Medical Humanities Education Research Articles

The Sound of Music: Transforming Medical Students into Reflective Practitioners

There is a growing focus on the introduction of courses in humanities in medical education. Music is not a widely-used tool in medical education. It has unique features that make it an excellent educational resource for the possibility to express emotions. Within minutes, topics of interest in learning medicine, such as loss, compassion, sorrow, and solidarity can be identified and used in pedagogical processes. Music—like other art forms—can deal with the emotional universe of the student. Promoting a reflective attitude within an academic discipline requires the creation of space to make it formal. The Public Health Department of Jundiai Medical School (Sao Paulo, Brazil) offers a special course on family medicine core values, led by a SOBRAMFA Medical Education & Humanism faculty member. The process of understanding a student’s experience has allowed for the unveiling of a phenomenon that encompasses the student’s inner world as he/she attends to his/her medical training. The music is played on the outside resonates with the story and emotions of the student. Students realize that the pace imposed by the medical school does not allow them to reflect on either their own lives or their formation. The musical experience allows students to hear their feelings and share them with the professor and peers. They are surprised by memories and feelings that surface that they were unaware of or could not remember. These feelings are presented in themes that organize the affective experience of students, mobilized by the music. Several themes have emerged, such as the search for the self; family; vocational doubts; relationships with peers, professors, and patients. The findings of the experience of the music spectrum come in, offering numerous prospects for development in the context of medical education, as noted in the themes that emerged. As the basic experience we have of the world is emotional, the music—this form of human knowledge of affective tone—also becomes educational force, because the teaching process is not limited to transmission of content. Instead, more importantly, it implies that the teacher in development processes of meaning and significance enable the learner to reflect and transform the everyday practice, especially in medicine, where the interpersonal relationship is the basis for the full realization of future professional action.

Faculty Assessment of an Innovative Approach to Medical Education

The Clinical Presentation (CP) Model and inductive reasoning process is an innovative approach to undergraduate medical education delivery used at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA). Embedding cohorts of students into community campus settings during the second, third and fourth year is equally as innovative and a unique model for training future physicians that fosters contextual learning. We investigated faculty impressions of the CP Curriculum (CPC), inductive reasoning process and the early contextual learning experience. Electronic surveys were sent to 36 Mesa campus faculty and 23 Regional Directors of Medical Education (RDME) at each of the 11 National Association of Community Health Centers (NACHC) affiliated Community Health Campuses (CHC’s) in nine states.1 A total of 40 respondents (68%) completed the survey. Seventy percent of faculty respondents indicated that they “Completely Understand or “Understand Very Well” the CP Model as a teaching tool. Ninety-five percent of respondents stated they understand the application of “inductive vs. deductive” processes as they apply to medicine, and 88% expressed that they understood at least “Somewhat” how to use the CP Model to arrive at a diagnosis in “real life”. More than half (53%) indicated that placing the medical student in the contextual learning campus beginning in year 2 is the “right idea that is implemented at the right time”. Since about half of faculty surveyed indicated that they understand the inductive reasoning aspect of the CP Model very well or well, additional faculty development training is warranted. In the classroom, 70% reported including clinical presentation schemes 80–100% of the time during instruction. Clinical faculty were statistically significantly more likely to indicate that placing the medical students in the community health clinic settings at the beginning of their second year is the right idea at the right time.

Preliminary exploration of medical humanistic quality education in pathology teaching

Enhancing medical humanistic quality education is the essence of medicine and it is also a necessity of conforming to the transformation of medical model.The pathological teachers should improve their humanistic quality actively,integrate humanistic quality training into pathology teaching and focus on training the social responsibility and healthy psychological qualities in order to enhance medical students' humanistic accomplishment and to make them become high qualified medical talents. Key words: Pathology; Teaching; Humanistic quality; Medical education

Application and exploration of the pervasive teaching method in medical humanity education

