What are the Humanities in Medical Education For?

00:55:40
https://www.youtube.com/watch?v=F3LTtMIrfvY

Ringkasan

TLDRThe Brodie lecture, presented by Dr. Rebecca Volpe, explores the integration of health humanities into medical education. Dr. Volpe is an expert from Penn State's College of Medicine, focusing on how humanities can enhance humanistic medical practices. The lecture discusses the recent curriculum changes motivated by the COVID-19 pandemic and social justice movements in 2020. It highlights the challenges of defining clear educational outcomes in health humanities due to its varied interpretations. Dr. Volpe emphasizes the importance of institutional support, critical consciousness, and practical application in clinical settings to better reach educational goals.

Takeaways

  • 🎓 Health humanities enrich medical education by integrating humanities disciplines.
  • 🩺 Empathy and humanistic practice are central goals of health humanities.
  • 🛠 Institutional support is critical for successful humanities programs in medicine.
  • 📚 Penn State's curriculum includes foundational courses, visual thinking, and identity formation.
  • 🔄 COVID-19 and social justice movements motivated curriculum revisions.
  • 🧠 There's a lack of consensus on educational outcomes in health humanities.
  • 🌐 Practical application in clinical settings is essential for effective learning.
  • 📊 Penn State conducted a mixed-methods study to assess their humanities curriculum.
  • 🌱 Students found humanities learning more impactful when connected with clinical experience.
  • 🤔 Critical medical humanities encourage questioning of personal biases and assumptions.

Garis waktu

  • 00:00:00 - 00:05:00

    Margaret Hayden introduces the session, providing logistical information and introductory remarks, focusing on the change in the medical education format at UVA and introducing Evan Heald.

  • 00:05:00 - 00:10:00

    Evan Heald gives a brief history of Anne L. Brodie's contribution to medical education, emphasizing the importance of patient-doctor relationships, and introduces Doctor Rebecca Volpe as the 2024 Brodie Medical Education Scholar.

  • 00:10:00 - 00:15:00

    Doctor Volpe begins her lecture discussing the role of humanities in medical education, questioning what makes a good doctor, and taking inputs from the audience about desirable doctor attributes.

  • 00:15:00 - 00:20:00

    She highlights the importance of humanities in health professions and introduces the concept of 'health humanities,' focusing on its role in understanding the human condition and patient experience.

  • 00:20:00 - 00:25:00

    Doctor Volpe discusses the diversity in how medical schools implement health humanities and the various educational outcomes, noting the lack of consistency in approach and measuring success.

  • 00:25:00 - 00:30:00

    Critical versus traditional medical humanities approaches are explored, emphasizing different goals such as cultivating empathy versus developing critical consciousness.

  • 00:30:00 - 00:35:00

    Doctor Volpe outlines the humanities curriculum at Penn State. This includes theoretical foundations, visual thinking, and communication courses that aim to develop critical engagement and humanistic practice.

  • 00:35:00 - 00:40:00

    She shares a study conducted to evaluate the impact of the curriculum, mentioning the methodology and the demographics of participants, but acknowledges the challenges posed by the limited response rate.

  • 00:40:00 - 00:45:00

    The qualitative findings are discussed, showing how students perceive the humanities as important but often overshadowed by other pressing medical education demands.

  • 00:45:00 - 00:55:40

    Concludes with a critique of the lack of unified goals in health humanities, the importance of institutional support, and suggests moving humanities education into clinical settings for better real-world application.

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Video Tanya Jawab

  • Who is giving the Brodie lecture?

    The lecture is led by Dr. Rebecca Volpe, who is an ethicist and vice chair for education at Penn State's College of Medicine.

  • What is the main focus of the Brodie lecture?

    The main focus is on integrating humanities in medical education to cultivate empathy, humanistic practice, and critical consciousness among medical students.

  • What is the purpose of integrating humanities into medical education?

    It aims to integrate humanities disciplines into medical education to enhance humanistic practices and critical engagement among physicians.

  • What motivated the recent changes in Penn State's health humanities curriculum?

    The COVID-19 pandemic and social justice movements in 2020 influenced the revision of Penn State's health humanities curriculum.

  • What challenges do educators face in implementing health humanities?

    There is a lack of consensus on what health humanities should achieve in medical education, causing varied educational outcomes.

  • What support is needed to implement effective health humanities programs?

    Dr. Volpe emphasizes the importance of having institutional support to effectively integrate health humanities into medical education.

  • What courses are included in Penn State's health humanities curriculum?

    The curriculum includes foundational courses in humanities, visual thinking skills, and professional identity, among others.

