Practicing Medicine from the HEART: A Qualitative Study on Humanistic Education on the Healer´s Art Course

Practicing Medicine from the HEART: A Qualitative Study on Humanistic Education on the Healer´s Art Course | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Practicing Medicine from the HEART: A Qualitative Study on Humanistic Education on the Healer´s Art Course Maria Sofia Cuba-Fuentes, Lyan Chang Sedano, Natalia Nombera-Aznaran, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9161459/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: The Healer’s Art (HA) is a course developed in 1991 to strengthen the humanistic dimensions of health professions education, including empathy, altruism, self-reflection, and self-care, areas that are often underemphasized in traditional medical curricula. This project aimed to explore medical students’ perceptions of The Healer’s Art course instructed at a Peruvian university and to examine its influence on their professional, personal, and human development during medical training. Material and methods: A qualitative study using thematic analysis was conducted in accordance with the Standards for Reporting Qualitative Research (SRQR). Semi-structured interviews were performed with medical students who had completed the HA course. Data were analyzed using a combination of inductive and deductive coding, guided by Self-Determination Theory, with the support of qualitative analysis software. Results: Ten medical students participated in the study. Three main themes emerged: (a) Seeking the human side of medicine , reflecting students’ motivations for enrolling in the course; (b) An unconventional course , describing meaningful and transformative learning experiences during the course; and (c) More human-centered medical communication , capturing the integration of course learnings into physician–patient relationships and clinical practice. Together these findings highlighted shifts toward intrinsic motivation, relational competence, and a deeper sense of professional meaning. Conclusion: The HA course strengthens the humanistic dimension of medical education by providing safe and reflective learning spaces. It promotes empathy, reflection, and professional identity development, highlighting the importance of integrating humanism, empathy, and self-care into medical curricula and clinical practice. Humanism Medical Education Self-care Empathy Background Humanistic formation is a core component of medical education and encompasses the values, attitudes, and relational competencies required to deliver ethical, person centered, and socially responsive care ( 1 ) . Despite its recognized importance, integrating these dimensions remains difficult, as contemporary medical curricula often prioritize biomedical knowledge and intensive clinical exposure ( 2 – 5 ) . As a result, students may have fewer structured opportunities for humanistic learning. This curricular imbalance also points to a broader issue in medical education: reconciling biomedical training with professional identity formation. Although medical programs aim to develop clinically competent physicians, professional identity formation extends beyond the acquisition of medical knowledge and technical skills, emerging through reflective practice and meaningful relational experiences ( 6 – 8 ) . Moving beyond an exclusively biomedical model is therefore essential to fostering person centered care and humanizing clinical practice. The Healer’s Art (HA) is an innovative discovery model course in values clarification and professionalism for first- and second-year medical students now offered annually at more than 90 U.S. medical schools as well as medical schools around the world ( 9 )( 10 ) . Designed in 1991 by Rachel Naomi Remen, M.D., (U.S.) the course offers a safe learning environment for a personal in-depth exploration of the time-honored values of service, healing relationship, reverence for life and compassionate care. It is a 15-hour elective course and consists of five evening sessions spaced two weeks apart at least. Each three-hour session is involving a large and small group session. The groups are facilitated by physicians recruited from medical school faculty and the community. (10). Implementation studies, particularly when the course is delivered as a required component, indicate benefits consistent with professional identity formation. Students report enhanced empathy toward peers and patients, strengthened commitment to service, clearer conceptions of what it means to be a physician, and perceived reductions in burnout-related dimensions ( 11 ) . Importantly, concerns that mandatory participation might diminish engagement have not been supported; students who would not have elected the course demonstrate comparable experiences and outcomes over time, including on measures of emotional exhaustion, engagement, and cynicism, supporting its scalability within formal curricula. Faculty implementation research further suggests that the course fosters relational and reflective educational climates, as instructors report professional growth and deeper connections with learners. Adaptations across different stages of medical training also indicate that the model is transferable beyond the pre-clinical years ( 12 ) . Recent evaluations, including online implementations and follow-up interviews with junior doctors, reinforce the course’s benefits. Participants describe strengthened empathy, self-care and self-awareness, supportive peer community, renewed professional meaning, and improved capacity to navigate the challenges of medical culture ( 13 , 14 ) . These findings suggest that the course promotes durable humanistic and professional identity development across training stages and delivery formats. Despite this growing body of evidence, most published evaluations originate from North American or Australian contexts, leaving important questions about contextual transferability insufficiently explored. Evidence from Latin America remains limited, particularly regarding implementations in Spanish and within distinct sociocultural contexts. This gap is especially relevant given the substantial stressors of medical training in low- and middle-income countries across the region. Evidence from Peru underscores this concern, as a 2010 cross-sectional study among medical interns at the Universidad Peruana Cayetano Heredia (UPCH) reported a burnout prevalence of 57.2% (15) . Humanistic educational approaches may provide cognitive, emotional, and relational resources to help students cope with stress and potentially reduce the risk of burnout ( 9 ) . Moreover, the Peruvian sociocultural context adds complexity to care delivery: the coexistence of multiple understandings of health and illness, together with limited capacity for culturally responsive and relational care, may exacerbate inequities in healthcare access and quality ( 16 , 17 ) . Strengthening empathy, reflective listening, and self-awareness is therefore essential to humanize shared decision-making and foster equitable therapeutic relationships. Examining how a reflective, relationship-centered curriculum is received and experienced within this context is thus both educationally and socially relevant. In 2024, UPCH offered the HA course for the first time in Spanish to fourth- and fifth-year medical students, which are equivalent to the first- and second-year year of medical school in the USA. This qualitative study explores students’ motivations for enrolling, their perceptions of the course, and its perceived influence on their professional identity formation and humanistic development during clinical training. By doing so, it helps address the limited evidence on HA in Latin America. By generating context-specific evidence, this study contributes to understanding whether and how HA’s core principles translate across linguistic, cultural, and institutional settings, thereby informing future adaptations and potential regional scale-up. Methods Study Design This study was conducted within a constructivist qualitative paradigm, recognizing that students’ perceptions are socially constructed and contextually situated. We employed reflexive thematic analysis following Braun and Clarke to allow for both experiential description and interpretive depth. We adhered to the Standards for Reporting Qualitative Research (SRQR) to ensure transparent reporting of the study design, analysis, and findings. Ethical approval was obtained from the Institutional Research Ethics Committee of Universidad Peruana Cayetano Heredia (UPCH) through expedited review (SIDISI No. 213199). All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the Declaration of Helsinki and with applicable institutional guidelines. Participants and Sampling We used purposeful sampling to recruit students who completed the HA course at the Alberto Hurtado Faculty of Medicine, UPCH, Peru. The course is offered to medical students during their clinical training, with approximately 15 students participating per academic year. Of 19 eligible students, 10 participated. Inclusion criteria: Current enrollment in the medical program Successful completion of the HA course during the 2024 or 2025 cohorts Provision of informed consent to participate in post-course data collection Exclusion criteria: Failure to participate in the interview After course completion, eligible students from both cohorts were contacted by email and invited to participate. The invitation included a link to an online consent form (Google Forms). Recruitment occurred between May and August 2025. Students were informed that participation was voluntary, that they could withdraw at any time, and that participation (or non-participation) would have no academic consequences. The interviewer was not involved in course grading or evaluation, reducing potential power imbalance. Recruitment continued until no additional students expressed interest in participating. During the data collection process, we observed that thematic saturation had been reached, as no substantially new themes emerged in the later interviews. In determining sample adequacy, we were also guided by the principle of information power ( 18 ) , whereby the specificity of the study aim, the strength of the theoretical framework, the quality of dialogue, and the depth of analysis supported a sufficient sample size. Data Collection Following consent, participants completed a semi-structured interview conducted by a trained qualitative researcher. Interviews were conducted in Spanish, either in person or virtually, according to participant preference. An interview guide (Appendix 1) was developed based on study objectives and Self-Determination Theory constructs and pilot-tested with one student not included in the final sample. After a brief introduction, interviews explored students’ motivations for enrolling, experiences during the course, and perceived effects on their clinical training and professional development. Interviews lasted approximately 30 minutes, were audio-recorded with permission, and transcribed verbatim. Field notes were recorded after each interview to capture contextual observations and analytic impressions We also collected brief demographic information (including gender identity). Audio files and transcripts were de-identified prior to analysis by removing names and other potentially identifying details. Data Analysis Analysis followed Braun and Clarke’s six-phase process: (1) familiarization, (2) initial coding, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report ( 19 ) . Informed by Self-Determination Theory (SDT) as a conceptual framework to interpret students’ perceptions, motivations, and experiences of the HA course ( 19 , 20 ) . SDT provided sensitizing concepts to examine dimensions related to autonomy, competence, and relatedness, as well as intrinsic and extrinsic motivation ( 20 ) . The analytic process began with transcription and familiarization with the data. Transcripts were reviewed for accuracy and anonymized before analysis. Initial coding followed a hybrid inductive–deductive approach. Inductive coding allowed themes to emerge directly from the data, while deductive coding drew on SDT constructs and concepts related to humanism, empathy, and emotional experience in medical training. Two researchers independently coded an initial subset of transcripts and met to compare interpretations and refine the coding framework. Subsequent coding was conducted iteratively, with regular analytic discussions to refine themes and ensure coherence. ATLAS.ti software (version 10.1) was used to support systematic data organization and coding. Codes were subsequently clustered into higher-order themes reflecting students’ perceptions of the course, its perceived utility, and its influence on their professional development. Themes were organized in relation to the study objectives, particularly students’ motivations for participation, perceived impact on humanistic and relational competencies, and the relevance of the course for navigating challenges in clinical training. Interpretation of