Progress integrating medical humanities into medical education: a global overview

Meaningful Connections: Exploring the Relationship Between Empathy and Professional Identity Formation

OBJECTIVE

To describe the literature on the connections between empathy and professional identity formation (PIF) in pharmacy and other health professions education. A PRISMA-Scoping Review methodology was used for this study. Searches were conducted in PubMed and CINAHL from 2010 to January 12, 2023, with English added as a limiter. Articles had to address empathy and PIF, whether implicitly or explicitly. "Theory talk" was modified and utilized with 6 levels of connectedness to assess article quality.

FINDINGS

A total of 419 articles were reviewed for inclusion into the study with a total of 45 articles being included. Seventeen (37.8 %) and 12 articles (26.7 %) included a definition for empathy and PIF, respectively. Thirty-eight articles (84.4 %) implicitly discussed a connection between PIF and empathy. Educational initiatives that fostered connections between empathy and PIF focused on classroom activities, clinical rotation activities, and assessments. Key elements to enhance empathy and PIF development across articles focused on mentorship, role models, and reflective practice, alongside intentional curricular integration. Similarly, barriers to empathy and PIF are multifaceted.

SUMMARY

Despite educational initiatives in the literature that attempt to foster connections between empathy and PIF in classroom activities, clinical rotation activities, and assessments, most connections are implicit, as opposed to explicit. This may be due to the multiple barriers, such as the hidden curriculum, which make the connection between empathy and PIF difficult. This area needs further research and development given the importance of empathy in all health care provider interactions.

Nurturing Empathy through Arts, Literature, and Role Play for Postgraduate Trainees of Ophthalmology

Background and Purpose

Empathy is essential in patient-centered compassionate health care. Lack of formal training, workload, patient factors, and digitalization have been attributed to its regression. Empathy can be nurtured by educational interventions. A structured empathy education module for postgraduate trainees is not available in India. The aim for this research was to develop, deliver, and evaluate one for ophthalmology postgraduate trainees.

Methodology

This interventional study was conducted in the tertiary ophthalmology department of Western India during 2022-2023. Four workshops comprising of interactive lectures, literature, creative arts, and role plays were delivered with trained facilitators. Data from surveys for trainee self-assessment, patient perception of trainee empathy, pre-post knowledge test, and trainee and facilitator feedback were collected and analyzed.

Results

Seventy-nine ophthalmology postgraduate trainees participated in this intervention. Excessive workload and lack of training were shared as the barriers to empathetic care. Trainees showed improved knowledge, skills, and attitude in empathy after the workshops. The facilitators and trainees were satisfied with the learning goals, execution, utility, feasibility, and relevance of the workshops. Ninety-three percent trainees want this module to be a part of postgraduate curriculum.

Conclusion

This study substantiates the use of structured interactive training for cultivating empathy in postgraduate trainees. Barriers against empathy were identified and can be mitigated by restorative measures. Literature, arts, and role plays are the effective education tools for empathy.

Scenario- and discussion-based approach for teaching preclinical medical students the socio-philosophical aspects of psychiatry

BACKGROUND

This study used a scenario- and discussion-based approach to teach preclinical medical students the socio-philosophical aspects of psychiatry and qualitatively evaluated the learning outcomes in a medical humanities course in Taiwan.

METHODS

The seminar session focused on three hypothetical psychiatry cases. Students discussed the cases in groups and were guided by facilitators from multiple disciplines and professions. At the end of the semester, students submitted a narrative report comprising their reflections on the cases and discussions. The authors utilized content analysis to categorize students' narratives into three facets, namely, the philosophical, social and individual.

RESULTS

In total 163 preclinical medical students participated in the class; 150 of them mentioned the scenario-based lesson in their reports; 33.3% of these reports discussed the case at the philosophical dimension (n = 50), 45.3% at the social dimension (n = 68), and 26.6% at the individual dimension (n = 40). Four major themes emerged: (1) a psychiatric diagnosis has far-reaching consequences for an individual's life, (2) the social structure affects how patients experience psychiatric disorders, (3) students related personal experience or those of friends and family to understand psychiatric disorders, and (4) medical humanities are of particular importance in psychiatric education.