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Teks
en
Gulir Otomatis:
  • 00:01:16
    Welcome to those of you in person
  • 00:01:18
    and those of you on zoom.
  • 00:01:20
    My name is Margaret Hayden.
  • 00:01:21
    I'm new faculty
  • 00:01:22
    at UVA with the Center for Health, Humanities
  • 00:01:24
    and Ethics filling in for Justin today.
  • 00:01:26
    We have a fantastic program.
  • 00:01:28
    Really quickly before we get to this wonderful
  • 00:01:30
    Brodie lecture by Doctor Rebecca Volpe.
  • 00:01:32
    I'm quickly go through the CME medical education slides,
  • 00:01:36
    which, as you all may have heard.
  • 00:01:38
    The format to get them has changed.
  • 00:01:40
    You can now get them via texting or online.
  • 00:01:42
    The key code, if you should need it is right
  • 00:01:45
    here 24642.
  • 00:01:47
    There are also fliers outside.
  • 00:01:49
    You can take a photo. And feel free to email
  • 00:01:51
    if you need any questions or help.
  • 00:01:53
    With that. More info here.
  • 00:01:56
    But again, we'll help you if you need it.
  • 00:01:58
    There's more handouts outside.
  • 00:02:00
    There will be a question answer at the end of the program.
  • 00:02:04
    For those of you on zoom.
  • 00:02:05
    Feel free to put questions on the Q&A
  • 00:02:07
    on the zoom, and we'll monitor it and can sort of ask them here
  • 00:02:10
    as, as needed.
  • 00:02:13
    To start, I'm going to introduce
  • 00:02:15
    Evan Heald, who will then introduce Doctor
  • 00:02:18
    Becky Volpe.
  • 00:02:19
    Doctor Heald is, a general internist at UVA
  • 00:02:23
    whose long been known for being a compassionate
  • 00:02:24
    and caring and humanistic physician.
  • 00:02:26
    I'm lucky to work alongside him at the, clinic.
  • 00:02:29
    He has a special interest in teaching students
  • 00:02:31
    and residents about narrative and relationship based primary
  • 00:02:34
    care, and directs the Brodie Committee
  • 00:02:36
    for Innovation in Education of the Renaissance.
  • 00:02:38
    physician. Doctor Heald.
  • 00:02:41
    Well, thank you, Doctor Hayden.
  • 00:02:43
    And, thank you all.
  • 00:02:45
    Our committee is named for Anne L Brodie.
  • 00:02:49
    Mrs. Brodie's expertise was as a patient and a human.
  • 00:02:54
    She so valued the longitudinal relationship
  • 00:02:57
    she had with her trusted physician
  • 00:02:59
    that she committed her estate to him
  • 00:03:02
    and the school of medicine, with instructions
  • 00:03:04
    that he assure that there would be doctors in the future
  • 00:03:09
    that would care for
  • 00:03:10
    patients in the way that he had cared for her.
  • 00:03:13
    We reflect on these home visits
  • 00:03:15
    that occurred some 30 years ago, and it's tempting to think
  • 00:03:18
    that this is quaint and old fashioned
  • 00:03:22
    and harkening back to a different time.
  • 00:03:24
    In fact, it was radical, and it remains radical.
  • 00:03:28
    This was a doctor and a patient creating a path forward
  • 00:03:31
    together when the usual care was failing to meet their needs.
  • 00:03:36
    It was also Mrs.
  • 00:03:37
    Brodie and Doctor Corbett imagining
  • 00:03:39
    future medical training with doctors and patients,
  • 00:03:42
    collaborating in the flattened hierarchy to challenge
  • 00:03:45
    unmet needs.
  • 00:03:47
    Then even they could not predict.
  • 00:03:50
    Each year, the Brodie Committee invites an external scholar
  • 00:03:53
    to help us to look at ourselves critically.
  • 00:03:56
    Doctor Volpe is the 2024 Brodie Medical Education Scholar,
  • 00:04:00
    and she joins us from the Department of Humanities
  • 00:04:03
    at Penn State's College of Medicine,
  • 00:04:05
    where she's vice chair for education.
  • 00:04:08
    Penn State formed the first medical department of humanities
  • 00:04:11
    in the nation, and has continued to be a role model.
  • 00:04:15
    Doctor Volpe as an ethicist there.
  • 00:04:17
    She attained her PhD at Saint Louis University
  • 00:04:20
    and did her clinical fellowship at California Pacific
  • 00:04:23
    Medical Center in San Francisco.
  • 00:04:26
    Doctor Volpe teaches and directs the Penn State Humanities
  • 00:04:30
    and Ethics curriculum and studies
  • 00:04:32
    how humanities are utilized
  • 00:04:34
    in the health profession, education,
  • 00:04:36
    and how to assess the outcomes.
  • 00:04:40
    Mrs. Brodie and Doctor Corbett focused our work not just on
  • 00:04:43
    teaching clinical skills and communication skills,
  • 00:04:46
    but also on advocacy and the humanism
  • 00:04:49
    that sustains our patients and ourselves.
  • 00:04:53
    How does a medical curriculum ensure
  • 00:04:55
    that it is training physicians for humanistic practice?
  • 00:05:00
    What does that even mean?
  • 00:05:03
    How do we measure our success?
  • 00:05:06
    Doctor Volpe.
  • 00:05:08
    I can you hear me?
  • 00:05:08
    Can you hear me?
  • 00:05:09
    Okay.
  • 00:05:11
    I'm not sure I've ever been primed in quite that way before.
  • 00:05:13
    Thank you so much for that generous introduction.
  • 00:05:16
    Doctor Heald, and I'm glad to be here with you.
  • 00:05:21
    As we were saying earlier, a small and mighty crowd.
  • 00:05:23
    And let me just formally apologize to the people on zoom.
  • 00:05:27
    I'm a roamer.
  • 00:05:29
    So, see you in an hour.
  • 00:05:34
    We are a small but mighty crew.
  • 00:05:36
    And it feels like
  • 00:05:38
    we're small enough that I like to know sort of who you are.
  • 00:05:41
    Maybe not names, but, like, roles. So we have.
  • 00:05:43
    I've met some of the, curricular faculty.
  • 00:05:47
    Are you guys medical students?
  • 00:05:50
    Yes. Okay. Raising the roof over there.
  • 00:05:54
    More medical students.
  • 00:05:55
    Okay. Amazing. All right.
  • 00:05:57
    So great.
  • 00:05:58
    I just want to talk to you about this
  • 00:06:00
    seemingly simple question, which is,
  • 00:06:02
    what are the humanities and medical education for?
  • 00:06:05
    And I want to get started with another
  • 00:06:07
    seemingly simple question, which is, what is a good doctor?
  • 00:06:11
    I don't have my pen.
  • 00:06:14
    Oh. Thank you.
  • 00:06:16
    Okay.
  • 00:06:17
    And we're all experts in this room
  • 00:06:19
    about what is a good doctor.
  • 00:06:20
    And you're an expert either because you are a doctor
  • 00:06:23
    or because you're a patient, or because you're somehow
  • 00:06:25
    involved in the delivery of health care.
  • 00:06:27
    So I am actually hoping
  • 00:06:28
    that you can tell me what is a good doctor.
  • 00:06:30
    And I'm going to take notes.
  • 00:06:38
    What skills, dispositions,
  • 00:06:41
    attributes, knowledge are required to be a good doctor?
  • 00:06:47
    Go. Active listening.
  • 00:06:51
    Active listening.
  • 00:06:52
    Okay.
  • 00:06:55
    I could go crazy.
  • 00:06:56
    And right on here.
  • 00:06:59
    Okay.
  • 00:07:01
    I hope this was an essential where we solving,
  • 00:07:03
    like, world problems here.
  • 00:07:07
    Active listening.
  • 00:07:08
    Okay.
  • 00:07:11
    What else?
  • 00:07:15
    Compassion.
  • 00:07:19
    What else?
  • 00:07:20
    A caregiver, caregiver.
  • 00:07:25
    What else?
  • 00:07:27
    I advocacy.
  • 00:07:34
    We can make.
  • 00:07:36
    What does that mean?
  • 00:07:38
    Creative.
  • 00:07:40
    What does that mean?
  • 00:07:42
    From.
  • 00:07:48
    Okay.
  • 00:07:49
    I like it all, but is it okay
  • 00:07:50
    if I write down solving problems together?
  • 00:07:52
    Okay.
  • 00:07:54
    What else?
  • 00:07:58
    Okay.
  • 00:08:00
    Do I need a new pen?
  • 00:08:01
    Maybe intensive.
  • 00:08:04
    Only because I don't know if you can see that one.
  • 00:08:07
    Attentive. Okay.
  • 00:08:08
    What else?
  • 00:08:11
    Okay,
  • 00:08:13
    guys, do you have to know anything to be a doctor?
  • 00:08:16
