Syllabi: Medical Humanities in Patient-Doctor II

INSTITUTION: University of California, Irvine

COURSE DIRECTOR:
Desiree Lie, M.D. M.S.Ed.

COURSE INSTRUCTOR:
Johanna Shapiro, Ph.D. Medical Humanities Content Area Expert
University of California, Irvine College of Medicine
email: jfshapiro@msx.ndc.mc.uci.edu

ENROLLMENT: 2nd year Medical students; required

SEMESTER: Fall 1999 - Spring 2000

ELECTIVE LINK: A medical humanities second year elective, Medical Humanities II, is thematically linked to the PDII course.

DESCRIPTION:
Patient-Doctor II is a year-long, required course for all second year medical students (n = 92). The course is organized into eight modules, each of which is built around a patient case. Students working in small learning groups interview a Standardized Patient and then identify specific learning issues that will help them to better understand and care for the patient. Content areas include behavioral science, cross-cultural medicine, palliative care, complementary and alternative medicine, environmental and occupational medicine, epidemiology, ethics, medical economics, medical informatics, nutrition, and sexuality, as well as medical humanities. More information can be obtained from the PDII website: www.com.uci.edu/pd2.

Medical humanities are integrated into the PDII course through a required literary selection that reflects the topic for each of the given modules, which are organized around different organ systems or patient categories (ie., mental health, heart, pulmonary, liver and abdomen, pregnancy and gynecologic exam, pediatric illness, neurology, and geriatrics), as well as a responsive journaling assignment.

OBJECTIVES:
At the end of the course, students will be able to

• Use creative imagination to understand the experience of illness
• Enter into other points of view
• Demonstrate understanding of the uses of language and tone
• Empathically analyze complex interactions between physicians and patients as portrayed through literature
• Use writing as a tool to reflect on and organize experience

FORMAT:
Each module has a required literary reading assignment to be completed by students and small group co-leaders. These are typically very brief (a single poem, a short short story, or excerpts) and reflective of issues raised in the module. Students are required to respond to the selection in written "journaling" form, no more than a page of typing, exploring their reaction to the piece, what it taught them about being a better doctor, what they learned about the experience of the patient, or what they learned about themselves. Explicit directions for this journaling, as well as examples of other students' journal entries, are provided at the start of the course. Students and co-leaders incorporate discussion of the literary selection into the final group discussion of the module.

REQUIRED READING (all excerpts):
Module 1: Darkness Visible William Styron
Module2: Heart Attack! Michael Crichton; EKG Paula Tatarunis
Module 3: The Patient Examines the Doctor Anatole Broyard
Module 4: Imagine a Woman Richard Selzer
Module 5: If The River Was Whiskey T. Coraghessan Boyle
Module 6: Autobiography of a Face Lucy Grealy
Module 7: On Being a Cripple Nancy Mairs
Module 8: Dr. Cahn's Visit Richard Stern

EVALUATION:
The medical humanities component of the course is evaluated through an interstation exercise during an OSCE (Objective Structured Clinical Examination) evaluation at the end of the year. In this computerized exercise, students first read a brief fictional work, then write a response designed to elicit both empathic reactions and ethical decision-making. The criteria for evaluating this writing assignment include assessment of key words connoting empathy and ethical awareness, as well as a global appraisal.