扬弃与超越——医学人文教育的重新审视与思考

目前,医学人文教育依然存在诸多问题。通过对医学人文教育现状的审视,追根溯源,重新认识人文教育的内涵,并就认识取向、课程体系、教学模式、评价方法、专业教育与人文教育的关系等方面的障碍或弊端提出扬弃与改革措施。     

The educational philosophies behind the medical humanities programs in the United States: An empirical assessment of three different approaches to humanistic medical education

This study investigates the three major educational philosophies behind the medical humanities programs in the United States. It summarizes the characteristics of the Cultural Transmission Approach, the Affective Developmental Approach, and the Cognitive Developmental Approach. A questionnaire was sent to 415 teachers of medical humanities asking for their perceptions of the amount of time and effort devoted by their programs to these three philosophical approaches. The 234 responses constituted a 54.6% return. The approximately 80:20 gender ratio of males to females and other demographic data on age and educational background were consistent with other studies of the field of medical humanities. Reflections on the results in Table II indicate that some changes need to take place in the teaching of the medical humanities if the perceived ideal is to be achieved. In order for the current teachers of the medical humanities to think that the appropriate philosophies behind the teaching of the medical humanities are being implemented as they should be, much less time and effort need to be devoted to the Cultural Transmission Approach. With no other published reports on the educational philosophies behind the medical humanities programs, this study created a new knowledge base about this relatively young and rapidly emerging field.     

扬弃与超越——医学人文教育的重新审视与思考

目前,医学人文教育依然存在诸多问题.通过对医学人文教育现状的审视,追根溯源,重新认识人文教育的内涵,并就认识取向、课程体系、教学模式、评价方法、专业教育与人文教育的关系等方面的障碍或弊端提出扬弃与改革措施.     

Instructional issues in the medical humanities

This paper examines instructional issues such as how, when, and where the medical humanities are taught in medical school settings. The author interviewed seven humanities scholars teaching in medical schools using open-ended questions which elicited data illustrating 1) informants' teaching styles; 2) where/how their teaching currently fits in the medical curriculum; 3) their suggestions on ideal curricular integration of the medical humanities; and 4) informants' teaching successes.     

Who we are: The political origins of the medical humanities

The medical humanities were organized, beginning in the late 1960s, by a small group of people who shared a critique of medical education and a commitment to vigorous action to change it. They proposed to create several demonstration programs in humanities education at American schools. Although the group began with a religious orientation, it soon acquired a broader, more secular mission. As a result of shrewd political organizing, the group attracted members from within medicine, and was awarded a grant to promote the medical humanities. This paper describes these events and sets them in the context of the social and medical history of the 1960s and early 1970s.     

Being skeptical about the medical humanities

In this paper the author challenges the prevailing view that contemporary writing in the medical humanities is serving the needs of the various health care disciplines. The current medical humanities literature assumes that physicians are the appropriate target group. This is most notably the case within health care ethics literature. There appears to be an unexamined assumption that physician-centric approaches to clinical ethical decision-making are the standard by which appropriate ethical practice is judged. The author challenges this assumption and addresses the problems that this approach engenders. The medical humanities literature appears to reinforce hierarchical, patriarchal arrangements which are themselves not morally neutral.     

医学与艺术:临床医学和医学人文学关系探索

医学与艺术是医学人文学研究的重要课题.医学与艺术有着广泛的联系,涉及对临床医学性质的争论,医学人文学对临床医学教育与实践的作用,艺术对医学的表现与理解,以及作为治疗康复手段的艺术.     

Context,voice and choice: A curricular framework for the medical humanities

Although the humanities' place in the medical school curriculum has been established, how we can best approach our teaching remains unanswered. A curricular framework which addresses process, as well as subject matter and structure is needed. A process-oriented framework demands that we enhance our student's ability to contextualize experience through multiple realms of meaning; encourage our students in the struggle to find a voice; and once a voice is found, to endow our students with the courage to let it be heard.     

The need for teaching philosophy in medical education

The dearth of philosophical contributions to medicine has recently been discussed in a series of articles in this journal. The present article focuses on physicians' lack of training in philosophy as a part of the explanation of the scarcity of works in philosophy of medicine. In section I I outline two philosophy courses which would be reasonable additions to the medical school curriculum required of all medical students. In section II I suggest two other philosophy courses as electives in a medical education. All four courses are in the fields of epistemology and metaphysics, and so will help others see the relevance to medicine of philosophical fields other than ethics.     

The humanities and gross anatomy: Forgotten alternatives

Researchers in medical education have extensively studied negative reactions to gross anatomy, sometimes grouped under the term “the cadaver experience.” Although there has been disagreement about the extent and importance of such phenomena, several attempts at curricular reform have been designed to “humanize” the student-cadaver encounter. However, some obvious sources linking gross anatomy and the humanities have been consistently overlooked. Such sources—from the history of art, the history of anatomy, and autobiographical and imaginative literature—not only bear witness to the “cadaver experience” for anatomists of the past, but also offer forgotten alternatives for placing present-day reactions in perspective. Former methods of teaching which used such material might serve as models for reintegrating the humanities into the study of gross anatomy as a possible humanizing force.     

Integrative thinking: The essence of good medical education and practice

Integrative medicine implies the ability to extract bits of information from seemingly disparate disciplines, and synthesize them into something that is meaningful. Contemporary medical research is more apt to be driven by purely commercial incentives that not only do not favor integrative efforts, but deliberately suppress them when vested interests are threatened. Good health depends entirely on good communication whenever homeostasis is threatened. This requires a continual and instantaneous exchange of information between the constituency of the internal environment that can only be comprehended by an integrative approach. Various examples are given to illustrate these and other relevant issues.     

The use of animals in medical education and research

After noting why the issue of the use of animals in medical education and research needs to be addressed, this article briefly reviews the historical positions on the role of animals in society and describes in more detail the current positions in the wide spectrum of positions regarding the role of animals in society. The spectrum ranges from the extremes of the animal exploitation position to the animal liberation position with several more moderate positions in between these two extremes. Then the philosophical issue of the moral agency of animals is discussed in terms of an explication of the concept of rights and the concept of personhood. Further research is suggested concerning institutional policies regarding medical students who refuse to do physiology dog labs or other assignments which involve the suffering and/or death of animals.