findings was guided by SDT to deepen understanding of motivational processes and how participation in the HA course contributed to humanistic competence development within medical education. Self-Determination Theory functioned as a sensitizing framework rather than a priori coding template, guiding interpretation of motivational dimensions while preserving openness to emergent themes. Rigour and Trustworthiness We employed multiple strategies to strengthen credibility and trustworthiness. Investigator triangulation was employed through collaborative theme development among multiple researchers. Theme development and interpretation were discussed collaboratively by several members of the research team to enhance analytic depth and reduce idiosyncratic interpretation. Preliminary themes were shared with selected participants to assess interpretive resonance rather than to seek validation of factual accuracy. The research team included individuals with experience in humanistic medical education and qualitative research. Reflexive discussions were conducted throughout the analytic process to examine assumptions related to professional identity formation and humanism in medical training Reflexivity In keeping with our reflexive approach to thematic analysis, our subjectivities as researchers productively shaped this project. The research team included physicians with experience in qualitative research and humanistic medical education, as well as two recent medical graduates familiar with The Healer’s Art training. The senior author has expertise in qualitative methods and healthcare communication. This positionality may have heightened sensitivity to themes related to professional identity and relational practice. Reflexive journaling and regular team discussions were conducted to critically examine assumptions and minimize interpretive bias throughout the study. Results Ten medical students registered interest in the study and all were invited to participate in the interviews. Six of the selected participants belonged to the 2024 cohort and four to the 2025 cohort. Participants were fourth- and fifth-year medical students; four were male and six were female. Overview of themes Thematic analysis revealed that students’ perceptions of the HA course were situated along a motivational continuum ranging from extrinsic to intrinsic motivation, consistent with SDT. Three major themes were identified. 1. Seeking the human side of medicine This theme captures students’ motivations for enrolling in the HA course and reflects a shared desire to reconnect with the emotional, relational, and human dimensions of medicine. Many participants described feeling that traditional medical education prioritizes logic, diagnosis, and clinical reasoning, leaving limited space for reflection, emotions, and personal growth. In contrast, the HA course was perceived as an opportunity to cultivate a more empathic and human approach to patient care: “What caught my attention was that it didn’t focus so much on the logical side of things, but rather on the emotional accompaniment of patients and a better understanding of their emotions and feelings throughout the illness process—not only focusing on pathology, but also on the social and emotional components that can affect treatment and suffering.” (Student 4) The title of the course itself, “The Art of Healing”, sparked curiosity and suggested a different way of learning, one that integrates self-awareness, compassion, and care not only for patients but also for oneself. This initial curiosity was reflected in students’ perceptions of the course as an opportunity to reflect on self-care and the emotional dimension of healing: “At first, I didn’t really know what the course was about, and then the title itself, “The Healer´s Art” made me think, ‘Well, it’s not only important to know how to treat people in different situations.’ I thought it was purely medical, but it was also about personal care, about us.” (Student 2) Participants also reported being drawn to topics such as grief, communication, and emotional accompaniment, which they perceived as opportunities to cultivate empathy and so-called “soft skills” essential for patient care: “I understood the course as a holistic view of health and disease. I expected to better understand how to relate to patients, like developing soft skills to connect better with them and to understand myself and them better in their suffering, because the process of illness is not easy. Through the course, I also realized that there are aspects we hadn’t really been paying attention to.” (Student 5) Regardless of their initial expectations, students’ motivations were rooted in a deeper longing to restore humanity within their medical education and to reconnect with the human meaning of becoming a physician. 2. An unconventional course: learning through experience and shared humanity This theme describes students’ lived experiences of participating in the HA course and explores the elements that distinguish it from traditional academic courses. Unlike conventional medical school subjects, participants consistently described the course as a unique space within medical school, where learning was constructed through dialogue, emotional reflection, and meaningful connections between students and faculty: “For example, it’s not the kind of course where they just put up a PowerPoint or go through topics one after another. It asks for much more active participation between participants, faculty, and students. Even for me [since I consider myself a reserved person] I opened up more and shared opinions and emotions. And the group work didn’t feel like an assignment or an obligation, but more like ‘tell us what happened, how are you?’ Almost like therapy.” (Student 6) Beyond technical learning, students recognized the course’s holistic and human-centered approach, oriented not only toward patient well-being but also toward self-care and personal growth: “The care they gave to us… because when we choose an elective, we usually think about learning something for the patient. But this course was not only oriented toward the patient, it was oriented toward us and the patient, and even more toward us.” (Student 5) Many participants also highlighted the importance of the course as a space for generous listening (a concept central to The Healer’s Art) and emotional accompaniment, which they considered uncommon within medical school. Being listened to and genuinely understood, by both experienced faculty and peers, was perceived as both a personal and clinical learning experience: “It provides real generous listening… it’s easy to say ‘yes, I’m listening,’ but generous listening is ‘I listen and I feel what you feel.’ That’s what the course gave me, and it’s something you won’t find at the university, except maybe with close friends.” (Student 2) Participants valued the conversational and co-learning dynamics, in which each person’s stories and reflections became collective learning material. Rather than lectures, sessions were built around dialogue, shared experience, and mutual respect: “The fact that it was a course without traditional theoretical classes… It was discussions, conversations. The professors gave a brief introduction and then time to participate, share experiences, and reflect. Communication among everyone was very good, and there was always a lot of respect between students and professors.” (Student 1) For many, this approach to teaching and learning was unique within their medical training: “At least within the medical program, I don’t think I’ve had any other course like this—mandatory or even similar. I’ve taken humanities or social science courses, but none of them addressed these topics as deeply as this course did.” (Student 9) Taken together, these experiences show that the HA course offered something students perceived as unusual in their medical education: a safe, relational, and deeply human space, where vulnerability, empathy, and connection replaced performance, hierarchy, and competition. 3. The art of healing: toward a more humanistic medical communication This theme illustrates how The Healer’s Art course enabled students to rediscover the human dimension of medical practice and to develop a more empathic, mindful, and respectful approach to communication with patients. Through their testimonies, students described a profound shift in how they understood the clinical encounter, moving from a predominantly biomedical logic (centered on diagnosis and treatment) toward a relationship based on understanding, generous listening, and emotional accompaniment. One student reflected on how their approach to patients changed over time, recognizing that clinical encounters involve much more than data collection: “Before, when I was in fourth year or halfway through fifth year, I would just take the medical history, ask for specific data, and then move on to the next patient. But after the course, and progressively, I realized that every person had a story to tell. Every person had their own perspectives and fears. What we might see as just another day at work, they experience as something new and frightening. And honestly, I felt it was also my duty to give patients reassurance and understand them better.” (Student 6) This growing awareness translated into more humanistic communication during clinical practice. Another participant described feeling more confident and effective when interacting with patients and families, particularly in emotionally sensitive settings: “Now, during my pediatric internship, I feel it helps me a lot to communicate with mothers and with pediatric patients. I feel I’ve improved in transmitting calm and peace to patients, both to mothers and to children. That also makes the interview and the physical exam easier.” (Student 6) This openness to emotional and experiential dimensions led students to reflect on their language and their capacity to accompany patients, especially in situations involving loss and grief: “What the course teaches us is what not to say to people who have experienced loss. Sometimes we say things like ‘calm down, it will pass,’ and those comments, even if well intentioned, don’t really help. In the course you learn what to say, what can help a patient and what won’t. That’s what I remember the most, and now I try to apply it not only in the clinic but in general when someone is going through a loss.” (Student 8) Several participants emphasized that the course helped them place themselves in the patient’s experience and recognize vulnerability as a shared dimension of the clinical encounter: “Now when I see patients, I try to think more about their situation, what they’re going through. In those critical moments, I try to be very respectful in what I say and how I treat them, because being in the hospital is not a pleasant experience.” (Student 4) Others articulated a clear shift toward seeing patients as people rather than diseases, highlighting the importance of trust and emotional support: “We are treating people, not diseases. That became very clear to me in the course. It helps a lot when patients feel supported, because without trust there won’t be treatment adherence, and there’s also a psychosocial factor that influences recovery, which is closely related to the doctor–patient relationship.” (Student 3) In this context, empathy began to be understood as a clinical competence that goes beyond technical expertise: “I feel the course opened my eyes to more personalized patient care. It’s about having empathy, but also going beyond that—seeing more of the patient’s situation, personal or economic difficulties, and not focusing only on relieving pain or curing the disease, but also on the consequences and complications, and talking about those with patients.” (Student 3) Students further emphasized that technical competence alone is insufficient without strong communication and relational skills: “The course helped me understand that soft skills are just as important, some might even say more important, than knowledge and technical expertise. Without good interaction and a strong doctor–patient relationship, even the best clinical knowledge won’t work.” (Student 1) The course also introduced key concepts that resonated deeply with participants, such as generous listening and the idea of the “wounded healer”: “I remember the concept of generous listening very clearly, and also the idea of the wounded healer—those doctors don’t have to be perfect to help others, and having doubts or fears doesn’t make you less of a doctor.” (Student 9) Finally, many students described how The Healer’s Art helped them slow down and truly listen to patients, cultivating presence in the clinical encounter: “It helped me pay more attention to patients and understand them better. It also helped me value what I’m studying and realize how important it is to be at the service of others.” Discussion The findings indicate that the HA course offers a meaningful educational experience that allows medical students to reconnect with the human dimension of medicine, which they perceive as