    You're just curious.
  • 00:08:17
    Curious? Okay.
  • 00:08:21
    These are so many dispositions
  • 00:08:23
    and attributes.
  • 00:08:26
    Yeah.
  • 00:08:31
    Oh. Stay open.
  • 00:08:35
    Like lifelong learner, skilled.
  • 00:08:43
    Are there any big gaps
  • 00:08:44
    in our list?
  • 00:08:48
    Do we do?
  • 00:08:48
    Okay.
  • 00:08:50
    Okay, so the real question I have for you, is
  • 00:08:53
    how do you learn those things?
  • 00:08:54
    How do you learn to be and and I think I'm interested in the.
  • 00:08:59
    You got an answer? Oh.
  • 00:09:02
    So when you had an answer.
  • 00:09:03
    Okay.
  • 00:09:04
    How do you learn to be an active listener
  • 00:09:06
    and compassionate and a caregiver and an advocate
  • 00:09:09
    and a shared decision maker, and attentive and humble
  • 00:09:14
    and curious.
  • 00:09:15
    I think we have ideas about how you learn stuff.
  • 00:09:17
    And I think we have ideas about how you learn skills, but
  • 00:09:20
    how do you learn how to be open and a lifelong learner?
  • 00:09:23
    And I think that
  • 00:09:24
    the sort of academic response to the question of
  • 00:09:26
    how do you learn all those things?
  • 00:09:27
    Is the way that you learn those things is through
  • 00:09:31
    the health humanities.
  • 00:09:34
    But what is the health humanities?
  • 00:09:37
    So the Health
  • 00:09:39
    Humanities Consortium, which is a national professional
  • 00:09:43
    organization, developed this definition.
  • 00:09:47
    And they say that the health humanities is a study
  • 00:09:49
    of the intersection of health and humanistic disciplines
  • 00:09:53
    like philosophy, religion, literature,
  • 00:09:56
    fine arts, as well as social science research
  • 00:09:58
    that gives insight to the human condition.
  • 00:10:00
    The health humanities uses methods such as reflection,
  • 00:10:02
    contextualized deep textual reading, and slow critical
  • 00:10:06
    thinking to examine the human condition
  • 00:10:08
    the patients experience,
  • 00:10:09
    the healers experience, and to provide renewal
  • 00:10:11
    for the health care professional.
  • 00:10:13
    So that is a really broad, I would argue, definition.
  • 00:10:17
    And there are, I think, flowing from that,
  • 00:10:21
    lots of ways of integrating
  • 00:10:22
    and understanding what the health humanities says.
  • 00:10:24
    This is not a proscriptive definition.
  • 00:10:26
    Like here's what you need to do in your health
  • 00:10:28
    humanities curriculum in your school of medicine.
  • 00:10:30
    So most schools of medicine, I would say, do include some
  • 00:10:33
    health humanities.
  • 00:10:35
    Some include all the moves, guys.
  • 00:10:39
    I was going to lean on it, but no.
  • 00:10:43
    Some include a lot of health humanities curriculum,
  • 00:10:45
    and some include a little some sort of in the middle,
  • 00:10:48
    and the, the,
  • 00:10:50
    the types of things that schools are, including
  • 00:10:53
    in their health humanities curriculum very widely.
  • 00:10:57
    Right.
  • 00:10:58
    So some programs are, painting masks inside
  • 00:11:03
    and outside of masks
  • 00:11:05
    in pursuit of helping the student
  • 00:11:07
    think about what is their identity as a person,
  • 00:11:09
    what is their identity as a future professional.
  • 00:11:11
    So questions of professional identity formation.
  • 00:11:14
    So some programs are, you know, doing art, painting masks.
  • 00:11:18
    Some programs are looking at art in pursuit of visual
  • 00:11:22
    thinking skills,
  • 00:11:24
    and some programs are having lectures in rooms like this on
  • 00:11:27
    race as a social construct.
  • 00:11:30
    And that
  • 00:11:31
    definition kind of like fits all that stuff.
  • 00:11:34
    All all of those disparate activities fit into,
  • 00:11:38
    fit into an understanding of health, humanity.
  • 00:11:41
    So the way what I'm trying to convey
  • 00:11:43
    is that the way that schools in Act
  • 00:11:45
    health and humanities varies really widely,
  • 00:11:50
    and I think that this lack of cohesion becomes
  • 00:11:53
    really apparent when you look at the educational outcomes
  • 00:11:56
    that folks are studying.
  • 00:11:58
    About the outcomes of health humanities curriculum in schools
  • 00:12:01
    of medicine.
  • 00:12:03
    So this is a not exhaustive like me and med line for an hour
  • 00:12:08
    looking at outcomes of health humanities curriculum and
  • 00:12:11
    ranging from empathy, compassion, respect, humanism,
  • 00:12:15
    altruism, identity, excellence, integrity, service, vets
  • 00:12:20
    well-being and social accountability.
  • 00:12:24
    So what I find really interesting about this
  • 00:12:26
    list is twofold.
  • 00:12:27
    First, this is obvious.
  • 00:12:30
    There's a lot of them.
  • 00:12:32
    There's a lot of educational outcomes
  • 00:12:33
    that people are studying.
  • 00:12:35
    And second, they don't cohere in any particular way
  • 00:12:39
    like they're not circling around 1 or 2 ideas.
  • 00:12:43
    Visual thinking skills is just sort of like very different
  • 00:12:47
    than professional identity formation,
  • 00:12:49
    which is very different
  • 00:12:51
    than, you know, than than empathy,
  • 00:12:54
    which is very different than well-being.
  • 00:12:57
    So even though we have that lovely definition
  • 00:12:59
    from the Health Humanities Consortium about
  • 00:13:01
    what is the health humanities, we, we don't,
  • 00:13:06
    I think, have agreement in the field about
  • 00:13:08
    why we're doing this, about what we think we're achieving,
  • 00:13:12
    what our goals are in our students,
  • 00:13:14
    with our health humanities curriculum.
  • 00:13:16
    And to point out something
  • 00:13:17
    that might be really obvious, this is quite different
  • 00:13:21
    than other areas of medical education.
  • 00:13:24
    So for the basic sciences,
  • 00:13:26
    I don't think there is a lot of questions about why
  • 00:13:28
    we teach medical students basic sciences.
  • 00:13:30
    We teach them because it is necessary for clinical practice.
  • 00:13:33
    We probably also have
  • 00:13:34
    some critical thinking, clinical reasoning,
  • 00:13:37
    learning goals there.
  • 00:13:38
    But but we would never see
  • 00:13:40
    a slide like this for educational outcomes
  • 00:13:42
    of basic science teaching and health.
  • 00:13:44
    And in the basic sciences, in medical, education.
  • 00:13:48
    And I think that a
  • 00:13:50
    recent, a recent distinction that we can draw.
  • 00:13:53
    And as we think about this bigger
  • 00:13:54
    question of what what is health humanities trying to do?
  • 00:13:58
    A distinction we can draw as between
  • 00:14:00
    a more traditional approach,
  • 00:14:02
    and something that has more recently
  • 00:14:04
    been called critical medical humanities.
  • 00:14:07
    So a more traditional approach to the idea is to,
  • 00:14:10
    sort of illuminate and enlighten
  • 00:14:14
    the doctor patient relationship.
  • 00:14:16
    We're trying to cultivate empathy,
  • 00:14:18
    and our clinicians focus on the human connection.
  • 00:14:21
    And those studies and those programs
  • 00:14:23
    are usually assessing to see, have we increased empathy,
  • 00:14:26
    have we on this scale of patient
  • 00:14:28
    centeredness, are we improving our
  • 00:14:30
    our students patient centeredness?
  • 00:14:32
    And maybe also looking at self-awareness and wellness?
  • 00:14:36
    And then there's this sort of other camp
  • 00:14:38
    that's saying like, no, no, no,
  • 00:14:40
    we've spent too much time talking about empathy.
  • 00:14:42
    There's really a lot more to it than that.
  • 00:14:44
    And we need to sort of analyze,
  • 00:14:46
    the outcomes of health humanities
  • 00:14:48
    from this much more critical perspective.
  • 00:14:50
