care

The Arts and Humanities in Medical Education: thoughts on an International Project

Klimt_hygeia

Hygeia – Portion of Klimt’s painting Medicine        (Public Domain)

The art, science and technology of medicine have co-existed relatively peacefully for many years; however, this situation is changing. Science and technology are advancing so fast that medicine risks being dominated by them. Nevertheless, there is increasing disquiet about leaving qualities like empathy and compassion, which constitute the art of medicine, tacit. Doctors are increasingly held to account for their art, which has resulted, for example, in a proliferation of measurement scales for empathy or Emotional Intelligece. Failures in Mid Staffordshire and the Winterbourne care scandal have led people to say that we should explicitly develop caring amongst doctors and the health professions. Ethicist Anna Smajdor went so far as to question if it is still possible for patient care to have an emotional dimension [1]. Many people might, however, be appalled by her idea that healthcare cannot, under present conditions, be fundamentally different from the care we receive in a hotel. I, and my colleague Jonathan, amongst many others, think that there is an affective dimension to medicine, which society would lose at its peril.

Medical philosopher Kieran Sweeney argued that the tension between the humanistic and technical aspects of medicine goes back to the times of the ancient Greeks [2]. He did so using a Greek myth where Hygeia stood for the promotion of health, whereas Panacea stood for medicine as the “warrior” against the state of disease. The Panacean view prevailed with the Medical Act of the 1858, which instituted the General Medical Council, establishing medicine as a profession assigned to defeat disease. This was the point where the science of medicine established dominance over the art of medicine, which I think is reflected in the way we deliver medical curricula.

Medical students confront professional dilemmas with an emotional impact [3] that influence their identity development; the need to address the “ever-present absence” of emotions in medical curricula has recently been raised by McNaughton [4]. There is no doubt that medical education requires professional values to be made explicit, hence we (Jonathan and I) are attempting to contribute to the discourses of emotions and compassion in healthcare by exploring ways to cultivate an increasingly humanistic view of the medical profession in our future doctors. We have recently started a project, called “The Doctor as a Humanist: Humanities in Medical Education”, which will unfold in three phases. Phase 1 will be aimed at running a pilot educational intervention to groups of 4 to 6 medical students from some international Universities. The intent is to add an element of inter-cultural communication to hopefully further stimulate students’ reflection.

Through reading and discussing some relevant works of literature, the pilot will attempt to:

  • Nurture students’ humanistic vision of the medical profession
  • Cultivate students’ ability to use poems and literature to reflect on how they deal with medicine, disease and health
  • Develop students’ ability to identify and effectively deal with cross-cultural issues in the medical profession
  • Cultivate students’ capacity to observe and look into the complex socio-cultural dynamics of the medical profession
  • Facilitate students’ discussion and exchange of opinions and experiences on the humanities with other students from different countries and backgrounds

The pilot will then be evaluated and discussed at a Symposium (Phase 2) in October, where one student representative from each participating Medical School will be invited, amongst a small group of educationalists and clinicians. The aim of the symposium is to further develop ways to include the humanities in the medical curriculum and to hopefully begin the design of a more established curriculum element (e.g. SSC or intercalated degree) to be implemented and evaluated in a 3rd Phase.

The following is Jonathan‘s description of the project:

In a recent book on Medical Humanities [5], the authors explain how the humanities can contribute to “cultivating personality, intellectual curiosity, emotional honesty, social awareness, and the exercise of sound judgement and moral imagination – virtues and skills indispensable to good doctoring”.

Likewise, our global project aims to reintroduce this humanistic vision to medical education, and thus to counteract the ever-increasing over-dependence on technology. It hopes to teach future medical doctors that a balance between the “scientific” and the “humanistic” is essential for their future medical careers. They will be treating humans and thus need to know as many aspects as possible of what it means to be human in the twenty first century, and this project believes that the teaching of works of literature will help them towards this goal.

Do let us know if you wish to be updated or involved in this exciting project!

