Personal view or opinion piece
Open Access

Asking Medical Students on Medical Education and Humanities: How do I do it?; and, how I would like to do it?

Joan B. Soriano[1], Ognen Poposki[2], Laura Moreno-Bueno[3]

Institution: 1. Hospital La Princesa, 2. Facultat de Medicina, Universitat Pompeu Fabra, Barcelona, 3. Facultat de Medicina, Universitat de les Illes Balears, Palma
Corresponding Author: Prof Joan B. Soriano ([email protected])
Categories: Educational Strategies, Students/Trainees, Teaching and Learning, Curriculum Evaluation/Quality Assurance/Accreditation, Undergraduate/Graduate
Published Date: 06/09/2018

Abstract

Far too often, the view on Medical Education comes from scholars. Yet, it is less common to ask medical students themselves, who are living with (and suffering from) the currently established practices on how Medicine and Surgery are taught.  Within this special issue of MedEdPublish, two unrelated medical students, who are second to none in their scores within their respective Medical Schools, naïvely share with us how they thrive in Medicine and beyond, and how they would like that their teachers change the way on how their medical education be transmitted and assessed.  

Keywords: Doctors; Fishing; Humanistic Medicine; Patients; Piano; Students

Ognen’s: a fourth-year medical student opinion

A widespread misconception is that whenever starting any graduate studies, and especially Medicine, students are pushed to abandon their previous sports or cultural lifestyle, in order to excel, or merely pass their subjects. However, I believe it is possible to combine a life full of activities with a good academic performance. 

 

I am Ognen Poposki, a fourth-year medical student at the Pompeu Fabra Medical School in Barcelona. I was born in Skopje, the capital of Macedonia, where I lived for six years before moving to Barcelona. In Spain, I learnt six languages and have become a high competition athlete in the discipline of shore-fishing, also known as surf-casting (Figure 1).

 

Figure 1

Ognen fishing at the 2017 Spanish Championship in El Perelló, Valencia

 

Most weekends I prepare and attend regional and national competitions. In addition to passing my exams with remarkable marks, I often go freediving to practice underwater fishing. Twice a week, I train artistic gymnastics; and, another two days per week, I complement my studies with English lessons and philosophical lectures. 

 

I would not be telling the truth if I state it is easy to have this pace of life, and that anyone can accomplish it. As the challenge it is, discipline and sacrifices are essential.

 

At first glance, the rule within my Medical School colleagues, is not to carry out any activities beyond the academic sphere, because most of them view this as a means of distraction, instead of relaxation. From my point of view, this decision is unacceptable. Performing such activities is extremely important for sustaining a healthy mind. As the popular Latin quote says, Mens sana in corpore sano; these spare moments provide ourselves stability, balance, and mental rest. Likewise, the absence of these have several negative effects. Further, a studying obsession does not allow to enjoy the education process, and have a high quality learning. Therefore, it is important that the hours devoted to university tasks be worthwhile. Even though they could be relatively few, they must be intense, so if you can enjoy the moment, the results you get when doing any kind of activity will be much more satisfactory.

 

However, we must not forget that a heavy investment of study hours is fundamental to achieve academic success. If these hours are invested in activities unrelated to the curricular study subjects, result expectations should consequently be realistic. By this, I mean that it is necessary to find a balance within the three elements that make up all the "free" time in a day: resting, studying Medicine, and the practice of sports and humanistic activities. Having a well-developed personal discipline since youth hood and a controlled self-demanding capacity, are also required to complete this equation.

 

The only viable option that makes this equation feasible is to find an individual activity in which the distribution of time depends only on yourself. It should also not require several hours of daily training; finally, championships, if there are any, should be during weekends. Even so, to succeed in everything, often too high a price has to be paid: sleeping less than 6 hours a day, increased cortisol levels, worsening academic performance due to fatigue and, in the worst case, illnesses related to an excess of stress and tiredness. 

 

The difficulty of finding the perfect formula makes medical students with these skills infrequent. Nevertheless, the ones who achieve this should end up being much more balanced people, a valuable asset as future medical professionals. 