Objective To explore an effective educational method of medical humanity to improve the medical humanistic quality for nursing students and to lay a basis for the culture of medical personnel with high-quality.Methods Two classes of nursing students in grade 2010 were selected randomly and divided into the control group ( CG,n=65 ) and the experimental group ( EG,n=62 ).Personnel training project of our school was applied in the control group including the teaching of compulsory basis medical humanity courses:medical psychology,interpersonal communication,medical ethics and laws from the first semester to the third semester after entering the school.The pervasive teaching method was used in the EG.The basic content of humanistic quality,education was integrated systematically into the teaching of every course,class and extra-curricular activity in a planned way.The check on the topic of etiquette,verbal expression and communication and psychological quality ( the full mark of each topic was 10 points ) was conducted in the third semester in the two groups.The average points of the three topics were graded as the students' final mark of this course.T-test analysis on students' mark of each subject was used.Results The result of t-test showed that the marks of etiquette and psychological quality in EG were obviously higher than those in CG ( P＜0.05 ),however,no statistic difference in speech communication and expression was observed.Conclusion The pervasive teaching method is beneficial to students concerning the accepting,understanding,digesting and absorbing of medical humanity knowledge can it can effectively enhance the humanistic quality of medical students. Key words: Medical humanities education; Pervasive teaching; Humanistic quality

Perspective

Medical education accreditation organizations require medical ethics and humanities education to develop professionalism in medical learners, yet there has never been a comprehensive critical appraisal of medical education in ethics and humanities. The Project to Rebalance and Integrate Medical Education (PRIME) I Workshop, convened in May 2010, undertook the first critical appraisal of the definitions, goals, and objectives of medical ethics and humanities teaching. The authors describe assembling a national expert panel of educators representing the disciplines of ethics, history, literature, and the visual arts. This panel was tasked with describing the major pedagogical goals of art, ethics, history, and literature in medical education, how these disciplines should be integrated with one another in medical education, and how they could be best integrated into undergraduate and graduate medical education. The authors present the recommendations resulting from the PRIME I discussion, centered on three main themes. The major goal of medical education in ethics and humanities is to promote humanistic skills and professional conduct in physicians. Patient-centered skills enable learners to become medical professionals, whereas critical thinking skills assist learners to critically appraise the concept and implementation of medical professionalism. Implementation of a comprehensive medical ethics and humanities curriculum in medical school and residency requires clear direction and academic support and should be based on clear goals and objectives that can be reliably assessed. The PRIME expert panel concurred that medical ethics and humanities education is essential for professional development in medicine.

The analysis on student assessment of outline of medical humanities course in military medical university

Objective To improve the teaching quality of medical humanity education in medical university.Methods A cluster sampling survey was given to 448 sophomores who studied the outline of medical humanities course in military medical university,and the data were descriptively and statistically analyzed.Results The survey shows that 90％ sophomores satisfy with this course,95％ sophomores understand the importance of medical humanity education,and the students have more requirements on education resources and teaching ways.Conclusion Outline of medical humanities course is important to cultivate the medical humanity spirit of medical students,and the course still needs more improvements. Key words: Military medical university; Medical humanity; Student assessment

Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method

ObjectiveTo further develop and validate previously published national prescribing appropriateness criteria to assist in identifying drug-related problems (DRPs) for commonly occurring medications and medical conditions in older (≥65 years old)...

Medical colleges should strengthen the role of second classroom role in humanistic education

“The second class” in medical college is an important carrier of humanities education.In order to give full play to its function,we must effectively rationalize the organization and management of medical humanities education institutions,not only to broaden the content and form of“ the second class”,but also to establish appropriate evaluation incentives. Key words: The second classroom; Medical students; Humanistic education

Exploration of the method to medical humanistic education

Medical humanistic education becomes “remarkable leaning” because many problems arise from the development of contemporary medicine such as the meaning of life,the medical aim,the medical model and doctor-patient relationship etc.Multi-channel and multi-modal development of medical humanistic education has become a must to understand medicine and makes it develope soundly,and all-directional resultant force and the environment of medical humanistic education,striving for studies,is an exploration and even a mission and responsibility Key words: Medical humanistic; Education; Course construction

