Music in medical education: A critical interpretive synthesis

INTRODUCTION

While many have championed the value of music in medical education, research specific to how and why music has been offered in medical education is sparse and there have been few attempts to synthesise the literature.

METHODS

A Critical Interpretive Synthesis (CIS) of 56 texts including published articles, correspondence, abstracts and one thesis published between 1977 and 2022 was undertaken to explore the evidence basis for offering music in medical education.

RESULTS

A total of 52 music-focused programmes/activities were described, encompassing both curricular and extra-curricular, receptive and participatory music activities and a wide range of musical genres. Inductive analysis of data extracted from texts revealed a variety of rationales for the use of music in medical education, which could be grouped within seven interrelated themes: well-being; supportive learning environment; affective engagement; teaching and learning; developing skills for clinical practice; humanism in medicine; and creative expression (identity).

DISCUSSION

The results of this synthesis demonstrate that there remains a gap between what is claimed about the affordances of music and what has been explicitly addressed in medical education research. Despite a paucity of research in this area, the available data support that the affordances of music are 'multiple' and may not be well represented by linear models. Evidence that engagement with music is beneficial for medical students is strongest in relation to the affordances of music for well-being, facilitating a supportive learning environment, affective engagement, memorisation and creative expression (identity). That engagement with music might enhance humanism, including developing skills for clinical practice, requires further investigation. Accounting for student agency and the 'multiple' affordances of music will ensure that future teaching and research are best positioned to benefit medical students' well-being and personal and professional development.

The employment of art therapy to develop empathy and foster wellbeing for junior doctors in a palliative medicine rotation - a qualitative exploratory study on acceptability

BACKGROUND

The interdisciplinary realm of medical humanities explores narratives and experiences that can enhance medical education for physicians through perspective-taking and reflective practice. However, there is a gap in comprehension regarding its appropriateness at the postgraduate level, especially when utilising art therapists as faculty. This study aims to assess the acceptability of an innovative art therapy-focused educational initiative among junior doctors during a palliative care rotation, with the goal of cultivating empathy and promoting well-being.

METHODS

A qualitative research project was conducted at the Division of Supportive and Palliative Care (DSPC) in the National Cancer Centre Singapore (NCCS). The study involved the recruitment of junior doctors who had successfully completed a three-month palliative care rotation program, spanning from January 2020 to April 2021. In a single small-group session lasting 1.5 h, with 3 to 4 participants each time, the individuals participated in activities such as collage making, group reflection, and sharing of artistic creations. These sessions were facilitated by an accredited art therapist and a clinical psychologist, focusing on themes related to empathy and wellbeing. To assess the acceptability of the program, two individual interviews were conducted three months apart with each participant. An independent research assistant utilised a semi-structured question guide that considered affective attitude, burden, perceived effectiveness, coherence, and self-efficacy. Thematic analysis of the transcribed data was then employed to scrutinise the participants' experiences.

RESULTS

A total of 20 individual interviews were completed with 11 participants. The three themes identified were lack of pre-existing knowledge of the humanities, promotors, and barriers to program acceptability.

CONCLUSIONS

The participants have mixed perceptions of the program's acceptability. While all completed the program in its entirety, the acceptability of the program is impeded by wider systemic factors such as service and manpower needs. It is vital to address these structural limitations as failing to do so risks skewing current ambivalence towards outright rejection of future endeavours to integrate humanities programs into medical education.

Exploring the experiences of Canadian medical students with a background in the arts and humanities

Background

Arts and Humanities (A/H) training is a powerful strategy to help medical students develop key competencies which align with the CanMEDS roles that Canadian physicians are expected to embody. Students with backgrounds in A/H may enter medical school with the skills and dispositions that A/H training provides. This paper explores the varied experiences of medical students with prior A/H backgrounds, with an emphasis on how they navigate relationships with their student cohorts and participate in undergraduate medical training environments.

Methods

Descriptive qualitative research methodology was used to conduct and analyze semi-structured interviews exploring the perspectives of Canadian medical students with either a A/H degree or training in A/H (n = 13). Domains such as identity, integration of interests, and challenges in maintaining A/H interests during medical training were explored.

Results

Participants described their A/H identity as intertwined with their identity as medical trainees and described their sense of interconnection between the disciplines. Challenges included imposter syndrome and difficulties in relating with peers from science backgrounds. Participants described returning to their A/H interests as a tool for wellness amidst medical training.

Conclusions

Medical students with a background in A/H training describe this background as offering both affordances and challenges for their sense of identity, belonging, and wellness. These students offer an untapped resource: they come with dispositions of value to medicine, and they perceive a positive, hidden A/H curriculum that supports their maintenance of these dispositions during training. Understanding more about these hidden treasures could help foster the development of well-rounded and humanistic physicians in the entire medical class.

Reversing the medical humanities

The paper offers the concept of reversing the medical humanities In agreement with the call from Kristeva et al to recognise the bidirectionality of the medical humanities, I propose moving beyond debates of attitude and aptitude in the application and engagement (either friendly or critical) of humanities to/in medicine, by considering a reversal of the directions of epistemic movement (a reversal of the flow of knowledge). I situate my proposal within existing articulations of the field found in the medical humanities meta-literature, pointing to a gap in the current terrain. I then develop the proposal by unfolding three reasons why we might gain something from exploring a reversed knowledge flow. First, a reversed knowledge flow seems to be an inherent-but still to be articulated-possibility in medical humanities and thus provides an opportunity for more knowledge. Second, the current unidirectionality of the field is founded on an inconsistency in the depiction of the connection between medicine and humanities, which risks creating the very divide that medical humanities set out to bridge. Practising a reversal may help avoid this divide. And third, a reversal might help rebalance the internal epistemic power, so as to motivate less external scepticism and in turn displace more external epistemic power towards medical humanities. I end the paper with a remark on precursors for a reversal, and ideas for where to go from here.

The quantified analysis of the correlation between medical humanities curriculums and medical students' performance

BACKGROUND

A high-quality medical humanities (MH) education program is essential to developing a successful medical practitioner and can influence clinical performance. It is also vital to improve the evaluation of MH education to restore harmonious mutual relationships in medical care. However, studies have yet to discuss the correlation between the learning quality and quantity of medical humanities curriculums (MHC) and medical students' scores of clinical curriculums and clinical performance. The study aimed to assess the correlation between the learning quality and quantity of MHC and medical students' performance.

METHODS

We conducted a retrospective cohort study by analyzing a dataset of students' learning records. After excluding students with missing demographic information (n = 1) and overseas Chinese students (n = 15), the study included six- and seven-year program medical school students (n = 354) at National Yang-Ming University who were admitted between 2012 and 2014. The correlation between learning quality and quantity in MHC and students' following performance was evaluated by multivariable-adjusted regression analyses.

RESULTS

After adjusting for potential confounders (gender, residential area, age at enrollment, type of administration, and school program), the number of MHC with good learning outcomes was significantly correlated with clinical curriculum scores (p < 0.05), clerkship performance (p < 0.001), and weighted average mark (p < 0.001).

CONCLUSIONS

Our study found a correlation between MHC with good learning outcomes and medical students' following performance. A future study of improving the quality of MH education is warranted.

Life, Death, and Humanity in Veterinary Medicine: Is it Time to Embrace the Humanities in Veterinary Education?

