|Year : 2016 | Volume
| Issue : 1 | Page : 6-8
Why teach humanities?
Jan van Dalen
Skillslab, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
|Date of Web Publication||2-Jun-2016|
Jan van Dalen
Skillslab, School of Health Professions Education, Maastricht University, Maastricht
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
van Dalen J. Why teach humanities?. Arch Med Health Sci 2016;4:6-8
Humanities as a topic in medical schools are much discussed.
There are several sides to this debate. First, it is often stated that humanities cannot be learned. When it has been accepted that they can be learned the question arises if it is the task of the medical school to teach them? Third, if they should be learned in medical school, how should we best measure if students have “sufficient humanities” to be a good doctor? Moreover, what is “sufficient humanities” anyway?
The trouble starts with trying to describe what we are talking about when we talk about humanities. Wikipedia reveals: “Medical humanities is an interdisciplinary field of medicine which includes the humanities (literature, philosophy, ethics, history, and religion), social science (anthropology, cultural studies, psychology, sociology, and health geography), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. There is no universally agreed definition of the medical humanities.” Yet, a generally accepted component in which humanities are expressed is doctor–patient communication. In doctor–patient communication, most of the above-mentioned aspects are integrated: Doctors' knowledge, culture, background, ability to empathize, and wisdom to know the individual patient is or should be fully integrated.
In cases that are under discussion, it is always helpful to turn to the available evidence. When we turn to what our evidence tells us about acquiring skills in humanities, we can safely conclude that these competencies can be learned. The leading handbook in this field  lists over 30 pages of scientific publications reporting studies that evidence to this issue. Learners can develop the capability to “put themselves in other peoples' shoes” and they can learn to incorporate this empathy into the consultation.
Hence, it seems that this issue is out of the way when we know our literature.
Now that we know that humanities can be learned we can turn to the next question: Should they be part of the medical curriculum? I will give a couple of arguments why not. First: Humanities have been parts of our learners' lives before they came to our medical schools. There is nothing new in the topic for learners, so what can medical school add to what they already know? They may not be fully aware of their background, culture, and intellectual luggage, but do they need medical school to become aware of this or will this be rather enhanced by life itself?
In addition, we run into the problem of assessment. If humanities are considered to be part of the medical curriculum, should we measure our students' humanities? Moreover, can we fail students who do not meet the standards? And what standards do we have, by the way?
This is the gravest issue and it has been recognized for a long time.
Our current thinking about assessment is moving away from the summative use of tests for a decision. We all know how we prepared for an oral examination: A substantial proportion of the available time was devoted to finding out the assessor's preferences not only in content but also for the way we ought to be dressed…Our current assessment system is quite subjective and suffers from the cumulative “snapshot approach.” At the end of a course, we are subjected to a test and once we have passed that we do not have to worry anymore about that topic, at least not until we meet with patients.
This system is losing ground. Current testing is more comparable to developing a patient file in hospital: Collect as much evidence as we can in as many as possible circumstances and use this information (about students' accomplishments) to arrive at a judgment. Such a judgment will be more representative of students' accomplishments in real life and it will suffer less from the stress that accompanies the high stakes exams nowadays.,
Since much information is accumulated in such a system, it is not a great disadvantage if one of the tests is somewhat subjective. As long as much information per student is accumulated and aggregated, “objectivity” can safely and more realistically be replaced by “intersubjectivity,” a credible and acceptable alternative.
This opens perspectives for the assessment of humanities. A 360° feedback can help to collect much evidence about student behavior in real life. All stakeholders can add to this evidence, including the most important group: Patients. Of course, each stakeholder can add information about the topics they know about, so patients can provide feedback about how well they felt attended to.
Regarding the pass–fail boundary for this topic: To be honest, any pass–fail boundary is arbitrary, so this issue should be addressed by a debate searching for the best arguments in a forum rather than by individuals.
Hence, actually evidence does not provide strong arguments why humanities should not be included in a medical curriculum. That leaves us with the most important question: What are the arguments in favor of inclusion?
For this, we have to focus on two issues: Developments in health care and developments in society.
Health care has changed tremendously in the past decades. Exponential growth of the technological possibilities and increased specialization has resulted in a much more rapid turnover of patients in the hospitals. Between 1991 and 2004, the mean length of stay in an average American hospital decreased from 8.7 to 4.9 days (P < 0.001). Such a change implies that students will have less and less opportunity to address “whole” people during their training. Increasingly, they will see “an arm here and a leg there.” The hidden message to the students is that whole people and their overall wellbeing matter less.
It is not just changes in health care that have seen rapid developments. Our society has quickly turned into a global village, with enormous changes in the populations of any community. Moreover, people reached higher ages than only a relatively short while ago. Chronic diseases that people died from a few decades ago are now much better controlled. The care-cure balance has tilted toward more need for “care.” The poor doctor is however still trained to cure, so they are likely feel empty-handed when patients visit for the regular diabetes checkup: What can we talk about? An understandable reaction is therefore not to talk at all about other things than the disease.
And yet, there would be so much to be gained when we do inquire about our patients' general well-being, and when we do express an interest beyond their disease.
When doctors incorporate their humanities into their daily work with patients, first of all, patients are more satisfied but that is obvious and not much news. Perhaps more surprisingly, a number of clear and objectifiable outcomes can be established: After adequate information to the patient and their family, before an operation, fewer painkillers are asked afterward; diabetes and blood pressure are better under control when it is properly addressed what patients should look for and how they and their families can recognize symptoms. In short: Compliance is higher and — not unimportant — fewer lawsuits are initiated against doctors who include humanities into their consultations. An overview of these outcomes is provided.
The final question is then: How can we teach humanities?
The most obvious motivator in medical school is the patient's voice. Yet, we postpone the patient's voice in the curriculum until the clinical phase of the study, which is usually the 3rd or 4th year. Interestingly, the first patients students see in their medical studies are dead. Somewhat exaggeratingly we can state that the hidden message in this phenomenon is obvious. It is the bodies that are of primary importance, not the minds…
We cannot move “the patients' voice” forward in the curriculum because students obviously must have acquired necessary knowledge before they can be of any use to patients. However, we can make use of actors, who are not themselves in need of healthcare but who can act outpatient scenarios for students in a safe teaching environment. Such actors or simulated patients can provide feedback to the students and help them to see the relevance of including the “human touch” in the doctor–patient encounter. Such simulated patient programs exist in many medical schools in the world and the results of these programs are very promising. This way, students will gradually learn how to integrate their medical knowledge with their developing humanities.
In view of the results of such a program, the investment is a small price to pay.
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