Medical Science, Medical Humanities, and the Quest for Empathy

INSTITUTION: University of California, Irvine.

INSTRUCTOR: Johanna Shapiro, Ph.D., Director of Medical Humanities in Family Medicine, email: jfshapiro@msx.ndc.mc.uci.edu; Lloyd Rucker, M.D., Medicine Clerkship Director, Assistant Dean of Medical Education

ENROLLMENT: 3rd year medical students; required; limit: 18 per quintile

SEMESTER: Spring 2000

DESCRIPTION: Two three-hour clinical humanities sessions as part of an eight session didactic series required for all third year medical students participating in the Junior Medicine Clerkship. (Other sessions include communication skills, bioethics, and four case discussions examining doctor-patient communication, clinical reasoning, and medical decision-making).

COURSE OBJECTIVES:

At the end of the clinical humanities sessions, students will

  • Understand the role of the humanities in a) developing insight into the doctor-patient relationship b) cultivating understanding and empathy for both patients and physicians
  • Discover how to use expressive art, literature or music to better understand the patient, the physician, and the physician-patient relationship with special emphasis on the medical student experience
  • Recognize the humanities as a resource for maintaining empathy, understanding, and compassion throughout careers in medicine

FORMAT:

Session I: Group discussion.

In preparation for this discussion session, we will distribute a series of brief literary essays, writings, and poems. Students should read these materials before attending the session, and be prepared to discuss them in the context of their experiences with patients or their experiences as a patient, patient’s relative, or patient’s friend.

Session II: Group presentations.

Each student will prepare a project or presentation. This may consist of

  • a presentation of the relevant work of another person
  • personal essay
  • creative writing or poetry
  • movie or video
  • artwork
  • music

The presentations may be verbal, visual, performance, or analytical. For instance, students may choose to write an essay or poem about their own experience or they may choose to read a poem or essay written by someone else about their experience as a patient or as a medical student. Students may also choose to describe their own experience as a patient or the experience of someone close to them.

The only requirements are these:

1. Every student must do something

2. Every student must turn in something: either the original work or a brief written description of that work, including a description of its significance to the student.

3. Oral anecdotes or stories about encounters with patients are acceptable. These must be accompanied by a written document describing the incident or relationship; please no spontaneous oral presentations.

4. No single work should be longer than 5 minutes. Students may work together in groups, in which case they can pool their time and use multiples of the 5 minutes. However, when working in groups, each of the participants must demonstrate a significant contribution to the project.

We will not engage in criticism or dissection of the work. Instead, students will practice attentive listening and being fully present while creative works are shared. Our goal is not literary or artistic analysis. Rather, it is to provide students the opportunity to understand their patients, their roles, and themselves through the humanities.

REQUIRED READING:

"A Good Story" (book chapter) Michael Crichton: humorous account of Crichton’s experiences as a medical student; explores the various meanings of patients’ stories, and the importance of close listening to patients

"Morning Report" (poem), Veneta Masson: a student describes an encounter with a patient early in her training that raises issues about life and death and what the patient can give to the physician

"The Log of Pi" (poem), Marc J. Straus: talks about how to respond to the really important, difficult-to-answer patient questions that cannot be answered solely by "facts," but involve hope and faith

"I Stare Out" (poem), David Kopacz: a third year medical student expresses anger both toward a demanding resident and a stressful on-call situation, and uses distancing and detachment as coping mechanisms

"Transformation" (poem), Michelle Steele Rebelsky: a medical student struggles with her conflicting roles as daughter and physician when her mother undergoes a breast biopsy and waits for the results

"Invasions" (book chapter), Perri Klass: written when Klass was a third year student at Harvard, this essay explores intimacy and privacy issues in clinical practice and warns against callousness

"On Being a Patient" (essay), Allison S. Clay: a third year student suddenly becomes a patient and discovers life looks very different from the other side of the doctor-patient relationship

EVALUATION:

Students complete a brief pre-post self-report questionnaire at the introductory session to the clerkship, immediately after completion of the final humanities session, and at the end of the third year. Items focus on the perceived usefulness of the humanities to increase understanding of and empathy for patients and physicians, and whether medical humanities should be a required component of the medical school curriculum.