 

At this point, I may suggest that universities and their administrations around the World do not often help, and even worsen this trend, not offering sufficient, if any, opportunities, facilities or help for medical students who want to keep doing what they were thriving for before starting Medical School. Such changes lead to academic failure or the truncation of a possible elite athlete career. I propose that these outcomes should be changed in the near future, so that starting Medicine should be synonym with starting new activities for personal growth, the stimulation of practicing sports, free thinking, the promotion of general culture, and learning beyond formal education. The current educational system, focused on the creation of a community with diffuse knowledge, should be replaced by a more open system whose priority is to prepare professionals who know how to treat people, not diseases.

 

So, we have to borrow the idea of other European and American universities where sports and culture clubs are much more frequent. Furthermore, I strongly support the idea for these activities to be favourably evaluated in the students’ scores, because importance and incentives must be given to carry out enriching actions. In this way, I am sure that it would increase the ease of working as a team for a common goal, the organization of the personal time for students would be improved, as well as their own feelings of commitment. These are, once again, characteristics highly valued later on in senior medical staff.

 

After all, we, medical students, residents, doctors or teachers are an element of society that promotes health. But; how healthy can a life of subordination to the chair and the desk be?. How untruthful is a doctor who recommends not smoking and smells of tobacco?. Or one who recommends weight loss and is overweight, or prescribes sleeping pills, being the one who needs them the most?

 

Let's think, let's help students learn and give them tools and ease to grow, discover new ways of seeing the World, and cultivate their mind in fields other than the strictly academic ones. Let's develop more humanistic student doctors.

Laura’s: a third-year medical student opinion

21st century: unprecedented technological advances, extraordinary scientific discoveries, all information at our fingertips, a society increasingly competitive, lives dedicated mostly to work, ... But, what about our essence as human beings?. How do we manage it in such a World?. Can we cultivate our inner side to become balanced people, not only with ourselves, but with everything/everyone that surrounds us?. 

 

My name is Laura Moreno Bueno, and I am from Mallorca. I am 20 years old and I am about to start the third year of Medical School at the University of the Balearic Islands (UIB). Yes, I know that I am very young and there is a huge world of knowledge and experiences to discover. However, I have been learning during these years a number of things about student’s life that many people do not know; or, rather, some things that we should all consider essential, but in the end only a few decide to incorporate into their lives. 

 

My father is a professional musician so, as expected, my parents signed me up when I was only 3 years old to violin and choir classes. I always saw him immensely enjoying himself when he played the piano, so I became curious about it. One year later, I wanted to start playing that instrument too. Over the years I decided to leave the violin to focus only on piano, and this has been the case until today. Piano has accompanied me throughout the years in all my moments, both good and bad, and has become for me not only a tool of disconnection essential in my day to day (Figure 2).

 

Figure 2

 

Yet in a parallel world of very diverse emotions, it has always helped me to find myself. When I play the piano I feel that there is nothing else around. It is just something very personal for me. I would even consider it my moment of "meditation". Yet music has not been my only companion during my life: sport has also played a fundamental role. A role that in the end does not differ much from that of music. After passing through the years by various sports such as basketball, soccer or tennis, I currently train paddle-tennis and crossfit. Both give me disconnection, the pleasure of meeting different people, setting goals and working hard to get them. Not only that: sports are essential to lead a healthy life, eliminate stress, and cultivate your body.

 

During my student life I have seen how most of my colleagues or friends were abandoning sports or music because "they needed time to study", but I have always been very contrary to this idea. Studying medicine requires much sacrifice, hours of study above average, and maximum dedication. For that, I do not consider it necessary to renounce to those things that identify us, and that help us in our day to day life, which give us happiness. It simply requires the desire to make the most of study time and a high level of concentration in what is done, at all times.

 

If we want to be well with ourselves we must cultivate and take care of our inner side, and that can only be done by focusing time, always limited. With that I also include our family and friends. It is not easy to combine, as I do, medicine, piano, an active social life and two sports (with their respective trainings and weekly championships), and all with excellent grades; but, if I can do it, it is by a series of key elements: organization, perseverance, and effort.

