Toward “Harder” Medical Humanities: Moving Beyond the “Two Cultures” Dichotomy

Abstract

Using the current international debate surrounding the incorporation of medical humanities into medical curricula as a starting point, the authors address both the legitimacy and didactics of teaching medical humanities to medical students. They highlight the paradox of the increasing prevalence of medical humanities in medical curricula and the often critical reception humanities courses receive. The alleged lack of empirical evidence linking such courses with improved patient care cannot alone explain the criticism they engender. After a short overview of the debate surrounding medical humanities and their inclusion in outcomes-based education, the authors outline the medical humanities block, "The History, Theory, and Ethics of Medicine," which is part of the German medical curriculum. A model developed at Ulm University exemplifies the integrated inclusion of the heterogeneous aspects of medical culture into medical education. This model emphasizes a reflexive approach (i.e., understanding how the humanities are manifested in medicine) as an alternative to the currently dominant narrative approach (i.e., liberal arts, moral development, and/or mental retreat), which has gradually been limited to a quasi-"secular religion" for doctors. This model uses established concepts from science and cultural studies as the "instruments" for seminars and courses; paradigms, discourses, social systems, and cosmologies constitute the tools for teaching and learning about the historical, theoretical, and ethical dimensions of medicine. The authors argue that this approach both precludes the need to justify the medical humanities and overcomes the dichotomy that has heretofore existed between the two cultures of science and the humanities in medicine.

The Challenge of Promoting Professionalism Through Medical Ethics and Humanities Education

“…Qualitative assessment strategies need to be developed that address these nonquantifiable aspects of medical ethics and humanities teaching. 12,13 Educators need to help learners selfidentify and promote incremental growth of professional virtues through critical reflection on the values, attitudes, and behaviors requisite for excellent patient care. [14][15][16][17][18] Learners need to appreciate that professionalism entails a lifelong commitment to internalizing and adhering to the standard of providing safe, competent, patient-centered care.…”

Providing context for a medical school basic science curriculum: The importance of the humanities

“…Our results suggest the importance of implementing humanities courses and suggest that early in medical school is appropriate and beneficial. We propose that the lessons students learn from humanities courses in the first and second year of medical school might act to habituate patient-centered attitudes and skills, perhaps inoculating students against the hidden curriculum especially prominent in the clinical curriculum (Doukas et al 2012;Polianski & Fangerau 2012).…”

“…During the first two years of medical school, students encounter a medical school curriculum that is mostly an objective, scientific endeavor that requires learning factual knowledge of the science of medicine and technical skills (Shapiro et al 2009;Polianski & Fangerau 2012;Mullangi 2014). This biomedical model of care, which focuses on the detection and treatment of abnormal body structures and functions, has been the foundation of medical education since the original Flexner report.…”

Bringing Home the Health Humanities

“…7,9 Less attention, however, has been paid to the risks of this type of instruction. As Kumagai and Wear 3 claim, literature and the arts often "[portray] daily events, habits, practices, and people … in a way that disturbs and disrupts one's assumptions, perspectives, and ways of acting so that one sees the self, others, and the world anew."…”

“…This finding suggests that medical students closely associate the content and pedagogy of health humanities programs with their own identities and values, which they are repeatedly asked to contemplate and externalize by narration. [3][4][5][7][8][9][10][11][12] By giving students the opportunity to write or talk about painful personal experiences, and by exposing them to texts that might evoke distressing thoughts, health humanities educators put students at risk of being retraumatized by their disclosures, especially those who already feel vulnerable or marginalized.…”