Commentary
Open Access

Opening Editorial - The Importance of the Humanities in Medical Education

Jonathan McFarland[1], Irina Markovina[1], Trevor Gibbs[2]

Institution: 1. Sechenov University, Moscow, 2. AMEE
Corresponding Author: Mr Jonathan McFarland (mcfarland.jonathan@gmail.com)
Categories: Professionalism/Ethics, Continuing Professional Development
Published Date: 09/07/2018

Abstract

An Abstract was not necessary for this article.

Keywords: Medical Humanities, MedEdPublish special issue

Introduction

Physicians are poised at the interface between the scientific and lay cultures”  (Kleinman, 1988)

 

The world of healthcare is changing. As we look through the lens of a bio-psycho-social approach to healthcare we are frequently amazed at the speed of growth of the science behind the subject and the new innovations that occur in technological support and operative procedures, almost on a daily basis. Our social approach to healthcare is rapidly undergoing such change. We see the rise of patients (the e-patient (Riggare, 2018)) coming into healthcare, already equipped with the information about possible diagnoses and their treatment and looking for confirmatory evidence of what they feel should be next steps in their management.  Whilst we are still in control, sometimes we feel that only happens when we can justify our actions from evidence-based research.

 

At the same time the number of people with complex, chronic or multiple conditions is increasing, many of who remain in and place increasing demands upon their social community. We are seeing an ageing population, and the total number of years people can expect to live in poorer health continues to rise.

 

Just as healthcare is changing, then the world of healthcare education must change in response. Changes are occurring in curricula; new teaching, learning and assessment methodologies are presented with rapidity in the increasing number of educational journals. New simulation technologies abound to bring student learning closer to reality whilst recognising patient safety. 

 

Frenk and colleagues, however, in a seminal Lancet report, spoke of how “Professional education has not kept pace with these challenges [in healthcare delivery] largely because of fragmented, out-dated, and static curricula that produce ill-equipped graduates”  (Frenket al., 2010)

 

But what about the social side of healthcare education?  

 

In 2016, the Behavioural & Social Sciences Teaching in Medicine (BeSST) Sociology Steering Group produced a Core Curriculum for Sociology in UK Undergraduate Medical Education (BeSST, 2018). 

In an opening forward from that report Ronald Harden (Professor of Medical Education at the University of Dundee, UK) was quoted as saying 

 

We see now a renewed emphasis on an ‘authentic’ curriculum in medicine with a move from the ivory tower of the university to the real world of medical practice…….. this report from BeSST illustrates how sociology can ensure that as teachers, practitioners and students we can have a better understanding of the human being”.

 

One of the elements of the sociology core curriculum is Topic 3 -Experiences of Health, Illness, Disability and Healthcare, and suggests that the students’ learning outcomes are:

 

To be able to:

  • Discuss factors influencing patients’ experiences of health care 
  • Demonstrate an understanding of the experience and the role of carers
  • Explain the ways in which health and illness and disability shape identity
  • Identify the social, physical and emotional impact of living with illness
  • Apply an understanding of the patient experience to medical practice

 

Whilst the BesSST document spoke of the outcomes rather than the teaching methods, we believe as co-editors of this MedEdPublish theme that some of the opportunities for teaching these learning outcomes lie in the Humanities- looking backwards to look forward. Although not given to thinking that all the answers lie with the Humanities, we do believe this approach, that casts a reflective look at various art forms, can inspire in addressing the BeSST learning outcomes.

Discussion

This special issue of MedEdPublish will concentrate on the Humanities in Medical Education. The Medical Humanities is not a new discipline, with the term first being used by George Sarton in the 1940’s in the pages of a journal ominously called ISIS (Hurwitz and Dakin, 2009). However, we believe that its relevance now is stronger than ever. There are many definitions, but this seems as good and appropriate as any; “an interdisciplinary field concerned with understanding the human condition of health and illness in order to create knowledgeable and sensitive health care providers, patients, and family caregivers” (Klugman, 2017). In most instances this insight into people (patients) can be gained through looking at art, seeing through the eyes of the subject or the artist, reading stories, poems and novels that describe the human form, physical and psychological, listening to music and reflecting on why the composer wrote that piece of music, in that way and at that time.

 

And why are the humanities so necessary for 21st century medical education, what can they add, and how can students benefit? Critical but difficult questions with a diversity of responses; perhaps they can help students and all levels of practitioners develop their own valuesand their communication skills; to better understand the patient point of view and their approach to illness: to think and reflect on theirs and others experiences: to cope better under stress: to see things more critically and probably much more. But, of course, this maybe the tip of the iceberg, and we want to hear your particular suggestion(s). 

 

Medical education seemingly can appear to concentrate on one perspective; how to train medical practitioners to look after their patients better, which. without doubt, is critical in todays’ healthcare arena. Medicine is now firmly set and triangulated between the patient, the practitioner and the carer; all are equally vulnerable. To quote Liao “ the reality is that the practice of Medicine is a human one. Medicine is about people at their most intimate frontiers. It is also practised by people.” (Liao, 2017). 