 

As Plato said: "First of all, it is necessary to take care of the soul if you want the head and the rest of the body to function correctly." At the end of the day everything is summed up in a necessary balance between our intellect, our physique, and our spiritual being. With this, you can achieve greater happiness and a strength that helps you to be a better physician, hopefully the sooner than the latter.

 

However, all these issues, which I consider, from my humble point of view, are indispensable, are not taught in most universities, or at least not as much as it should be. There is something that I have already noticed in my first two years of medical career, and it is an issue that worries me. I am referring to the lack of humanistic training that exists today.

 

The great competitiveness, a work overload, the social pressure, and the hectic pace of life that plague many students (and even medical professionals) compel them to leaving aside their more humanistic aspects, and focus their time only on academic, technical or scientific knowledge. The personal integrity of the medical students or the teaching management of the universities are also problematic, which is reflected, as I mentioned earlier, in the lack of “a life” of medical students with respect to the humanist spirit.

 

Perhaps this suggests that the current medical education that trains professionals is not adapted to what modern medicine really requires today. To me, it is essential for changing this trend, a smooth re-introduction of the application of arts and humanities in medicine, such as arts, music, writing, philosophy ... Doctors do not have the duty to face only the diseases of their patients, but they must also work with their pain and suffering. It is likely true that little by little all this is beginning to improve, but there is still a long way to go. We should not be relentless in aiming to promoting and teaching a more patient-centred, more humanistic medicine. And, to succeed in this, we must be provided with the necessary tools from the beginning, so that day by day we ourselves can be trained and grow in this aspect as good doctors.

 

All that balance as a person and human being that I referred to earlier, is what helps later to be able to develop ourselves in the medical profession. A profession that, after all, deals with nothing more and nothing less than people. Each patient is a World and, as such, deserves our full attention, our understanding, and our listening. If we really want to help people (because that is, after all, our main goal), we must first find well with ourselves. Only then, we can give each patient what he/she needs. Only then we can give the best of ourselves.

Some concluding remarks

These two bright fellows offer us two admittedly biased opinions on how they are doing their medical education, and most importantly, how they would like to do it.

 

The view on Medical Education often comes from senior doctors and scholars (Cooper  et al., 2018). One of the many innovative approaches on this initiative “The Doctor as a Humanist: Can the Humanities transform 21st Century Medicine?”, masterly led by Mr Jonathan McFarland, is to include the active participation and opinion of medical students themselves.  So, it was a no-brainer, that for this special issue of MedEdPublish 2018, on the theme of Humanities in Medical Education, to identify a couple of medical students and ask them directly (Makarovaet al., 2018). As per above, you can easily recognise these two opinions and proposals are very, very different (Table 1).

 

Table 1. Quick questions

Item

Ognen Poposki

 Laura Moreno

Recommend a book to another medical student

1984, by George Orwell 

Being mortal, by Atul Gawande

Recommend a movie to another medical student

The possible lives of Mr. Nobody, by Jaco Van Dormael

The pianist, by Roman Polánski; Seven years in Tibet, by Jean-Jacques Annaud

Whenever stressed, how do you relax?

 I go to the beach in the afternoon and I fish

I use to play the piano at any time, but I also go tennis training some days 

What is the historical person that you identify the most with?

 Epicteto

Nelson Mandela

What is the living person that you would like to meet?

 Dalai Lama, Tenzin Gyatso

Malala Yousafzai

Can you share something that you learnt from a patient?

Their reality is not our reality, that's why we have to understand patients. I learnt that from a woman who just wanted to go for a walk and be truly listened at by someone. She knew that, beyond medicine and drugs, what would speed up her recovery was human contact 

I haven’t seen any patients yet, and I am aware that I still have lots to learn. But there is one thing I already know: every patient is a World, and we have to put ourselves in their shoes. We have to learn to listen and treat them just as we would like to be treated

 

Beyond Plato, fishing vs paddle-tennis, philosophy vs piano, sleeping or not …  If only, they share their brightness and their potentials, unlimited. But by actively discussing these opinions with other students on how they do it, and how they would like to do it, we can walk the way to improving the system (Wald, McFarland and Markovina, 2018). Many have been exploring medical humanism for a number of years (Soriano 2011, and 2018), but we think that this “The Doctor as a Humanist” initiative will be long lived. Overall, six years of Medical School should not only be judged by the score in a 250-multiple choice examination within a few hours of a given day (Yedidia et al., 2003).