The European Respiratory Society: future directions in medical education

Today’s fast-moving societal, economic and technological changes are reshaping the medical profession. The movement of both patients and doctors within the European Union (EU) has focused even greater attention on the competence of doctors and their fitness to practice. Horsley et al. [1] have described the variation between continuing professional development systems across EU countries, arguing for harmonisation of accreditation systems to simplify this process. At the same time, technological changes have introduced new concepts and challenges in how we conduct medical education, both by instruction and assessment, such as e-learning, simulators and simulation scenarios. These trends will particularly impact on the practice of respiratory medicine and it is therefore crucial that the profession keeps pace. This requires particular effort in education and training. Medical education reforms have become relevant and call for: 1) standardisation of learning outcomes and individualisation of the learning process; 2) promotion of multiple forms of integration; 3) methods of self-reflection and self-improvement; and 4) focus on the progressive formation of the physician’s professional identity [2]. These reforms will need to be supported appropriately by the EU and its member states. Therefore, the European Respiratory Society (ERS) is in a unique position to propose EU-wide principles, values and measures. For …

Use of social media in graduate-level medical humanities education: Two pilot studies from Penn State College of Medicine

Background: Social media strategies in education have gained attention for undergraduate students, but there has been relatively little application with graduate populations in medicine.Aims: To use and evaluate the integration of new social media tools into the curricula of two graduate-level medical humanities electives offered to 4th-year students at Penn State College of Medicine.Methods: Instructors selected five social media tools – Twitter, YouTube, Flickr, blogging and Skype – to promote student learning. At the conclusion of each course, students provided quantitative and qualitative course evaluation.Results: Students gave high favourability ratings to both courses, and expressed that the integration of social media into coursework augmented learning and collaboration. Others identified challenges including: demands on time, concerns about privacy and lack of facility with technology. Integrating social media tools into class activities appeared to offer manifold benefits over traditional classroom methods, including real-time communication outside of the classroom, connecting with medical experts, collaborative opportunities and enhanced creativity.Conclusions: Social media can augment learning opportunities within humanities curriculum in medical schools, and help students acquire tools and skill-sets for problem solving, networking, and collaboration. Command of technologies will be increasingly important to the practice of medicine in the twenty-first century.

What's in a name?

As non-medically qualified individuals with long-standing chairs in clinical pharmacology, we would like to comment on Doctor Aronson's recent manifesto [1] implying that our titles are inappropriate. According to the manifesto, a clinical pharmacologist is a multi-skilled practitioner who conducts research, teaches, makes policy, provides information and advice about the actions and proper use of medicines in humans and implements that knowledge in clinical care. Given the last stipulation, we agree that only the medically qualified can aspire to perform all of these functions to a significant degree. However, the reality is different in that not all ‘clinical’ pharmacologists carry out research, especially related to the scientific basis of the discipline, and, in some cases, their clinical apprenticeship and patient contact is very limited. So, whether medically qualified or not, we believe that 80% compliance with the stipulations is not to be dismissed. Furthermore, we would argue that Doctor Aronson's (and, indeed IUPHAR's [2]) definition of a clinical pharmacologist, as interpreted in a narrow professional sense to refer to those physicians who specialize in clinical pharmacology, is divisive, fails to recognize the major contribution of non-medically qualified individuals to the discipline, and is to the detriment of the future of clinical pharmacology. The latter is an especially important consideration given the decline in the number of medically qualified clinical pharmacologists in the UK [3] and in Australia, the likely increasing dependence of the discipline on professionals who are not medically trained and an increasing responsibility of pharmacists and nurses for prescribing. It may be that exclusivity in the definition of a clinical pharmacologist is a price to pay for increased support for specialist medical training in the discipline, but we object that it is at the expense of highly qualified non-medically trained professionals. In Australia non-medically qualified clinical pharmacologists continue to have a pivotal role in driving clinical pharmacological research. Furthermore, they contribute to the development and implementation of clinical guidelines and the development of health policy, and do much of the undergraduate and graduate-entry teaching of pharmacology and therapeutics. In the UK resuscitation of the discipline and the input to it of non-medically qualified individuals will be difficult given the demise of many departments and units of clinical pharmacology and associated teaching, a development that has been presided over by some clinical pharmacologists who became Deans of medical schools or Directors of Medical Education. The contribution of the non-medically qualified to the research role of clinical pharmacology and its direct involvement with drug development has also been compromised in the UK as our medical colleagues have watched a significant segment of ‘translational medicine’ disappear overseas, strangled by excessive bureaucracy. If there are young, non-medically qualified scientists who would want to help carry the flag for ‘clinical pharmacology’ in the future, we hope that they are not too put off by old-fashioned, closed-shop attitudes. We are encouraged to note that Doctor Aronson's views on non-medically qualified individuals and the definition of a clinical pharmacologist are not endorsed by the senior editors of the Journal [4]. There are no competing interests to declare.