  1. Smajdor, A. (2013). Reification and compassion in medicine: A tale of two systems. Clinical Ethics, 8: 11-118.
  1. Dixon, M, Sweeney, K. (2000). The human effect in medicine: theory, research and practice. Radcliffe Medical Press, Oxford.
  1. Monrouxe, L, Rees, CE, Endacott, R, Ternan, E. (2014). ‘Even now it makes me angry’: health care students’ professionalism dilemma narratives. Medical Education, 48: 502-517.
  1. McNaughton, N. (2013). Discourse(s) of emotion within medical education: the ever-present absence. Medical education, 47: 71-79.
  1. Medical Humanities: An Introduction, Thomas R. Cole, Nathan S. Carlin, Ronald A. Carson; Cambridge University Press, 2015.

Musing on Critical Pedagogy, “care” and Medical Education – Part 1

I am in now in a stage where it seems that all I have been reading so far is not enough in order to write a decent literature review, so I am spending all the available time in full immersions of reading, jumping between several books and articles, following  a rather personal logic that often takes me to more reading and more information to digest. I wonder if I should just stick to a book at the time, being more organised and linear, or this approach is actually the normal result of an iterative reading, non-linear, where the connections with other resources are just part of the process.

Anyway, during the past few weeks I’ve been shifting between 3 books (see references) which made me think about the concept of care and how this is a bridge between education in general, the more specific area of medical education and more broad themes like co-belonging and formation/growth of the human being.

“Medical Education for the Future: Identity, Power and Location”. A particular passage has caught my attention:

“The traditional academic view of medical education as a translation of learning theory into clinical practice is no longer sufficient to help us face the culture of change and uncertainty in which doctors of the future will practice. To rise to the challenge facing medical education and practice for the future, medical educators need to develop a systematic and programmatic approach to research in the field and also to have a clear idea of what it is that they are researching, why they are researching it and what they hope to achieve. Medical educators— researchers, teachers and clinicians—need to look again at what they are doing, why they are doing it and how they can do it better. We argue in this book that all the answers to these questions can and should be found within the care of patients.” (Boldtype is mine)

I can see two big thematics here: one related to the concept of care, which is placed at at the centre of the whole medical education paradigm; and one related to the necessity of grounding medical education research, teaching and clinical practice within the social fabric, in a way that makes them intrinsically connected to the “here and now”. Both these concepts are at the heart of Critical Pedagogy.

Critical pedagogy gives full importance to the historical and social nature of educative process. This means that the educative process should start and be grounded on a critical theory of society, of science and of the subject. The meaning of the term “critic” here is to “explain and interpret the society in order to actively change it” (see Max Horkheimer).

In this sense I think critical pedagogy foundations should be applied to medical education, using a critical approach to research and teaching. This means really embedding these processes into the social environment to get full benefits, which will eventually improve patients care. This is not an innovative thought, in fact while reflecting on this I remembered about Virchow‘s social medicine, which I read about at the university. This 19th century’s German doctor stated that:

“Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution… The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”

In fact, when he was invited to write a report on a typhus epidemic, he stated that that “the outbreak could not be solved by treating individual patients with drugs or with minor changes in food, housing, or clothing laws, but only through radical action to promote the advancement of an entire population, which could only be achieved by full and unlimited democracy, education, freedom and prosperity”. 5

He is not the only one to connect democracy, education and economy – just to mention some: philosopher and psychologist John Dewey, Economist Amartya Sen and sociologist Antony Giddens – but surely he connects these more explicitly with health. I will explore these connections further for my literature review.

Part 1 ends here, I need to translate some rather confusing itanglish sentences… Part 2 will be more about the concept of care and a wrap-up of both posts… Hopefully I’ll manage to do it tomorrow while travelling, or under the Sardinian sun perhaps!

 

References (3 and 4 are for Part 2):

1. Bernhard, A. (2006). Pedagogia critica : tendenze di sviluppo e progetti per l ’ avvenire. Collana di Studi Internazionali di Scienze Filosofiche e Pedagogiche Studi pedagogici, (1), 1-24.

2. Bleakley A, Bligh J, Browne J. Medical Education for the Future: Identity, Power and Location. New York: Springer, 2011.

3. Carlgren, I. From Teaching to Learning: The End of Teaching or a Paradigmatic Shift in Teachers’ Work? in Hudson, H & Meyer, M. A. Beyond Fragmentation: Didactics, Learning and Teaching in Europe. BB, 2011.

4. Granese A. Istituzioni di Pedagogia Generale: Principia Educationis. Padova: CEDAM, 2003.

5. Wikipedia http://en.wikipedia.org/wiki/Rudolf_Virchow