    This like social critique.
  • 00:14:51
    And the goal is to develop
  • 00:14:53
    critically conscious physicians
  • 00:14:55
    with a focus on social knowledge.
  • 00:14:56
    And so those outcomes of interest
  • 00:14:58
    are more like critical consciousness,
  • 00:15:00
    cultural humility, social accountability.
  • 00:15:02
    And both I think both of these approaches
  • 00:15:05
    are trying to cultivate humanistic practice.
  • 00:15:12
    But I think the difference is in how they get there.
  • 00:15:16
    Right. So everyone agrees.
  • 00:15:18
    I think that
  • 00:15:19
    the point of humanities education for medical students
  • 00:15:22
    and residents is to cultivate humanistic practice.
  • 00:15:24
    I think we just don't agree about what
  • 00:15:25
    is humanistic practice and how do we get there?
  • 00:15:28
    How do we cultivate it in our learners?
  • 00:15:31
    I've represented these as like discrete.
  • 00:15:36
    I think probably most programs are pulling a little
  • 00:15:38
    from column A and a little from column B,
  • 00:15:40
    and it's probably more likely of than like overlapping
  • 00:15:44
    Venn diagram than quite,
  • 00:15:46
    quite as discreet as I'm suggesting visually here.
  • 00:15:50
    So that is your like, whirlwind
  • 00:15:52
    introduction to the field of health humanities.
  • 00:15:56
    And now what I want to do is tell you a little bit
  • 00:15:58
    about our own curriculum
  • 00:15:59
    really quickly, so that I can tell you
  • 00:16:01
    about a study we did on our curriculum
  • 00:16:03
    to try to look at, what are we doing here anyway?
  • 00:16:07
    Like, what are the outcomes?
  • 00:16:11
    So we did,
  • 00:16:12
    at Penn State, we did a major humanities
  • 00:16:14
    curricular renewal in the summer of 2020,
  • 00:16:17
    which you might remember, was sort of a big moment.
  • 00:16:20
    In in the world.
  • 00:16:22
    So we had in the spring of 2020, the Covid 19 pandemic
  • 00:16:27
    pushed everything remote,
  • 00:16:28
    including undergraduate medical education.
  • 00:16:30
    And then in the spring and early summer of 2020,
  • 00:16:33
    there was sort of a growing recognition of the racial
  • 00:16:35
    and ethnic disparities in Covid 19 morbidity and mortality.
  • 00:16:39
    And then in May, George Floyd, was murdered
  • 00:16:43
    in Minneapolis, sparking, protests worldwide.
  • 00:16:47
    So this was like the motivating context for us as
  • 00:16:50
    we were revising and revisioning our humanities curriculum.
  • 00:16:55
    And given that context, I think we sort of fairly
  • 00:16:58
    naturally found our way
  • 00:16:59
    to more of a critical medical humanities approach.
  • 00:17:03
    And so we started our curricular renewal project
  • 00:17:06
    by saying, what's our vision?
  • 00:17:07
    And so we
  • 00:17:09
    worked collaboratively over time with lots of groups of people.
  • 00:17:12
    Over a couple of months to develop
  • 00:17:13
    this vision statement, which is that
  • 00:17:16
    the health humanities is intrinsic to medical
  • 00:17:17
    education, developing capacities to approach patients
  • 00:17:20
    as whole person's
  • 00:17:22
    health, humanities
  • 00:17:23
    learning experience, cultivate knowledge for practice
  • 00:17:24
    and critical engagement engagement
  • 00:17:26
    focusing on content, skills and behaviors
  • 00:17:28
    that advance humanism in medicine and society.
  • 00:17:30
    So I think in that definition, you actually can already see
  • 00:17:33
    or in that vision statement, you can see sort of themes
  • 00:17:36
    of a more traditional approach, and also themes
  • 00:17:38
    coming from more of a critical medical humanities approach.
  • 00:17:43
    The vision is sort of necessarily broad.
  • 00:17:46
    And so we also, developed six
  • 00:17:49
    more concrete, curricular goals.
  • 00:17:53
    And just skimming across the top of the goals,
  • 00:17:56
    you can just leave the details, in my opinion.
  • 00:17:58
    But skimming across the bolded top goals,
  • 00:18:01
    you can see,
  • 00:18:02
    I think evidence of sort of the canon,
  • 00:18:03
    I would say, right, like communication, ethics,
  • 00:18:07
    professional identity,
  • 00:18:08
    but also I think,
  • 00:18:10
    some of the more critical medical humanities.
  • 00:18:12
    So we're seeking to demonstrate cultural humility,
  • 00:18:15
    demonstrate critical habits of mind.
  • 00:18:17
    And then even within the canon,
  • 00:18:19
    which I would say, like ethics is a good example of the canon,
  • 00:18:22
    that second one
  • 00:18:23
    under there understand the importance of social justice
  • 00:18:25
    to the ethical health care provision.
  • 00:18:26
    So even within the canon,
  • 00:18:28
    I think you can see sort of a bent
  • 00:18:30
    towards a critical medical humanities approach.
  • 00:18:36
    So I just want to quickly tell you about the courses
  • 00:18:39
    so that when I tell you
  • 00:18:41
    what we found in our study, you have a context
  • 00:18:44
    for understanding what the intervention was.
  • 00:18:46
    So, in the fall of the first year,
  • 00:18:50
    and this is the required curriculum
  • 00:18:52
    that all of the students go through.
  • 00:18:54
    So the first course is a 12
  • 00:18:56
    week course called Foundations of Health Humanities.
  • 00:18:59
    And it's really a pretty theory driven course,
  • 00:19:01
    which it turns out the students don't always like.
  • 00:19:05
    But the idea is to set sort of a theoretical foundation,
  • 00:19:09
    where the primary theoretical foundation
  • 00:19:12
    that's being set
  • 00:19:13
    is a social construction of reality,
  • 00:19:14
    including concepts
  • 00:19:15
    like the social construction of race and gender.
  • 00:19:18
    And then that theoretical foundation
  • 00:19:21
    sort of sets up, then the subsequent courses.
  • 00:19:24
    The next course is called Observation and Interpretation.
  • 00:19:27
    And this is our visual thinking skills for like
  • 00:19:31
    we zoomed in on these slides, I apologize.
  • 00:19:34
    This is our visual thinking skills course.
  • 00:19:38
    And so the idea here is to help the students, distinguish
  • 00:19:43
    between observation and interpretation
  • 00:19:45
    and visual art analysis and clinical medicine,
  • 00:19:47
    with maybe an ultimate goal of, cultivating
  • 00:19:51
    curiosity and open mindedness.
  • 00:19:55
    The third
  • 00:19:56
    course, in the first year, is called Humanities and context.
  • 00:19:59
    This is the third, third and final course in the first year.
  • 00:20:02
    And the idea of this course is to sort of
  • 00:20:05
    take their prior learning, in those first two courses
  • 00:20:09
    and to ground it really thoroughly in clinical context.
  • 00:20:12
    So our goals in the in this course are to really,
  • 00:20:18
    help the students think about
  • 00:20:19
    what does it look like to engage in humanistic practice.
  • 00:20:23
    And we try to break that down
  • 00:20:24
    into the components of humanistic practice
  • 00:20:27
    and the steps of humanistic
  • 00:20:28
    practice for learners for whom it may not sort of
  • 00:20:31
    come naturally or intuitively, how to do this?
  • 00:20:35
    And all of that is grounded in clinical cases.
  • 00:20:37
    So every week we're talking about a clinical case.
  • 00:20:39
    And maybe it's the concurrent PBL case,
  • 00:20:41
    or maybe it's a rich description of a case,
  • 00:20:43
    that has been written for the course.
  • 00:20:45
    And then the, in the second year,
  • 00:20:48
    the students take a communication course,
  • 00:20:51
    where the focus is, patient clinician communication.
  • 00:20:55
    And then they have this really nice element of it,
  • 00:20:57
    at the end where they are making a detailed
  • 00:21:01
    and specific plan for deliberate practice of communication
  • 00:21:03