underrepresented in the traditional curriculum. Despite entering the course with varied motivations, participants shared a common desire to integrate personal, emotional, and relational dimensions into their developing professional identities. Engagement in the course supported more empathic, person-centered interactions, strengthened their capacity to navigate emotionally challenging situations such as grief, and affirmed self-care as an ethical and professional responsibility. Overall, HA functioned as an integrative space in which motivation, experiential learning, skill development, and professional identity formation aligned around a shared humanistic orientation to care. Guided by SDT’s core dimensions of autonomy, competence, and relatedness, and informed by our inductive thematic analysis, we examined how participation in HA supported intrinsic motivation and relational engagement within medical training. Building on this theoretical interpretation, we draw on participants’ narratives to illuminate the core gains and enduring relevance of The Healer’s Art course. We synthesize these insights through the HEART mnemonic—Humanistic Reconnection, Empathy and Emotional Competence, Authentic Professional Identity, Reflection and Relational Safety, and Transformative Learning—which captures the foundational capacities cultivated through the course. Together, these dimensions highlight how HA supports students in developing a more relational, reflective, and meaning-centered approach to clinical practice, enabling them to practice medicine from the HEART. Humanistic reconnection (H) was central to students’ initial motivations for enrolling in HA. Participants described actively seeking a learning space distinct from the competitive, performance-oriented culture of the formal medical curriculum. This search reflected both extrinsic pressures and intrinsic needs, aligning with prior literature documenting emotional strain, isolation, and erosion of meaning during medical training ( 21 , 22 ) . Within this context, HA functioned as a counter-space that reconnected students with the human dimension of medicine, reframing clinical practice as a relational and moral endeavor rather than a purely technical one. Participation thus represented not only an academic choice, but an existential and vocational response to perceived gaps in contemporary medical education ( 23 ) . Medical curricula should intentionally integrate structured humanistic counter-spaces that allow students to reconnect with the relational and moral dimensions of medicine. Educational scholarship shows a strong interest in humanistic-oriented training as an essential complement to biomedical education, with calls for opportunities that support reflection, narrative engagement, and relational skills in clinical training ( 24 ) . Educational programs must recognize that many learners actively seek environments that counterbalance competitive, performance-driven cultures. Professional identity formation research highlights the importance of relational and reflective learning environments that scaffold identity development rather than simply technical skill acquisition ( 25 , 26 ) . Designing curricula that explicitly address vocation, meaning, and relational identity may strengthen students’ intrinsic motivation and sustain their sense of purpose in clinical practice. The literature on humanism in medical education emphasizes that explicit attention to reflective practice, emotional engagement, and purpose contributes to the formation of resilient, patient-centered professionals ( 25 , 27 ) . Through sustained engagement in the course, students developed empathy and emotional competence (E) as legitimate clinical capacities. HA legitimized compassion, emotional presence, and attentive listening as core professional skills rather than optional personal traits ( 28 ) . Educational interventions that emphasize empathy and communication skills improve students’ ability to understand and respond to patients’ emotions and experiences , suggesting that empathy training enhances emotional attunement and clinical relational skills in healthcare learners ( 29 ) . These findings reinforce the view that empathic communication is not ancillary to biomedical care, but foundational to meaningful clinical practice. In parallel, empathy and emotional competence should be explicitly framed as core clinical skills. Educational programs should incorporate supervised practice in emotionally complex encounters, structured reflection, and faculty modeling to reinforce that compassionate communication is foundational, not secondary to high-quality clinical care. At the level of professional identity, HA supported the emergence of an authentic professional identity (A) grounded in the integration of personal values, emotions, and meaning. Rather than encouraging conformity to norms of emotional detachment, the course legitimizes authenticity, self-awareness, and moral integrity as integral to professional excellence ( 4 ) . Participants described reconciling who they are as individuals with who they are becoming as physicians, suggesting that HA creates conditions for identity formation that align personal and professional selves ( 30 ) . In doing so, the program offers a counterbalance to elements of the hidden curriculum that often marginalize emotional expression and relational labor ( 31 ) . This identity development is made possible through the program’s intentional creation of reflection and relational safety (R) . HA provides a psychologically safe, dialogical learning environment where vulnerability, uncertainty, and emotional complexity can be explored without judgment, countering the shame-inducing and emotionally unsafe climates described in medical education as barriers to authentic engagement and learning ( 32 ) . Through structured reflection and peer dialogue, students are supported in examining inherited norms, articulating difficult experiences, and engaging in shared meaning-making ( 33 ) . By fostering relational safety and reflective depth, the program strengthens belonging, professional coherence, and collective moral awareness within medical training, aligning with scholarship that positions professional identity formation as foundational to professional coherence and emphasizes humanistic education as essential for cultivating moral awareness and relational professionalism ( 4 ) . Finally, students’ accounts highlight transformative learning (T) as a defining feature of HA. Participants described the course as fundamentally different from other medical school subjects, with effects that extended beyond discrete skill acquisition to influence how they understood medicine itself. By countering reductionist and technocratic orientations, HA fostered a shift toward seeing patients as whole persons and care as a moral and relational practice ( 34 , 35 ) . Importantly, the outcomes of practicing medicine from the HEART were perceived to benefit not only patients, through improved communication and trust, but also physicians, by supporting self-care, ethical practice, and protection against burnout ( 36 ) . These benefits were achieved without additional clinical resources, underscoring the broader relevance of humanistic education for sustainable health systems. Strengths and limitations This study has limitations that warrant consideration. Voluntary participation may have introduced selection bias, as students more interested in medical humanism may have been more likely to participate. Additionally, the study was conducted at a single institution, which may limit transferability to other settings. Finally, self-reported experiences may be influenced by social desirability. Nonetheless, these limitations are offset by the strengths of the qualitative design, which enabled in-depth exploration of experiences and meanings that are difficult to capture quantitatively. The use of thematic analysis informed by SDT provided a robust framework for understanding student motivation and learning processes. Moreover, this study contributes novel empirical evidence from a Peruvian context, where research on medical humanism initiatives remains limited. Implications for Research and Educational Practice The HEART mnemonic (Humanistic Reconnection, Empathy and Emotional Competence, Authentic Professional Identity, Reflection and Relational Safety, and Transformative Learning) proposes a set of core principals for advancing research and educational practice in medical education, while also highlighting the broader relevance of The Healer’s Art (HA) as a transferable and scalable educational model. By articulating how humanistic reconnection, emotional competence, authenticity, reflective safety, and transformative learning interact, HEART offers a coherent structure for examining educational experiences that shape professional identity beyond technical skill acquisition. From an educational practice standpoint, the findings suggest that HA should not remain a marginal or optional enrichment experience but be more deliberately integrated into medical curricula worldwide. HEART underscores the value of embedding protected spaces for reflection, dialogue, and relational learning within mainstream training, particularly in contexts characterized by performance pressure and emotional silencing. Faculty development initiatives could draw on HA principles to cultivate psychological safety, model authentic professional identities, and legitimize emotional competence as a core clinical skill. More broadly, incorporating HA into educational strategies internationally reframes medical training as a moral, relational, and socially embedded practice. Practicing medicine from the HEART does not oppose scientific rigor, but complements it by fostering humane, reflective, and resilient physicians. As such, HEART and HA together offer a practical and conceptually robust contribution to global efforts to humanize medical education and support the sustainability of the healthcare workforce. From a research perspective, HEART can guide future qualitative, mixed-methods, and longitudinal studies examining how HA and similar humanistic curricula influence motivation, identity formation, empathic practice, and moral agency across diverse training stages and cultural contexts. Importantly, HA warrants systematic investigation beyond single institutions or national settings. Comparative and cross-cultural research could explore how HA is adapted, experienced, and sustained in different health systems, and how its core principles interact with local educational cultures, norms of professionalism, and clinical hierarchies. Such work would strengthen the global evidence base for humanistic medical education and support theory-building around relational and moral dimensions of clinical practice. Conclusions The HA course meaningfully strengthens the humanistic dimension of medical education by addressing students’ need for safe, reflective learning spaces. In increasingly performance-driven training environments, courses like HA serve as a valuable counterbalance by fostering empathy, reflection, and professional identity development. These results support the integration of experiential, relationship-centered courses into medical curricula and highlight the need for educational programs to more deliberately incorporate humanism, empathy, and self-care as core components of medical training and everyday clinical practice. Declarations Ethics approval and consent to participate: Ethical approval was obtained from the Institutional Research Ethics Committee of Universidad Peruana Cayetano Heredia (UPCH) through expedited review (SIDISI No. 213199). All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the Declaration of Helsinki and with applicable institutional guidelines. All participants signed informed consent before enrollment. Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests Funding: None Authors' contributions: MSCF, LCS, JHMT, and AGGC conceived the study. NNA, KDCT, and NRES drafted the initial manuscript. KDCT and NRES conducted the interviews and performed the data analysis. All authors reviewed, and approved the final manuscript. Acknowledgements: We sincerely thank the UPCH medical students who generously shared their time and experiences, making this study possible. References Branch J William T, Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, et al. Teaching the Human Dimensions of Care in Clinical Settings. JAMA. 5 de septiembre de 2001;286(9):1067-74. doi:10.1001/jama.286.9.1067 Wear D, Zarconi J. Can compassion be taught? Let’s ask our students. J Gen Intern Med. julio de 2008;23(7):948-53. doi:10.1007/s11606-007-0501-0 PubMed PMID: 18612722; PubMed Central PMCID: PMC2517940. Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med J Assoc Am Med Coll. agosto de 2011;86(8):996-1009. doi:10.1097/ACM.0b013e318221e615 PubMed PMID: 21670661. Branch WT. Teaching professional and humanistic values: suggestion for a practical and theoretical model. Patient Educ Couns. febrero de 2015;98(2):162-7. doi:10.1016/j.pec.2014.10.022 PubMed PMID: 25468396. Cruess SR, Cruess RL, Steinert Y. Supporting the development of a professional identity: General principles. Med Teach. junio de 2019;41(6):641-9. doi:10.1080/0142159X.2018.1536260 PubMed PMID: 30739517. Sharpless J, Baldwin N, Cook R, Kofman A, Morley-Fletcher A, Slotkin R, et al. The becoming: students’ reflections on the process of professional identity formation in medical education. Acad Med J Assoc Am Med Coll. junio de 2015;90(6):713-7. doi:10.1097/ACM.0000000000000729 PubMed PMID: 25881650. Wald HS. Professional identity (trans)formation in medical education: reflection, relationship, resilience. Acad Med J Assoc Am Med Coll. junio de 2015;90(6):701-6. doi:10.1097/ACM.0000000000000731 PubMed PMID: 25881651. Sarraf-Yazdi S, Teo YN, How AEH, Teo YH, Goh S, Kow CS, et al. A Scoping Review of Professional Identity Formation in Undergraduate Medical Education. J Gen Intern Med. noviembre de 2021;36(11):3511-21. doi:10.1007/s11606-021-07024-9 PubMed PMID: 34406582; PubMed Central PMCID: PMC8606368. Remen RN, Rabow MW. The Healer’s Art: professionalism, service and mission. Med Educ. noviembre de 2005;39(11):1167-8. doi:10.1111/j.1365-2929.2005.02296.x PubMed PMID: 16262843. The Healer’s Art Course Description. rishi [Internet]. [citado 9 de marzo de 2026]. Disponible en: https://rishiprograms.org/healers-art/the-healers-art-course-description/ Lawrence EC, Carvour ML, Camarata C, Andarsio E, Rabow MW. Requiring the Healer’s Art Curriculum to Promote Professional Identity Formation Among Medical Students. J Med Humanit. diciembre de 2020;41(4):531-41. doi:10.1007/s10912-020-09649-z PubMed PMID: 32748226. Geary C, McKee J, Sierpina V, Kreitzer MJ. The Art of Healing: An Adaptation of the Healer’s Art Course for Fourth-Year Students. Explore J Sci Heal. septiembre de 2009;5(5):306-7. doi:10.1016/j.explore.2009.06.010 Manger JK, McManamon AC, Todd A, Stolfi A, Parmelee DX, Andarsio E. Healer’s Art in the Online Era: Successes, Challenges, and Implications. Med Sci Educ. abril de 2025;35(2):977-89. doi:10.1007/s40670-024-02272-w PubMed PMID: 40353038; PubMed Central PMCID: PMC12058631. Jaiswal C, Anderson K, Haesler E. A self-report of the Healer’s art by junior doctors: does the course have a lasting influence on personal experience of humanism, self-nurturing skills and medical counterculture? BMC Med Educ. 29 de noviembre de 2019;19(1):443. doi:10.1186/s12909-019-1877-3 PubMed PMID: 31783846; PubMed Central PMCID: PMC6884863. Estela-Villa LM, Jiménez-Román CR, Landeo-Gutiérrez JS, Tomateo-Torvisco JD, Vega-Dienstmaier JM. Prevalencia de síndrome de burnout en alumnos del séptimo año de medicina de una universidad privada de Lima, Perú. Rev Neuro-Psiquiatr. 13 de junio de 2011;73(4):147-56. doi:10.20453/rnp.v73i4.1700 Chávez Agurto P. Competencias interculturales del profesional de salud serumista. An Fac Med. enero de 2022;83(1):54-7. doi:10.15381/anales.v83i1.21328 Brierley CK, Suarez N, Arora G, Graham D. Healthcare access and health beliefs of the indigenous peoples in remote Amazonian Peru. Am J Trop Med Hyg. enero de 2014;90(1):180-3. doi:10.4269/ajtmh.13-0547 PubMed PMID: 24277789; PubMed Central PMCID: PMC3886418. Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. noviembre de 2016;26(13):1753-60. doi:10.1177/1049732315617444 PubMed PMID: 26613970. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 1 de enero de 2006;3(2):77-101. doi:10.1191/1478088706qp063oa Deci EL, Ryan RM. The «What» and «Why» of Goal Pursuits: Human Needs and the Self-Determination of Behavior. Psychol Inq. 1 de octubre de 2000;11(4):227-68. doi:10.1207/S15327965PLI1104_01 Egnew TR, Lewis PR, Meyers KR, Phillips WR. The Suffering Medical Students Attribute to Their Undergraduate Medical Education. Fam Med. abril de 2018;50(4):296-9. doi:10.22454/FamMed.2018.116755 PubMed PMID: 29669149. Watson HR, Millin P, Close J, Jeffery R, Stephenson H, Zahra D. «Let’s work together to pass medical school»: a qualitative study of medical student attitudes to teamwork, competition and collaboration. FEBS Open Bio. febrero de 2025;15(2):359-72. doi:10.1002/2211-5463.13915 PubMed PMID: 39509580; PubMed Central PMCID: PMC11788744. Assing Hvidt E, Ulsø A, Thorngreen CV, Søndergaard J, Andersen CM. Weak inclusion of the medical humanities in medical education: a qualitative study among Danish medical students. BMC Med Educ. 5 de septiembre de 2022;22(1):660. doi:10.1186/s12909-022-03723-x PubMed PMID: 36064397; PubMed Central PMCID: PMC9442995. Martimianakis MAT, Michalec B, Lam J, Cartmill C, Taylor JS, Hafferty FW. Humanism, the Hidden Curriculum, and Educational Reform: A Scoping Review and Thematic Analysis. Acad Med J Assoc Am Med Coll. noviembre de 2015;90(11 Suppl):S5-13. doi:10.1097/ACM.0000000000000894 PubMed PMID: 26505101. Wald HS, Anthony D, Hutchinson TA, Liben S, Smilovitch M, Donato AA. Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice. Acad Med J Assoc Am Med Coll. junio de 2015;90(6):753-60. doi:10.1097/ACM.0000000000000725 PubMed PMID: 25901874. Sarraf-Yazdi S, Pisupati A, Goh CK, Ong YT, Toh YR, Goh SPL, et al. A scoping review and theory-informed conceptual model of professional identity formation in medical education. Med Educ. octubre de 2024;58(10):1151-65. doi:10.1111/medu.15399 PubMed PMID: 38597258. Zohdi WNWM, Azme N. Integrating Humanities into Medical Education. Int J Soc Sci Res. 6 de febrero de 2025;13(1):111. doi:10.5296/ijssr.v13i1.22545 Eikeland HL, Ørnes K, Finset A, Pedersen R. The physician’s role and empathy – a qualitative study of third year medical students. BMC Med Educ. 9 de agosto de 2014;14(1):165. doi:10.1186/1472-6920-14-165 Patel S, Pelletier-Bui A, Smith S, Roberts MB, Kilgannon H, Trzeciak S, et al. Curricula for empathy and compassion training in medical education: A systematic review. PLOS ONE. 22 de agosto de 2019;14(8):e0221412. doi:10.1371/journal.pone.0221412 Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med J Assoc Am Med Coll. septiembre de 2012;87(9):1185-90. doi:10.1097/ACM.0b013e3182604968 PubMed PMID: 22836834. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching. BMJ. 2 de octubre de 2004;329(7469):770-3. doi:10.1136/bmj.329.7469.770 PubMed PMID: 15459051; PubMed Central PMCID: PMC520997. Han PKJ, Schaufel M, Schei E. Shame among medical learners: An uncertainty-focused conception. Patient Educ Couns. 5 de febrero de 2026;147:109516. doi:10.1016/j.pec.2026.109516 PubMed PMID: 41671726; PubMed Central PMCID: PMC12919643. Wald HS, Borkan JM, Taylor JS, Anthony D, Reis SP. Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing. Acad Med J Assoc Am Med Coll. enero de 2012;87(1):41-50. doi:10.1097/ACM.0b013e31823b55fa PubMed PMID: 22104060. Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 20 de octubre de 2001;323(7318):908-11. doi:10.1136/bmj.323.7318.908 PubMed PMID: 11668137; PubMed Central PMCID: PMC58543. Shelley BP. Re-humanizing “high-tech, no touch” medicine: Narrative medicine and cinemeducation perspectives. Arch Med Health Sci. junio de 2016;4(1):1. doi:10.4103/2321-4848.183367 Post SG. Compassionate care enhancement: benefits and outcomes. Int J Pers Centered Med. 20 de diciembre de 2011;1(4):808-13. doi:10.5750/ijpcm.v1i4.153 Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor invited by journal 21 Mar, 2026 Editor assigned by journal 20 Mar, 2026 Submission checks completed at journal 20 Mar, 2026 First submitted to journal 18 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9161459","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626061497,"identity":"1d2c282e-bf7e-48b0-ab74-69a3e3b576b3","order_by":0,"name":"Maria Sofia Cuba-Fuentes","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYJCCAyDCgIH5AIxNtBa2BOK1MEC08BgQp0W3/ezDAz8Y7BK3s5/5Jl1Qc4fBnL0BvxazM+kGB3sYkhN39uRuk55x7BmDZQ8Bm8wOpDEc4GE4kLjhAFALb8NhBoMbCQS0nH/GcPAPSMv5N88gWu4/IKDlRhrDYbAtN3LYoLbg1wHU8ozhsIxBsvHOGc+MrWccO8xj2UPQYWnMH99U2Mlu509+eLug5rCcOfsBAtaAgQGEYgZiHgNiNMABM5L2UTAKRsEoGAVwAAA6H0l6MMu2YgAAAABJRU5ErkJggg==","orcid":"","institution":"Cayetano Heredia University","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"Sofia","lastName":"Cuba-Fuentes","suffix":""},{"id":626061498,"identity":"9709ee05-d907-49dc-a64e-0fd244cdca62","order_by":1,"name":"Lyan Chang Sedano","email":"","orcid":"","institution":"Cayetano Heredia University","correspondingAuthor":false,"prefix":"","firstName":"Lyan","middleName":"Chang","lastName":"Sedano","suffix":""},{"id":626061499,"identity":"43910acb-26f0-4138-96b7-1b70cc14a28b","order_by":2,"name":"Natalia Nombera-Aznaran","email":"","orcid":"","institution":"Cayetano Heredia University","correspondingAuthor":false,"prefix":"","firstName":"Natalia","middleName":"","lastName":"Nombera-Aznaran","suffix":""},{"id":626061500,"identity":"af014aef-1f6a-4b68-8acf-150cd6710369","order_by":3,"name":"Jorge Huerta-Mercado Tenorio","email":"","orcid":"","institution":"Cayetano Heredia University","correspondingAuthor":false,"prefix":"","firstName":"Jorge","middleName":"Huerta-Mercado","lastName":"Tenorio","suffix":""},{"id":626061501,"identity":"74ef4744-8c0e-4c2d-a473-fc087cb5d950","order_by":4,"name":"Alberto Guerra Garcia","email":"","orcid":"","institution":"Cayetano Heredia University","correspondingAuthor":false,"prefix":"","firstName":"Alberto","middleName":"Guerra","lastName":"Garcia","suffix":""},{"id":626061502,"identity":"7a9807f4-860e-4008-914d-3ad4b7b935d4","order_by":5,"name":"Kelly De la Cruz-Torralva","email":"","orcid":"","institution":"Cayetano Heredia University","correspondingAuthor":false,"prefix":"","firstName":"Kelly","middleName":"De la","lastName":"Cruz-Torralva","suffix":""},{"id":626061503,"identity":"ae3d28f1-23c8-4325-b72f-7ab03d5c558e","order_by":6,"name":"Nataly R. Espinoza Suarez","email":"","orcid":"","institution":"Université Laval","correspondingAuthor":false,"prefix":"","firstName":"Nataly","middleName":"R. Espinoza","lastName":"Suarez","suffix":""}],"badges":[],"createdAt":"2026-03-18 16:10:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9161459/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9161459/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108490792,"identity":"d0e0d0d9-611a-49e3-bd19-c72d1db8447b","added_by":"auto","created_at":"2026-05-05 09:48:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":268857,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9161459/v1/2fab7c80-13ea-40f8-8eb0-571f8ebfdbaa.pdf"},{"id":107502718,"identity":"1fd6a0eb-f335-4c16-bccb-675111a06201","added_by":"auto","created_at":"2026-04-22 06:14:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":22016,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9161459/v1/e3f6279322d2a49e3a70912e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Practicing Medicine from the HEART: A Qualitative Study on Humanistic Education on the Healer´s Art Course","fulltext":[{"header":"Background","content":"\u003cp\u003eHumanistic formation is a core component of medical education and encompasses the values, attitudes, and relational competencies required to deliver ethical, person centered, and socially responsive care\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. Despite its recognized importance, integrating these dimensions remains difficult, as contemporary medical curricula often prioritize biomedical knowledge and intensive clinical exposure\u003csup\u003e(\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e. As a result, students may have fewer structured opportunities for humanistic learning. This curricular imbalance also points to a broader issue in medical education: reconciling biomedical training with professional identity formation. Although medical programs aim to develop clinically competent physicians, professional identity formation extends beyond the acquisition of medical knowledge and technical skills, emerging through reflective practice and meaningful relational experiences\u003csup\u003e(\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. Moving beyond an exclusively biomedical model is therefore essential to fostering person centered care and humanizing clinical practice.\u003c/p\u003e \u003cp\u003eThe Healer\u0026rsquo;s Art (HA) is an innovative discovery model course in values clarification and professionalism for first- and second-year medical students now offered annually at more than 90 U.S. medical schools as well as medical schools around the world\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e. Designed in 1991 by Rachel Naomi Remen, M.D., (U.S.) the course offers a safe learning environment for a personal in-depth exploration of the time-honored values of service, healing relationship, reverence for life and compassionate care. It is a 15-hour elective course and consists of five evening sessions spaced two weeks apart at least. Each three-hour session is involving a large and small group session. The groups are facilitated by physicians recruited from medical school faculty and the community. (10).