 

As far as we know, there is no Cochrane review on the beneficial effects of medical humanism yet, either in pre-graduate students up to the most senior of professors. Perhaps it might be an initiative for The Association for Medical Education in Europe (AMEE). Time will tell. Medical Education is utterly important and journals and books are abundant to exploring on ways to improve current systems. Non-comprehensively, others have already asked 11-yr old children and their parents why they want to become doctors (McManus et al., 2015), or aimed to survey 4thyear medical students on bioethics (Phaosavasdi et al., 2010), or asked undergraduates how should residency be (Fürstenberg and Harendza, 2017). 

 

But by helping Ognen, Laura, and all other medical students to developing their potentials and future capacities in full, including their humanism, is when Sir William Osler could more proudly say that you are training and mentoring good doctors that not only treat diseases, but also great doctors who treat patients the way it should be, humanistically.

Take Home Messages

  • It is possible to thrive in Medical School and enjoy extracurricular activities in sports, arts, and other.
  • Common sense, effort, and discipline are key assets to excel in Medicine, Humanism, and else.
  • Better trained “humanist” medical students, should make more balanced doctors and human beings, all for the benefit of patients.

Notes On Contributors

Both medical students wrote their pieces, mentored by the author for correspondence. All authors helped to draft and approved the combined, final version of this manuscript

Acknowledgements

None.

Bibliography/References

Cooper, A., Walker, C., Splinter, A., Khan, M., et al.(2018) ‘Educational Handoffs between Medical School and Residency: A National Survey of Residency Program Directors’, MedEdPublish, Paper No:47. https://doi.org/10.15694/mep.2018.0000047.1

Fürstenberg, S. and Harendza, S (2017) ‘Differences between medical student and faculty perceptions of the competencies needed for the first year of residency’, BMC Med Educ, 17 (1), pp 198. https://doi.org/10.1186/s12909-017-1036-7

 

Makarova, V., Chisolm, M., Manca, A., Markovina, I., et al.(2017) ‘Putting the ‘Heart and Soul’ Back into Medicine: The First ‘The Doctor as a Humanist’ Symposium’, BMJ. Available at: https://blogs.bmj.com/medical-humanities/2017/11/14/putting-heart-soul-back-medicine-first-doctor-humanist-symposium/ Posted on November 14, 2017 by Anna McFarlane. (accessed: 27 August 2018).

 

McManus, I.C., Ng-Knight, T., Riglin, L., Frederickson, N., et al.(2015) ‘Doctor, builder, soldier, lawyer, teacher, dancer, shopkeeper, vet: exploratory study of which eleven-year olds would like to become a doctor’, BMC Psychol, 3, pp. 38. https://doi.org/10.1186/s40359-015-0094-z

 

Phaosavasdi, S., Taneepanichsakul, S., Witoonpanich, P., Tannirandorn, Y., et al.(2010) ‘Assessment of medical ethics of fourth-year medical students’, J Med Assoc Thai, 93 (9), pp. 1115-1118.

 

Soriano, J.B. (2011) ‘Ramblejant pels camins de la ciència i les arts: un viatge d'anècdotes personals i lectures’, Annals Med94 (3), pp. 124-126. https://www.raco.cat/index.php/AnnalsMedicina/article/viewFile/283216/371120.

 

Soriano, J.B. (2011) ‘On Doctors and Their Operas: A Critical (and Lyrical) Analysis of Medicine in Opera’, Chest, 154 (2), pp. 409-415. https://doi.org/10.1016/j.chest.2018.03.015

 

Wald, H.S., McFarland, J., and Markovina, I. (2018) ‘Medical humanities in medical education and practice’, Medical Teacher. Available at: https://doi.org/10.1080/0142159X.2018.1497151 (accessed 27 August 2018).

