The Thammasat University Library has acquired a new book that should be useful for students interested in the allied health sciences, culture, psychology, sociology, and related subjects.

Rethinking Medical Humanities: Perspectives from the Arts and the Social Sciences is about an interdisciplinary field of medicine which includes the humanities (philosophy of medicine, medical ethics and bioethics, history of medicine, literary studies and religion), social science (psychology, medical sociology, medical anthropology, cultural studies, health geography) and the arts (literature, theater, film, and visual arts) and their application to medical education and practice.

The TU Library collection includes other books about different aspects of medical humanities.

An article posted in 2009 on the website of Academic Medicine the official, peer-reviewed journal of the Association of American Medical Colleges explained:

As any medical educator will tell you, it is in the nature of medical students to complain about their curriculum, The medical humanities receive more than their fair share of students’critiques in terms of both quantity and virulence. Although the majority of students’ comments are supportive and positive, many refer to humanities teaching as pointless, boring, worthless, or just plain stupid. Even otherwise favorably disposed students are sometimes adamant about not making medical humanities required coursework. This situation leads us to ask, Why does humanities teaching regularly engender not just legitimate criticism, but outpourings of anger and contempt?

In this article, we offer a pedagogical definition of medical humanities, describe their potential contributions to the medical education enterprise, identify major critiques of the medical humanities from learners’ perspectives, and offer suggestions for systemic pedagogical responses to address these critiques.

A Pedagogical Definition of Medical Humanities

Despite ongoing lack of clarity on what exactly the medical humanities comprise, and how they should be integrated into medical education, medical humanities teaching activities share several characteristics:

They use methods, concepts, and content from one or more of the humanities disciplines to investigate illness, pain, disability, suffering, healing, therapeutic relationships, and other aspects of medicine and health care practice.

They employ these methods, concepts, and content in teaching health professions students how to better understand and critically reflect on their professions with the intention of becoming more self-aware and humane practitioners.

Their activities are interdisciplinary in theory and practice and necessarily nurture collaboration among scholars, healers, and patients.

Conditions 1 and 2 imply that medical humanities have a significant moral function. That is, an important goal of medical humanities is to reconceptualize health care, through influencing students and practitioners to query their own attitudes and behaviors, while offering a nuanced and integrated perspective on the fundamental aspects of illness, suffering, and healing. In Aristotelian terms, medical humanities aim to improve health care (praxis) by influencing its practitioners to refine and complexify their judgments (phronesis) in clinical situations, based on a deep and complex understanding (sophia) of illness, suffering, personhood, and related issues. In this respect, medical humanities have a more applied function than the humanities as they are traditionally defined in the academy.

Nevertheless, despite the substantial promise of the medical humanities during the past 35 years and compelling evidence of their significance for medical education, the incorporation of medical humanities in medical training has not proceeded smoothly. By and large, medical humanities remain an intriguing sideline in the main project of medical education. Below, we consider major critiques of medical humanities curricula that we have heard from learners and those critiques’ implications for the relationship between the humanities and medical education.

Learners’ Critiques of Medical Humanities Curricula

Critiques of medical humanities may be grouped as responses to three broad questions: (1) Is the content irrelevant? (2) Are humanities teachers and their methods the problem? (3) Is the positioning of humanities coursework within the curriculum inappropriate? Is it the content?

The relevance critique.

This critique acknowledges that the humanities may be important to future physicians in some indirect way, but it asserts that the material is impractical. The humanities can’t provide student physicians with concrete skills (such as learning how to start an IV) that are useful in clinical practice. How does reading a poem help the student measurably improve the treatment of patients? When one of us (J.C.) first introduced topics such as interviewing, clinical ethics, and medical humanities, some students found the material simplistic, commonsense, uninteresting, and—worst of all—irrelevant.

At the medical school of another one of us (M.M.), first- and second-year students were polled after their courses to assess, among other things, whether the humanities material presented in lecture, readings, and small-group discussion was “clinically relevant.” Results showed that almost half of the students gave the humanities material moderately low ratings for “clinical relevance”; the remainder of the students gave the material more positive ratings. A study examining possible outcomes of students’ exposure to poetry reading during an interstation break of a third-year OSCE indicated little or no effect in up to one third of respondents in terms of influencing treatment, increasing empathy, or improving stress. A kinder, gentler version of the relevance critique affirms the “niceness” of the humanities, as in “It’s a nice change of pace from pathophysiology” or “It’s very relaxing.” This modification assumes that the medical humanities are enjoyable but not crucial to the education of physicians. In either case, both anecdotal and investigational data suggest that medical humanities faculty have failed to adequately convince students that the medical humanities really matter to them as future physicians.

On the website of the Georgetown Medical Humanities Initiative, Dr. Lakshmi Krishnan noted:

How do we understand health, illness, and healing? What is the relationship between suffering, personhood, care, and our responsibilities to each other? How do we examine medical practice and its intersection with science and technology? What part do art and aesthetic expression, creativity and the imagination, play in these conversations? How do we express the body?

The biomedical sciences answer these questions incompletely. Medical humanities is an interdisciplinary field that re-centers health in its broader social, cultural, and historical context. Bridging the clinic and the archive, it uses the tools of the humanities and social sciences to explore, analyze, and critique the contexts of illness and health. These approaches play a frontline role in contextualizing healthcare, shaping health policy and communication, resource allocation, dismantling racism and health disparities, caring for vulnerable communities, understanding the experience of illness and suffering, providing comfort, interpreting and making meaning from crisis, engaging with uncertainty, and envisioning alternatives.

(All images courtesy of Wikimedia Commons)