    in each of the upcoming clerkships.
  • 00:21:05
    So trying to help
  • 00:21:06
    set the students up for success,
  • 00:21:08
    in the clerkships, in terms of communication.
  • 00:21:11
    And those are the four, the four required pre clerkship
  • 00:21:15
    courses that comprise the health humanities curriculum.
  • 00:21:19
    And for those courses, students meet and faculty
  • 00:21:22
    facilitated small groups. So it's like two hours a week.
  • 00:21:25
    And groups of maybe eight ish students.
  • 00:21:28
    And although
  • 00:21:29
    there is a lecture here and there, for the most part,
  • 00:21:32
    they're there.
  • 00:21:34
    The curriculum is delivered in a small group, setting.
  • 00:21:37
    I want to just briefly tell you about the third and fourth
  • 00:21:40
    year curriculum.
  • 00:21:41
    We did not study this, but just for completion.
  • 00:21:45
    So that you have the big picture in the third
  • 00:21:48
    year, the students, meet in humanities courses
  • 00:21:53
    approximately twice a month, that are unstructured,
  • 00:21:56
    and un assessed faculty facilitated small groups
  • 00:22:00
    that are just sort of
  • 00:22:01
    supposed to be, more informal,
  • 00:22:03
    sort of check in and support for the students
  • 00:22:05
    as they transition to clerkships.
  • 00:22:07
    And, and are in clerkships.
  • 00:22:08
    And then in the fourth year,
  • 00:22:10
    we call them electives because they're not elective,
  • 00:22:13
    that every student is required to select one.
  • 00:22:15
    And it's a one month course,
  • 00:22:19
    sometimes eight weeks, but 20 hours, usually over a month.
  • 00:22:22
    And there's usually about a dozen different courses offered.
  • 00:22:25
    And the student picks one I've shown you here,
  • 00:22:27
    just a couple of the options from a faculty perspective,
  • 00:22:30
    it got me.
  • 00:22:31
    Again, they're really fun to teach
  • 00:22:33
    because, we just get to sort of like teach a course on
  • 00:22:35
    whatever we're into right now.
  • 00:22:37
    And so, it results in
  • 00:22:38
    some really creative and interesting courses,
  • 00:22:41
    that I think the students
  • 00:22:42
    enjoy taking because the faculty enjoy teaching them.
  • 00:22:47
    Okay.
  • 00:22:48
    So we had this shiny and new curriculum
  • 00:22:51
    that we had spent a lot of time developing.
  • 00:22:54
    And, we did what
  • 00:22:57
    all academics do then and design a study to see
  • 00:23:01
    if it was working, to see what the outcomes were.
  • 00:23:07
    Sorry about the formatting.
  • 00:23:08
    So we designed
  • 00:23:12
    a sequential exploratory mixed methods study,
  • 00:23:15
    which is a fancy way of saying,
  • 00:23:18
    we first developed quantitative,
  • 00:23:20
    we first gathered quantitative data,
  • 00:23:22
    and then we gathered qualitative data.
  • 00:23:24
    So our quantitative data was that first we pre tested
  • 00:23:29
    the Ms1 students before they had any humanities curriculum.
  • 00:23:33
    And then after the phase one humanities curriculum, we post
  • 00:23:36
    tested them.
  • 00:23:38
    And students
  • 00:23:39
    were only eligible for the post-test
  • 00:23:41
    if they had completed the pretest.
  • 00:23:43
    So about half of students completed the pretest.
  • 00:23:46
    And then again,
  • 00:23:48
    half of the eligible students completed the post-test.
  • 00:23:50
    So we had about a quarter
  • 00:23:51
    of the students respond to both surveys,
  • 00:23:53
    which is a poor response rate, which we will circle back to.
  • 00:23:57
    And then for the qualitative part,
  • 00:23:59
    we after the humanities curriculum
  • 00:24:02
    and after we had gathered our quantitative data,
  • 00:24:04
    we circled back with the then third year medical students
  • 00:24:07
    and completed 26, semi-structured interviews.
  • 00:24:12
    And we thought that it was important to gather
  • 00:24:14
    both quantitative and qualitative data
  • 00:24:16
    because of the chaos in the field about,
  • 00:24:20
    what are the outcomes, right?
  • 00:24:22
    If we knew for sure
  • 00:24:23
    what we were aiming for
  • 00:24:25
    in our quantitative data, if we knew for sure
  • 00:24:27
    that the measures that we had picked
  • 00:24:29
    for our quantitative data were like the right ones,
  • 00:24:31
    then I think maybe
  • 00:24:33
    it's less important to do this type of mixed method study.
  • 00:24:35
    But but we weren't it we weren't at all sure.
  • 00:24:39
    So I want to just quickly tell you
  • 00:24:41
    about the quantitative data and then spend more time
  • 00:24:44
    telling you about the qualitative data,
  • 00:24:45
    because I think it's, more interesting and more helpful.
  • 00:24:49
    So the our this is our, demographics.
  • 00:24:52
    And you can see respondents were predominantly,
  • 00:24:56
    white, 68% predominantly heterosexual, 84%,
  • 00:25:01
    and predominantly or, female,
  • 00:25:04
    63%, which is like mostly
  • 00:25:08
    but not entirely representative of our student body population.
  • 00:25:11
    I think the,
  • 00:25:13
    gender identity is probably the biggest disconnect.
  • 00:25:15
    Right?
  • 00:25:16
    We do have more women than men, females and males
  • 00:25:20
    in our medical student body, but the, it's not quite that
  • 00:25:24
    imbalanced. Man.
  • 00:25:32
    Yeah.
  • 00:25:33
    Can we just do this?
  • 00:25:36
    Let's do that.
  • 00:25:37
    That better? No. So. Can't do it.
  • 00:25:40
    Still can't see the bottom.
  • 00:25:45
    Because it's
  • 00:25:45
    coming off the bottom.
  • 00:25:49
    There we go.
  • 00:25:51
    Can you see?
  • 00:25:51
    Is it right?
  • 00:25:55
    Where's my.
  • 00:25:59
    Ligament?
  • 00:26:00
    Here it is. Yeah,
  • 00:26:02
    yeah.
  • 00:26:02
    Okay.
  • 00:26:03
    That's better.
  • 00:26:07
    So it's a lot of data, but we're going to look at it together.
  • 00:26:10
    So you can see the scales we used here.
  • 00:26:14
    You okay? You're making big eyes.
  • 00:26:16
    Okay.
  • 00:26:17
    You can see the scales that we used,
  • 00:26:19
    our, cultural humility scale, and then a critical
  • 00:26:22
    consciousness scale
  • 00:26:23
    that has three subscales
  • 00:26:25
    a racism, classism and heterosexism subscale.
  • 00:26:28
    So this is aligned with what we thought was our emphasis.
  • 00:26:31
    Right.
  • 00:26:32
    Our critical medical humanities
  • 00:26:33
    emphasis in this revised curriculum.
  • 00:26:36
    And so for the cultural humility scale,
  • 00:26:39
    for our paired sample of 38 students, our pretest was 80.6.
  • 00:26:44
    Before the curriculum,
  • 00:26:46
    our post-test was 81.2 after the curriculum for a non
  • 00:26:50
    statistically significant change of about a half a point.
  • 00:26:53
    And then for the critical consciousness measure,
  • 00:26:55
    I actually want to start at the bottom with heterosexism.
  • 00:26:58
    So pretest mean 34.8 post-test mean 36.8.
  • 00:27:03
    Statistically significant change on the heterosexism subscale
  • 00:27:07
    of about a point.
  • 00:27:08
    And then for classism
  • 00:27:09
    and racism,
  • 00:27:10
    we see differences of less than a point
  • 00:27:13
    non statistically significant differences
  • 00:27:15
    of less than a point.
  • 00:27:16
    And for the scale overall,
  • 00:27:18
    we saw a statistically significant difference
  • 00:27:21
    of almost two points as probably mostly driven
  • 00:27:24
    by our difference on the heterosexism subscale.
  • 00:27:28
    So stepping back
  • 00:27:29
    and looking at this data
  • 00:27:30
    big picture, I think I have two sort of high level takeaways.
  • 00:27:33
    The first is that
  • 00:27:34
    we have a poor response rate, with 27% of students.
  • 00:27:38
    So we don't know
  • 00:27:39
    if what we found is actually representative.
  • 00:27:41