 

Yedidia, M.J., Gillespie, C.C., Kachur, E., Schwartz, M.D., et al.(2003) ‘Effect of communications training on medical student performance’, JAMA, 290 (9), pp. 1157-1165. https://doi.org/10.1001/jama.290.9.1157.

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

Ethics Approval was not required for this article.

External Funding

This paper has not had any External Funding

Reviews

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Peter Dieter - (19/09/2018) Panel Member Icon
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Although not really scientific – an excellent paper, easy to read and important for everybody working in the field of medicine, students, teachers, leaders, doctors, administrators,… It emphasises that the balance of life –study, work vs resting, personal interests, … is most important.
Richard Hays - (07/09/2018) Panel Member Icon
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While I welcome a paper that so eloquently expresses the human side of being a medical student, what I feel is missing is how to help others to find their 'inner selves' and achieve balance in life. Ideally, all of us have an equally interesting story to tell. The message is equally relevant to established practitioners, but it can take some time to emerge amidst busy lives dominated by study, exams and getting onto a career path. This does not preclude, and in fact may enhance, successful professional careers. It is disappointing to read that students feel pressured to give up 'outside' interests to focus on study and would be surprised if that were supported by educators. While the literature on professional identity is increasing, less is said about the importance of personal identity, which will always be at the centre of professional identity. For me, while applying science to people feeds the intellect, art, literature and music feed the soul. I cannot imagine one without the other, and find them complementary, although it took some time to work out how to achieve the right balance. Just what works, and in what balance, for others, may well be very different. The key message here should be that we should all try to find that balance. There are probably many different ways of doing this, but do the authors have any advice for getting there sooner?
Trevor Gibbs - (06/09/2018) Panel Member Icon
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An interesting paper that looks at the social lives of two students who although studying in different medical schools are both from Spanish schools. I am not sure if that makes a difference but certainly I would consider the cultural variation and up-bringing of medical schools. Compare the life of a Chinese or Japanese students to these two students. I do not disagree with their thoughts, no one is in a position to do that but just as life is a balance, then so is the way that students, particularly students of the professions, run their lives. Trying to achieve that balance is difficult and also I feel very personal. As a medical student I played rugby to relax, but because I was not that brilliant academically, I had to give up rugby in the later years of the course in order to keep up with my clinical studies. As a very busy General Practitioner, I relaxed through going regularly to the gym, often to wear off the frustrations of a very busy day ( many of my colleagues played golf which I had no inclination to do!)
So whilst not disagreeing with the paper, I do feel that the way we study, the way we balance our lives and our studies is very personal. True, it can be shaped by external forces, some of which are due to out-moded curricula that force the student to learn something that they will never ever use again. Whether achieving a life balance makes a better person, I no doubt it does; whether it produces a better, more caring and compassionate doctor, I am unsure. Despite these reservations I do applaud the students who so eloquently expressed their views.
P Ravi Shankar - (06/09/2018) Panel Member Icon
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This interesting article raises a number of questions. I agree an interest in activities beyond medicine is important to create a well-rounded doctor who can respond empathetically to patient voices. The situation is however, challenging. The amount of knowledge is increasingly exponentially. The time to learn is six years in Europe but is only four years in the United States system which offshore Caribbean schools also follow. We as teachers and academic leaders, realize we may not be acting in the best interest of the student with regard to scheduling teaching sessions, assignments and assessments but do not have much choice in the matter.
I do agree with the authors that it is important to listen to medical students and consider their opinions while creating and modifying the curriculum. At Saint Lucia we do have student members in the curriculum committee. The major challenge we face is the short duration of the course. The Basic sciences are taught over five semesters of 15 weeks each. The number of subjects and courses is always increasing while the time remains static. As mentioned in previous article obtaining evidence of the impact of the medical humanities is becoming increasingly urgent. This article will appeal to all medical educators.