title: Insisting on the Healer's Art: The Implications of Required Participation in a Medical School Course on Values and Humanism.
abstract: BACKGROUND
  Elective courses, by definition, allow medical students to self-select for participation in the class. In a small-group learning setting, students uninterested or not ready for a particular learning topic might change the educational experience ("poison the well") for those students most interested in the topic. It is not known how medical students required to take a course in humanism (that they otherwise would not have elected to take) might be impacted by the course or how their presence might affect students originally interested in the course.
  
  
  OBJECTIVE
  Medical students in a required course on humanism and values in medicine will have different experiences based on whether a particular student might have or not have elected to enroll in the course. Students uninterested in taking a course in humanism and values, but required to enroll, will limit the benefit of the course for those students originally interested in participating.
  
  
  METHODS
  In 2012, all 1st-year students at a U.S. medical school were required to take the Healer's Art, an elective on professional values and humanism offered at more than 90 other schools in the United States and internationally. Students completed pre/postcourse surveys assessing emotional exhaustion, work engagement, positive emotions, and cynicism. We analyzed differences between those who would have elected to take the course (Elective students) and those who would not have elected to take it (Required students).
  
  
  RESULTS
  Elective students did not differ from Required students in baseline demographic characteristics, emotional exhaustion, work engagement, or positive emotions. At baseline, Elective students did report feeling safer to talk openly, a greater sense of community, and higher levels of cynicism. Over time, there were no differences in course evaluations or outcomes between Elective and Required students.
  
  
  CONCLUSIONS
  Required students do not differ greatly from those who would have elected to take Healer's Art, and all students appear to have similar experiences in the course.
authors.affiliation: a Department of Medicine , University of California, San Francisco , San Francisco , California , USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rabow
authors.affiliation: a Department of Medicine , University of California, San Francisco , San Francisco , California , USA.
authors.forename: Marissa
authors.initials: M
authors.lastname: Lapedis
authors.affiliation: b Department of Pediatrics , Cooper Medical School at Rowan University , Camden , New Jersey , USA.
authors.forename: Anat
authors.initials: A
authors.lastname: Feingold
authors.affiliation: c Department of Medicine , Cooper Medical School at Rowan University , Camden , New Jersey , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Thomas
authors.affiliation: d Department of Family and Community Medicine , University of California, San Francisco , San Francisco , California , USA.
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Remen
mesh_terms: D000328:Adult; D003479:Curriculum; D005260:Female; D006808:Humanism; D006801:Humans; D008297:Male; D037141:Mandatory Programs; D009515:New Jersey; D012577:Schools, Medical; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires; D026712:Value of Life; D055815:Young Adult
keywords: cynicism; emotional exhaustion; humanism