\u003c/p\u003e \u003cp\u003eImplementation studies, particularly when the course is delivered as a required component, indicate benefits consistent with professional identity formation. Students report enhanced empathy toward peers and patients, strengthened commitment to service, clearer conceptions of what it means to be a physician, and perceived reductions in burnout-related dimensions\u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e. Importantly, concerns that mandatory participation might diminish engagement have not been supported; students who would not have elected the course demonstrate comparable experiences and outcomes over time, including on measures of emotional exhaustion, engagement, and cynicism, supporting its scalability within formal curricula. Faculty implementation research further suggests that the course fosters relational and reflective educational climates, as instructors report professional growth and deeper connections with learners.\u003c/p\u003e \u003cp\u003eAdaptations across different stages of medical training also indicate that the model is transferable beyond the pre-clinical years\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e. Recent evaluations, including online implementations and follow-up interviews with junior doctors, reinforce the course\u0026rsquo;s benefits. Participants describe strengthened empathy, self-care and self-awareness, supportive peer community, renewed professional meaning, and improved capacity to navigate the challenges of medical culture\u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e. These findings suggest that the course promotes durable humanistic and professional identity development across training stages and delivery formats.\u003c/p\u003e \u003cp\u003eDespite this growing body of evidence, most published evaluations originate from North American or Australian contexts, leaving important questions about contextual transferability insufficiently explored. Evidence from Latin America remains limited, particularly regarding implementations in Spanish and within distinct sociocultural contexts. This gap is especially relevant given the substantial stressors of medical training in low- and middle-income countries across the region. Evidence from Peru underscores this concern, as a 2010 cross-sectional study among medical interns at the Universidad Peruana Cayetano Heredia (UPCH) reported a burnout prevalence of 57.2%\u003csup\u003e(15)\u003c/sup\u003e. Humanistic educational approaches may provide cognitive, emotional, and relational resources to help students cope with stress and potentially reduce the risk of burnout\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMoreover, the Peruvian sociocultural context adds complexity to care delivery: the coexistence of multiple understandings of health and illness, together with limited capacity for culturally responsive and relational care, may exacerbate inequities in healthcare access and quality\u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/sup\u003e. Strengthening empathy, reflective listening, and self-awareness is therefore essential to humanize shared decision-making and foster equitable therapeutic relationships. Examining how a reflective, relationship-centered curriculum is received and experienced within this context is thus both educationally and socially relevant.\u003c/p\u003e \u003cp\u003eIn 2024, UPCH offered the HA course for the first time in Spanish to fourth- and fifth-year medical students, which are equivalent to the first- and second-year year of medical school in the USA. This qualitative study explores students\u0026rsquo; motivations for enrolling, their perceptions of the course, and its perceived influence on their professional identity formation and humanistic development during clinical training. By doing so, it helps address the limited evidence on HA in Latin America. By generating context-specific evidence, this study contributes to understanding whether and how HA\u0026rsquo;s core principles translate across linguistic, cultural, and institutional settings, thereby informing future adaptations and potential regional scale-up.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study was conducted within a constructivist qualitative paradigm, recognizing that students\u0026rsquo; perceptions are socially constructed and contextually situated. We employed reflexive thematic analysis following Braun and Clarke to allow for both experiential description and interpretive depth. We adhered to the Standards for Reporting Qualitative Research (SRQR) to ensure transparent reporting of the study design, analysis, and findings. Ethical approval was obtained from the Institutional Research Ethics Committee of Universidad Peruana Cayetano Heredia (UPCH) through expedited review (SIDISI No. 213199). All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the Declaration of Helsinki and with applicable institutional guidelines.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Sampling\u003c/h3\u003e\n\u003cp\u003eWe used purposeful sampling to recruit students who completed the HA course at the Alberto Hurtado Faculty of Medicine, UPCH, Peru. The course is offered to medical students during their clinical training, with approximately 15 students participating per academic year. Of 19 eligible students, 10 participated.\u003c/p\u003e \u003cp\u003eInclusion criteria:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eCurrent enrollment in the medical program\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSuccessful completion of the HA course during the 2024 or 2025 cohorts\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProvision of informed consent to participate in post-course data collection\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eExclusion criteria:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eFailure to participate in the interview\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAfter course completion, eligible students from both cohorts were contacted by email and invited to participate. The invitation included a link to an online consent form (Google Forms). Recruitment occurred between May and August 2025. Students were informed that participation was voluntary, that they could withdraw at any time, and that participation (or non-participation) would have no academic consequences. The interviewer was not involved in course grading or evaluation, reducing potential power imbalance. Recruitment continued until no additional students expressed interest in participating. During the data collection process, we observed that thematic saturation had been reached, as no substantially new themes emerged in the later interviews. In determining sample adequacy, we were also guided by the principle of information power\u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e, whereby the specificity of the study aim, the strength of the theoretical framework, the quality of dialogue, and the depth of analysis supported a sufficient sample size.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eFollowing consent, participants completed a semi-structured interview conducted by a trained qualitative researcher. Interviews were conducted in Spanish, either in person or virtually, according to participant preference. An interview guide (Appendix 1) was developed based on study objectives and Self-Determination Theory constructs and pilot-tested with one student not included in the final sample.\u003c/p\u003e \u003cp\u003eAfter a brief introduction, interviews explored students\u0026rsquo; motivations for enrolling, experiences during the course, and perceived effects on their clinical training and professional development. Interviews lasted approximately 30 minutes, were audio-recorded with permission, and transcribed verbatim. Field notes were recorded after each interview to capture contextual observations and analytic impressions We also collected brief demographic information (including gender identity). Audio files and transcripts were de-identified prior to analysis by removing names and other potentially identifying details.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eAnalysis followed Braun and Clarke\u0026rsquo;s six-phase process: (1) familiarization, (2) initial coding, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report\u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e. Informed by Self-Determination Theory (SDT) as a conceptual framework to interpret students\u0026rsquo; perceptions, motivations, and experiences of the HA course\u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e. SDT provided sensitizing concepts to examine dimensions related to autonomy, competence, and relatedness, as well as intrinsic and extrinsic motivation\u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe analytic process began with transcription and familiarization with the data. Transcripts were reviewed for accuracy and anonymized before analysis. Initial coding followed a hybrid inductive\u0026ndash;deductive approach. Inductive coding allowed themes to emerge directly from the data, while deductive coding drew on SDT constructs and concepts related to humanism, empathy, and emotional experience in medical training. Two researchers independently coded an initial subset of transcripts and met to compare interpretations and refine the coding framework. Subsequent coding was conducted iteratively, with regular analytic discussions to refine themes and ensure coherence. ATLAS.ti software (version 10.1) was used to support systematic data organization and coding. Codes were subsequently clustered into higher-order themes reflecting students\u0026rsquo; perceptions of the course, its perceived utility, and its influence on their professional development. Themes were organized in relation to the study objectives, particularly students\u0026rsquo; motivations for participation, perceived impact on humanistic and relational competencies, and the relevance of the course for navigating challenges in clinical training. Interpretation of findings was guided by SDT to deepen understanding of motivational processes and how participation in the HA course contributed to humanistic competence development within medical education. Self-Determination Theory functioned as a sensitizing framework rather than a priori coding template, guiding interpretation of motivational dimensions while preserving openness to emergent themes.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRigour and Trustworthiness\u003c/h3\u003e\n\u003cp\u003eWe employed multiple strategies to strengthen credibility and trustworthiness. Investigator triangulation was employed through collaborative theme development among multiple researchers. Theme development and interpretation were discussed collaboratively by several members of the research team to enhance analytic depth and reduce idiosyncratic interpretation. Preliminary themes were shared with selected participants to assess interpretive resonance rather than to seek validation of factual accuracy. The research team included individuals with experience in humanistic medical education and qualitative research. Reflexive discussions were conducted throughout the analytic process to examine assumptions related to professional identity formation and humanism in medical training\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eReflexivity\u003c/h2\u003e \u003cp\u003eIn keeping with our reflexive approach to thematic analysis, our subjectivities as researchers productively shaped this project. The research team included physicians with experience in qualitative research and humanistic medical education, as well as two recent medical graduates familiar with The Healer\u0026rsquo;s Art training. The senior author has expertise in qualitative methods and healthcare communication. This positionality may have heightened sensitivity to themes related to professional identity and relational practice. Reflexive journaling and regular team discussions were conducted to critically examine assumptions and minimize interpretive bias throughout the study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTen medical students registered interest in the study and all were invited to participate in the interviews. Six of the selected participants belonged to the 2024 cohort and four to the 2025 cohort. Participants were fourth- and fifth-year medical students; four were male and six were female.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOverview of themes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThematic analysis revealed that students’ perceptions of the HA course were situated along a motivational continuum ranging from extrinsic to intrinsic motivation, consistent with SDT. Three major themes were identified.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. \u003cstrong\u003eSeeking the human side of medicine\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme captures students’ motivations for enrolling in the HA course and reflects a shared desire to reconnect with the emotional, relational, and human dimensions of medicine.