The Introduction of a Medical Informatics Course into a Medical School Curriculum

Fulfilling the need for a course in medical informatics to be taught to medical students requires an effort on the part of the teaching faculty and administration. Creators of the curriculum must take into account contemporary pedagogical trends and the direction of medical education. Producing a course of study requires a firm conviction that practicing medicine in the 21st century demands currency, accuracy, and literacy with the available information sources.

Can Literature Enhance Oncology Training? A Pilot Humanities Curriculum

DOI: 10.1200/JCO.2010.33.3617 The use of humanities curricula, specifically narrative-based instruction, is increasingly common in medical education. The overarching goal for introducing humanities into medical training is to allow physicians to empathize with the patient’s perspective, and thus to train physicians to adopt patient-centered approaches in the delivery of medical care. As physician and writer Verghese points out, “To hear the voice of the patient preserves our capacity to imagine the suffering of the patient.” Furthermore, using humanities in medical education allows for self-reflection and introspection and can lead to alliance building with colleagues. A conceptual framework for the use of illness narratives in medical education has recently been proposed. In this framework, illness narratives and patient encounters lead to an understanding of chronic illness that is personal and immediate, rather than abstract or statistical, and this fosters identification with patients. Humanities-based education can be a transformative experience. Oncology is a stressful occupation, and oncologists commonly deal with burnout and grief. In one survey, 56% of oncologists reported being burned out. Oncology trainees may be particularly susceptible to these feelings. In a recent French survey of oncology residents, 44% of trainees experienced burnout, and 18% had abnormally elevated levels of emotional exhaustion and depersonalization. In this study, burnout was significantly associated with the desire to either leave health care altogether or to change specialties. It is also notable that medical training has been shown to be associated with a progressive decline in empathy that can be measured using a quantitative scale. The use of medical humanities in its various forms may help oncology trainees and other physicians to rekindle empathy and cope with burnout. Indeed, Krasner et al demonstrated that an education program in mindful communication that included narratives and discussion of meaningful clinical experiences significantly increased empathy and reduced symptoms of burnout (including depersonalization and emotional exhaustion) among participants. Despite the increasing use of humanities-based medical education, a majority of these efforts to date have focused on medical students and, to a lesser extent, on residents, and only rarely on specialty fellows. Informal discussion forums and lecture series focusing on various aspects of oncology, particularly end-of-life care, have been created at various institutions. However, to our knowledge, there is no oncology-specific humanities curriculum. Furthermore, humanities are not a required part of oncology fellowship training, although humanities training may help trainees meet several required Accreditation Council for Graduate Medical Education competencies, particularly in the areas of patient care, interpersonal and communication skills, and professionalism. Since 2003, we have held occasional lecture series related to medical humanities and narratives as part of oncology fellowship training at our institution. In 2009, we decided to create a more formal humanities curriculum and integrate it into the oncology fellowship curriculum. We describe here the development and implementation of this pilot program, discuss qualitative feedback, and offer suggestions that may help other oncology training programs to incorporate humanitiesbased curricula.

Part 3: Evidence Evaluation Process

Part 3: Evidence Evaluation Process

Part 7: CPR Techniques and Devices

Part 7: CPR Techniques and Devices : 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Threatment Recommendations

