empathy

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.

#Rhizo15 Week two – numbers, and a semi-organised flow of thoughts.

The quantified self

This weeks’ #rhizo15 theme has made me wander with my thoughs, at a point that I didn’t really know what to write, or where to start. But this is probably the most exciting challenge of the rhizome, that not only connects you with people and different views, but also takes you to reflective paths which make you question what you thought was a formed opinion. However, here is part of what I’ve been thinking about in relation to learning measures, facets of human experience we want to quantify and numbers, of course…

Pedagogy was born as “applied philosophy” in the Ancient Greece, so mostly a subjective, dialogic matter. However during the 8th century pedagogy acquired the status of “science” trough the tools of biology, psychology, sociology, using them to define its own aims and tools[1]. This until when, through various reinterpretations over the centuries, in the late 19th century pedagogy reached the point to define itself on strict experimental and empirical basis, often taking a reductive and anti-humanistic turn [2].

We have now passed that point though. However, while in the current academic contexts pedagogy sits between philosophic, scientific and critical paradigms, it seems that the scientific, measurable part still gets the upper hand. Especially with the use of emerging technologies in education, educators aim to “make learning visible” through these tools, which in part is absolutely great. I say in part, because have my own views on this matter, and these fall mostly in in favour of the dialectic, qualitative domain rather than the quantitative.

I’ve been reading a lot about “learning analytics” in the past few years. These have been defined as a

field associated with deciphering trends and patterns from educational big data, or huge sets of student-related data, to further the advancement of a personalized, supportive system of higher education. [3]

So what we are doing with these is essentially quantifying students’ learning and engagement looking at their grades and at how many times they viewed or posted on the VLE, to then personalise the system of higher education to increase these numbers(???). The problem is that we are “personalising” something (often a VLE, or a curriculum) for someone else, which per se is a strange concept. For example, see this presentation from Stephen Downes, where he makes the distinction between personal and personalised learning. This post nicely defines the concept:

Personalized learning, while customized for the student, is still controlled by the system. A district, teacher, company, and/or computer program serve up the learning based on a formula of what the child ‘needs’.

Shouldn’t we be allowing and supporting learners to develop personal learning landscapes, instead?

I think it is far too easy to equate meaningful participation, or learning, with numbers coming from analytics. @e_hothersall, @nlafferty and I have recently wrote a conference paper on a Twitter experience with medical students. We used SNA to look at students’ engagement, however it was quite clear that the number of tweets or mentions doesn’t account for the deeper processes of learning. They can offer an initial evaluation (and beautiful, colourful charts!), but without careful content (or discourse) analysis the portrait, in my opinion, is rather incomplete.

In medical education, but I’m sure not only here, metrics seem to prevale as objective ways to evaluate students, their participation, depth of learning, engagement. Sometimes we count whether and how many boxes they have ticked in their online portfolios, which should provide evidence of an achievement. This happens even with things such as empathy or emotions. Not only we aim to make them more explicit, but we want to do it in such a way that they can be measured. This is perhaps because doctors are increasingly held to account for qualities such as empathy and compassion. One consequence of this tendency has been, for example, the development of measurement scales; 38 different measurement scales for empathy, for instance, were described in a recent review [4]. The construct of Emotional Intelligence (EI), used within the medical academic environment to define a set of skills in which students are “trained” and then assessed for, serves exactly the same reason. Emotions are captured and measured from their instrumental use, which manifests itself in certain skills, behaviour and patterns of communication that can be learned, practiced, observed and evaluated.

This is what the psychometrics era brought in education. Measures to objectively evaluate and quantify students’ performance. But, where do the subjective and the collective fit?

This is an extract from a great paper by Brian Hodges:

The psychometric era brought not only the concept of reliability, but also other new concepts that gave credence to some practices and delegitimized others. The most important discursive shift was the negative connotation taken on by the word subjective. Framed in opposition to objective, the use of subjective in conjunction with assessment came to mean biased and biased came to mean unfair. [5]

I think we are slowly correcting this shift, and last week theme in #rhizo15 is the proof. Also, hybrid, critical pedagogies (see, for example @HybridPed) are surely highlighting the value of dialogic, unfixed, complex and dynamic elements, which cannot be quantified in education.

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P.s: As humans, though, we tend to quantify, even socially. Social Media tools have exasperated this tendency… Don’t we all get a sense of increased self-appreciation, when we get many retweets, many favourites, new followers, “likes” or comments on a blog post? Even more-or-less subconsciously, I think many look at these numbers, judging, at least initially, a person’s social media account from the amount of followers. These are numbers… but they get a (social) meaning.

References:
1 – Cambi, F. (2008). Introduzione alla filosofia dell’educazione. Editori Laterza.
2 – Striano, M. (2004). Introduzione alla pedagogia sociale. Editori Laterza.
3 – Horizon Report 2013
4 – Hemmerdinger, JM, Stoddart, SDR, Lilford, RJ. (2007). A systematic review of tests of empathy in medicine. BMC Medical Education, 7: 1-8.
5 – Hodges, B. (2013). Assessment in the post-psychometric era: Learning to love the subjective and the collective. Medical Teacher, 7: 564-568.