    And the second is that
  • 00:27:45
    even if it's great data
  • 00:27:47
    and it's representative, these small changes,
  • 00:27:50
    while statistically significant, probably
  • 00:27:52
    don't have like a real world impact.
  • 00:27:56
    It probably isn't making a big difference.
  • 00:27:59
    If if we say like, okay,
  • 00:28:01
    this is good data,
  • 00:28:02
    which like
  • 00:28:03
    maybe it's not honestly, because we have a poor
  • 00:28:05
    response rate, but if we say it is,
  • 00:28:07
    I think it's still unclear what,
  • 00:28:10
    if any, is the sort of relevance of, of this data.
  • 00:28:15
    So for these reasons,
  • 00:28:16
    I don't think the quantitative data helps us, that much.
  • 00:28:20
    And so what I'd like to do is turn to the qualitative.
  • 00:28:25
    So, two analysts performed a thematic content analysis.
  • 00:28:29
    It was myself and, and, and a colleague,
  • 00:28:33
    and we developed a codebook through an iterative,
  • 00:28:36
    collaborative process that wound up having 56 discrete codes.
  • 00:28:40
    And then we each independently applied the codebook
  • 00:28:43
    to each of the 26 interview transcripts.
  • 00:28:46
    And then we ran a Kappa, which is a measure of agreement.
  • 00:28:53
    And, it was I think it was like .76
  • 00:28:57
    before we discussed any of our,
  • 00:28:59
    any of our
  • 00:29:00
    areas of disagreement, which is actually still
  • 00:29:02
    very good for qualitative research.
  • 00:29:03
    And then after we had discussed our areas of disagreement,
  • 00:29:06
    our kappa was 0.96, which is considered excellent.
  • 00:29:11
    And our qualitative data we found was,
  • 00:29:14
    really interesting.
  • 00:29:15
    We revealed four,
  • 00:29:17
    themes about the students
  • 00:29:19
    experience of the health humanities curriculum.
  • 00:29:21
    So I want to talk to you about them now.
  • 00:29:24
    So the first one was that the participants identified
  • 00:29:27
    health humanities
  • 00:29:28
    learning as helpful knowledge for practice,
  • 00:29:30
    but some participants felt like
  • 00:29:31
    the classroom context was limiting.
  • 00:29:33
    And here we can see student eight saying,
  • 00:29:36
    I would say that the most impactful
  • 00:29:37
    was not the in-class learning.
  • 00:29:39
    I do appreciate the humanities courses.
  • 00:29:41
    They definitely built a good foundation,
  • 00:29:42
    but the most impactful was when I gone to the floors
  • 00:29:45
    and actually had to interact with the patients.
  • 00:29:47
    So whether it was using a translator,
  • 00:29:48
    having patients just respond, saying,
  • 00:29:50
    I can't do that, I can't do what you're recommending
  • 00:29:52
    because of cultural reasons.
  • 00:29:54
    I think those have been the most influential.
  • 00:29:56
    But then again, I don't think I would have
  • 00:29:57
    had as good a learning experience in clerkships
  • 00:29:59
    had I not had some foundational knowledge for how to cope
  • 00:30:02
    with those from the pre clerkship courses.
  • 00:30:05
    So I think what we saw in this theme was that students
  • 00:30:08
    talked about their pre clerkship health, humanities learning
  • 00:30:12
    through the lens of clerkships.
  • 00:30:15
    And they talked about it as knowledge for practice. So
  • 00:30:20
    I think that
  • 00:30:22
    what they're really sort of saying
  • 00:30:23
    is the way that we understand
  • 00:30:24
    this is not so much the theory driven first course.
  • 00:30:27
    Right?
  • 00:30:28
    The way that we can understand this and make meaning of this
  • 00:30:30
    in the way that feels relevant to us is when we think about it
  • 00:30:32
    through the lens of the patients
  • 00:30:33
    who are encountering
  • 00:30:34
    and clerkships, which of course, makes perfect sense.
  • 00:30:38
    And then we did have some additional students saying,
  • 00:30:41
    that the classroom context was really limiting.
  • 00:30:45
    And the way that it was limiting
  • 00:30:47
    was that it created a disconnect. Right?
  • 00:30:49
    So they would talk about these concepts in class.
  • 00:30:51
    They would talk about like, issues of like medical racism
  • 00:30:55
    and class.
  • 00:30:56
    And then the class was over
  • 00:30:58
    and they could just sort of stop thinking about those things.
  • 00:31:00
    And it was like out of sight, out of mind.
  • 00:31:02
    So, so that there was a disconnect.
  • 00:31:05
    There was a distance
  • 00:31:06
    between learning about these important concepts,
  • 00:31:08
    which they acknowledged was important,
  • 00:31:10
    and, and not really seeing it happen in reality.
  • 00:31:16
    The second theme was that the students reported
  • 00:31:18
    that humanities learning opportunities,
  • 00:31:20
    challenged
  • 00:31:21
    participants to question their beliefs and assumptions.
  • 00:31:24
    Guys, my formatting was not like this.
  • 00:31:29
    So subtheme 2.1, which is has been cut off on
  • 00:31:32
    the purple, is that participants questioned themselves.
  • 00:31:36
    And so they reported that the health humanities
  • 00:31:40
    prompted them to really reflect on themselves
  • 00:31:43
    and that that often resulted
  • 00:31:45
    in a realization of their own bias.
  • 00:31:47
    And so we can see this in interview
  • 00:31:48
    one where the student says, I think it definitely showed
  • 00:31:52
    that I do have implicit bias.
  • 00:31:54
    I was like,
  • 00:31:55
    oh, there's no way I'm going to have implicit bias
  • 00:31:57
    on the one where we were looking at
  • 00:31:58
    people with disabilities because my family
  • 00:32:00
    member has genetic diseases causing developmental delay,
  • 00:32:03
    but then it still showed that I didn't.
  • 00:32:05
    I was really taken aback and it made me think more about it.
  • 00:32:08
    So you always have to be aware
  • 00:32:10
    of these things and try to overcome them,
  • 00:32:12
    no matter how good you think you're being.
  • 00:32:14
    So that the humanities, prompt,
  • 00:32:18
    it seems to reflect on themselves.
  • 00:32:19
    And it also prompted them the second sub subtheme
  • 00:32:23
    to reflect on science, right,
  • 00:32:24
    to sort of more critically appraise
  • 00:32:27
    the science that they were learning
  • 00:32:28
    in their basic science classes.
  • 00:32:30
    And they realized that science can have embedded bias
  • 00:32:34
    and that the health humanities curriculum made them
  • 00:32:37
    sort of question
  • 00:32:38
    their assumptions about the infallibility of science.
  • 00:32:40
    So I just love this quote where student six says,
  • 00:32:43
    I guess if I had to say
  • 00:32:45
    one thing, it would be I always look at medicine
  • 00:32:47
    and be like, this is fact.
  • 00:32:48
    This is rooted in truth and science,
  • 00:32:50
    and there's no room for humans to mess that up
  • 00:32:53
    or exert our bias on it, because it's science.
  • 00:32:55
    And that's true and real and raw.
  • 00:32:57
    But I think that the discussion about the different spirometry
  • 00:33:00
    results, it's like, oh, it just sort of
  • 00:33:02
    made me think about all the ways that humans
  • 00:33:04
    can impact this thing that is seemingly truth.
  • 00:33:09
    The third theme that we found was that,
  • 00:33:11
    students reported feeling stressed and overwhelmed
  • 00:33:14
    with adapting to medical school generally and being successful
  • 00:33:17
    in their biomedical science courses in particular,
  • 00:33:20
    and that that led them to prioritize
  • 00:33:21
    their health humanities learning.
  • 00:33:23
    So what was pretty interesting was that students concurrently
  • 00:33:26
    indicated that they felt like the health humanities curriculum
  • 00:33:29
    was important to being a great doctor.
  • 00:33:32
    And they also said,
  • 00:33:34