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMany participants described feeling that traditional medical education prioritizes logic, diagnosis, and clinical reasoning, leaving limited space for reflection, emotions, and personal growth. In contrast, the HA course was perceived as an opportunity to cultivate a more empathic and human approach to patient care:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“What caught my attention was that it didn’t focus so much on the logical side of things, but rather on the emotional accompaniment of patients and a better understanding of their emotions and feelings throughout the illness process—not only focusing on pathology, but also on the social and emotional components that can affect treatment and suffering.” (Student 4)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe title of the course itself, “The Art of Healing”, sparked curiosity and suggested a different way of learning, one that integrates self-awareness, compassion, and care not only for patients but also for oneself. This initial curiosity was reflected in students’ perceptions of the course as an opportunity to reflect on self-care and the emotional dimension of healing:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“At first, I didn’t really know what the course was about, and then the title itself, “The Healer´s Art” made me think, ‘Well, it’s not only important to know how to treat people in different situations.’ I thought it was purely medical, but it was also about personal care, about us.” (Student 2)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants also reported being drawn to topics such as grief, communication, and emotional accompaniment, which they perceived as opportunities to cultivate empathy and so-called “soft skills” essential for patient care:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“I understood the course as a holistic view of health and disease. I expected to better understand how to relate to patients, like developing soft skills to connect better with them and to understand myself and them better in their suffering, because the process of illness is not easy. Through the course, I also realized that there are aspects we hadn’t really been paying attention to.” (Student 5)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRegardless of their initial expectations, students’ motivations were rooted in a deeper longing to restore humanity within their medical education and to reconnect with the human meaning of becoming a physician.\u003c/p\u003e\n\u003cp\u003e2. \u003cstrong\u003eAn unconventional course: learning through experience and shared humanity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme describes students’ lived experiences of participating in the HA course and explores the elements that distinguish it from traditional academic courses. Unlike conventional medical school subjects, participants consistently described the course as a unique space within medical school, where learning was constructed through dialogue, emotional reflection, and meaningful connections between students and faculty:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“For example, it’s not the kind of course where they just put up a PowerPoint or go through topics one after another. It asks for much more active participation between participants, faculty, and students. Even for me [since I consider myself a reserved person] I opened up more and shared opinions and emotions. And the group work didn’t feel like an assignment or an obligation, but more like ‘tell us what happened, how are you?’ Almost like therapy.” (Student 6)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBeyond technical learning, students recognized the course’s holistic and human-centered approach, oriented not only toward patient well-being but also toward self-care and personal growth:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“The care they gave to us… because when we choose an elective, we usually think about learning something for the patient. But this course was not only oriented toward the patient, it was oriented toward us and the patient, and even more toward us.” (Student 5)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMany participants also highlighted the importance of the course as a space for generous listening (a concept central to The Healer’s Art) and emotional accompaniment, which they considered uncommon within medical school. Being listened to and genuinely understood, by both experienced faculty and peers, was perceived as both a personal and clinical learning experience:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“It provides real\u0026nbsp;\u003c/em\u003egenerous\u003cem\u003e\u0026nbsp;listening… it’s easy to say ‘yes, I’m listening,’ but\u0026nbsp;\u003c/em\u003egenerous\u003cem\u003e\u0026nbsp;listening is ‘I listen and I feel what you feel.’ That’s what the course gave me, and it’s something you won’t find at the university, except maybe with close friends.” (Student 2)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants valued the conversational and co-learning dynamics, in which each person’s stories and reflections became collective learning material. Rather than lectures, sessions were built around dialogue, shared experience, and mutual respect:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“The fact that it was a course without traditional theoretical classes… It was discussions, conversations. The professors gave a brief introduction and then time to participate, share experiences, and reflect. Communication among everyone was very good, and there was always a lot of respect between students and professors.” \u0026nbsp;(Student 1)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor many, this approach to teaching and learning was unique within their medical training:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“At least within the medical program, I don’t think I’ve had any other course like this—mandatory or even similar. I’ve taken humanities or social science courses, but none of them addressed these topics as deeply as this course did.” (Student 9)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTaken together, these experiences show that the HA course offered something students perceived as unusual in their medical education: a safe, relational, and deeply human space, where vulnerability, empathy, and connection replaced performance, hierarchy, and competition.\u003c/p\u003e\n\u003cp\u003e3. \u003cstrong\u003eThe art of healing: toward a more humanistic medical communication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme illustrates how \u003cem\u003eThe Healer’s Art\u003c/em\u003e course enabled students to rediscover the human dimension of medical practice and to develop a more empathic, mindful, and respectful approach to communication with patients. Through their testimonies, students described a profound shift in how they understood the clinical encounter, moving from a predominantly biomedical logic (centered on diagnosis and treatment) toward a relationship based on understanding, generous listening, and emotional accompaniment.\u003c/p\u003e\n\u003cp\u003eOne student reflected on how their approach to patients changed over time, recognizing that clinical encounters involve much more than data collection:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Before, when I was in fourth year or halfway through fifth year, I would just take the medical history, ask for specific data, and then move on to the next patient. But after the course, and progressively, I realized that every person had a story to tell. Every person had their own perspectives and fears. What we might see as just another day at work, they experience as something new and frightening. And honestly, I felt it was also my duty to give patients reassurance and understand them better.” (Student 6)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis growing awareness translated into more humanistic communication during clinical practice. Another participant described feeling more confident and effective when interacting with patients and families, particularly in emotionally sensitive settings:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Now, during my pediatric internship, I feel it helps me a lot to communicate with mothers and with pediatric patients. I feel I’ve improved in transmitting calm and peace to patients, both to mothers and to children. That also makes the interview and the physical exam easier.” (Student 6)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis openness to emotional and experiential dimensions led students to reflect on their language and their capacity to accompany patients, especially in situations involving loss and grief:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“What the course teaches us is what not to say to people who have experienced loss. Sometimes we say things like ‘calm down, it will pass,’ and those comments, even if well intentioned, don’t really help. In the course you learn what to say, what can help a patient and what won’t. That’s what I remember the most, and now I try to apply it not only in the clinic but in general when someone is going through a loss.” (Student 8)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSeveral participants emphasized that the course helped them place themselves in the patient’s experience and recognize vulnerability as a shared dimension of the clinical encounter:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Now when I see patients, I try to think more about their situation, what they’re going through. In those critical moments, I try to be very respectful in what I say and how I treat them, because being in the hospital is not a pleasant experience.” (Student 4)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOthers articulated a clear shift toward seeing patients as people rather than diseases, highlighting the importance of trust and emotional support:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“We are treating people, not diseases. That became very clear to me in the course. It helps a lot when patients feel supported, because without trust there won’t be treatment adherence, and there’s also a psychosocial factor that influences recovery, which is closely related to the doctor–patient relationship.” (Student 3)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn this context, empathy began to be understood as a clinical competence that goes beyond technical expertise:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“I feel the course opened my eyes to more personalized patient care. It’s about having empathy, but also going beyond that—seeing more of the patient’s situation, personal or economic difficulties, and not focusing only on relieving pain or curing the disease, but also on the consequences and complications, and talking about those with patients.” (Student 3)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudents further emphasized that technical competence alone is insufficient without strong communication and relational skills:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“The course helped me understand that soft skills are just as important, some might even say more important, than knowledge and technical expertise. Without good interaction and a strong doctor–patient relationship, even the best clinical knowledge won’t work.” (Student 1)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe course also introduced key concepts that resonated deeply with participants, such as generous listening and the idea of the “wounded healer”:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“I remember the concept of\u0026nbsp;\u003c/em\u003egenerous\u003cem\u003e\u0026nbsp;listening very clearly, and also the idea of the wounded healer—those doctors don’t have to be perfect to help others, and having doubts or fears doesn’t make you less of a doctor.” (Student 9)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFinally, many students described how \u003cem\u003eThe Healer’s Art\u003c/em\u003e helped them slow down and truly listen to patients, cultivating presence in the clinical encounter:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“It helped me pay more attention to patients and understand them better. It also helped me value what I’m studying and realize how important it is to be at the service of others.”\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings indicate that the HA course offers a meaningful educational experience that allows medical students to reconnect with the human dimension of medicine, which they perceive as underrepresented in the traditional curriculum. Despite entering the course with varied motivations, participants shared a common desire to integrate personal, emotional, and relational dimensions into their developing professional identities. Engagement in the course supported more empathic, person-centered interactions, strengthened their capacity to navigate emotionally challenging situations such as grief, and affirmed self-care as an ethical and professional responsibility. Overall, HA functioned as an integrative space in which motivation, experiential learning, skill development, and professional identity formation aligned around a shared humanistic orientation to care.