Over the weekend, The New York Times published an opinion piece urging medical schools to more fully integrate humanities courses and themes into their curriculum. The op-ed, written by Dr. Molly Worthen, a historian at the University of North Carolina at Chapel Hill, notes that amidst the covid crisis and student transitions to distance learning, humanities classes proliferated. Worthen discusses the usefulness of these topics when addressing questions relevant to modern healthcare. “This is the moment for champions of the medical humanities to strike. To make sense of disproportionate Covid death rates in Black and Latino communities or white evangelicals’ vaccine resistance, researchers need to consider everything from the history of redlining to theologies of God’s judgment. They cannot afford to stay in highly specialized lanes or rely solely on the familiar quantitative methods of the medical sciences.”
Dr. Worthen’s piece is just the latest among recent efforts in the healthcare community to call attention to the benefits that humanities and the arts provide within the medical curriculum. Last year, the AAMC published a report titled, The Fundamental Role of the Arts and Humanities in Medical Education. The report identified four aspects of medical training that are improved by the integration of the arts and humanities: 1) Mastering skills – improving clinical care capabilities (e.g., case presentation, critical thinking); 2) Taking perspective – showcasing the sometimes contradictory perspectives of patients and others in clinical situations; 3) Personal insight – nurturing reflection and self-understanding to promote personal wellbeing and resilience; and 4) Social advocacy – urging students to assess and improve norms when identifying and rectifying potential inequities and injustices within health care.
While the report found that most medical schools have, to varying extents, incorporated arts and humanities into their curriculums, the potential benefits have yet to be fully realized because of inconsistencies. The report details “significant variation in the content, curricula integration, teaching methods, and evaluation methods” in MD programs, and recommends ways they could both improve and assess the benefits. A few of the recommendations direct medical schools to demonstrate the linkages between humanities coursework and core physician competencies, as well as increase the collaboration between faculty, students, patients, and partners in the arts and humanities to create and implement programs.
The report also details a few of the noteworthy humanities programs currently offered in medical schools.
- Jazz and the Art of Medicine at Penn State: This four-week elective is offered to senior-level students. Students are asked to listen to jazz music, the give and take between the lead and accompanying musicians, then relate it to standard conversations facilitated by physicians with patients. At its core, the course is about how to listen and respond, rather than simply going through the motions. Students practice these improvisational techniques in clinical visits, which allows them to improve their listening and response skills while under real time constraints. The students are also encouraged to play to their strengths and thoughtfully and proactively build their communication style as care providers. A study that compared 30 of the students to a control group showed that they displayed statistically significant and meaningful gains in adaptability and listening.
- My Life, My Story at VA Boston Healthcare System: This program is integrated into students’ clinical work, though it does require additional time outside of standard rounds. Students work with military veterans to help them compose a personal narrative which, with the patient’s permission, is entered into their electronic medical record. This promotes the idea of patient-centered care and demonstrates to the medical students the benefits of knowing and understanding a patient as a complex human being. In qualitative assessments, students described the power of the exercise as being the “best thing they’ve done in medical school,” with many stating that they wish they knew more of their patients so intimately.
- Program in Bioethics and Film at Stanford: Events are integrated throughout the curriculum. Students watch documentaries and films about health issues and medical care. Faculty then lead small group discussions about how gaining additional insight into people’s lives and experiences may drive a physician’s thinking when working with patients, as well as in their role as care providers in a community. These small groups also delve into topics in medical ethics, culture and perspective, and communication. While the incorporation of the film events throughout the curriculum make it difficult to measure the program’s affect, faculty say that they can see the impact on students by the quality of the discussions and student conversations afterwards.
In 2019 Richard Ratzan, MD published a piece in JAMA, How to Fix the Premedical Curriculum – Another Try, in which he described the importance of taking humanities courses as a prerequisite for understanding the human condition, and thus medicine. He recommended that medical school admissions officers boldly look for students who majored in the humanities, with science classes as options on the side. He wrote, “... No premed majors need apply; the science training will come after acceptance.” While this provocative stance has not been wholly accepted by the medical community, the many proponents of the medical humanities are gaining attention. Admissions committees are looking for more well-rounded students who understand that there are many lenses through which a physician must look to see, hear, and heal a patient. Dr. Worthen’s editorial stated it potently, “… medicine is not a science but an art that uses science as one of many tools … The scale of the Covid crisis should force both scientists and humanists to ask new questions, to realize how much they don’t know — and perhaps to learn more from one another.”