    but everything else is really important, too.
  • 00:33:36
    And it's really important in more immediate ways.
  • 00:33:38
    Like, I have to pass this basic science course
  • 00:33:40
    and I have to pass this high stakes credentialing exam.
  • 00:33:43
    And so here, students noted that regardless
  • 00:33:48
    of the excellence of the curriculum
  • 00:33:49
    that we designed,
  • 00:33:50
    whether the students sort of bought into it
  • 00:33:52
    or not, is is sort of out of the hands of the faculty
  • 00:33:56
    designing and deploying the curriculum.
  • 00:33:58
    So in an interview, nine, the student says humanities was
  • 00:34:01
    kind of at the bottom of my list in preclinical for important.
  • 00:34:05
    It was like the organ blocks and anatomy were at the top.
  • 00:34:07
    Then humanities and health systems were at the bottom, and
  • 00:34:10
    there was a lot of other stuff that gotten away.
  • 00:34:12
    So having an assignment to do for humanities
  • 00:34:14
    or read something,
  • 00:34:15
    we had humanities on Tuesdays, and so it'd be done
  • 00:34:17
    Monday night as quick as possible,
  • 00:34:18
    so you'd have time for other stuff.
  • 00:34:20
    I think it's important
  • 00:34:21
    and it can make us better doctors, the division of time.
  • 00:34:24
    There's just a lot more pressing things, I felt,
  • 00:34:26
    and so the understanding wasn't
  • 00:34:28
    as effective regardless of how it was taught.
  • 00:34:30
    I guess, if that makes sense.
  • 00:34:33
    All right.
  • 00:34:34
    And then our fourth and final theme was that participants
  • 00:34:37
    reported that they didn't learn as much about diversity
  • 00:34:39
    and equity concepts when they were
  • 00:34:40
    in racially homogeneous groups.
  • 00:34:43
    So students really
  • 00:34:45
    wanted to have diverse learners in their small group
  • 00:34:49
    when discussing topics like medical racism.
  • 00:34:52
    So we can see that students, for says in terms of talking
  • 00:34:56
    about cultural humility in central Pennsylvania, it's
  • 00:34:58
    kind of hard because my class is primarily white.
  • 00:35:01
    Most of the facilitators in our group are white.
  • 00:35:03
    I remember having one, maybe two people of color in my group.
  • 00:35:06
    I think that was a shortcoming,
  • 00:35:07
    just that we were talking about a lot of these experiences
  • 00:35:09
    that a lot of us didn't really have.
  • 00:35:11
    Not that we have to always talk about it
  • 00:35:13
    from personal experience,
  • 00:35:14
    but I think
  • 00:35:15
    sometimes those things are more meaningful
  • 00:35:17
    when you talk about them in concrete ways,
  • 00:35:19
    rather than these abstract things that we as people
  • 00:35:21
    who don't really experience those things bring to the table.
  • 00:35:25
    So this was an interesting and challenging one
  • 00:35:28
    for us as faculty to like, see, in the data and code.
  • 00:35:31
    Because this idea that it's the
  • 00:35:35
    that it's like
  • 00:35:36
    the responsibility of minoritized students to teach
  • 00:35:39
    majority learners has been well described
  • 00:35:43
    in the curriculum, in the literature
  • 00:35:45
    as something called this conscripted curriculum.
  • 00:35:48
    Right.
  • 00:35:49
    And this is a problematic practice
  • 00:35:50
    that places an undue burden on minority students,
  • 00:35:54
    thus perpetuating structural inequity.
  • 00:35:56
    Right.
  • 00:35:56
    Because then
  • 00:35:58
    the minoritized student doesn't have the privilege
  • 00:35:59
    of just being a learner in the room.
  • 00:36:00
    The minoritized student
  • 00:36:02
    then has the responsibility of teaching their peers.
  • 00:36:04
    And so from that perspective, it makes sense, actually,
  • 00:36:08
    that we saw in our data evidence
  • 00:36:10
    that at least one racially diverse
  • 00:36:12
    participants felt that burden to teach their peers.
  • 00:36:15
    And this student said,
  • 00:36:17
    I feel like sometimes going again, from the perspective
  • 00:36:20
    of being a minority in a lot of these classes,
  • 00:36:22
    I felt like there's this unspoken responsibility,
  • 00:36:24
    this placed on whoever identifies
  • 00:36:26
    with the population you're talking about,
  • 00:36:28
    and you feel this pressure that everyone's
  • 00:36:29
    looking at you to say something about it in a way.
  • 00:36:32
    So I think without people knowing,
  • 00:36:34
    they were creating this feeling of,
  • 00:36:36
    oh, if you identify with this,
  • 00:36:37
    you should be contributing the most to this discussion.
  • 00:36:40
    And I realized that feeling
  • 00:36:41
    was not just with me when I spoke with others.
  • 00:36:43
    It was this nuanced.
  • 00:36:44
    Yeah, you end up teaching in a way,
  • 00:36:46
    and sometimes that gets exhausting
  • 00:36:48
    because it's not my job to teach.
  • 00:36:52
    Okay.
  • 00:36:53
    So conclusions, what what sort of high level things
  • 00:36:57
    as I think about what do we take away from from this data?
  • 00:37:01
    The first is that health humanities is a young field.
  • 00:37:05
    And I think that the next step for us is
  • 00:37:08
    that we've got to generate a bit of consensus
  • 00:37:11
    about what our goal is, what we're aiming for.
  • 00:37:15
    The Association of American Medical Colleges,
  • 00:37:17
    WAMC recently put out a big report called frame.
  • 00:37:20
    So let's see fundamental role of arts and humanities
  • 00:37:24
    in medical education.
  • 00:37:25
    And I was really hoping that they would like address
  • 00:37:28
    some of these questions and talk about
  • 00:37:31
    what is the point of health humanities.
  • 00:37:33
    But instead, I think that they they sort of perpetuated
  • 00:37:36
    the problem,
  • 00:37:36
    because what the frame
  • 00:37:38
    report does is offer is just like a smorgasbord of cool stuff
  • 00:37:42
    that you can do in your program
  • 00:37:44
    and you can like
  • 00:37:45
    pick and choose, but there's no discussion of like,
  • 00:37:48
    what are the philosophical underpinnings,
  • 00:37:50
    what are your goals? What should we be aiming for?
  • 00:37:52
    And so I'm not trying to I'm not trying to diss the AMC,
  • 00:37:55
    but just to say the point is this is a field level problem.
  • 00:37:58
    I think. So
  • 00:38:02
    I think we still don't know what the humanities are for.
  • 00:38:05
    My little study did not, unfortunately, solve
  • 00:38:07
    that problem.
  • 00:38:09
    I think what we did find was that a critical
  • 00:38:12
    medical humanities didn't significantly
  • 00:38:14
    change critical consciousness or cultural humility
  • 00:38:16
    with a huge asterisk because, like, the data
  • 00:38:18
    is the quantitative data not so great, right?
  • 00:38:22
    And concurrently
  • 00:38:24
    in our qualitative data, students are reporting
  • 00:38:27
    that something important,
  • 00:38:28
    they feel like something important is happening
  • 00:38:30
    in the humanities curriculum.
  • 00:38:31
    They think that it's important,
  • 00:38:34
    but we just don't know what.
  • 00:38:36
    We don't know quite how.
  • 00:38:37
    And we need to figure that out.
  • 00:38:40
    A worry that I have is that medicine,
  • 00:38:42
    and medical education is really outcomes oriented.
  • 00:38:46
    And I'm, I'm not totally sure how long we,
  • 00:38:49
    the health humanities will be tolerated.
  • 00:38:52
    If we don't have a better sense of what we're doing.
  • 00:38:57
    Okay.
  • 00:38:59
    So, practical implications from the study.
  • 00:39:03
    I think that for the institution interested in effective health
  • 00:39:05
    humanities learning,
  • 00:39:07
    there are, some implications from our qualitative data.
  • 00:39:10
    The first is that the the data showed us
  • 00:39:13
    that, students really think that science is king, right?