\u003c/p\u003e \u003cp\u003eGuided by SDT\u0026rsquo;s core dimensions of autonomy, competence, and relatedness, and informed by our inductive thematic analysis, we examined how participation in HA supported intrinsic motivation and relational engagement within medical training. Building on this theoretical interpretation, we draw on participants\u0026rsquo; narratives to illuminate the core gains and enduring relevance of \u003cem\u003eThe Healer\u0026rsquo;s Art\u003c/em\u003e course. We synthesize these insights through the HEART mnemonic\u0026mdash;Humanistic Reconnection, Empathy and Emotional Competence, Authentic Professional Identity, Reflection and Relational Safety, and Transformative Learning\u0026mdash;which captures the foundational capacities cultivated through the course. Together, these dimensions highlight how HA supports students in developing a more relational, reflective, and meaning-centered approach to clinical practice, enabling them to practice medicine from the HEART.\u003c/p\u003e \u003cp\u003e \u003cb\u003eHumanistic reconnection (H)\u003c/b\u003e was central to students\u0026rsquo; initial motivations for enrolling in HA. Participants described actively seeking a learning space distinct from the competitive, performance-oriented culture of the formal medical curriculum. This search reflected both extrinsic pressures and intrinsic needs, aligning with prior literature documenting emotional strain, isolation, and erosion of meaning during medical training\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e. Within this context, HA functioned as a counter-space that reconnected students with the human dimension of medicine, reframing clinical practice as a relational and moral endeavor rather than a purely technical one. Participation thus represented not only an academic choice, but an existential and vocational response to perceived gaps in contemporary medical education\u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMedical curricula should intentionally integrate structured humanistic counter-spaces that allow students to reconnect with the relational and moral dimensions of medicine. Educational scholarship shows a strong interest in humanistic-oriented training as an essential complement to biomedical education, with calls for opportunities that support reflection, narrative engagement, and relational skills in clinical training\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e. Educational programs must recognize that many learners actively seek environments that counterbalance competitive, performance-driven cultures. Professional identity formation research highlights the importance of relational and reflective learning environments that scaffold identity development rather than simply technical skill acquisition\u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/sup\u003e. Designing curricula that explicitly address vocation, meaning, and relational identity may strengthen students\u0026rsquo; intrinsic motivation and sustain their sense of purpose in clinical practice. The literature on humanism in medical education emphasizes that explicit attention to reflective practice, emotional engagement, and purpose contributes to the formation of resilient, patient-centered professionals\u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThrough sustained engagement in the course, students developed \u003cb\u003eempathy and emotional competence (E)\u003c/b\u003e as legitimate clinical capacities. HA legitimized compassion, emotional presence, and attentive listening as core professional skills rather than optional personal traits\u003csup\u003e(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/sup\u003e. Educational interventions that emphasize empathy and communication skills improve \u003cem\u003estudents\u0026rsquo; ability to understand and respond to patients\u0026rsquo; emotions and experiences\u003c/em\u003e, suggesting that empathy training enhances emotional attunement and clinical relational skills in healthcare learners\u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/sup\u003e. \u003cb\u003eThese findings reinforce the view that empathic communication is not ancillary to biomedical care, but foundational to meaningful clinical practice. In parallel, empathy and emotional competence should be explicitly framed as core clinical skills. Educational programs should incorporate supervised practice in emotionally complex encounters, structured reflection, and faculty modeling to reinforce that compassionate communication is foundational, not secondary to high-quality clinical care.\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAt the level of professional identity, HA supported the emergence of an \u003cb\u003eauthentic professional identity (A)\u003c/b\u003e grounded in the integration of personal values, emotions, and meaning. Rather than encouraging conformity to norms of emotional detachment, the course legitimizes authenticity, self-awareness, and moral integrity as integral to professional excellence\u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e. Participants described reconciling who they are as individuals with who they are becoming as physicians, suggesting that HA creates conditions for identity formation that align personal and professional selves\u003csup\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e. In doing so, the program offers a counterbalance to elements of the hidden curriculum that often marginalize emotional expression and relational labor\u003csup\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis identity development is made possible through the program\u0026rsquo;s intentional creation of \u003cb\u003ereflection and relational safety (R)\u003c/b\u003e. HA provides a psychologically safe, dialogical learning environment where vulnerability, uncertainty, and emotional complexity can be explored without judgment, countering the shame-inducing and emotionally unsafe climates described in medical education as barriers to authentic engagement and learning\u003csup\u003e(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/sup\u003e. Through structured reflection and peer dialogue, students are supported in examining inherited norms, articulating difficult experiences, and engaging in shared meaning-making\u003csup\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/sup\u003e. By fostering relational safety and reflective depth, the program strengthens belonging, professional coherence, and collective moral awareness within medical training, aligning with scholarship that positions professional identity formation as foundational to professional coherence and emphasizes humanistic education as essential for cultivating moral awareness and relational professionalism\u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFinally, students\u0026rsquo; accounts highlight \u003cb\u003etransformative learning (T)\u003c/b\u003e as a defining feature of HA. Participants described the course as fundamentally different from other medical school subjects, with effects that extended beyond discrete skill acquisition to influence how they understood medicine itself. By countering reductionist and technocratic orientations, HA fostered a shift toward seeing patients as whole persons and care as a moral and relational practice\u003csup\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/sup\u003e. Importantly, the outcomes of practicing medicine from the HEART were perceived to benefit not only patients, through improved communication and trust, but also physicians, by supporting self-care, ethical practice, and protection against burnout\u003csup\u003e(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/sup\u003e. These benefits were achieved without additional clinical resources, underscoring the broader relevance of humanistic education for sustainable health systems.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis study has limitations that warrant consideration. Voluntary participation may have introduced selection bias, as students more interested in medical humanism may have been more likely to participate. Additionally, the study was conducted at a single institution, which may limit transferability to other settings. Finally, self-reported experiences may be influenced by social desirability. Nonetheless, these limitations are offset by the strengths of the qualitative design, which enabled in-depth exploration of experiences and meanings that are difficult to capture quantitatively. The use of thematic analysis informed by SDT provided a robust framework for understanding student motivation and learning processes. Moreover, this study contributes novel empirical evidence from a Peruvian context, where research on medical humanism initiatives remains limited.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Research and Educational Practice\u003c/h2\u003e \u003cp\u003eThe HEART mnemonic (Humanistic Reconnection, Empathy and Emotional Competence, Authentic Professional Identity, Reflection and Relational Safety, and Transformative Learning) proposes a set of core principals for advancing research and educational practice in medical education, while also highlighting the broader relevance of The Healer\u0026rsquo;s Art (HA) as a transferable and scalable educational model. By articulating how humanistic reconnection, emotional competence, authenticity, reflective safety, and transformative learning interact, HEART offers a coherent structure for examining educational experiences that shape professional identity beyond technical skill acquisition.\u003c/p\u003e \u003cp\u003eFrom an educational practice standpoint, the findings suggest that HA should not remain a marginal or optional enrichment experience but be more deliberately integrated into medical curricula worldwide. HEART underscores the value of embedding protected spaces for reflection, dialogue, and relational learning within mainstream training, particularly in contexts characterized by performance pressure and emotional silencing. Faculty development initiatives could draw on HA principles to cultivate psychological safety, model authentic professional identities, and legitimize emotional competence as a core clinical skill.\u003c/p\u003e \u003cp\u003eMore broadly, incorporating HA into educational strategies internationally reframes medical training as a moral, relational, and socially embedded practice. Practicing medicine from the HEART does not oppose scientific rigor, but complements it by fostering humane, reflective, and resilient physicians. As such, HEART and HA together offer a practical and conceptually robust contribution to global efforts to humanize medical education and support the sustainability of the healthcare workforce.\u003c/p\u003e \u003cp\u003eFrom a research perspective, HEART can guide future qualitative, mixed-methods, and longitudinal studies examining how HA and similar humanistic curricula influence motivation, identity formation, empathic practice, and moral agency across diverse training stages and cultural contexts. Importantly, HA warrants systematic investigation beyond single institutions or national settings. Comparative and cross-cultural research could explore how HA is adapted, experienced, and sustained in different health systems, and how its core principles interact with local educational cultures, norms of professionalism, and clinical hierarchies. Such work would strengthen the global evidence base for humanistic medical education and support theory-building around relational and moral dimensions of clinical practice.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe HA course meaningfully strengthens the humanistic dimension of medical education by addressing students\u0026rsquo; need for safe, reflective learning spaces. In increasingly performance-driven training environments, courses like HA serve as a valuable counterbalance by fostering empathy, reflection, and professional identity development. These results support the integration of experiential, relationship-centered courses into medical curricula and highlight the need for educational programs to more deliberately incorporate humanism, empathy, and self-care as core components of medical training and everyday clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: Ethical approval was obtained from the Institutional Research Ethics Committee of Universidad Peruana Cayetano Heredia (UPCH) through expedited review (SIDISI No. 213199). All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the Declaration of Helsinki and with applicable institutional guidelines. All participants signed informed consent before enrollment.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Funding: None\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: MSCF, LCS, JHMT, and AGGC conceived the study. NNA, KDCT, and NRES drafted the initial manuscript. KDCT and NRES conducted the interviews and performed the data analysis. All authors reviewed, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: We sincerely thank the UPCH medical students who generously shared their time and experiences, making this study possible.