Medical humanities is a multidisciplinary, interdisciplinary field of study that has experienced explosive growth in the United States since the 1960s. Two key components of medical humanities include first, the use of literature, poetry, and visual arts in the education of medical students, and second, the representation or examination of medical culture by scholars in the humanities, arts, and social sciences such as literary and film creators, sociologists, and anthropologists. The American Association of Medical Colleges recently reported that as of 2018, approximately 94% of medical schools had core or elective humanities offerings in their curricula. The examination of the medical milieu by scholars across the humanities has resulted in the emergence of important specialty fields such as end-of-life care, disability studies, and health disparities research. Veterinary medicine has been slow to embrace the humanities as relevant to our profession and to the education of our students. Only sporadic, isolated attempts to document the value of the arts and humanities can be found in the veterinary literature, and valuable observations on our profession made by scholars in diverse disciplines of the humanities are largely buried in publications not often accessed by veterinarians. Here a case is made that the time is right for the emergence of a more cohesive field of veterinary humanities. Embracing the observations of humanities scholars who engage with our profession, and appreciating the ways in which the humanities themselves are effective tools in the education of veterinary professionals, will bring many benefits to our evolving profession.

Reflection, Sense of Belonging, and Empathy in Medical Education-Introducing a "Novel" Model of Empathetic Development by Literature

Empathy, self-reflection, and inclusion of the medical humanities in medical education are increasingly gaining attention. This seems prudent, as studies indicate that high physician empathy is associated with better patient outcomes and could protect against physician burnout. In addition, utilizing self-reflection has been reported to surge diagnostic accuracy and increase the ability of clinical health care providers. Therefore, in medical education, there is a need to address these, however intricate, most important skills. Not oblivious to this, for decades many medical schools have reaped experience from the humanities, sprouting the field of the medical humanities. However, significant barriers encountered when teaching the medical humanities to medical students are of concern. Consequently, a theory-based, inclusive, representative, and intuitive approach to the teachings is coveted. The aim of this article is to describe and present such an approach. To this end, I introduce a novel Model of Empathetic Development by Literature, schematizing the path from reading a text to displaying an act of empathy. Ever mindful of the relevance and feasibility to medical students, this article reflects on thoughts and evidence behind the hypothesis; that sense of belonging, self-reflection, and empathy could be gained by reading and discussing literary fiction. Referring to both original research articles, books of popular science, and philosophical considerations, a clear line of reasoning for the inclusion of literary fiction in medical education is made. Thereafter, it is outlined, how-in a medical humanities course at Copenhagen University-specific literary excerpts are utilized to bring forth reflection on different aspects, circumstances, and conditions of being a physician, thereby kindling the medical students' sense of belonging to their profession. As such, this perspective piece demonstrates a concrete approach to how a literary educative technique could manifest.

Perception of Medical Humanities among Polish Medical Students: Qualitative Analysis

Medical humanities (MH) courses are a critical element of the medical curriculum influencing the establishment of a physician in the medical profession. However, the opinion about MH among medical students remains unknown. Interviews from seven focus groups were analysed. The students attended one of three Polish medical schools in Gdansk, Krakow, and Warsaw and were recruited to the discussion focused on the impact of drug manufacturers' presence at medical universities on socialization in the medical profession. Thematic analysis was conducted using the theoretical framework of social constructivism. The students' opinions about the MH classes arose during the analysis. In six groups, students thought that MH courses would be helpful in their future medical practice. However, in four groups, different opinion was expressed that MH courses were unnecessary or even "a waste of time". Factors discouraging students from the MH classes included poorly taught courses (monotonous, uninteresting, unrelated to medical practice, taught by unsuitable lecturers). Secondly, students thought that the time investment in the MH was too extensive. Furthermore, curriculum problems were identified, reflecting the incompatibility between the content of MH courses and teaching semesters. Lastly, some students stated that participation in MH courses should be elective and based on individual interests. Addressing problems recognized in this work could improve the training of future Polish physicians.

Exploring a brief medical improvisational performing arts intervention for genetic counseling graduate students

Psychosocial counseling is the foundation of genetic counseling. Genetic counseling students are required to receive in-depth training on psychosocial counseling techniques. In other medical disciplines, "medical improv," an educational method derived from improvisational theatre, has been used to allow trainees to practice clinical skills without also having to focus on medical knowledge they've not yet mastered. The present study aims to investigate the acceptability of medical improv as an educational tool for genetic counseling students. Fourteen genetic counseling students and new genetic counselors completed a 2-hr medical improv workshop and participated in follow-up interviews to discuss the workshop. Participants' responses to the intervention were positive, with 92.9% of participants responding that they would recommend medical improv training to other genetic counseling students. Participants described the medical improv workshop as helping build psychosocial skills in a safe environment, which may facilitate the use of more advanced counseling skills in clinical situations. By training students to practice psychosocial skills and building students' confidence, medical improv may help genetic counseling students and genetic counselors be more effective in challenging clinical situations, and to feel more comfortable in experimenting with new ideas and psychosocial techniques in their clinical practice.

InspirE5: a participatory, internationally informed framework for health humanities curricula in health professions education

BACKGROUND

Reporting on the effect of health humanities teaching in health professions education courses to facilitate sharing and mutual exchange internationally, and the generation of a more interconnected body of evidence surrounding health humanities curricula is needed. This study asked, what could an internationally informed curriculum and evaluation framework for the implementation of health humanities for health professions education look like?

METHODS

The participatory action research approach applied was based on three iterative phases 1. Perspective sharing and collaboration building. 2. Evidence gathering 3. Development of an internationally relevant curriculum and evaluation framework for health humanities. Over 2 years, a series of online meetings, virtual workshops and follow up communications resulted in the production of the curriculum framework.

RESULTS

Following the perspective sharing and evidence gathering, the InspirE5 model of curriculum design and evaluation framework for health humanities in health professions education was developed. Five principal foci shaped the design of the framework.

ENVIRONMENT

Learning and political environment surrounding the program. Expectations: Graduate capabilities that are clearly articulated for all, integrated into core curricula and relevant to graduate destinations and associated professional standards.

EXPERIENCE

Learning and teaching experience that supports learners' achievement of the stated graduate capabilities.

EVIDENCE

Assessment of learning (formative and/or summative) with feedback for learners around the development of capabilities. Enhancement: Program evaluation of the students and teachers learning experiences and achievement. In all, 11 Graduate Capabilities for Health Humanities were suggested along with a summary of common core content and guiding principles for assessment of health humanities learning.

DISCUSSION

Concern about objectifying, reductive biomedical approaches to health professions education has led to a growing expansion of health humanities teaching and learning around the world. The InspirE5 curriculum and evaluation framework provides a foundation for a standardised approach to describe or compare health humanities education in different contexts and across a range of health professions courses and may be adapted around the world to progress health humanities education.

Factors influencing medical students' approaches to learning in Qatar

BACKGROUND

This study investigated the relevance of the revised 2-factor study process questionnaire (R-SPQ-2F) for exploring medical students' approaches to learning in Qatar and identify how factors like gender, age, educational attainment, and prior experience with health care influence students' adoption of deep approaches to learning.

METHODS

The sample consisted of 108 medical students (44% male, 56% female) from all four years of medical school at Weill Cornell Medicine-Qatar (WCM-Q). Participants completed the 20-item R-SPQ-2F questionnaire to measure their learning approaches through a structural model contrasting deep and surface learning. Participants also completed a survey collecting demographic information.

