Since the 1960s, faculty from diverse fields have banded together under the banner of the medical humanities, a term which unites art, literature, history, anthropology, religious studies, philosophy, and other disciplines. Arguments for the relevance of medical humanities often emphasize contributions that any of these disciplines can make to medical education, whether those involve empathy, professionalism, critical reasoning, or tolerating ambiguity. The authors argue that the constituent disciplines of the medical humanities are not interchangeable parts, but represent different perspectives and methodologies that offer their own distinct contributions to medical training. Efforts to define a role for medical humanities in medical education should pursue two strategies in parallel. On the one hand, advocates of the medical humanities should continue to make the case for the shared contributions that all of the disciplines can make to medical education. But advocates for the medical humanities should also emphasize the valuable contributions of each specific discipline, in terms that medical educators can understand. The authors illustrate this point by delineating contributions of their own discipline, medical history. Historical analysis contributes essential insights to the understanding of disease, therapeutics, and institutions-things that all physicians must know in order to be effective as clinicians, just as they must learn anatomy or pathophysiology. Analogous but different arguments can be made for literature, philosophy, and the other disciplines that constitute the medical humanities. The field of medical humanities will be most successful if it builds on both the shared and the distinct contributions of its disciplines.
Clinical educators use medical humanities as a means to improve patient care by training more self-aware, thoughtful, and collaborative physicians. We present three examples of integrating fine arts - a subset of medical humanities - into the preclinical and clinical training as models that can be adapted to other medical environments to address a wide variety of perceived deficiencies. This novel teaching method has promise to improve physician skills, but requires further validation.
Medical students and faculty explore the medical humanities for diverse reasons: as a medium for self-reflection, a means to cultivate professionalism and humanism, and a way to gain an appreciation for the broader contexts in which illness and health occur. One important area for development is increasing the exposure of learners and clinicians of various levels of training to the medical humanities and to role models in the field. Student-led programs in the medical humanities at the American Medical Student Association (AMSA) address these needs by offering unique opportunities for learning and sharing experiences. AMSA programs connect physicians-in-training using technology to create virtual communication and learning opportunities. These include monthly book discussion webinars, the Writers' Institute and the Medical Humanities Scholars Program (MHSP).
Increasingly, medical educators integrate art-viewing into curricular interventions that teach clinical observation-often with local art museum educators. How can cross-disciplinary collaborators explicitly connect the skills learned in the art museum with those used at the bedside? One approach is for educators to align their pedagogical approach using similar teaching methods in the separate contexts of the galleries and the clinic. We describe two linked pedagogical exercises--Visual Thinking Strategies (VTS) in the museum galleries and observation at the bedside--from "Training the Eye: Improving the Art of Physical Diagnosis," an elective museum-based course at Harvard Medical School. It is our opinion that while strategic interactions with the visual arts can improve skills, it is essential for students to apply them in a clinical context with faculty support-requiring educators across disciplines to learn from one another.
This review explores the relationship between engagement with the creative arts and health outcomes, specifically the health effects of music engagement, visual arts therapy, movement-based creative expression, and expressive writing. Although there is evidence that art-based interventions are effective in reducing adverse physiological and psychological outcomes, the extent to which these interventions enhance health status is largely unknown. Our hope is to establish a foundation for continued investigation into this subject and to generate further interest in researching the complexities of engagement with the arts and health.
The inclusion of the humanities in medical education may offer significant potential benefits to individual future physicians and to the medical community as a whole. Debate remains, however, about the definition and precise role of the humanities in medical education, whether at the premedical, medical school, or postgraduate level. Recent trends have revealed an increasing presence of the humanities in medical training. This article reviews the literature on the impact of humanities education on the performance of medical students and residents and the challenges posed by the evaluation of the impact of humanities in medical education. Students who major in the humanities as college students perform just as well, if not better, than their peers with science backgrounds during medical school and in residency on objective measures of achievement such as National Board of Medical Examiners scores and academic grades. Although many humanities electives and courses are offered in premedical and medical school curricula, measuring and quantifying their impact has proven challenging because the courses are diverse in content and goals. Many of the published studies involve self-selected groups of students and seek to measure subjective outcomes which are difficult to measure, such as increases in empathy, professionalism, and self-care. Further research is needed to define the optimal role for humanities education in medical training; in particular, more quantitative studies are needed to examine the impact that it may have on physician performance beyond medical school and residency. Medical educators must consider what potential benefits humanities education can contribute to medical education, how its impact can be measured, and what ultimate outcomes we hope to achieve.
BACKGROUND: Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation.
OBJECTIVE: To improve students' visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care.
DESIGN: Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis.
PARTICIPANTS: Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training.
INTERVENTION: Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session.
MEASUREMENTS: The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation.
RESULTS: Following the course, class participants increased their total mean number of observations compared to controls (5.41 +/- 0.63 vs. 0.36 +/- 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A 'dose-response' was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03).
CONCLUSIONS: This interdisciplinary course improved participants' capacity to make accurate observations of art and physical findings.
Rafael Camp. 2007. The Enemy, Pp. 112. Durham, NC: Duke University Press.