Changes in Humanism During Medical School: a Synthesis of the Evidence

Abstract

The importance of humanism in medical education and practice has been well established with relevance to patient satisfaction, adherence to recommended treatment plans, medical-legal risk, and potential for physician burnout. This review focused on longitudinal studies of medical students to answer two research questions: (1) Do components of humanism change over time in medical students? (2) Do components of humanism respond to intervention? We conducted a systematic review of the literature for English language articles published between 2000 and 2014. We searched using the word “humanism” and terms that represent constructs of humanism combined with “undergraduate medical education.” Articles including humanism at more than one point in time were included. Data extracted included the following: construct of humanism measured, measurement tool, timing of measurements, type of intervention included (deliberate programming vs. standard curriculum), and direction of change of the construct being assessed. Descriptive and non-parametric statistics were used. Forty-eight studies from 22 journals were reviewed. The direction of change was associated with study duration (Spearman’s rho = −.573, p = .000), indicating that studies with longer duration were more likely to report negative change. Study duration also differed across design categories (F = 17.447, p = .000). Empathy was assessed in 37 (77%), humanism in 16 (33%), and altruism in 1 study. Recommendations for practice include intentional, ongoing educational experiences to address humanism in medical students. Recommendations for future investigations include additional exploration of the role of context and perspective in understanding changes in humanism.