RESULTS

Statistical analysis revealed significant differences in deep learning approaches across year levels for both men and women. Additionally, educational attainment played a significant role in students' approaches to learning.

CONCLUSIONS

Based on structural equation modeling, this cross-verification study supports the R-SPQ-2F instrument and offers additional evidence for its robustness and application to medical education. These findings may help educational and program leaders in Qatar better understand medical students' learning approaches to enhance their pedagogical practices.

Medical Humanities Education and Its Influence on Students' Outcomes in Taiwan: A Systematic Review

Background

Medical education has emphasized the importance of integrating medical humanities training into the curriculum to benefit medical and nursing students' future practice, featuring in the list of national funding priorities for healthcare education research in Taiwan for many years. However, the extent to which this drive has resulted in medical humanities training, what rationales underpin its inclusion, and its efficacy is largely unknown. This study aims to address these issues across medical humanities programs within the Taiwanese context.

Methods

We conducted a systematic review. Inclusion criteria included studies in English or Mandarin reporting outcomes of medical humanities courses in healthcare education settings in Taiwan between 2000 and 2019. We searched across five electronic databases (PubMed, Embase, ERIC, PsycInfo, Web of Science), following PRISMA guidelines. The Best Evidence Medical Education (BEME) Global Scale and Kirkpatrick Levels are used for identifying the strength of evidence.

Results

17 articles were extracted from the 134 identified. Intrinsic and instrumental rationales for the inclusion of medical humanities education were common, compared with epistemological-based and critical-based approaches. Several positive impacts were identified in relation to participation including modification of attitudes, knowledge, and skills. However, the highest level (i.e., unequivocal) of evidence characterized by effects on students' behaviors or ongoing interaction with colleagues and patients is lacking.

Conclusion

Findings suggest that although medical humanities education is widely implemented in Taiwan, no clear consensus has been reached regarding the rationale for inclusion or how it is localized from Western to Asian contexts. Future research still needs to explore the long-term impact of medical humanities education for medical and nursing students and its impact on patient care.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42019123967.

Medical Students' Creation of Original Poetry, Comics, and Masks to Explore Professional Identity Formation

INTRODUCTION

This study examines differences in students' perceived value of three artmaking modalities (poetry, comics, masks) and whether the resulting creative projects offer similar or different insights into medical students' professional identity formation.

METHODS

Mixed-methods design using a student survey, student narrative comments and qualitative analysis of students' original work.

RESULTS

Poetry and comics stimulated insight, but masks were more enjoyable and stress-reducing. All three art modalities expressed tension between personal and professional identities.

DISCUSSION

Regardless of type of artmaking, students express concern about encroachments of training on personal identity but hoped that personal and professional selves could be integrated.

Health Humanities curriculum and evaluation in health professions education: a scoping review

BACKGROUND

The articulation of learning goals, processes and outcomes related to health humanities teaching currently lacks comparability of curricula and outcomes, and requires synthesis to provide a basis for developing a curriculum and evaluation framework for health humanities teaching and learning. This scoping review sought to answer how and why the health humanities are used in health professions education. It also sought to explore how health humanities curricula are evaluated and whether the programme evaluation aligns with the desired learning outcomes.

METHODS

A focused scoping review of qualitative and mixed-methods studies that included the influence of integrated health humanities curricula in pre-registration health professions education with programme evaluate of outcomes was completed. Studies of students not enrolled in a pre-registration course, with only ad-hoc health humanities learning experiences that were not assessed or evaluated were excluded. Four databases were searched (CINAHL), (ERIC), PubMed, and Medline.

RESULTS

The search over a 5 year period, identified 8621 publications. Title and abstract screening, followed by full-text screening, resulted in 24 articles selected for inclusion. Learning outcomes, learning activities and evaluation data were extracted from each included publication.

DISCUSSION

Reported health humanities curricula focused on developing students' capacity for perspective, reflexivity, self- reflection and person-centred approaches to communication. However, the learning outcomes were not consistently described, identifying a limited capacity to compare health humanities curricula across programmes. A set of clearly stated generic capabilities or outcomes from learning in health humanities would be a helpful next step for benchmarking, clarification and comparison of evaluation strategy.

How Are the Arts and Humanities Used in Medical Education? Results of a Scoping Review

PURPOSE

Although focused reviews have characterized subsets of the literature on the arts and humanities in medical education, a large-scale overview of the field is needed to inform efforts to strengthen these approaches in medicine.

METHOD

The authors conducted a scoping review in 2019 to identify how the arts and humanities are used to educate physicians and interprofessional learners across the medical education continuum in Canada and the United States. A search strategy involving 7 databases identified 21,985 citations. Five reviewers independently screened the titles and abstracts. Full-text screening followed (n = 4,649). Of these, 769 records met the inclusion criteria. The authors performed descriptive and statistical analyses and conducted semistructured interviews with 15 stakeholders.

RESULTS

The literature is dominated by conceptual works (n = 294) that critically engaged with arts and humanities approaches or generally called for their use in medical education, followed by program descriptions (n = 255). The literary arts (n = 197) were most common. Less than a third of records explicitly engaged theory as a strong component (n = 230). Of descriptive and empirical records (n = 424), more than half concerned undergraduate medical education (n = 245). There were gaps in the literature on interprofessional education, program evaluation, and learner assessment. Programming was most often taught by medical faculty who published their initiatives (n = 236). Absent were voices of contributing artists, docents, and other arts and humanities practitioners from outside medicine. Stakeholders confirmed that these findings resonated with their experiences.

CONCLUSIONS

This literature is characterized by brief, episodic installments, privileging a biomedical orientation and largely lacking a theoretical frame to weave the installments into a larger story that accumulates over time and across subfields. These findings should inform efforts to promote, integrate, and study uses of the arts and humanities in medical education.

Stories and perspective taking: Augmenting dental students' understanding of patient care

INTRODUCTION

Medical schools have reported on the integration of humanities, through literature, which offer diverse content and approaches that can be used to enhance patient care. The integration of humanities in dental education is a recent development. At the International Medical University (IMU) Malaysia, a literature module which focused on perspective taking activities was offered to the Bachelor of Dentistry program. We aimed to study if the module impacted dental students' understanding of patient care.

METHODS

Third-year undergraduate dental students were facilitated to discuss stories, engage in perspective taking activities and keep a portfolio for assessment in the Stories and Perspectives selective. Thematic analysis was used to analyze the data in their portfolios.

RESULTS

The dental students identified key learning points that would better prepare them for patient-centered care. Three themes emerged: (1) facilitate empathy in students, (2) stimulate self-awareness in students, and (3) motivate students to be perceptive communicators. Students were able to appreciate the complexities of care giving as it involved taking into account the thoughts and feelings of the other while recognizing their own mental state. They further valued the choice of appropriate words and actions in mediating this process.

CONCLUSION

The potential for incorporating humanities based approaches to teach patient care to dental students is favorable. Reading stories and extending this to perspective taking activities to induce creative ways to shift between experiences of self and other is a positive approach in preparing health professionals for care giving encounters.

