Medical Education and Humanities Medical Humanities Shankar PR1 Abstract Medical humanities (MH) have been described as using subjects traditionally known as the humanities for specific purposes in medical education. Learning MH provides a number of advantages to medical students. I have been involved in facilitating MH sessions for over seven years. MH modules are still not common in South Asia. There are various challenges in initiating a MH module in a medical school in south Asia. MH modules should be driven by the energy and creativity of facilitators in each medical school, should use small group learning strategies and be fun. Key words: Medical humanities, medical students, South Asia Recently there has been a lot of debate and discussion in South Asia about the medical humanities. The Indian Journal of Medical Ethics and other publications regularly publish articles related to the medical humanities (MH) and recently a new publication dealing predominantly with MH called Research and Humanities in Medical Education (RHIME) (www.rhime.in) has been started. MH has been discussed at various fora and there are a number of medical educators keen to introduce MH in medical education. Dr Radha Ramaswamy and her team from the Centre for Community Dialogue and Change (www.ccdc.in) have been regularly conducting workshops on theatre of the oppressed in various institutions in India and abroad. I remember when I first got interested in MH in early 2007 and decided to develop and implement a curriculum innovation project (CIP) for students at Pokhara, Nepal as part of a Foundation for Advancement of International Medical Education and Research (FAIMER) fellowship in health professions education the subject was still novel and not many knew about MH. I will start this article by examining what are the medical humanities.
WHAT ARE THE MEDICAL HUMANITIES? Like I had mentioned in my book chapter on MH1(1) there is no widely accepted definition of what are the medical humanities. The definition which is most widely accepted is that provided by Dr Deborah Kirklin from the United Kingdom (UK) who defined MH as ‘an interdisciplinary, and increasingly international endeavor that draws on the creative and intellectual strengths of diverse disciplines, including literature, art, creative writing, drama, film, music, philosophy, ethical decision making, anthropology and history in pursuit of medical educational goals.’(2) Another authority on MH had defined it as subjects like history, philosophy, literature, ethics, anthropology, sociology, theology, psychology and others which explore the world as it appears from the viewpoint of frail, flesh-bound human experience.(3) MH may not fit into the traditional boundaries of subjects and disciplines but is a perspective whose concern is what it means to be fully human.(4) MH programs were initiated in the United States (US), United Kingdom (UK), Europe and other developed nations as a response to the domination of science in medicine but has become increasingly
international with programs in a number of countries. WHY SHOULD MEDICAL STUDENTS LEARN MH? Learning MH provides a number of advantages to medical students. Literature can introduce students to common shared human experiences, unfamiliar life situations, underline the uniqueness of each individual human being and enrich the language and thought of students.(5,6) Drama can introduce students to oral communication while philosophy can teach them the skills of analysis and argument. Literature can provide case histories to students while painting can highlight the different non-verbal ways in which feelings and attitudes can be expressed. Art and paintings have been shown to increase visual diagnostic skills and visual thinking strategies among medical students.(7,8) MH can stimulate the practice of reflection among students and improve reflective competence among both students and practitioners.(9,10) MH can serve as a source of relaxation and provide doctors with a new focus for appreciating and recharging their daily work.(11) The history of medicine provides a perspective on the growth of medical thought and
1
Chair, Curriculum Committee, Xavier University School of Medicine, Aruba, Kingdom of the Netherlands. Correspondence to Dr P Ravi Shankar (