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBranch J William T, Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, et al. Teaching the Human Dimensions of Care in Clinical Settings. JAMA. 5 de septiembre de 2001;286(9):1067-74. doi:10.1001/jama.286.9.1067\u003c/li\u003e\n\u003cli\u003eWear D, Zarconi J. Can compassion be taught? Let\u0026rsquo;s ask our students. J Gen Intern Med. julio de 2008;23(7):948-53. doi:10.1007/s11606-007-0501-0 PubMed PMID: 18612722; PubMed Central PMCID: PMC2517940.\u003c/li\u003e\n\u003cli\u003eNeumann M, Edelh\u0026auml;user F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med J Assoc Am Med Coll. agosto de 2011;86(8):996-1009. doi:10.1097/ACM.0b013e318221e615 PubMed PMID: 21670661.\u003c/li\u003e\n\u003cli\u003eBranch WT. Teaching professional and humanistic values: suggestion for a practical and theoretical model. Patient Educ Couns. febrero de 2015;98(2):162-7. doi:10.1016/j.pec.2014.10.022 PubMed PMID: 25468396.\u003c/li\u003e\n\u003cli\u003eCruess SR, Cruess RL, Steinert Y. Supporting the development of a professional identity: General principles. Med Teach. junio de 2019;41(6):641-9. doi:10.1080/0142159X.2018.1536260 PubMed PMID: 30739517.\u003c/li\u003e\n\u003cli\u003eSharpless J, Baldwin N, Cook R, Kofman A, Morley-Fletcher A, Slotkin R, et al. The becoming: students\u0026rsquo; reflections on the process of professional identity formation in medical education. Acad Med J Assoc Am Med Coll. junio de 2015;90(6):713-7. doi:10.1097/ACM.0000000000000729 PubMed PMID: 25881650.\u003c/li\u003e\n\u003cli\u003eWald HS. Professional identity (trans)formation in medical education: reflection, relationship, resilience. Acad Med J Assoc Am Med Coll. junio de 2015;90(6):701-6. doi:10.1097/ACM.0000000000000731 PubMed PMID: 25881651.\u003c/li\u003e\n\u003cli\u003eSarraf-Yazdi S, Teo YN, How AEH, Teo YH, Goh S, Kow CS, et al. A Scoping Review of Professional Identity Formation in Undergraduate Medical Education. J Gen Intern Med. noviembre de 2021;36(11):3511-21. doi:10.1007/s11606-021-07024-9 PubMed PMID: 34406582; PubMed Central PMCID: PMC8606368.\u003c/li\u003e\n\u003cli\u003eRemen RN, Rabow MW. The Healer\u0026rsquo;s Art: professionalism, service and mission. Med Educ. noviembre de 2005;39(11):1167-8. doi:10.1111/j.1365-2929.2005.02296.x PubMed PMID: 16262843.\u003c/li\u003e\n\u003cli\u003eThe Healer\u0026rsquo;s Art Course Description. rishi [Internet]. [citado 9 de marzo de 2026]. Disponible en: https://rishiprograms.org/healers-art/the-healers-art-course-description/\u003c/li\u003e\n\u003cli\u003eLawrence EC, Carvour ML, Camarata C, Andarsio E, Rabow MW. Requiring the Healer\u0026rsquo;s Art Curriculum to Promote Professional Identity Formation Among Medical Students. J Med Humanit. diciembre de 2020;41(4):531-41. doi:10.1007/s10912-020-09649-z PubMed PMID: 32748226.\u003c/li\u003e\n\u003cli\u003eGeary C, McKee J, Sierpina V, Kreitzer MJ. The Art of Healing: An Adaptation of the Healer\u0026rsquo;s Art Course for Fourth-Year Students. Explore J Sci Heal. septiembre de 2009;5(5):306-7. doi:10.1016/j.explore.2009.06.010\u003c/li\u003e\n\u003cli\u003eManger JK, McManamon AC, Todd A, Stolfi A, Parmelee DX, Andarsio E. Healer\u0026rsquo;s Art in the Online Era: Successes, Challenges, and Implications. Med Sci Educ. abril de 2025;35(2):977-89. doi:10.1007/s40670-024-02272-w PubMed PMID: 40353038; PubMed Central PMCID: PMC12058631.\u003c/li\u003e\n\u003cli\u003eJaiswal C, Anderson K, Haesler E. A self-report of the Healer\u0026rsquo;s art by junior doctors: does the course have a lasting influence on personal experience of humanism, self-nurturing skills and medical counterculture? BMC Med Educ. 29 de noviembre de 2019;19(1):443. doi:10.1186/s12909-019-1877-3 PubMed PMID: 31783846; PubMed Central PMCID: PMC6884863.\u003c/li\u003e\n\u003cli\u003eEstela-Villa LM, Jim\u0026eacute;nez-Rom\u0026aacute;n CR, Landeo-Guti\u0026eacute;rrez JS, Tomateo-Torvisco JD, Vega-Dienstmaier JM. Prevalencia de s\u0026iacute;ndrome de burnout en alumnos del s\u0026eacute;ptimo a\u0026ntilde;o de medicina de una universidad privada de Lima, Per\u0026uacute;. Rev Neuro-Psiquiatr. 13 de junio de 2011;73(4):147-56. doi:10.20453/rnp.v73i4.1700\u003c/li\u003e\n\u003cli\u003eCh\u0026aacute;vez Agurto P. Competencias interculturales del profesional de salud serumista. An Fac Med. enero de 2022;83(1):54-7. doi:10.15381/anales.v83i1.21328\u003c/li\u003e\n\u003cli\u003eBrierley CK, Suarez N, Arora G, Graham D. Healthcare access and health beliefs of the indigenous peoples in remote Amazonian Peru. Am J Trop Med Hyg. enero de 2014;90(1):180-3. doi:10.4269/ajtmh.13-0547 PubMed PMID: 24277789; PubMed Central PMCID: PMC3886418.\u003c/li\u003e\n\u003cli\u003eMalterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. noviembre de 2016;26(13):1753-60. doi:10.1177/1049732315617444 PubMed PMID: 26613970.\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 1 de enero de 2006;3(2):77-101. doi:10.1191/1478088706qp063oa\u003c/li\u003e\n\u003cli\u003eDeci EL, Ryan RM. The \u0026laquo;What\u0026raquo; and \u0026laquo;Why\u0026raquo; of Goal Pursuits: Human Needs and the Self-Determination of Behavior. Psychol Inq. 1 de octubre de 2000;11(4):227-68. doi:10.1207/S15327965PLI1104_01\u003c/li\u003e\n\u003cli\u003eEgnew TR, Lewis PR, Meyers KR, Phillips WR. The Suffering Medical Students Attribute to Their Undergraduate Medical Education. Fam Med. abril de 2018;50(4):296-9. doi:10.22454/FamMed.2018.116755 PubMed PMID: 29669149.\u003c/li\u003e\n\u003cli\u003eWatson HR, Millin P, Close J, Jeffery R, Stephenson H, Zahra D. \u0026laquo;Let\u0026rsquo;s work together to pass medical school\u0026raquo;: a qualitative study of medical student attitudes to teamwork, competition and collaboration. FEBS Open Bio. febrero de 2025;15(2):359-72. doi:10.1002/2211-5463.13915 PubMed PMID: 39509580; PubMed Central PMCID: PMC11788744.\u003c/li\u003e\n\u003cli\u003eAssing Hvidt E, Uls\u0026oslash; A, Thorngreen CV, S\u0026oslash;ndergaard J, Andersen CM. Weak inclusion of the medical humanities in medical education: a qualitative study among Danish medical students. BMC Med Educ. 5 de septiembre de 2022;22(1):660. doi:10.1186/s12909-022-03723-x PubMed PMID: 36064397; PubMed Central PMCID: PMC9442995.\u003c/li\u003e\n\u003cli\u003eMartimianakis MAT, Michalec B, Lam J, Cartmill C, Taylor JS, Hafferty FW. Humanism, the Hidden Curriculum, and Educational Reform: A Scoping Review and Thematic Analysis. Acad Med J Assoc Am Med Coll. noviembre de 2015;90(11 Suppl):S5-13. doi:10.1097/ACM.0000000000000894 PubMed PMID: 26505101.\u003c/li\u003e\n\u003cli\u003eWald HS, Anthony D, Hutchinson TA, Liben S, Smilovitch M, Donato AA. Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice. Acad Med J Assoc Am Med Coll. junio de 2015;90(6):753-60. doi:10.1097/ACM.0000000000000725 PubMed PMID: 25901874.\u003c/li\u003e\n\u003cli\u003eSarraf-Yazdi S, Pisupati A, Goh CK, Ong YT, Toh YR, Goh SPL, et al. A scoping review and theory-informed conceptual model of professional identity formation in medical education. Med Educ. octubre de 2024;58(10):1151-65. doi:10.1111/medu.15399 PubMed PMID: 38597258.\u003c/li\u003e\n\u003cli\u003eZohdi WNWM, Azme N. Integrating Humanities into Medical Education. Int J Soc Sci Res. 6 de febrero de 2025;13(1):111. doi:10.5296/ijssr.v13i1.22545\u003c/li\u003e\n\u003cli\u003eEikeland HL, \u0026Oslash;rnes K, Finset A, Pedersen R. The physician\u0026rsquo;s role and empathy \u0026ndash; a qualitative study of third year medical students. BMC Med Educ. 9 de agosto de 2014;14(1):165. doi:10.1186/1472-6920-14-165\u003c/li\u003e\n\u003cli\u003ePatel S, Pelletier-Bui A, Smith S, Roberts MB, Kilgannon H, Trzeciak S, et al. Curricula for empathy and compassion training in medical education: A systematic review. PLOS ONE. 22 de agosto de 2019;14(8):e0221412. doi:10.1371/journal.pone.0221412\u003c/li\u003e\n\u003cli\u003eJarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med J Assoc Am Med Coll. septiembre de 2012;87(9):1185-90. doi:10.1097/ACM.0b013e3182604968 PubMed PMID: 22836834.\u003c/li\u003e\n\u003cli\u003eLempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students\u0026rsquo; perceptions of teaching. BMJ. 2 de octubre de 2004;329(7469):770-3. doi:10.1136/bmj.329.7469.770 PubMed PMID: 15459051; PubMed Central PMCID: PMC520997.\u003c/li\u003e\n\u003cli\u003eHan PKJ, Schaufel M, Schei E. Shame among medical learners: An uncertainty-focused conception. Patient Educ Couns. 5 de febrero de 2026;147:109516. doi:10.1016/j.pec.2026.109516 PubMed PMID: 41671726; PubMed Central PMCID: PMC12919643.\u003c/li\u003e\n\u003cli\u003eWald HS, Borkan JM, Taylor JS, Anthony D, Reis SP. Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing. Acad Med J Assoc Am Med Coll. enero de 2012;87(1):41-50. doi:10.1097/ACM.0b013e31823b55fa PubMed PMID: 22104060.\u003c/li\u003e\n\u003cli\u003eLittle P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 20 de octubre de 2001;323(7318):908-11. doi:10.1136/bmj.323.7318.908 PubMed PMID: 11668137; PubMed Central PMCID: PMC58543.\u003c/li\u003e\n\u003cli\u003eShelley BP. Re-humanizing \u0026ldquo;high-tech, no touch\u0026rdquo; medicine: Narrative medicine and cinemeducation perspectives. Arch Med Health Sci. junio de 2016;4(1):1. doi:10.4103/2321-4848.183367\u003c/li\u003e\n\u003cli\u003ePost SG. Compassionate care enhancement: benefits and outcomes. Int J Pers Centered Med. 20 de diciembre de 2011;1(4):808-13. doi:10.5750/ijpcm.v1i4.153\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Humanism, Medical Education, Self-care, Empathy","lastPublishedDoi":"10.21203/rs.3.rs-9161459/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9161459/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003e\u003cem\u003eThe Healer’s Art\u003c/em\u003e (HA) is a course developed in 1991 to strengthen the humanistic dimensions of health professions education, including empathy, altruism, self-reflection, and self-care, areas that are often underemphasized in traditional medical curricula. This project aimed to explore medical students’ perceptions of The Healer’s Art course instructed at a Peruvian university and to examine its influence on their professional, personal, and human development during medical training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and methods: \u003c/strong\u003eA qualitative study using thematic analysis was conducted in accordance with the Standards for Reporting Qualitative Research (SRQR). Semi-structured interviews were performed with medical students who had completed the HA course. Data were analyzed using a combination of inductive and deductive coding, guided by Self-Determination Theory, with the support of qualitative analysis software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eTen medical students participated in the study. Three main themes emerged: \u003cem\u003e(a) Seeking the human side of medicine\u003c/em\u003e, reflecting students’ motivations for enrolling in the course; \u003cem\u003e(b) An unconventional course\u003c/em\u003e, describing meaningful and transformative learning experiences during the course; and \u003cem\u003e(c) More human-centered medical communication\u003c/em\u003e, capturing the integration of course learnings into physician–patient relationships and clinical practice. Together these findings highlighted shifts toward intrinsic motivation, relational competence, and a deeper sense of professional meaning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe HA course strengthens the humanistic dimension of medical education by providing safe and reflective learning spaces. It promotes empathy, reflection, and professional identity development, highlighting the importance of integrating humanism, empathy, and self-care into medical curricula and clinical practice.\u003c/p\u003e","manuscriptTitle":"Practicing Medicine from the HEART: A Qualitative Study on Humanistic Education on the Healer´s Art Course","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-22 06:14:52","doi":"10.21203/rs.3.rs-9161459/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-30T14:51:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63682284383946349068328489386422597041","date":"2026-04-17T11:46:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-15T06:01:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-21T15:28:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-20T05:10:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-20T05:10:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-18T15:51:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"98ea3bfa-67db-4517-a7c3-cdf6c790025e","owner":[],"postedDate":"April 22nd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-04-30T14:51:14+00:00","index":51,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T06:14:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-22 06:14:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9161459","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9161459","identity":"rs-9161459","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}