On the arts and humanities in medical education

This paper aims to position the birth of the Medical Humanities movement in a greater historical context of twentieth century American medical education and to paint a picture of the current landscape of the Medical Humanities in medical training. It first sheds light on the model of medical education put forth by Abraham Flexner through the publishing of the 1910 Flexner Report, which set the stage for defining physicians as experimentalists and rooting the profession in research institutions. While this paved the way for medical advancements, it came at the cost of producing a patriarchal approach to medical practice. By the late 1960s, the public persona of the profession was thus devoid of humanism. This catalyzed the birth of the Medical Humanities movement that helped lay the framework for what has perpetuated as the ongoing incorporation of humanistic subjects into medical training. As we enter a time in medicine in which rates of burnout are ever-increasing and there are growing concerns about a concomitant reduction in empathy among trainees, the need for instilling humanism remains important. We must consequently continue to consider how to ensure the place of the Medical Humanities in medical education moving forward.

Exploring intentional medication non-adherence in patients with systemic lupus erythematosus: the role of physician-patient interactions

Objective

Medication non-adherence contributes to worse health outcomes among SLE patients. The underlying mechanisms that drive medication non-adherence are poorly understood. The purpose of this study was to explore possible mechanisms of medication non-adherence by eliciting patient experiences.

Methods

Consented adult patients with ACR- or SLICC-classified SLE were recruited. Ten semi-structured interviews were conducted across six participants. Interviews were audio recorded, transcribed, and analysed using an iterative process. The findings were presented to an interactive public forum with SLE patients, family members and friends of patients, and health-care professionals to assess validity and for elaboration of the concepts developed.

Results

The following three interrelated themes emerged from the interviews. First, why do rheumatologists not know more about lupus or share what they do know with their patients? Second, why do I have to take so many drugs and why do the drugs not work? Third, if my rheumatologist cannot communicate with me, why should I follow the prescribed medication regimen?

Conclusion

Our exploratory findings lay out a possible underlying logic by which patients might choose intentionally to engage with medication non-adherence behaviours. Patients suggested that poor communication with their rheumatologists along with a lack of validation of their symptoms contributed to them not valuing the recommendations of physicians. This also contributed to development of a cynical outlook and little belief that medication would improve their condition. Although further work is needed to validate these findings, our preliminary work suggests that interventions focusing on the development of communication skills among both patients and rheumatologists are necessary to reduce medication non-adherence.

Role-playing: an Effective Method for Clinical Novitiate Teaching of Infectious Diseases

OBJECTIVE

This study aims to apply the role-play method of teaching to clinical novitiate teaching of infectious diseases and assess the student feedback and learning effect.

METHODS

The students were randomly divided into a role-playing group (taught using a role-playing method) and a standard group (taught using traditional method). Typical cases of hemorrhagic fever with renal syndrome (HFRS) with fever, hypertensive shock, and oliguria phase overlap as clinical manifestations were selected. Students in the role-playing group underwent pre-class preparation according to a well-designed script and performed the patient's consultation process of suspected HFRS in the classroom, followed by a discussion and questionnaire survey. The standard group underwent routine theory teaching. Teaching efficacy was evaluated by theoretical examination.

RESULTS

The test scores and case analysis ability were higher for students in the role-playing group than in the standard group (p < 0.05). Nearly 90% of the students in the role-playing group gave positive feedback on the role-playing pedagogy and were willing to participate in its classroom implementation.

CONCLUSION

Role-playing has positive effects on knowledge acquisition, skills upgrading, and attitudes related to medical teaching. Therefore, this method can be introduced in the teaching of other medical courses.

SUPPLEMENTARY INFORMATION

The online version of this article (10.1007/s40670-020-01031-x) contains supplementary material, which is available to authorized users.

Beyond empathy: a qualitative exploration of arts and humanities in pre-professional (baccalaureate) health education

For nearly four decades, researchers have explored the integration of arts and humanities content into health professions education (HPE). However, enduring controversies regarding the purpose, efficacy, and implementation of humanities initiatives suggest that the timing and context of trainees' exposure to such content is a key, but seldom considered, factor. To better understand the affordances of introducing humanities-based health curriculum prior to the HPE admissions gateway, we conducted a qualitative instrumental case study with participants from Canada's first Health Humanities baccalaureate program. Fully anonymized transcripts from semi-structured interviews (n = 11) and focus groups (n = 14) underwent an open-coding procedure for thematic narrative analysis to reveal three major temporal domains of described experience (i.e., prior to, during, and following their participation in a 12-week semester-long "Introduction to Health Humanities" course). Our findings demonstrate that perceptions of arts- and humanities content in health education are generated well in advance of HPE admission. Among other findings, we define a new concept-epistemological multicompetence-to describe participants' emergent capability to toggle between (and advocate for the role of) multiple disciplines, arts and humanities particularly, in health-related teaching and learning at the pre-professional level. Improved coordination of baccalaureate and HPE curricula may therefore enhance the development of capabilities associated with arts and humanities, including: epistemological multicompetence, aesthetic sensibility, and other sought-after qualities in HPE candidates. In conclusion, attending to the pre-professional admissions gateway presents a new, capabilities-driven approach to enhancing both the implementation and critical understanding of arts and humanities' purpose, role, and effects across the "life course" of health professions education.

Integrating drawings into health curricula: university educators' perspectives

The literature has identified promising findings regarding the application of arts-based initiatives to enhance healthcare professional (HCP) training. Research shows that drawings offer a window into the authentic, insider view of health and illness, with potential to be a platform for healthcare student and HCP learning. In addition, drawings may also have a place in health communication. Our previous work provides support for the educational application of patients' drawings in bringing HCPs closer to the patient's lived experience. Subsequently, this study aimed to explore university educators' opinions regarding the implementation of drawings as an educational tool for higher education healthcare students. The objective of this study was to explore pathways for using drawings as an art form in an educational context, and provide recommendations for developing curricula and resources for further evaluation. Findings from focus group interviews with nine university educators revealed support for the use of drawings as a novel medium as they offer rich insights into the patient's perspective while encouraging creative and critical thinking. Key perceived benefits were that drawings foster student appreciation of (1) the holistic impact of illness, (2) the importance of patients' priorities and (3) the value of learning from the patient. Patients' drawings of their experiences would offer needed opportunities for students to explicitly reflect about the 'person' holistically rather than view the patient as a 'biomedical problem'. Shifting students' perspectives and possible assumptions to be better aligned with and appreciative of the patient's experiences was noted as central to adopting a person-centred approach to healthcare practice. Our findings suggest that incorporating drawings, or indeed other art forms, as educational tools would be a valuable addition to the health curricula.

Empathy of dental students towards children after behaviour guidance lectures and clinical experience

INTRODUCTION

The empathetic behaviour of dentists is essential for perfect patient care. Because the behaviour of child patients in a dental clinic differs from that exhibited by the adults, knowing of empathy of dental students towards the child in the dental clinic is an important concern.

METHODS

We distributed a modified form of the Health Professions Student version (HPS-version) of the Jefferson Scale of Empathy (JSE) to dental students in two rounds: (R1) before and (R2) after introducing behaviour guidance subcourse and exposure to 3 clinical experiences with children to measure changes in empathy of dental students towards child patients. The modifications include replacing the "patient" words with "child patients" and translation into Arabic. We checked the internal consistency of the modified form of HPS-version by Cronbach's coefficient alpha test. The significance level was set at 0.05 for all statistical analyses.

