and keep choosing over and over again amidst the realities of current medical practice)."
If you were inspired by these amazing doctors, please share this article, read the information below, and consider making a tax deductible donation to the AMSA Foundation for HEART.
More Information, thanks, and supplemental notes:
1. HEART-IM Funding
HEART relies on the generous and crucial support of donors to help keep HEART beating for years to come. Student tuition does not fully cover all costs and requires $5,000-15,000 annually from grants and donations.
Donations can help in the following ways:
● $25 covers a month of activity supplies for one student,
● $100 covers honoraria for an in-state faculty speaker,
● $250 covers honoraria for an out-of-state faculty speaker,
● $875 covers a week of food for the whole HEART community,
● $1,000 covers tuition for one future student in need, and
● $15,000 covers the cost of our communal space at Ben Lomond Quaker Center for the month.
Those interested in learning about donating can visit: https://secure.actblue.com/donate/amsa-heart-im or webpage: https://www.amsa.org/events/heart-im/.
In addition, all donations are tax-deductible. 501(c)3 Tax ID #: AMSA Foundation 366-11-6589
2. Interviews: Thanks to my physician contributors and interviewees: Bill Manahan, Wendy Kohatsu, Mara Merritt, Bill Nunely, Eileen Wang
3. Article Reference: Dossett ML, Kohatsu W, Nunley W, Mehta D, Davis RB, Phillips RS, Yeh G. A medical student elective promoting humanism, communication skills, complementary and alternative medicine and physician self-care: an evaluation of the HEART program. Explore (NY). 2013 Sep-Oct;9(5):292-8. doi: 10.1016/j.explore.2013.06.003. PMID: 24021470; PMCID: PMC3876728.
4. Historical notes:
• Past people who helped or supported Global One/LIGHT/HEART (too many to name, but here are a few more mentioned by interviewees): Nisha Money, Judy Yang, Piper Lillard, Spencer Blackman, Lori Fendell & Walton Deva, Nina Stoyan, Michelle Dossett, Joel Kresiberg, the George Family.
• Pali Delevitt continued to run inspirational and transformative educational programming for both medical students and health practitioners until her death in 2010. She is remembered for her love of community and teaching (also good chocolate!)—opening her home to local medical students over the years for retreats and meals. In memorium, she was featured on the John Weeks Integrator Blog.
5. Disclosure: I received no compensation for this article. However, I must disclose that I’m biased toward HEART, based on my amazing past experiences in AMSA and Circle of Healers! I was not able to find any critics out there, but I'm sure there will be someone out there with a contrarian view--I apologize if your views were not represented here.