CONCLUSIONS

This study demonstrated that the scenario-based discussions led by a multidisciplinary team of facilitators can benefit medical students with limited clinical experience to contemplate the socio-philosophical aspects of psychiatry. The authors suggest that this pedagogical model during preclinical education should be encouraged.

Black, White and Gray: Student Perspectives on Medical Humanities and Medical Education

ISSUE

In recent years, the value and relevance of humanities-based teaching in medical education have become more widely acknowledged. In many medical schools this has prompted additions to curricula that allow students to explore the gray-as opposed to the black and white-areas of medicine through arts, humanities, and social sciences. As curricula have expanded and diversified in this way, both medical educators and students have begun to ask: what is the best way to teach medical humanities?

EVIDENCE

In this article, five current medical students reflect on their experiences of medical humanities teaching through intercalated BSc programmes in the UK. What follows is a broad exploration of how the incorporation of medical humanities into students' time at university can improve clinical practice where the more rigid, objective-driven, model of medicine falls short.

IMPLICATIONS

This article reinforces the merit of moving beyond a purely biomedical model of medical education. Using the student voice as a vector for critique and discussion, we provide a starting point for uncovering the path toward true integration of humanities-style teaching into medical school curricula.

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.

Accepting the Incomprehensible: What Samuel Beckett Can Tell Psychiatrists Today

ABSTRACT

The aim of this article is to propose that reading Samuel Beckett's novels can improve compassionate acceptance of mental phenomena and human behavior deemed incomprehensible. In a narrative inquiry into all of Beckett's novels, we could discern nihilism and existential insecurity as themes both central to Beckett's prose and relevant in working with people with severe mental disorders. By deconstructing narrative structures and struggling to say the unsayable, Beckett can provide a perspective that goes beyond rational understanding. Beckett's prose can extend our imagination of mental and embodied phenomena by describing absurd and incomprehensible aspects of human experience and behavior. His unique sense of humor in dealing with bleak, meaningless situations and the acceptance and perseverance that his characters show in their struggles could help promote compassionate therapeutic relationships and improve clinical teaching in psychiatry. This can help psychiatrists and patients to face the existential aspects of mental illness, "limit situations" according to Jaspers, in a manner both respectful and open to subjective views.

Healthcare Management and the Humanities: An Invitation to Dialogue

Throughout the fields of medicine and organization studies, there are growing indications of the value of the humanities for enriching scholarship, education, and practice. However, the field of healthcare management has yet to consider the promise of the humanities for illuminating its particular domain. This perspective paper explores how the humanities might begin to play a role in healthcare management by focusing on three broad areas: (1) understanding the lived experiences of management, (2) offsetting the "tyranny of metrics", and (3) confronting rather than avoiding anxiety. While preliminary in presentation, these areas are intended to facilitate wider consideration of the humanities in healthcare management and to encourage interdisciplinary dialogue. The paper also identifies actionable approaches that might be derived from such a dialogue, including substantiating critical healthcare management scholarship, collaborating with humanities educators to design novel curricula, proposing alternatives to unduly circumscribed performance targets and competency assessments, creating case studies of formative experiences of practicing healthcare managers, and advancing guidelines for better managing anxiety and its concomitant stress, burnout, and compassion fatigue in healthcare organizations. The paper concludes by discussing the potential risks of incorporating the humanities into healthcare management, while also offering a prospective synthesis from an interdisciplinary approach.

Motivations for and Challenges in the Development of Global Medical Curricula: A Scoping Review

PURPOSE

The aim of this scoping review is to understand the motivations for the creation of global medical curricula, summarize methods that have been used to create these curricula, and understand the perceived premises for the creation of these curricula.

METHOD

In 2018, the authors used a comprehensive search strategy to identify papers on existing efforts to create global medical curricula published from 1998 to March 29, 2018, in the following databases: MEDLINE; MEDLINE Epub Ahead of Print, In-Process, and Other Non-Indexed Citations; Embase; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; PsycINFO; CINAHL; ERIC; Scopus; African Index Medicus; and LILACS. There were no language restrictions. Two independent researchers applied the inclusion and exclusion criteria. Demographic data were abstracted from publications and summarized. The stated purposes, methods used for the development, stated motivations, and reported challenges of curricula were coded.