RESULTS

Out of eighty-one, sixty-five dental students completed the survey and attended a behaviour guidance course and three clinical sessions. The questionnaire showed accepted reliability. There was a significant decrease in the empathy of dental students in R2 than R1 (P < .05). The level of empathy for males was less than female students in both rounds (P < .05).

CONCLUSIONS

The clinical interaction of children by dental students inhibits their empathy towards child patients, and a specific training course is needed to improve dental students' empathy towards children since learning behaviour guidance may not sufficient.

Exploring the Socialization Experiences of Medical Students From Social Science and Humanities Backgrounds

PURPOSE

To explore the structural, cultural, and interpersonal issues that may contribute to the inadvertent marginalization of medical students with social science and humanities (SSH) backgrounds.

METHOD

Using the hidden curriculum as an analytic construct, the lead author interviewed 14 medical students with SSH backgrounds at the University of Toronto Faculty of Medicine from February to October 2015. The authors analyzed the interview transcripts for common themes around positive and negative cultural, structural, and interpersonal dimensions of the socialization process.

RESULTS

Participants reported barriers to applying to medical school: needing to complete prerequisite courses and to do well on an exam geared toward those with a strong science background (the Medical College Admission Test) and lacking an application cohort. Some participants felt they were not ideal candidates for medical school. Participants appreciated how their SSH backgrounds and associated skill sets shaped both their perspectives on patient care and their developing professional identities. However, they perceived that others largely deemed their previous training as irrelevant, and they felt marginalized in medical school by peers, instructors, and the curriculum. These experiences led both to self-censorship, which enabled them to seem to conform to normative behaviors, and to the pursuit of reaffirming elective experiences.

CONCLUSIONS

The existing hidden curriculum inadvertently marginalizes SSH medical students; their experiences likely reflect the socialization experiences of other students from underrepresented backgrounds. Curricular and institutional reforms are imperative to shift the hidden curriculum toward one of epistemological inclusion that better supports students from nontraditional backgrounds.

Can I Get a Suggestion? Medical Improv as a Tool for Empathy Training in Obstetrics and Gynecology Residents

BACKGROUND

Physician empathy is associated with improved patient outcomes. No studies have examined the outcomes of medical improvisational (improv) training on empathy.

OBJECTIVE

Our aims were to determine whether an improv workshop is an effective tool to deliver empathy training for obstetrics and gynecology (OB-GYN) residents, and whether that effect is sustained over time.

METHODS

We conducted a prospective cohort study of OB-GYN residents undergoing empathy training through 4 improv games in a 1-hour session. Empathy surveys (score range 20-140) with validity evidence were administered 2 weeks prior to empathy training, immediately after, and 1, 3, and 6 months later. Fisher's exact test, Student's t test, and Wilcoxon rank sum test were used to compare statistical differences at each post-intervention assessment.

RESULTS

All 22 invited residents participated in empathy training. Empathy scores improved immediately after (120.0 ± 9.8 versus 113.1 ± 10.6, P = .026), though they regressed toward baseline through 6 months (116.3 ± 11.0 versus 113.1 ± 10.6, P = .43). When asked on a scale of 1-5 how much the workshop would impact their work, there was an increase in scores both immediately after (mean 3.5 versus 4.6, P < .001) and 1 month later (mean 3.5 versus 4.1, P = .039), but this difference disappeared at 6 months.

CONCLUSIONS

Using improv comedy to deliver empathy training is associated with a minor improvement in empathy scores in OB-GYN residents, which decreased at 6 months. Residents found the activity to be acceptable and reported the training would impact their clinical practice.

Women's Auto/Biography and Dissociative Identity Disorder: Implications for Mental Health Practice

Dissociative Identity Disorder (DID) is an uncommon disorder that has long been associated with exposure to traumatic stressors exceeding manageable levels commonly encompassing physical, psychological and sexual abuse in childhood that is prolonged and severe in nature. In DID, dissociation continues after the traumatic experience and produces a disruption in identity where distinct personality states develop. These personalities are accompanied by variations in behaviour, emotions, memory, perception and cognition. The use of literature in psychiatry can enrich comprehension over the subjective experience of a disorder, and the utilisation of 'illness narratives' in nursing research have been considered a way of improving knowledge about nursing care and theory development. This research explores experiences of DID through close textual reading and thematic analysis of five biographical and autobiographical texts, discussing the lived experience of the disorder. This narrative approach aims to inform empathetic understanding and support the facilitation of therapeutic alliances in mental healthcare for those experiencing the potentially debilitating and distressing symptoms of DID. Although controversies surrounding the biomedical diagnosis of DID are important to consider, the lived experiences of those who mental health nurses encounter should be priority.

Building bridges between medicine and the humanities: The role of scaffolds and articulation in surgical learning

Introduction: Learning about medicine from the humanities is a complex process that requires pedagogical strategies to avoid fragmentation and the paradox of transference. Instructional design in surgical education for these purposes is limited. Objective: To present the results of an educational strategy for the integration of surgery and the medical humanities based on the theoretical perspectives of the cognitive apprenticeship model and to assess its association with the students’ perceptions of learning. Materials and methods: An instructional design was developed for the teaching of clinical conditions through the medical humanities. Students’ perceptions of teachers’ support and articulation for the integration of both disciplines, as well as students’ self-perceptions of learning, were evaluated using validated questionnaires. Linear regression models were used to test the proposed association. Results: A total of 216 students was included in the analysis. High scores were obtained for each variable. The increase of one unit of teacher support and articulation for the integration of both disciplines was associated with an increase in student perception of learning (b) of 0.45 (CI 95% 0.30-0.60) and 0.40 (CI 95% 0.25 -0.55) (R2=0.64, p<0.001), respectively. Conclusions: Educational strategies focused on the techniques of support and articulation with the aim of integrating the medical humanities and surgery, demonstrated positive associations with students’ perceptions of learning. Further studies are needed to evaluate the effects of these interventions on memory and long-term learning.

Navigating uncertainty: Narrative medicine in pregnancy options counseling education

OBJECTIVES

Pregnancy options counseling, or nondirective counseling of patients with unintended pregnancy, is a "necessary competency" for medical students according the Association of Professors of Gynecology and Obstetrics. Narrative Medicine (NM) utilizes stories of illness to inform clinical practice and promotes self-reflection in medical education. The authors analyzed the effect of a NM workshop on medical students' ability to provide pregnancy options counseling.

METHODS

The authors randomized students in the major clinical year at Columbia University Medical Center (CUMC) to either a 2-hour NM workshop or to a control intervention. The NM group participated in reading and reflective writing exercises addressing varying perspectives on pregnancy. Students then completed a video-taped and numerically-scored OSCE (Objective Structured Clinical Examination) regarding pregnancy options counseling. The authors compared mean OSCE scores between the groups.

RESULTS

The study analyzed 103 participants. Overall mean OSCE scores were higher in the NM group (11.9 ± 1.5, n = 51) than the control group (11.3 ± 1.6, n = 52) (p = 0.049).

CONCLUSIONS

Students undergoing a NM workshop had higher scores on a pregnancy options counseling OSCE.

PRACTICE IMPLICATIONS

This brief intervention may aid future physicians in providing nondirective pregnancy options. This novel approach to teaching is an easily shared learning tool.

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.