Introduction

The reports presented in this issue provide a glimpse at the breadth of issues medical educators face today, and the creative ways they are tackling the issues across the continuum of medical education. Because “Really Good Stuff” (RGS) represents medical schools throughout the world, it offers a snapshot of the universal nature of the problems faced by medical educators. The reports in this issue range from community outreach in the Amazon to the use of art and writing to understand chronic pain in patients in the United Kingdom. In fact, there were so many contributions that dealt with the application of the arts and humanities in medical education that I created a category in this issue for these reports. One of the challenges we face as editors of the section is to define the kinds of reports to include in “Really Good Stuff”. The number of submissions to the section remains high and the goal is to provide readers with the highest quality and most useful reports submitted. The reviewers serve a critical role in helping me and Kevin Eva decide which of the many good reports truly represent “really good stuff”. Two of the most common concerns raised in the reviews for the reports submitted this time were 1) a lack of detail to help understand what is being presented; and 2) a lack of support for a variety of statements made in the reports. The word limit presents a challenge to authors to provide enough detail in as few words as possible but as you read through the reports presented here, please note how the authors of the accepted reports have provided important details to help you understand their intent. I ask you to read through the reports selected for publication in this issue and consider what you are doing that you want the world to know about. Remember, the really good stuff cannot have been in place for more than 3 years and we are interested in things that have worked, as well as promising initiatives that were not successful. Kieran Walsh poses a question in his thought provoking letter in this issue of Medical Education1– are we just too positive in medical education? I hope you will read Dr. Walsh’s letter and give some thought to exposing the really good stuff that turned out to be not so good after all. As RGS continues to evolve, we hope it will continue to better meet your needs. Let us know what you think about “Really Good Stuff” and ideas you have for improving this feature in Medical Education. Most of all, submit your own really good stuff (and the things that did not work as you planned) for review and consideration. (Deadlines for the section are: November 1 for the following May issue and May 1 for the following November issue).

Part 4: Conflict of interest management before, during, and after the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Part 4: Conflict of interest management before, during, and after the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

A tool for managing medical students humanistic education

Medical undergraduate programs demand great dedication by students and teachers. While teachers need to deal with thepreparation of classes and evaluations, students must what they can to obey deadlines teachers set and to deal, with a huge amountof ineducation in a relatively short time. Before such an amount of “technical” ineducation, future doctors may distract and lose sightof the goal that made them choose the medical career: caring for human beings. The result is well known: the market is flooded bydoctors preoccupied in technically managing diseases – something which is undoubtedly importantly – but with little skill to caring forpeople. Therefore it is important that students learn to deal with patients, them as human beings and not mere organisms bearing healthdisturbances. This skill is not acquired in a classroom during a theoretical class, but we need to expose the student to medical practicein several pedagogic settings. Humanistic education implies another task for medical teachers: how to value students’ performance orhow to measure how much the student learned about treating patients, guaranteeing that they do not set aside the scientific knowledgenecessary for the practice of the profession? In this context, the program of credits idealized and implemented by SOBRAMFA proposesa scale for evaluating students’ performance in practical, academic and scientific activities in order to provide an integral educationincluding all the skills necessary to practice medicine as Science and Art.

Suggestions for the Improvement of Medical Humanities Education

Medical humanities has become a third area of medical education following basic and clinical medicine. Also, in the national evaluation of medical schools, medical humanities education is an important factor. However, there are many difficulties in teaching medical humanities in medical schools. First, it is still an unfamiliar education area to medical schools and professors. Second, still, there is no consensus on the definition and contents of this education. Third, it is usually very difficult to find professors who have interest and the ability to teach medical humanities. Fourth, even medical students do not understand why they should study medical humanities and sometimes do not eagerly participate in class. This paper suggests some solutions for these problems. First, medical humanities need to be divided into sections according to how easily the contents can be accepted by existing medical education system and apply these sections in the introduction of this education gradually and in stage. One example of the division can be as follows: Group 1) medical ethics and medical law which can be most easily accepted. Group 2) medical communication skills which can be relatively easily accepted. Group 3) medical history and medical professionalism which is relatively difficult to accept, and Group 4) medical philosophy, medicine and music, medicine and literature, medicine and art, medicine and religion, etc. which is the most difficult to accept. In this paper, four things are suggested. Second, divide the contents into mendatory courses and elective courses. Third, allocate the contents throughout the four years from the first year though the fourth year according to the spiral curriculum model. This paper reports some new ideas and methods for medical humanities education. First, to stimulate students’ participation, several methods were applied in a large size lecture and student projects. Second, the emphasis of writing in class and evaluation were discussed. Third, the provision of hands on experience is more emphasized than lectures. Fourth, inviting some doctors who work in non-medical areas such as journalism, pharmaceutical industry, etc is suggested. Trial and error is inevitable in this education, but it is essential in molding a good doctor, so medical professors who are interested or in charge of this medical humanities education need to share their ideas and experiences.