Striving to do Good Things: Teaching Humanities in Canadian Medical Schools

We provide the results of a systematic key-informant review of medical humanities curricula at fourteen of Canada's seventeen medical schools. This survey was the first of its kind. We found a wide diversity of views among medical educators as to what constitutes the medical humanities, and a lack of consensus on how best to train medical students in the field. In fact, it is not clear that consensus has been attempted - or is even desirable - given that Canadian medical humanities programs are largely shaped by individual educators' interests, experience and passions. This anarchic approach to teaching the medical humanities contrasts sharply with teaching in the clinical sciences where national accreditation processes attempt to ensure that doctors graduating from different schools have roughly the same knowledge (or at least have passed the same exams). We argue that medical humanities are marginalized in Canadian curricula because they are considered to be at odds philosophically with the current dominant culture of evidence-based medicine (EBM). In such a culture where adhering to a consensual standard is a measure of worth, the medical humanities - which defy easy metrical appraisal - are vulnerable. We close with a plea for medical education to become more comfortable in the borderlands between EBM and humanities approaches.     

The dental anomaly: how and why dental caries and periodontitis are phenomenologically atypical

Use of humanities content in American medical education has been debated for well over 60 years. While many respected scholars and medical educators have purported the value of humanities content in medical training, its inclusion remains unstandardized, and the undergraduate medical curriculum continues to be focused on scientific and technical content. Cited barriers to the integration of humanities include time and space in an already overburdened curriculum, and a lack of consensus on the exact content, pedagogy and instruction. Edmund Pellegrino, physician and scholar of the latter twentieth century, spent much of his professional life promoting the value and importance of the humanities in medical education, seeking the best way to incorporate and teach this content in clinically relevant ways. His efforts included the founding of multiple enterprises starting in the 1960s and 1970s to promote human values in medical education, including the Society for Health and Human Values and its Institute on Human Values in Medicine. Regardless of his efforts and those of many others into the current century, the medical humanities remains a curricular orphan, unable to find a lasting home in medical education and training.     

The Medical Humanities Today: Humane Health Care or Tool of Governance?

The medical humanities have been presented as a panacea for medical reductionism; a means for 'humanizing' medicine. However, there is a lack of consensus about the appropriate contributing disciplines and how curricula should be taught and assessed. This special issue critically examines the role of the medical humanities in medical education and their potential to serve, inadvertently or otherwise, as a tool of governance. The contributors, who include medical educators and medical practitioners, employ a range of perspectives for analysing the pertinent issues.     

军医大学人文教育需求的实证研究

军医大学人文教育需求的实证研究,以第三军医大学2005级7个不同专业的学生为主要对象进行医学人文教育需求问卷调查,初步探讨军医大学学生对开设医学人文课程的心理需求和知识需求。调研中还发现,学生对医学人文科学抱有浓厚兴趣,认为具备良好的医学人文素质是未来医生的核心竞争力。     

Toward an Aesthetic Medicine: Developing a Core Medical Humanities Undergraduate Curriculum

The medical humanities are often implemented in the undergraduate medicine curriculum through injection of discrete option courses as compensation for an overdose of science. The medical humanities may be reformulated as process and perspective, rather than content, where the curriculum is viewed as an aesthetic text and learning as aesthetic and ethical identity formation. This article suggests that a "humanities" perspective may be inherent to the life sciences required for study of medicine. The medical humanities emerge as a revelation of value inherent to an aesthetic medicine taught and learned imaginatively.     

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.     

Bearing Response-Ability: Theater, Ethics and Medical Education

This paper addresses a growing concern within the medical humanities community regarding the perceived need for a more empathically-focused medical curricula, and advocates for the use of creative pedagogical forms as a means to attend to issues of suffering and relationality. Drawing from the ethical philosophy of Emmanuel Levinas, I critique the notion of empathy on the basis that it erases difference and disregards otherness. Rather, I propose that the concept of empathy may be usefully replaced with that of ethical responsibility, which suggests a shared sense of humanity outside the boundaries of presumed knowledge of the other. To illustrate this argument, I theorize the importance of theater within medical education. Theater, I argue, may engender ethical responsibility in the Levinasian sense, and thus may allow learners to differently engage with the experience of the suffering other. As such, I examine Margaret Edson's widely used play Wit as a platform for such an ethical encounter to occur. Thus, rather than working to understand the value of theater in medical education in terms of knowledge and skill acquisition, I theorize that its primacy within medical curricula arises from its ethical/relational potential, or potential to engender new forms of inter-human relationality.     

Medical Humanities Teaching in North American Allopathic and Osteopathic Medical Schools

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools’ websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 (as of June 2016) member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on required and elective humanities content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools (145 AAMC; 31 AACOM). 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean (MD 45.4; DO 37.1) and 30 (MD 29; DO 37.5) median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students.     

医学人文社科系列课程的整合优化及教学模式改革

医学院校人文教育主要存在观念上的唯科学取向、内容上的唯知识取向、方法难输化和组织形式化等弊端.提出促进学科间的交叉融合是高校医学院校人文科学课程改革的根本目的之一.以学科为基础的实质性融合是人文学科体制改革的基本点.     