The long-term impact of a comprehensive scholarly concentration program in biomedical ethics and medical humanities

BACKGROUND

There is a strong and growing interest in biomedical ethics and medical humanities (BEMH) within medical education for facilitating key components of medical professionalism and ethics, clinical communication and observational skills, and self-care and reflective practices. Consequently, United States (US) medical institutions have begun to incorporate BEMH through formal Scholarly Concentrations (SCs). This is the first study to examine the impact of a US BEMH SC, from student experience in medical school to post-graduate development, as perceived by graduate physicians.

METHODS

Graduated students who participated in the BEMH SC or did extensive BEMH research prior to the BEMH SC's establishment (n = 57) were sampled for maximum variation across graduating years. In telephone surveys and interviews, participants discussed the perceived impact of the BEMH SC on (a.) student experience during medical school and (b.) post-graduate development. Interviews were audiotaped, transcribed, and de-identified. The authors iteratively generated a codebook; two raters coded independently, adjudicated codes, and completed inter-rater reliability (IRR) tests. The authors subsequently conducted a team-based thematic analysis, identifying emergent themes.

RESULTS

Nineteen BEMH graduates were interviewed. Results were analyzed according to (a.) student experience and (b.) post-graduate development. Overall, respondents perceived impacts in reinforcing knowledge and skills in clinical ethics; solidifying self-care and reflective practices; refining a sense of professional identity and integrity for ethically challenging situations; and promoting student skills, productivity, and later careers involving BEMH.

CONCLUSION

A comprehensive US BEMH SC achieved the purported aims of BEMH in medical education, with graduate physicians perceiving persisting effects into clinical practice. Furthermore, the structure and format of a SC may offer additional advantages in promoting student scholarly skill and productivity, career development, and professional identity formation-core competencies identified across clinical training and ethics programs. Our findings indicate that a BEMH SC is effective in achieving a range of desired immediate and post-graduate effects and represent a particularly promising venue for BEMH in medical education. We believe these findings to be of critical significance to medical educators and administrators when considering how best to incorporate BEMH into SCs and medical curricula.

Arts-based interventions in healthcare education

Healthcare education institutions are increasingly including arts-based interventions in their programmes. We analysed 62 studies of arts-based interventions to understand how these interventions may be beneficial, and why providing evidence continues to be a challenge for the field.Our analysis highlighted two issues. We found that 79% of the included studies reported that their interventions were successful, but without always defining this success or how it was measured. This lack of clarity was apparent in descriptions of both what arts-based interventions aimed to do, and in descriptions of how they might do this. We also found that only 34% of studies involved a collaboration with artists or arts educators, raising questions over who had the necessary experience and specialism in the arts to design and deliver such interventions.Our analysis revealed that arts-based interventions are failing to acknowledge, and subsequently capture through assessment, the process of learning in the moment. This is particularly important because arts-based pedagogies typically use embodied, practical, physical methods, in which what is being learnt cannot be separated from the process of learning. Involving artists and arts educators throughout the process of designing and delivering these interventions may help to bring clarity over what arts-based interventions are aiming to do and how they may do this, and ensure that appropriate evaluation methods are used. We suggest that close observation with feedback, and the use of reflective portfolios are two ways of assessing the process of learning in arts-based interventions.

The Medical Humanities Effect: a Pilot Study of Pre-Health Professions Students at the University of Rochester

Qualitative and quantitative research on the impact of medical and health humanities teaching in baccalaureate education is sparse. This paper reviews recent studies of the impact of medical and health humanities coursework in pre-health professions education and describes a pilot study of baccalaureate students who completed semester-long medical humanities courses in the Division of Medical Humanities & Bioethics at the University of Rochester. The study format was an email survey. All participants were current or former baccalaureate students who had taken one or more courses in literature and narrative in medicine, bioethics, history of medicine, and/or visual arts and healthcare during the past four years. The survey gathered numerical data in several areas: demographic information, career plans, self-reported influence of coursework on educational and career plans, and self-reported influence of coursework on intellectual skills and abilities. It also gathered narrative commentary that elaborated on students' responses to the numerically-based questions. Notable findings from preliminary analysis of the data include higher scores of self-reported impact of the coursework on specific habits of mind and on preparedness for intended career rather than on gaining admission to future educational programs. Discussion of the results focuses on several potential future directions this type of study might take, including multi-center, longitudinal, and sequential approaches.

Fostering Flu Vaccination in Healthcare Workers: Forum Theatre in a University Hospital

Background

The World Health Organization recommends flu vaccination as the most effective way to prevent the disease and its severe outcomes and has established the minimum vaccination coverage for people at risk at 75%. Even though healthcare workers (HCWs) represent a strongly recommended target group for flu vaccination campaigns, the average coverage among them is still inadequate. In flu season 2015/2016, our University Hospital tested Forum Theatre (FT) as a new participative strategy to foster HCWs engagement regarding flu vaccination. The aim of this study was to evaluate HCWs’ satisfaction with and perceived utility of FT.

Material/Methods

In 2015, five FT sessions were organized in hospital units which were considered at risk for flu based on the type of admitted patients. After each session, participants were asked to complete an assessment questionnaire. The χ² test or the t-test was used to compare the proportion of participants who were satisfied with the FT and considered it useful (utility score). Data was analyzed according to gender, profession, and age.

Results

In all, 16.5% of HCWs who worked in four out of five of the units identified, participated in the FT sessions. Questionnaire results indicated that 74% of spectators were satisfied with their experience and 70% considered this methodology a useful approach for other health issues. Gender, age, and profession did not influence satisfaction or utility scores.

Conclusions

Participative strategies such as FT represent an innovative solution to increasing HCWs’ awareness of the importance of flu vaccination and could positively impact their adherence to vaccination recommendations. FT can also be a meaningful HCW teaching tool for learning about and changing attitudes toward other clinic and public health issues.

Impact of a fictional reading intervention on empathy development in student pharmacists

OBJECTIVE

Determine the impact of a short longitudinal literary fiction intervention on empathy development in student pharmacists as measured by the Jefferson Scale of Empathy - Health Profession Students (JSE-HPS) version.

METHODS

Twenty-one student pharmacists were randomized to an intervention consisting of reading short excerpts of literary fiction over eight weeks (n=11) or a control group not participating in the intervention (n=10). Both groups completed the JSE-HPS at baseline and completion of the literary intervention. Categorical data were compared using a chi-square or Fisher's exact test, and continuous data were compared using paired or independent t-tests for within and across group comparisons respectively.

RESULTS

JSE-HPS scores increased in the intervention group (112.1±10.7 to 116.1±7.4; p=0.201) while they decreased in the control group (118.7±12.6 to 113.0±15.9; p=0.188). Changes across groups were not statistically significant (p=0.061).

CONCLUSIONS

Students randomized to an eight-week literature intervention demonstrated a non-statistically significant increase in empathy as measured by the JSE-HPS questionnaire. Similar increases were not observed in students randomized to a control group. As a result, this intervention may represent a novel way to foster empathy in student pharmacists using an intervention requiring few resources. Further research is needed with larger sample sizes, ideally across multiple institutions, in order to validate the effectiveness of this intervention.

