So many of you responded to last week’s blog by sharing stories about your professional education that I have been thinking about education and medical education all week long and wanted to share some of my thoughts with you.
For me, the process of education is intimately related to the process of healing. The root word of education–“EDUCARE”–means to lead forth a hidden wholeness in another person. A genuine education fosters self-knowledge, self-trust, creativity and the full expression of one’s unique identity. It gives people the courage to be more. Yet over the years so many health professionals have told me that they feel personally wounded by their experience of professional school and profoundly diminished by it. Many of you responded to my last blog with stories like this, experiences from your professional education that were disrespectful, even abusive. Some of you shared that these memories were still painful even after many years or that it has taken you years to recover from them. This was my experience as well.
It has made me wonder. Perhaps what we have all experienced is not an education at all but a training, which is something quite different. Certainly in medicine the training dimension of schooling has become more and more central and assumed a greater importance as the many techniques of the scientific approach have been developed. The goal of a training is competence and replicability. Uniqueness is often discouraged and may even be viewed as dangerous.
A training is all about the right way and the wrong way to do everything. In a training your own way of doing something can often become irrelevant. In such a milieu students often experience their learning is a constant struggle to be good enough. Training creates a culture of relentless evaluation and judgement. In response students try to become someone different than who they are.
At the end of the Healer’s Art in all the 90 schools that presently teach it, the students stand in a large circle, silently review their memories of the course and identify the most important thing that they learned or remembered during the course. They then turn this insight into an affirmation: a little phrase which begins in one of three ways: I AM…. I CAN…. or I WILL. One at a time, the students go around the circle each saying their phrase out loud. This year will be the 24th year that I have taught the course at my medical school. The most common thing that students say in this sharing is a simple three-word phase: I AM ENOUGH. Year after year it is the same phrase I myself say as well. It is the beginning of everything.
In Medicine, training is essential to technical competence. The real question is, is training good enough? Have we reduced the practice of medicine from a calling and a wish to live by values shared by generations before us to a very large collection of competencies? In our drive to train students to competence, have we neglected their education? Neglected it to the point that superbly trained young people are considering leaving medicine for other careers because they have lost their dream of medicine and their dream of themselves?
As I was reading some of your comments over again tonight, I remembered something that happened years ago. I had just given a talk on the messages, both positive and negative, that we convey to our patients without our awareness; sometimes with words but often with just our tone of voice, our touch, our facial expression or the way in which we listen. At the end of the talk I was standing with those who wanted to share their thoughts and discuss things a little more when a student came up to me, slipped a little piece of paper into the pocket of my white coat and walked off. I carried it around forgotten for almost a week. When I finally found it I was looking for something else (a lifelong pattern of mine). He had put together some lines from two other poems:
I had a dream
That honeybees were making honey in my heart
Out of my old failures.
There is no right or wrong
Beyond the right and the wrong
There is a field.
I’ll meet you there.
I have never had the chance to thank him for the healing and the gift of new eyes. As a patient myself I knew how strengthening and life transforming such genuine meetings can be. How they open new possibilities. Perhaps this poem is the message that medical education needs to deliver to every student. It is a message for all of us as well.
My dream of medicine was not to become competent. My dream was to become a friend to life. It was that dream that enabled me to endure the relentless pursuit of competency required of me. But competence did not fulfill me then and could not have fulfilled me for my medical lifetime. Only a dream can do that.
I would love to hear your stories about friends or family or teachers or even perfect strangers who strengthened your dream of yourself and led forth the hidden wholeness in you. They are all the architects of the future of the world!