Commentary by Linda Raphael, Ph.D., Director of Medical Humanities and Associate Clinical Professor of Psychiatry and Behavioral Sciences
My introduction to medicine and humanities occurred at a Narrative Medicine Seminar in New York in 2003. I was attracted to the seminar because my teaching and writing have focused on narrative theory and representations of the Holocaust in literature and film. Thus, how one tells stories, especially stories about pain and suffering, have long been an interest of mine. I was excited to find physicians, nurses, social workers, psychologists, historians, philosophers, and literature professors gathered to discuss the world of medicine and illness from a variety of perspectives. When I heard Shlomith Rimmon-Kenan’s talk, “Whose Story Is it Anyway?” I was convinced by the close reading of a patient’s story which had been determined and then narrated by family members and medical institutions that the relationship between the world of medicine and narrative theory was well worth pursuing. At the end of the seminar, I mentioned my interest in developing a course for GWU School of Medicine to Rita Charon, Director of the Program in Narrative Medicine at Columbia’s College of Physicians and Surgeons, whose encouragement was immediate. Both she and one of her colleagues know the Medical Director at GW Hospital and put me in touch with him because they knew he would be interested in humanities and medicine. I then started on an unanticipated and exciting path that led to developing a program rather than one course.
After meeting with the Medical Director I sought out medical faculty who were interested in medicine and humanities. I heard from a professor in the Physician Assistant program with whom I was acquainted about a few physicians on the faculty who would be interested in humanities. One of them discussed the idea with the Dean of the School of Medicine, which led to a meeting with me. Soon after that, I was asked to write a proposal for a program in medicine and humanities. I turned to Ann Hawkins of Penn State Hershey Medical Center, whom I had met briefly at the seminar at Columbia, and then to Kathryn Montgomery, of Feinberg School of Medicine at Northwestern University. Their generous sharing of materials and ideas enabled me to write the proposal that convinced the Dean that I would be able to initiate a small program in medicine and humanities.
My initial appointment was part-time (2005-06). I have worked under both the Dean and the Associate Dean for Academic Affairs. They have been extremely supportive (both have taught in the courses) and have carefully thought through how we can best introduce humanities into the medical school curriculum. They combine a visionary perspective and a cautious understanding of what will work and at what pace we should move. We introduced three electives in medicine and literature – greatly aided by the NYU Literature, Arts, and Medicine data base – for First Year students in their second term. Thirty-five students (approximately one fifth of the class) enrolled, which the deans and I regarded as a very positive sign. The courses were taught by me, the deans, and other physicians (a different doctor at each class session). It has been no problem finding doctors who are excellent and willing teachers. In the summer of 2006 I introduced a humanities session (reading distributed in advance followed by discussion and sometimes short writing exercises) to the clerkships; initially pediatrics, then primary care, and soon all. We have had book groups to which the entire medical school is invited, and I have also gathered faculty who express interest in small groups to discuss a book.
In the 2006-07, the university (Academic Affairs) gave me a grant for five Medical Humanities interdisciplinary seminars (art history, poetry, fiction, etc) and 30-35 townspeople, students, faculty and staff attended each session. The evaluations were positive, and Academic Affairs funded the seminars for a second year (2007-08). In this same year I added sessions with residents; these have included primary care medicine and psychiatry, and soon Ob/Gyn. We have had several book group sessions, some advertised to the entire medical community and others to individuals who have expressed interest in a reading group. The Dean was the first to suggest that we have an all medical school group, and he has continued to be a great enthusiast (and fine reader!). Finally, we now have, in addition to the two courses for First Year students, two courses for Second Year students.
My position is now full-time. Student evaluations for the electives have been extremely positive, and those who take the first-year electives tend to sign up for the second-year offerings. Some students have reported that they would like very much to take a humanities course, but they pass up the chance to take an elective because they worry that they won’t have enough time to study their required medical school course material.
The most important factors in the development of this program have been the enthusiasm and generous support from others in the field, a dean who was an English major and who continues to love to read and discuss literature, a medical school that prides itself on training students in the art of medicine, and the national visibility of other programs.
Thomas Johnson
Would you be able to provide me with a list of other articles that I might utilize in training my interns in the narrative approach?
Felice Aull
Thomas — you might want to visit the Narrative Medicine Program web site linked to in the above commentary (http://www.narrativemedicine.org/), which has a list of references, as well as information about workshops that train people in narrative medicine.
In addition, you might find the NYU medical humanities syllabus site (http://medhum.med.nyu.edu/syllabi.html) of some help.
Best wishes, Felice Aull
Linda Raphael
Thomas — I would make the same recommendations as Felice. If you have a general interest in narrative theory, I can recommend other readings.