Medical humanities play an important role in improving the doctor-patient relationship

Doctors in China have been wounded or even killed in frequent violence as conflict between doctors and patients has intensified. China has had a massive dearth of medical students over the past decade and doctors are dissatisfied with conditions in their profession. Conditions in medicine are not conducive to medical reform. This paper notes that the main factors affecting the doctor-patient relationship are a lack of humanity in medicine, the predominance of techniques and technologies, and inappropriate administration of hospitals. These factors are related to a lack of medical humanities. This paper describes several steps to make medicine more humane and to help establish a harmonious doctor-patient relationship, including improved humanities education for doctors and medical students, ending the predominance of techniques and technologies, bringing back "humanity" in medicine, and improving the administration of hospitals.

Looking and listening for learning in arts- and humanities-based creations

CONTEXT

The arts and humanities are gradually gaining a foothold in health professions education as a means of supporting the development of future clinicians who are compassionate, critical and reflexive thinkers, while also strengthening clinical skills and practices that emphasise patient-centredness, collaboration and interprofessional practices. Assignments that tap into trainee creativity are increasingly used both to prepare learners for the demands of clinical work and to understand the personal and professional challenges learners face in these contexts. Health professions educators need methods for interpreting these creations in order to understand each learner's expressions. This paper describes two theoretical frameworks that can be used to understand trainees' unique learning experiences as they are expressed in arts- and humanities-based creations.

METHODS

The authors introduce the philosophical underpinnings and interpretation procedures of two theoretical frameworks that enable educators to 'hear' and 'see' the multilayered expressions embedded within arts- and humanities-based student creations: Gilligan's Listening Guide and Kress and van Leeuwen's approach to visual rhetoric. To illustrate how these frameworks can be used, the authors apply them to two creative summaries that learners made as part of a humanities-informed, interprofessional education intervention that took place in a non-acute-care teaching hospital. The interpretations of two creative summaries, a poem and a pair of paintings, highlight how applying these theoretical frameworks can offer important insights into learners' experiences.

CONCLUSIONS

This cross-cutting edge paper describes how the Listening Guide and visual rhetoric can help health professions educators listen to and read the arts- and humanities-based creative expressions made by learners. Insights gained from these interpretations can advance the understanding of students' personal experiences in different learning environments and can inform curriculum development.

Italian translation and cultural adaptation of the communication assessment tool in an outpatient surgical clinic

Background

The aim of the study is to translate and cross-culturally adapt, for use in the Italian context, the Communication Assessment Tool (CAT) developed by Makoul and colleagues.

Methods

The study was performed in the out-patient clinic of the Surgical Department of Cardarelli Hospital in Naples, Italy. It involved a systematic, standardized, multi-step process adhering to internationally accepted and recommended guidelines. Corrections and adjustments to the translation addressed both linguistic factors and cultural components.

Results

The CAT was translated into Italian by two independent Italian mother-tongue translators. The consensus version was then back-translated by an English mother-tongue translator. This translation process was followed by a consensus meeting between the authors of translation and investigators, and then by two comprehension tests on a total of 65 patients.

Conclusions

Results of the translation and cross-cultural adaptation were satisfactory and indicate that the Italian translation of the CAT can be used with confidence in the Italian context.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1411-9) contains supplementary material, which is available to authorized users.

A review of creative and expressive writing as a pedagogical tool in medical education

CONTEXT

The act of writing offers an opportunity to foster self-expression and organisational abilities, along with observation and descriptive skills. These soft skills are relevant to clinical thinking and medical practice. Medical school curricula employ pedagogical approaches suitable for assessing medical and clinical knowledge, but teaching methods for soft skills in critical thinking, listening and verbal expression, which are important in patient communication and engagement, may be less formal. Creative and expressive writing that is incorporated into medical school courses or clerkships offers a vehicle for medical students to develop soft skills. The aim of this review was to explore creative and expressive writing as a pedagogical tool in medical schools in relation to outcomes of medical education.

METHODS

This project employed a scoping review approach to gather, evaluate and synthesise reports on the use of creative and expressive writing in US medical education. Ten databases were searched for scholarly articles reporting on creative or expressive writing during medical school. Limitation of the results to activities associated with US medical schools, produced 91 articles. A thematic analysis of the articles was conducted to identify how writing was incorporated into the curriculum.

RESULTS

Enthusiasm for writing as a pedagogical tool was identified in 28 editorials and overviews. Quasi-experimental, mixed methods and qualitative studies, primarily writing activities, were aimed at helping students cognitively or emotionally process difficult challenges in medical education, develop a personal identity or reflect on interpersonal skills. The programmes and interventions using creative or expressive writing were largely associated with elective courses or clerkships, and not required courses.

CONCLUSIONS

Writing was identified as a potentially relevant pedagogical tool, but not included as an essential component of medical school curricula.

Rethinking research in the medical humanities: a scoping review and narrative synthesis of quantitative outcome studies

OBJECTIVES

The rise of medical humanities teaching in medical education has introduced pressure to prove efficacy and utility. Review articles on the available evidence have been criticised for poor methodology and unwarranted conclusions. To support a more nuanced discussion of how the medical humanities work, we conducted a scoping review of quantitative studies of medical humanities teaching.

METHODS

Using a search strategy involving MEDLINE, EMBASE and ERIC, and hand searching, our scoping review located 11 045 articles that referred to the use of medical humanities teaching in medical education. Of these, 62 studies using quantitative evaluation methods were selected for review. Three iterations of analysis were performed: descriptive, conceptual, and discursive.

RESULTS

Descriptive analysis revealed that the medical humanities as a whole cannot be easily systematised based on simple descriptive categories. Conceptual analysis supported the development of a conceptual framework in which the foci of the arts and humanities in medical education can be mapped alongside their related epistemic functions for teaching and learning. Within the framework, art functioned as expertise, as dialogue or as a means of expression and transformation. In the discursive analysis, we found three main ways in which the relationship between the arts and humanities and medicine was constructed as, respectively, intrinsic, additive and curative.

CONCLUSIONS

This review offers a nuanced framework of how different types of medical humanities work. The epistemological assumptions and discursive positioning of medical humanities teaching frame the forms of outcomes research that are considered relevant to curriculum decision making, and shed light on why dominant review methodologies make some functions of medical humanities teaching visible and render others invisible. We recommend the use of this framework to improve the rigor and relevance of future explorations of the efficacy and utility of medical humanities teaching.

Developing and Evaluating Medical Humanities Problem-Based Learning Classes Facilitated by the Teaching Assistants Majored in the Liberal Arts: A Longitudinal Crossover Study

Although medical humanities courses taught by teachers from nonmedical backgrounds are not unusual now, few studies have compared the outcome of medical humanities courses facilitated by physicians to that by teaching assistants majored in the liberal arts. The objectives of this study were to (1) analyze the satisfaction of medical students with medical humanities problem-based learning (PBL) classes facilitated by nonmedical teaching assistants (TAF) majored in the liberal arts, and those facilitated by the attending physicians (APF) and (2) examine the satisfaction of medical students with clinical medicine-related and clinical medicine-unrelated medical humanities PBL classes.A total of 123 medical students, randomly assigned to 16 groups, participated in this study. There were 16 classes in the course: 8 of them were TAF classes; and the others were APF classes. Each week, each group rotated from 1 subject of the 16 subjects of PBL to another subject. All of the 16 groups went through all the 16 subjects in the 2013 spring semester. We examined the medical students' satisfaction with each class, based on a rating score collected after each class was completed, using a scale from 0 (the lowest satisfaction) to 100 (the highest satisfaction). We also conducted multivariate linear regression analysis to examine the association between the independent variables and the students' satisfaction.Medical students were more satisfied with the TAF (91.35 ± 7.75) medical humanities PBL classes than APF (90.40 ± 8.42) medical humanities PBL classes (P = 0.01). Moreover, medical students were more satisfied with the clinical medicine-unrelated topics (92.00 ± 7.10) than the clinical medicine-related topics (90.36 ± 7.99) in the medical humanities PBL course (P = 0.01).This medical humanities PBL course, including nonmedical subjects and topics, and nonmedical teaching assistants from the liberal arts as class facilitators, was satisfactory. This pedagogical approach of student-centered, nonmedical topics, nonmedical facilitators, and small groups, which is associated with a deep approach to learning medical humanities, should be highly encouraged.