[email protected])
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practice while medical biography provides information on how others had responded to tough challenges and can inspire students. (12) MY EXPERIENCE WITH MH I have always been interested in literature, art and photography. As a CIP for my FAIMER fellowship I facilitated a voluntary module for interested students and faculty members at the Manipal College of Medical Sciences, Pokhara, Nepal. (13) On joining a new medical school, KIST Medical College in Lalitpur, Nepal I conducted a module for faculty members.14 A module has been conducted for all first year medical students at the institution for over five years and participant response to the module was positive.(15,16) Since February 2013 I have been facilitating a module at the Xavier University School of Medicine in Aruba, Kingdom of the Netherlands. Student feedback about the inaugural MH module was mainly positive though they had some apprehensions as small group learning was not common at that time in the institution and they were not sure about the utility of the module to the United States Medical Licensing Exam (USMLE) step 1 exams. (17) MH MODULES IN SOUTH ASIA On conducting a literature search for published descriptions of MH modules in South Asia there were not many manuscripts. In New Delhi, India regular lectures on topics related to MH are conducted.(18) Street theatre has
also been used to gain a deeper understanding of MH.(19) An optional MH course for fourth year medical students at the University of Ruhuna, Sri Lanka includes lectures along with simple assessment.(20) Theater of the Oppressed (TO) workshops as mentioned have been conducted in various medical schools in India and at KIST Medical College in Nepal.(21) At the University College of Medical Sciences in New Delhi, India a medical humanities group has been established and they conducted a two day TO workshop which was well received by the participants.(22) The group publishes a journal titled ‘Research and humanities in medical education’ (www.rhime.in) and the editor-in-chief in a recent editorial discusses the need for MH in India and South Asia.(23) CHALLENGES IN STARTING A MH MODULE IN SOUTH ASIA In most developing countries including South Asia, MH is not a formal part of the medical curriculum. Like I had mentioned in the previous book chapter(1) MH can be introduced as a voluntary module and later a case made for its formal inclusion in the curriculum. The language of the module may also be a matter of debate. In South Asia English is the language of medical education due to a number of reasons. So MH modules will most likely be conducted in English and this has both advantages and disadvantages.(24) Lack of familiarity with facilitating
small group learning among teachers may be another challenge though the situation is improving.(25) There will be problems with literature excerpts which will be used in the module and material from South Asia is not readily available. Creating interest among other faculty members in the subject and creating linkages with humanities educators in institutions outside medical schools could be other challenges.(26) STARTING A MH MODULE Like I had mentioned in a previous article(27) each medical school can chalk out the learning objectives to be addressed through their MH module. I am not in favour of a uniform MH curriculum imposed by a central authority but would like MH to be driven forward by the energy and creativity of interested faculty in each institution. The fun nature of MH should be preserved and faculty involved should be familiar with small group dynamics and activity based sessions. Sharing of experiences between educators involved in MH in the region and involvement of humanities faculty from other institutions is important. CONCLUSION Taking into consideration the level of interest in the subject, the recent emphasis on medical education in the region and the demonstrated advantages of MH, medical schools in the region should consider offering a module to students.
REFERENCES 1. Shankar PR. Medical Humanities. In R Biswas. & CM Martin (Eds.), User-driven healthcare and narrative medicine: utilizing collaborative social networks and technologies. Hershey, PA, 2011: Medical Information Science Reference.