Best, Linda Raphael
Aliye Runyan
Dr Raphael,
I am a student at the UM-Miller medical school in Miami. I have been trying to approach our deans with ideas for establishing a program, such as you did at GWU, at UM. They are receptive so far, but I think the faculty support and resources aren’t entirely present, and I would much appreciate any ideas from you as to how to go about establishing a program. I intend on contacting Anne Hawkins and Rita Charon, as I have heard of them through my late mentor in undergrad Literature, Joanne Banks (formely of the Penn State Dept of Humanities). I hope to be a part of the development of such a program at UM, as I have great interest in continuing this aspect of my medical education. Many thanks, Aliye
Linda Raphael
Dear Aliye,
First, I hope this will be an ongoing conversation between us because I am certain that thoughts will come to me that are not in my head at present. However, I shall go ahead with what is in my head as I first read your message: having the deans’ support is essential, as you know, so you are off to a great start. You may need one faculty member who is willing to go to work with you on getting started. I find that medicine (primary care and internal medicine), pediatrics, and psychiatry are the specialities that attract the greatest number of people interested in humanities. I generally ask doctors to teach one session of an elective course, which does not overwhelm them and gives students the opportunity to meet different doctors. It also brings the doctors “on board.”
Don’t forget that you have an advantage as a student because deans care about what students think! Can you get a group of students together who will talk as a group to the deans?
One way to bring together potentially interested people is to have a book group that includes students and faculty. I’d be happy to share with you a list of the books we have discussed in our group over the last year. Good luck! Please let me know what other sorts of information might be helpful. Best, Linda
Elliott Addesso
Dr. Raphael,
I am a second year art therapy student at Eastern Virginia Medical School and for my thesis project I am proposing an exploratory 8 week humanities course for medical students enrolled in gross anatomy. Hopefully, it will just be the beginning of establishing a medical humanities program here at EVMS. I was originally going to do an all out 8-week crash course in figure drawing to coincide with the anatomy course, but the anatomy professor suggested that such a study would attract people who liked to draw and then the results of the study would be skewed heavily. Instead, he suggested a more well-rounded arts-based humanities course; I’m currently working on the proposal and looking for anything that might be helpful in terms of possible ideas for the sessions.
Thomas Lawrence Long
Elliott Addesso: you might want to contact Frederic B. Tate, PhD, at Eastern State Psychiatric Hospital (Williamsburg, Va), an art therapist.
Catherine Caldicott
Elliott,
Perhaps this recent article will be helpful to you:
Naghshineh S, et al. Formal Art Observation Training Improves Medical Studetnts’ Visual Diagnostic Skills. Journal of General Internal Medicine 2008;23(7):991-7. Also, I believe Dr. Charles Bardes at Columbia ran a course in which he took medical students to fine arts galleries to teach them visual observation skills.
Catherine Caldicott, MD
Center for Bioethics and Humanities
SUNY Upstate Medical University
Syracuse, NY
Felice Aull
Elliot —
You might want to look at the Columbia Arts in Medicine Projectto which Catherine Caldicott referred. It is linked with several New York City museums. At NYU School of Medicine we have also linked with the Frick Museum, which offers an Art and Observation seminar to medical students. NYU also offers life drawing classes to interested medical students (as well as to faculty and staff). Sandra Bertman, Ph.D. has worked with University of Massachusetts and other groups to develop several programs using the arts in medical education and with patients.
Howard Carter
Elliottt,
You might have a look at my FIRST CUT: A SEASON IN THE HUMAN ANATOMY LAB (Picador, 1997). An English professor, I observe the M-l anatomy course at Emory and comment on literary, artistic, and other cultural resonances.
I believe the book is now on print on demand status, but it is available. YOu can email me directly if you need to know more; I”m to your south, in Chapel Hill (ahcarter@nc.rr.com). All best wishes, Howard
Linda Raphael
Dear Elliott,
First, what a wonderful project! Bravo!
I suggest that you write to a second-year medical student at GW who has spent time doing research on a curriculum for a course in the visual arts and medicine. Contact me privately for her contact information.
We had an evening lecture and discussion on works of Edvard Munch, attended by community members, physicians, and a few students. The works were provocative (of course “The Scream” was central). I think it is interesting to consider the difference between painting and photography in this sense: Munch painted his very ill sister; how would photographs of an ill sibling be received? Would they appear to be too voyeuristic (this would depend in large part on the photograph, but I think there may be a general issue here).
I have used a painting of Freida Kahlo’s in a discussion of repeated spontaneous abortion with ob/gyn residents. Klimt’s work is intriguing for thinking about medicine; in Vienna I saw two of his murals, “Medicine” and “Philosophy,” hung next to one another. You should be able to find them in books on Klimt.
Please feel free to write again, on the blog, or to me directly.
Best regards,
Linda
Elliott Addesso
Thanks to all for the advice. I started my life drawing course with gross anatomy med students here at EVMS a couple weeks ago. I decided on making it more of a traditional introduction to drawing the figure with an opportunity for written reflection at the end of the sessions. So each session goes something like this: I teach/demonstrate techniques like gesture, contour, etc. and then we spend time drawing from a live model. After the drawings we spend about 15-20 minutes doing reflective journal writing that incorporates the students gross anatomy experience, for example:
1) Write a haiku or other short poem that combines both descriptions of the models outward appearance and your observations, thoughts, feelings, associations towards the model.
2) Write a companion piece about your patient in Gross Anatomy.
3) Are the poems similar or different? In what ways?
It is a small group but so far the students are really responding well and see it as a big stress release.
I am currently looking for someone to be a committee member for my thesis. This would involve reviewing, suggesting articles, and participating in things like the defense which could all be done via conference calls and e-mail. If anyone is interested, I would really like to have someone involved in a medical humanities program on the committee.
Thanks.