AAMC Reporter: October 2006

Viewpoint:
"Trends and Transitions in the Medical Humanities"

Delese Wear, Ph.D. Professor of Behavioral Sciences, Northeastern Ohio Universities College of Medicine

The medical humanities used to be tidier. When they began inching their way into the undergraduate medical curriculum more than 25 years ago, they knew their place. They could predictably be found in electives, all arranged by discipline: history of medicine, medical ethics, literature and medicine. The content of these courses was also fairly predictable. In literature and medicine we even spoke of a canon that included, among others, Tolstoy's "The Death of Ivan Ilych," Camus's "The Plague," or, for the very hardy, Mann's "The Magic Mountain."

Today, the medical humanities are located throughout the curriculum. This is a good thing. At some point in time, medical educators began to realize that the medical humanities were not decorative experiences running behind or parallel to the "real" curriculum. Instead, they came to understand that humanities inquiry might lead to a fuller, richer understanding of oneself, the experience of illness, the profession of medicine; and that students could benefit from the content, methods, skills, and orientations of such inquiry.

The curricular realignment of the medical humanities often moved them from stand-alone courses to inside the curriculum in a variety of interdisciplinary forms. Indeed, this move from discrete subject matter to interdisciplinarity (a move both inside and outside the medical academy) changed the face of the humanities in medical education. Cultural studies, narrative studies, women's studies, and disability studies found inroads into the curriculum as medical educators realized that the complex social issues embedded in medical practice — racism, sexism, homophobia, animosity based on ethnic or national origins — could be more widely illuminated by the content and methods of those domains. Indeed, medical students today are just as likely to be reading Barbara Ehrenreich's "Nickel and Dimed," an account of trying to make a living on $7 an hour, or Ann Pai's "My Other Body," a memoir of her sister's compulsive eating, as they are to be reading Tolstoy or Camus.

Today's locations for humanities inquiry are often in the longitudinal courses that have proliferated during the past decade. Under the leadership of Jack Coulehan, Peter Williams, and Catherine Belling, Stony Brook University Health Sciences Center School of Medicine's longitudinal "Medicine in Contemporary Society" curriculum has 50 class hours in each of the first two years, mostly in small groups, and draws heavily from literature and bioethics for its content.

Our own longitudinal course at Northeastern Ohio Universities College of Medicine called "Doctoring" has a once-a-month "Reflections on Doctoring" component that uses short stories, essays, poetry, film, and theater to connect students with the human dimensions of their biomedical studies at that time, such as Susan Smiley's documentary about her mother's schizophrenia, "Out of the Shadow," viewed and discussed during a "Brain, Mind, and Behavior" course.

The clinical years have also been enriched by the medical humanities. Rita Charon's far-reaching Program in Narrative Medicine at Columbia University College of Physicians and Surgeons has a presence in the clinical years along with a required course during the second year and an elective in the fourth year. The program also offers intensive narrative training workshops for health care professionals; writing seminars for doctors, nurses, and social workers in the hospital; and "narrative medicine rounds" once a month "for health professionals, patients, literary scholars, and narrativists of all stripes to tell and hear of research, teaching, and clinical work at the boundaries of medicine and narrative."

When at the University of Texas Medical School at San Antonio, Therese Jones established inroads for literature and bioethics into the third year, such as "The Myths and Abuses of Informed Consent," an exploration of patient/professional encounters using stories during the medicine clerkship. Doug Reifler directs "Patient, Physician and Society III: Professional Perspectives" at Northwestern University Feinberg School of Medicine, which meets for 90 minutes once a month throughout students' third year to explore human perspectives on medicine through writing. In addition, fourth-year electives in the medical humanities still flourish in many locations throughout North American medical education.

So, is all well with the medical humanities? For the most part, yes. But there is some uneasiness of late, mostly concerning the tendency to link, if not conflate, the current professionalism movement with the medical humanities. The medical humanities curriculum in past or present forms is not the servant of professional development, even though the two share some of the same goals.

As Mark Kuczewski wrote in an article we co-authored in 2004, "perhaps the greatest potential danger is that we educators will simply rename what has been called 'medical ethics' [or any dimension of the medical humanities] as 'professionalism' in the curriculum and be done with it." That is, the superficial and sometimes one-shot effort of "add a case, short story, or essay and stir" approach of many professionalism efforts dilutes and diminishes the rich possibilities of significant humanities inquiry in the medical curriculum.

And what are these possibilities of the humanities in the undergraduate medical curriculum? They remain unchanged: to deepen, enlarge, and sharpen one's sensibilities as students move through an increasingly complex life in medicine, examining themselves, their patients, their profession, and the culture in which they serve.

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