2. Kirklin D. The Centre for Medical Humanities, Royal Free and University College Medical School, London, England. Academic Medicine 2003;78:1048–1053. doi:10.1097/00001888-200310000-00023
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3. Evans M. Reflection on the humanities in medical education. Medical Education 2002;36:508–513. doi:10.1046/j.1365-2923.2002.01225.x 4. Greaves D, Evans M. Medical Humanities. Medical Humanities 2000;26, 1–2. doi:10.1136/mh.26.1.1 5. Macnaughton J. The humanities in medical education: context, outcomes and structures. Medical Humanities 2000;26: 23–30. doi:10.1136/mh.26.1.23 6. Scott PA. The relationship between the arts and medicine. Medical Humanities 2000;26: 3–8. doi:10.1136/mh.26.1.3 7. Karkabi K. Visual thinking strategies: a new role for art in medical education. Family Medicine 2006;38:158. 8. Naghshineh S, Hafler JP, Miller AR, Blanco MA, Lipsitz SR, Dubroff RP, Khoshbin S, Katz JT. Formal art observation training improves medical students' visual diagnostic skills. Journal of General Internal Medicine 2008;23:991-7. doi: 10.1007/s11606-008-0667-0. 9. Evans D. Imagination and medical education. Medical Humanities, 2001;27:30–34. doi:10.1136/mh.27.1.30 10. Karkabi K, Cohen Castel O. Teaching reflective competence in medical education using paintings. Medical Humanities 2011;37:58-9. doi: 10.1136/jmh.2010.006924. 11. Peterkin A. Medical humanities for what ails us. Canadian Medical Association Journal 2008;178:648. doi:10.1503/cmaj.071851 12. Hooker C. The medical humanities a brief introduction. Australian Family Physician, 2008;37:369–370. 13. Shankar PR. A voluntary Medical Humanities module at the Manipal College of Medical Sciences, Pokhara, Nepal. Family Medicine 2008;40:468-70. 14. Shankar PR, Piryani RM, Karki BMS. A medical humanities module for faculty members at KIST Medical College, Imadol, Lalitpur. Journal of Clinical and Diagnostic Research 2011;5:1489-1492. 15. Shankar PR. What I gained from six years of the Medical Humanities. Yale Journal for the Humanities in Medicine. Published March 4, 2012. http://yjhm.yale.edu/essays/rshankar20120304.htm 16. Shankar PR, Piryani RM, Singh KK, Karki BMS. Student feedback about the use of role-plays in Sparshanam, a medical humanities module. F1000 Research 2012;1:65.
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17. Shankar PR, Dubey AK. Student feedback on an inaugural medical humanities module at XUSOM, Aruba. Education in Medicine Journal 2013;5:e12-e20. DOI: 10.5959/eimj.v5i4.178 18. Gupta R, Singh S, Kotru M. Reaching people through medical humanities: an initiative. Journal of Educational Evaluation for Health Professions 2011;8:5. 19. Gupta S, Singh S. Confluence: understanding medical humanities through street theatre. Medical Humanities 2011;37:127-128. doi: 10.1136/jmh.2010.006973. 20. Anoja Fernando. Teaching ethics and medical humanities to medical students in Sri Lanka: A multi-cultural approach. 8th Bioethics Conference, Bangkok, Thailand, 1923 March 2007. http://www.powershow.com/view1/1070bd-ZDc1Z/Teaching_ethics_and_medical_humanities_to_medical_students_in_Sri_Lanka_a_multicultural_approach_powerpoint_ppt_presentation 21. Shankar PR. A three day workshop on the theatre of the oppressed in a Nepalese medical school. Australasian Medical Journal 2012:5:440-442. 22. Gupta S, Agrawal A, Singh S, Singh N. Theatre of the Oppressed in medical humanities education: the road less travelled. Indian Journal of Medical Ethics. 2013;10:200-203. 23. Dhaliwal U. Editorial: Why Medical Humanities? RHiME [Epub ahead of print] [cited 2014 Apr 3]. Available from: http://www.rhime.in/articles/1/1/Editorial.html 24. Shankar PR, Piryani RM. English as the language of Medical Humanities learning in Nepal: Our experiences. The literature, art and medicine blog http://medhum.med.nyu.edu/blog/?p=175 25. Shankar PR, Piryani RM, Morgan H, Thapa TP. Medical humanities in Nepal—snakes and ladders. Journal of College of Physicians and Surgeons of Pakistan 2010; 20: 219-20. 26. Shankar PR, Piryani RM. Four years of medical humanities in Nepal: What worked and what did not. Literature, arts and medicine blog. Posted on 12/09/10. http://medhum.med.nyu.edu/blog/?p=854. 27. Shankar PR. Developing and sustaining a medical humanities program at KIST Medical College, Nepal. Indian Journal of Medical Ethics 2013:10:51-53.
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