RESULTS

Of the 18,684 publications initially identified, 137 met inclusion criteria. The most common stated purposes for creating curricula were to define speciality-specific standards (50, 30%), to harmonize training standards (38, 23%), and to improve the quality or safety of training (31, 19%). The most common challenges were intercountry variation (including differences in health care systems, the operationalization of medical training, and sociocultural differences; 27, 20%), curricular implementation (20, 15%), and the need for a multistakeholder approach (6, 4%). Most curricula were developed by a social group (e.g., committee; 30, 45%) or Delphi or modified Delphi process (22, 33%).

CONCLUSIONS

The challenges of intercountry variation, the need for a multistakeholder approach, and curricular implementation need to be considered if concerns about curricular relevance are to be addressed. These challenges undoubtedly impact the uptake of global medical curricula and can only be addressed by explicit efforts to make curricula applicable to the realities of diverse health care settings.

Holding a mirror up to nature: the role of medical humanities in postgraduate primary care training

The humanities are academic disciplines that study aspects of human society, experience and culture. Typically, the humanities, including philosophy, literature, art, music, history and language have been used to interpret and record our understanding of the world. In recent decades, the humanities have seen somewhat of a renaissance within medicine, particularly within undergraduate medical education. This leading article explores the value of utilising medical humanities, such as art, poetry and theatre, within postgraduate primary care training. Using examples of approaches already interwoven into the fabric of undergraduate medical education, such as simulated patient consultations and anatomical body painting, the tangible benefits of applying humanities disciplines within general practice training are discussed. The humanities have much to offer from the value of utilising an artistic lens to examine the body, the creation of socially cohesive working environments and supporting the development of empathy within trainees. This article recommends the provision of both increased informal and formal engagement with the medical humanities within postgraduate primary care training, providing practical tips for GP educators looking to integrate the humanities within pre-existing tutorials.

Alignment of Ethics Curricula in Medical Education: A Student Perspective

Issue: Although there is consensus on the importance of including ethics in the medical school curriculum, there is wide variation in how this topic is taught. Recent literature also questions the effectiveness of current ethical teaching methods in changing student attitudes and future behavior. Furthermore, from the student perspective, there is a marked disconnect between the stated importance of and lack of effort in ethics courses. Evidence: Applying a student perspective of the hidden curriculum, as well as reviewing and applying insight from the available literature, we advocate for alignment of instructional design, content, and assessments. This article provides specific recommendations to increase student engagement in ethics courses and concludes by discussing whether a lack of engagement is attributable to intrinsic qualities of medical students in addition to pedagogical technique and educational setting and culture. Implications: This article has practical suggestions for medical educators to improve their ethics courses, leading to more well-rounded and thoughtful physicians.

Impact and educational outcomes of a small group self-directed teaching strategy in a clinical neuroscience curriculum

The complexity of the material being taught in clinical neuroscience within the medical school curriculum requires creative pedagogies to teach medical students effectively. Many clinical teaching strategies have been developed and are well described to address these challenges. However, only a few have been evaluated to determine their impact on the performance of students studying clinical neuroscience. Interactive, 2-hour, self-directed small-group interactive clinical case-based learning sessions were conducted weekly for 4 weeks to integrate concepts learned in the corresponding didactic lectures. Students in the small groups analyzed cases of patients suffering from neurological disease that were based on eight learning objectives that allowed them to evaluate neuroanatomical data and clinical findings before presenting their case analysis to the larger group. Students' performances on the formative quizzes and summative tests were compared to those of first-year medical students in the previous year for whom the self-directed, small-group interactive clinical sessions were not available. There was a significant improvement in the summative performance of first-year medical students with self-directed clinical case learning in the second year (Y2) of teaching clinical neuroscience (P < 0.05) when compared with first-year students in the first year (Y1) for whom the self-directed learning approach was not available. Student performance in the formative assessments between Y1 and Y2 was not significantly different (P = 0.803). A target of ≥70% student scoring above 80% in the final summative examination was met. The current study revealed evidence for the impact and educational outcomes of a self-directed, clinical teaching strategy in a clinical neuroscience curriculum for first-year medical students. Anat Sci Educ 11: 478-487. © 2017 American Association of Anatomists.