The Humanities in Medical Education: Ways of Knowing, Doing and Being

The personhood of the physician is a crucial element in accomplishing the goals of medicine. We review claims made on behalf of the humanities in guiding professional identity formation. We explore the dichotomy that has evolved, since the Renaissance, between the humanities and the natural sciences. The result of this evolution is an historic misconstrual, preoccupying educators and diverting them from the moral development of physicians. We propose a curricular framework based on the recovery of Aristotelian concepts that bridge identity and activity. The humanities and the natural sciences, jointly and severally, can fulfill developmental, characterological and instrumental purposes.

Seven Types of Ambiguity in Evaluating the Impact of Humanities Provision in Undergraduate Medicine Curricula

Inclusion of the humanities in undergraduate medicine curricula remains controversial. Skeptics have placed the burden of proof of effectiveness upon the shoulders of advocates, but this may lead to pursuing measurement of the immeasurable, deflecting attention away from the more pressing task of defining what we mean by the humanities in medicine. While humanities input can offer a fundamental critical counterweight to a potentially reductive biomedical science education, a new wave of thinking suggests that the kinds of arts and humanities currently used in medical education are neither radical nor critical enough to have a deep effect on students' learning and may need to be reformulated. The humanities can certainly educate for tolerance of ambiguity as a basis to learning democratic habits for contemporary team-based clinical work. William Empson's 'seven types of ambiguity' model for analyzing poetry is transposed to medical education to: (a) formulate seven values proffered by the humanities for improving medical education; (b) offer seven ways of measuring impact of medical humanities provision, thereby reducing ambiguity; and

"I wanted to communicate my feelings freely": a descriptive study of creative responses to enhance reflection in palliative medicine education

BACKGROUND

The recent growth of arts and humanities in medical education shows recognition that these disciplines can facilitate a breadth of thinking and result in personal and professional growth. However creative work can be a challenge to incorporate into a busy curriculum. Offering the option of creative media as a way of reflecting is an example of how this can occur. This study aimed to examine the medical student response to being given this option to explore a visit to a patient in a hospice.

METHODS

This was a mainly qualitative study. In the 2012 academic programme, the class of 86 students were given the option of using a creative medium to explore their responses to both the visit and their developing communication skills. Students were required to write an accompanying commentary if submitting the creative work option. Sixty-four percent of the class chose a creative medium e.g. poetry, visual art, narrative prose, music. These students were asked to take part in research including completing a short on-line survey and consenting for their creative work and commentaries to be further examined. The creative works were categorised by genre and the commentaries analysed using inductive thematic analysis.

RESULTS

Seventeen students completed the on-line survey and fifteen consented to their work being used for this research. Thematic analysis of the student commentaries revealed the following themes: effectiveness for expressing emotion or ideas that are difficult to articulate; engaging and energising quality of the task; time for reflection; flexibility for individual learning styles and therapeutic value.

CONCLUSIONS

Teaching the art of communicating at end-of-life is challenging especially when it involves patients, and teachers want to ensure students gain as much as possible from the experience. Offering the option to use creative media means that students can choose a medium for reflection that best suits them as individuals and that can enable them to benefit as much as possible from their experience.

Providing context for a medical school basic science curriculum: The importance of the humanities

INTRODUCTION

To increase students' understanding of what it means to be a physician and engage in the everyday practice of medicine, a humanities program was implemented into the preclinical curriculum of the medical school curriculum. The purpose of our study was to determine how medical students' views of being a doctor evolved after participating in a required humanities course.

METHODS

Medical students completing a 16-clock hour humanities course from 10 courses were asked to respond to an open-ended reflection question regarding changes, if any, of their views of being a doctor. The constant comparative method was used for coding; triangulation and a variety of techniques were used to provide evidence of validity of the analysis.

RESULTS

A majority of first- and second-year medical students (rr = 70%) replied, resulting in 100 pages of text. A meta-theme of Contextualizing the Purpose of Medicine and three subthemes: the importance of Treating Patients Rather than a Disease, Understanding Observation Skills are Important, and Recognizing that Doctors are Fallible emerged from the data.

CONCLUSIONS

Results suggest that requiring humanities as part of the required preclinical curriculum can have a positive influence on medical students and act as a bridge to contextualize the purpose of medicine.

Elective courses for medical students during the preclinical curriculum: a systematic review and evaluation

OBJECTIVE

Preclinical medical student electives are prevalent at medical schools across the United States, but the range of electives available and their impact on medical student education are not well described in the literature. The objective of this article is to review the literature relating to preclinical medical student electives and their impact on medical student educational outcomes.

METHODS

We reviewed studies that met the following criteria: English-language articles describing preclinical US-based medical electives. We used PubMed journal databases and limited our search for the time period 1999-2014. We excluded electives based in other countries or electives designed for third or fourth year students. Data abstracted included the topic of the elective, qualitative descriptions of the electives, and any associated surveys or exam data associated with the electives. Data were synthesized using descriptive tables sorting electives by broad topic. Reported outcomes and statistical methods were analyzed to assess study quality.

RESULTS

We found a wide range of subjects taught in the form of preclinical medical school electives. We identified electives in clinical skills, the humanities, student lifestyle, specialty-specific electives, and an assortment of other miscellaneous electives. Surveys and exams administered to students showed that the electives were universally well received by students. Of the 37 electives identified, 15 electives used quantitative objective assessments, such as knowledge exams, while the remaining tended to use student self-reported results.

CONCLUSIONS

Preclinical medical student electives are prevalent at medical schools across the United States and have a significant impact on medical student education.

Learning collaborative teamwork: an argument for incorporating the humanities

A holistic, collaborative interprofessional team approach, which includes patients and families as significant decision-making members, has been proposed to address the increasing burden being placed on the health-care system. This project hypothesized that learning activities related to the humanities during clinical placements could enhance interprofessional teamwork. Through an interprofessional team of faculty, clinical staff, students, and patient representatives, we developed and piloted the self-learning module, "interprofessional education for collaborative person-centred practice through the humanities". The module was designed to provide learners from different professions and educational levels with a clinical placement/residency experience that would enable them, through a lens of the humanities, to better understand interprofessional collaborative person-centred care without structured interprofessional placement activities. Learners reported the self-paced and self-directed module to be a satisfactory learning experience in all four areas of care at our institution, and certain attitudes and knowledge were significantly and positively affected. The module's evaluation resulted in a revised edition providing improved structure and instruction for students with no experience in self-directed learning. The module was recently adapted into an interactive bilingual (French and English) online e-learning module to facilitate its integration into the pre-licensure curriculum at colleges and universities.