将医学人文课程的教学目标落到实处

教学目标是教学的统帅和灵魂,具有导向、评价、调节、激励等多方面的功能。医学人文素质教育之所以处地乏力状态,很大程度上是没有将医学人文课程的教学目标落到实处。为改变医学人文课程教学乏力的状态,提高教学效果,有必要加强教学目标、教学内容、教学策略、教学资源、教学评价几方面的工作,将医学人文课程的教学目标落到实处。     

What is the Role of the Arts in Medical Education and Patient Care? A Survey-based Qualitative Study

To inform medical education reform efforts, we systematically collected information on the level of arts and humanities engagement in our medical school community. Attitudes regarding incorporating arts and humanities-based teaching methods into medical education and patient care were also assessed. An IRB-approved survey was electronically distributed to all faculty, residents, fellows, and students at our medical school. Questions focused on personal practice of the arts and/or humanities, as well as perceptions of, and experience with formally incorporating these into medical teaching. Of 13,512 community members surveyed, 2,775 responded (21% overall response rate). A majority of respondents agreed or strongly agreed that medical education and patient care could be "enhanced" by the integration of the arts (67% and 74% respectively). There was enthusiastic support for the creation of a formal program in the arts at our medical school (72 %). Integration of the arts into medical education may have a role in improving the quality of medical training and would likely be well received by teachers and learners.     

医学生医学人文素质现状的调查与分析

医学人文素质同医学科学素质一样,是医学生必备的基本素质.为了解当前在校医学生的医学人文素质现状,我们以复旦大学上海医学院部分在校医学生为调查对象,通过问卷调查的方式,从医学生对国内外医疗相关问题和事件的关注,对医学人文课程和提高医学人文素养的认识,以及医学人文素质对医学重要性的认识等方面,对医学生医学人文素质相关情况进行调查,了解当前在校医学生医学人文现状,为有的放矢的培养医学生的人文素养提供客观依据.     

Assessing the Integration of Genomic Medicine in Genetic Counseling Training Programs

Medical genetics has entered a period of transition from genetics to genomics. Genetic counselors (GCs) may take on roles in the clinical implementation of genomics. This study explores the perspectives of program directors (PDs) on including genomic medicine in GC training programs, as well as the status of this integration. Study methods included an online survey, an optional one-on-one telephone interview, and an optional curricula content analysis. The majority of respondents (15/16) reported that it is important to include genomic medicine in program curricula. Most topics of genomic medicine are either “currently taught” or “under development” in all participating programs. Interview data from five PDs and one faculty member supported the survey data. Integrating genomics in training programs is challenging, and it is essential to develop genomics resources for curricula.     

The Evolution of Psychology as a Basic Bio-behavioral Science in Healthcare Education

For over a century, researchers and educators have called for the integration of psychological science into medical school curricula, but such efforts have been impeded by barriers within medicine and psychology. In addressing these barriers, Psychology has re-examined its relationship to Medicine, incorporated psychological practices into health care, and redefined its parameters as a science. In response to interdisciplinary research into the mechanisms of bio-behavioral interaction, Psychology evolved from an ancillary social science to a bio-behavioral science that is fundamental to medicine and health care. However, in recent medical school curriculum innovations, psychological science is being reduced to a set of “clinical skills,” and once again viewed as an ancillary social science. These developments warrant concern and consideration of new approaches to integrating psychological science in medical education.     

微创体系中人文思想的探索

医学人文学是发展现代医学的一项重要内容.从微创医学体系中的人文思想、探索微创人文思想的意义、实现微创医学过程中的微创人文思想三个方面对建立在现代医学模式基础上的微创医学体系发展中的有关人文思想进行了系统的探索,以揭示微创医学体系中人文思想的意义和价值,同时强调其在医疗实践中的实际应用.     

Affirming the Existential within Medicine: Medical Humanities, Governance, and Imaginative Understanding

This paper first distinguishes governance (collective, autonomous self-regulatory processes) from government (externally-imposed mandatory regulation); it proposes that the second of these is essentially incompatible with a conception of the medical humanities that involves imagination and vision on the part of medical practitioners. It next develops that conception of the medical humanities, as having three distinguishable aspects (all of them distinct from the separate phenomena popularly known as "arts-in-health"): first, an intellectual enquiry into the nature of clinical medicine; second, an important dimension of medical education; third, a resource for moral and aesthetic influences upon clinical practice, supporting "humane health care" as the moral inspirations behind organised medicine. Medical humanities sustains these three aspects through paying proper attention to the existential and subjective aspects of medicine. By encouraging authentic imagination among health care practitioners, medical humanities aligns well with both humane health care and governance in the sense of self-regulation. However, it can neither be achieved mechanistically nor well-measured through proxies such as patient satisfaction. Above all, it should not be allowed to supply, through inappropriate qualitative "targets," new forms of management tyranny.     

Medicine and Humanities: Voicing Connections

Accepting as a given that the humanities disciplines are not product or "results" driven, this paper argues that the core of an interdisciplinary field of medicine and humanities, or medical humanities, is an interpretive enterprise that is not readily open to quantitative assessment. A more humanistically oriented medical practice can derive, however, from the process that produces new insights and works toward the development of a new, mutually shared, and humanizing language.     

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.     

医学人文运动与知识考古--中国人文医学的战略与策略

后现代理论影响和刺激了医学人文学,医学人文学学科意义与价值更加显明,医学需要人文学,人文学需要医学,医务人员迫切需要人文医学教育。经济发展、高新生命科学技术入驻世俗生活、医学模式转变、医疗改革与价值论哲学影响,这五大因素构成中国医学人文运动的背景;中国医学人文运动正在兴起。研究医学人文学的知识背景对制订人文医学战略与策略有重要意义。