Addressing Professionalism, Social, and Communication Competencies in Surgical Residency Via Integrated Humanities Workshops: A Pilot Curriculum

OBJECTIVE

We aimed to conduct professionalism and social competencies (PSC) training by integrating humanities into structured workshops, and to assess reception of this curriculum by first-year surgical residents.

DESIGN

An IRB-approved, pilot curriculum consisting of 4 interactive workshops for surgical interns was developed. The workshops were scheduled quarterly, often in small group format, and supplemental readings were assigned. Humanities media utilized to illustrate PSC included survival scenarios, reflective writing, television portrayals, and social media. Emphasis was placed on recognizing personal values and experiences that influence judgment and decision-making, using social media responsibly, identifying and overcoming communication barriers related to generational changes in training (especially technology and work-life balance), and tackling stereotypes of surgeons. Anonymous and voluntary pre- and postcurriculum surveys were administered. Univariate analysis of responses was performed with JMP Pro v12 using Fisher's exact, χ², and Students' t-tests for categorical and continuous variables.

SETTING

The study took place at the Cleveland Clinic in Cleveland, OH, within the general surgery program.

PARTICIPANTS

Surgical interns at the Cleveland Clinic were included in the study. A total of 16 surgical interns completed the curriculum.

RESULTS

Sixteen surgical interns participated in the curriculum: 69% were domestic medical school graduates (DG) and 31% were international medical school graduates (IMG). Overall, the majority (81%) of residents had received PSC courses during medical school: 100% of DG compared to 40% of IMG (p = 0.02). Before beginning the curriculum, 86% responded that additional PSC training would be useful during residency, which increased to 94% upon completion (p = 0.58). Mean number of responses supporting the usefulness of PSC training increased from 1.5 ± 0.2 before the curriculum to 1.75 ± 0.2 upon completion (p = 0.4). When describing public and medical student perceptions of surgeons, 60% and 83% of adjectives used were negative, respectively. When describing perceptions of female surgeons, 88% of adjectives used were negative.

CONCLUSIONS

Most interns received prior PSC coursework; however, the majority still desired additional training during residency. After completion, a greater percentage of interns responded that PSC training was important and choose more reasons in favor of the curriculum. Formalized didactics should be strongly considered, especially in programs with IMG. Future areas of investigation include expanding the cohort to additional years of residency; potentially identifying unique PSC needs for each postgraduate year.

Old man-young man: T.S. Eliot's Gerontion and the problem of identity

BACKGROUND

In his poem Gerontion (1920) Nobel laureate T.S. Eliot uses powerful language to give a fictional, highly condensed, first-person account of medical and psychological conditions that arise with old age: physical frailty, cognitive decline, sensory impairment, depressive symptoms with embitterment, social withdrawal and the psychological strain of having to face old age and make meaning of one's life. Surprisingly, he wrote the poem as a young man.

METHODS

In this qualitative study, we used a hermeneutic approach to interpret Gerontion from a psychiatric perspective. We considered how Gerontion could help us to further an empathic understanding of these mental states, why a young man expresses himself through the voice of an old man and how the depressed-aggressive tone of the poem with its contempt and anti-Semitism can be interpreted.

CONCLUSIONS

We concluded that Eliot was grappling with his identity as an American in England, as a sexually inhibited husband to a demanding wife, as a banker and poet and as someone who had witnessed the effects of WWI. Readers of the poem can simultaneously experience the suffering of an old man and the identity crisis of a young man. The poem can thus further insight into the development of contempt and promote empathy and professionalism in dealing with states such as late-life depression. Consequently it is well suited for use in medical classes on these issues, particularly because it is much shorter than a novel or film.