 

Along these lines, a recent study has investigated how the humanities can help medical students combat stress, and burnout. The results were positive, and the study confirmed the association between exposure to the humanities and a higher level of positive qualities (e.g. wisdom, empathy, spatial skills) in the students. The authors state, “ The humanities might actually provide an indispensable language for exploring that strange, nuanced, and often nonsensical land called the human condition”. (Mangione et al., 2018) This is why the humanities need to play a part in medical education; we are dealing withhuman beings, and their nonsensical ideas and emotions. The human condition cannot be fully understood by scientists; indeed “Most clinicians are not scientists; they have a different responsibility – to attempt to relieve distress and suffering ….” (Heath, 2016) We feel that by introducing the Humanities back into medical education we help to provide more tools for medical practitioners to deal with their patients and their problems.

 

The rapid advancement in medical technology has led to great leaps in terms of diagnosis and treatment, and doctors and healthcare practitioners are far better equipped than fifty or even twenty years ago. The question now is, can they give the patients what they really need? Are they being taught to do so? In a recent article, (Ofri, 2018) says, “In moments of medical crisis, you need a doctor who can help you navigate uncertainty. When your body threatens mutiny and you are peering into the abyss, you want a doctor who has contemplated mortality in a deep way. You want a doctor who is unafraid to wrestle with ambiguity and nuance”. 

Conclusion

We understand that there is a great deal of debate surrounding the medical humanities, and that one of the main issues is how to introduce it into medical education. Should it be fully integrated into the medical curriculum; should it be an elective; is it a “soft skill”, as compared to the hard currency of scientific knowledge? 

 

Through this MedEdPublish Themed Edition, we are looking for your ideas, your thoughts and your practical applications, about the Humanities and whether they have a place within modern medial education and if they have, how can they be used and developed. Although the topic is very broad, our outcomes can be easily as broad but with our aim being to open this debate across the disciplines, across the ages and across the countries. 

 

There are many initiatives around the world working on introducing the humanities into the medical curriculum, more and more symposia and more associations developing. The world we live in is not unidimensional, and precisely for this reason “we need more breadth, more balance, and more doubt”. (Heath, 2016) You may believe, like us, in the importance of the Humanities in medical education or you may not…..but please let your voice be heard. 

 

One hundred years ago, Osler stated, “{Science and Humanities are} twin berries on one stem, grievous damage has been done to both in regarding {them}…..in any other light than complemental”. (Osler, 1919)

We look forward to reading your thoughts on this subject and we accept all forms of publications: research and descriptive papers, opinion pieces and personal views.

Take Home Messages

Notes On Contributors

Mr. Jonathan McFarland is the Head of Academic Writing at Sechenov First State Medical University in Moscow, and a member of their international faculty. He currently holds the position of President of The Doctor as a Humanist Association, a new Association, which held its first international symposium in October 2017, and which aims to promote and develop internationally the concept of the humanities within undergraduate and postgraduate healthcare education.

Professor Irina Markovina is Director of Institute of Linguistics and Intercultural Communication at Sechenov University (Sechenov First Moscow State Medical University). Her interests lie in Psycholinguistics, and she is a representative of the Russian School of Psycholinguistics as well as an Editorial Board member of the peer-reviewed Russian journal “Problems of Psycholinguistics”.  She is also committed to developing the English language environment at Sechenov and in other medical universities.

Professor Trevor Gibbs is an Independent Consultant in Medical Education and Primary Care development. He is also AMEE International Development Officer and Associate Editor of MedEdPublish. His interests lie in curriculum transformation and development, the Social Accountability of medical schools and teaching, learning and assessment methodologies.

Acknowledgements

Bibliography/References

BeSST (2018) A Core Curriculum for Sociology in Undergraduate Medical Education. Available at: http://www.besst.info/publications (Accessed: 4 July 2018).

Frenk, J., Chen, L., Bhutta, Z., Cohen, J., et al. (2010) ‘Health professionals for a new century: transforming education to strengthen health systems in an interdependent world’, The Lancet, 376(9756), pp. 1923–1958. https://doi.org/10.1016/S0140-6736(10)61854-5.

Heath, I. (2016) ‘How medicine has exploited rationality at the expense of humanity: An essay by Iona Heath’, BMJ (Online), 355, p. i5705. https://doi.org/10.1136/bmj.i5705.

Hurwitz, B. and Dakin, P. (2009) ‘Welcome developments in UK medical humanities’, Journal of the Royal Society of Medicine, 102(3), pp. 84–85. https://doi.org/10.1258/jrsm.2009.080383.

Kleinman, A. (1988) The illness narratives: suffering, healing and the human condition. New York: Basic Books, USA.

Klugman, C. M. (2017) ‘Medical Humanities Teaching in North American Allopathic and Osteopathic Medical Schools’, Journal of Medical Humanities, [Epub AoP]. https://doi.org/10.1007/s10912-017-9491-z.

Liao, L. (2017) ‘Opening our eyes to a critical approach to medicine: The humanities in medical education’, Medical Teacher, 39(2), pp. 220–221. https://doi.org/10.1080/0142159X.2016.1231915.

Mangione, S., Chakraborti, C., Staltari, G., Harrison, R., et al. (2018) ‘Medical Students’ Exposure to the Humanities Correlates with Positive Personal Qualities and Reduced Burnout: A Multi-Institutional U.S. Survey’, Journal of General Internal Medicine. Journal of General Internal Medicine, 33(5), pp. 628–634. https://doi.org/10.1007/s11606-017-4275-8.

Ofri, D. (2018) Yes, Studying the Humanities Might Make You a Better Doctor, SLATE. Available at: https://slate.com/technology/2018/04/doctors-should-study-the-humanities.html (Accessed: 4 July 2018).

Osler, W. (1919) ‘The old humanities and the new science: The presidential address delivered before the Classical Association at Oxford, May, 1919’, Journal of the British Medical Association, 2(3053), pp. 1–7. https://doi.org/10.1136/bmj.2.3053.1.

Riggare, S. (2018) ‘E-patients hold key to the future of healthcare’, BMJ, 360, p. k846. https://doi.org/10.1136/bmj.k846.

Appendices

Declarations

There are some conflicts of interest:
Mr. Jonathan McFarland, Professor Irina Markovina and Professor Trevor Gibbs are all guest Theme Editors for the AMEE MedEdPublish themed issue for Humanities in Medical Education.
Trevor Gibbs is Associate Editor of MedEdPublish.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

Ethical approval was not required for this article.

External Funding

This paper has not had any External Funding

Reviews

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muiris houston - (12/07/2018)
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Thank you for a stimulating editorial for this theme issue. There is most definitely an unmet need to bring the humanities to a more central position within medical education. It may be a soft topic compared to others but it needs to be “hardened” by incorporating it into the core curriculum.
There are many fine programmes out there but too often they languish on the periphery in elective or special study modules. (Hats off to Univ Western Australia for reversing this)
Perhaps we could use this publishing opportunity to develop a “how to” exercise aimed at mainstreaming medical humanities ?

Dr Muiris Houston
Adjunct Prof Narrative Medicine
Trinity College Dublin
Yingzi Huang - (12/07/2018) Panel Member Icon
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Thanks for such an inspiring and interesting theme in a timely manner. Technology nowadays overwhelms people in medicine more and more with fashionable words like AI, big data etc, while humanities in medical education is in danger of being ignored. China is no exception as the second biggest economy with rocketing development since decades ago. A disruptive system without effective primary care has worsen the situation, a case in point is the tension between doctors and patients in China, where people start to reflect on our system and hopefully a consensus is reached that one of the fundamental solutions must be humanities. As an insider, I clearly see both sides of the story. What patients want in China might not necessarily equal what they need. But based on the consideration of information asymmetries, doctors can never avoid the responsibility to readjust their patients’ expectation and ‘educate’ them into rational decision and judgement of their own health, since who else can ever get the job done? To tackle the question of ’how exactly’, one of the weapons for both doctors and patients is humanities, which fully embrace the definition of uncertainties in medicine and diversity in human being, which is why we have to develop humanities in medical education before it’s too late. It’s bound to be difficult but worth the commitment in this field, where eventually trust can be built and our future doctors won’t be any more afraid to ‘wrestle with ambiguity and nuance’ for our patients. It’s a very important theme and I look forward to enjoying reading more thought provoking articles.
Sandra Carr - (10/07/2018)
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Thank you for this well written and thoughtful piece. The humanities have be utilised in the education of health professions for as long as we have been educating health professionals! It is important for us all to reflect on that periodically and this special issue will assist in this. As well as increasing understanding of personal values and beliefs, the humanities can be the vehicle to generate valuable learning and insight for both undergraduates and practitioners into our own unconscious bias and how these biases influence our health care provision. I also agree that the humanities can assist us to balance the sometimes competing tensions between the need to be clinically competent and the need to be caring and sensitive and sensible health professionals. It will be valuable to see what submissions are received in relation to these specific topic areas. With the shift to a graduate entry medical program, the University of Western Australia has developed an undergraduate major in Humanities for Health and Medicine in its Biomedical Science that will commence from 2019. It will be the first such undergraduate major in Australia and may well be the beginning of a new appreciation of the value of the humanities in ALL undergraduate health professions education.
P Ravi Shankar - (09/07/2018) Panel Member Icon
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I look forward with great interest to this edition of MedEdPublish on the Medical Humanities. I read the opening editorial with great interest. The editors succinctly sum up the importance of the humanities in medical education. Even today, medicine still deals with uncertainty and medical students and doctors should learn about dealing with uncertainty. The science of medicine is rapidly advancing and science is increasingly dominating modern medicine.
There is an increasing awareness of the importance of the humanities in medical education throughout the world. Initiatives are ongoing in various developing countries to use art in the education of doctors. Literature, art, music, painting and other arts contributes significantly to the development of the future physician. I have been involved with the medical humanities since 2007 first in Nepal and then in the Caribbean and look forward to this issue. I eagerly look forward to contributions especially by authors and educators from the developing world.