  • 00:39:16
    Which is not nuts.
  • 00:39:18
    Obviously. You need you need science.
  • 00:39:20
    And so a health communities
  • 00:39:24
    program to be successful, I think really needs, strong
  • 00:39:28
    institutional support because you're swimming upstream
  • 00:39:31
    on the students, deeply felt,
  • 00:39:34
    intuition that science is the most important thing.
  • 00:39:37
    That's that's one
  • 00:39:38
    another, is small group facilitator training.
  • 00:39:40
    So when students fall prey to the conscripted curriculum,
  • 00:39:44
    when majority students are,
  • 00:39:45
    like, wanting minority students to teach them about,
  • 00:39:48
    social justice concepts, for example,
  • 00:39:51
    that requires a pretty deft hand by the small group
  • 00:39:54
    facilitator to figure out how to handle that.
  • 00:39:57
    And I think that critical medical humanities,
  • 00:39:59
    topics in general include things like structural
  • 00:40:03
    racism, implicit bias, inequity in medicine,
  • 00:40:06
    historical discrimination.
  • 00:40:09
    We don't talk about those things well, as a society.
  • 00:40:12
    Right.
  • 00:40:13
    I would say our ability to engage
  • 00:40:14
    in discourse on difficult topics as a society is not so great.
  • 00:40:18
    And so a fair bit, I think, of facilitator training
  • 00:40:22
    is required to help faculty know how to navigate,
  • 00:40:26
    these discussions in small group settings.
  • 00:40:29
    And I don't know that
  • 00:40:30
    we necessarily medical education necessarily do longitudinal
  • 00:40:35
    like robust faculty training
  • 00:40:37
    particularly well or innately.
  • 00:40:41
    And the third and final implication, from the study
  • 00:40:45
    is that I think there's some evidence in our data
  • 00:40:50
    and my personal bias to start is that probably
  • 00:40:53
    it would be helpful to move more health humanities
  • 00:40:56
    curriculum into the clinical milieu.
  • 00:40:58
    So, our students talked about the disconnect, right,
  • 00:41:02
    between learning about these concepts
  • 00:41:03
    in the classroom and then, and then seeing them enacted
  • 00:41:07
    in clinic.
  • 00:41:08
    There was a big disconnect there.
  • 00:41:09
    So I think that our data
  • 00:41:11
    suggests that the disruptive environment of clerkships
  • 00:41:14
    seems to be pretty important for students to solidify
  • 00:41:18
    and make
  • 00:41:19
    or make meaning of their prior health humanities learning,
  • 00:41:22
    which aligns really well with transformative learning theory,
  • 00:41:26
    which is this idea that, folks need some type
  • 00:41:32
    of like disorientation or disruption, in order to,
  • 00:41:36
    in order to like, solidify their learning, just acquiring
  • 00:41:40
    knowledge isn't enough.
  • 00:41:41
    And so in that context,
  • 00:41:43
    clinic might actually be the disorienting setting.
  • 00:41:47
    So, so that just teaching them isn't enough.
  • 00:41:49
    They need some type of disorienting setting.
  • 00:41:52
    So blue skies,
  • 00:41:57
    although there are debates about the educational outcomes
  • 00:42:01
    that we should be aiming for in the health humanities,
  • 00:42:04
    I would argue that big picture, we're all sort of aiming
  • 00:42:07
    for the same thing, which is humanistic practice.
  • 00:42:11
    I don't think we agree about what that is, but
  • 00:42:14
    maybe we can just put that aside for right this second.
  • 00:42:17
    And,
  • 00:42:20
    and in a separate study that I did that I won't tell you
  • 00:42:23
    about, with clinicians exploring humanistic practice,
  • 00:42:29
    faculty are describing engaging as humanistic practice
  • 00:42:32
    in like battle analogies.
  • 00:42:35
    There are wars and fights and battles in order to engage
  • 00:42:39
    in humanistic practice.
  • 00:42:41
    So they talk about how
  • 00:42:43
    it's a war against a broken system,
  • 00:42:45
    a battle against a broken system.
  • 00:42:48
    So I can teach pre clerkship students
  • 00:42:51
    about narrative medicine.
  • 00:42:53
    Race is a social construct.
  • 00:42:55
    Disabilities, ethics in time.
  • 00:42:57
    Blue in the face.
  • 00:42:59
    But if they go, then into their clerkships
  • 00:43:02
    and residencies and say very little of it, role modeled,
  • 00:43:07
    I think a lot of it just goes right out the window.
  • 00:43:10
    And I think it's not that our clinicians are bad,
  • 00:43:14
    but they're not role
  • 00:43:15
    modeling these skills, attributes and dispositions.
  • 00:43:18
    It's that our role,
  • 00:43:19
    our clinicians are like burnt to a crisp,
  • 00:43:22
    fighting the broken system of health care.
  • 00:43:26
    So if I'm really dreaming big, I would, I would love to see
  • 00:43:31
    what I think would have the biggest impact
  • 00:43:32
    on humanistic practice in our learners,
  • 00:43:34
    is if we can support humanistic practice in our faculty,
  • 00:43:38
    because then they would consistently see a role modeled.
  • 00:43:44
    And, I think I think that's what I have.
  • 00:43:48
    I would love your questions.
  • 00:43:52
    To. Yeah.
  • 00:44:02
    I really resonated with what you said about,
  • 00:44:05
    institutional support needed for the humanities
  • 00:44:08
    and that idea of swimming upstream.
  • 00:44:10
    I know there's been some, like,
  • 00:44:12
    discussion that I've seen about how the pre-medical curriculum
  • 00:44:15
    and trying to fit in with all these requirements
  • 00:44:18
    that they have setting for the, that all of that
  • 00:44:20
    potentially creates a stigma against the humanities in
  • 00:44:24
    undergrad that then students
  • 00:44:26
    carry with them into medical school.
  • 00:44:28
    And I was wondering if you had any experience
  • 00:44:30
    when you were implementing the curriculum
  • 00:44:32
    with Overcoming these stigmas, or how you address them?
  • 00:44:38
    That's a great question.
  • 00:44:42
    Yeah.
  • 00:44:43
    I think it's interesting because I am more and more well,
  • 00:44:47
    so at Penn State,
  • 00:44:48
    where we have
  • 00:44:49
    the first Department of Humanities
  • 00:44:50
    in the college of Medicine in the US,
  • 00:44:52
    I think a lot of students come to us
  • 00:44:54
    because they are interested in the humanities.
  • 00:44:57
    But I do think in students and also in medical education,
  • 00:45:01
    in medicine more broadly, there is a lot of stigma about,
  • 00:45:04
    humanities
  • 00:45:06
    and the role and function of humanities in medicine.
  • 00:45:08
    I don't know what the solution is. I will tell you,
  • 00:45:12
    when I talk to
  • 00:45:13
    practicing clinicians, it seems like
  • 00:45:17
    the hard part of medicine is not the science.
  • 00:45:20
    The hard part of medical practice
  • 00:45:22
    is the people, like the humanness of your patient
  • 00:45:26
    and the humanness of you, and then all of that humanness
  • 00:45:29
    coming together.
  • 00:45:30
    So, it's a weird you obviously need to really
  • 00:45:34
    focus on the basic sciences and learn those concepts.
  • 00:45:38
    And so I guess I'm saying it's ironic
  • 00:45:41
    that there is such a bias against the humanities
  • 00:45:43
    because I think in practice, the humanities has tools
  • 00:45:47
    that are helpful
  • 00:45:48
    for the part of medicine that is actually hard,
  • 00:45:52
    which I think is,
  • 00:45:53
    difficult to see when you're in like a baccalaureate and,
  • 00:45:57
    setting.
  • 00:45:58
    I sort of haven't answered your question,
  • 00:45:59
    but mostly I don't know is the answer.
  • 00:46:01
    So I said some other things.
  • 00:46:04
    I think that
  • 00:46:06
    other questions.
  • 00:46:11
    I have a question.
  • 00:46:12
    Great.
  • 00:46:12
    So first of all, this whole
  • 00:46:16
    idea of disruption, resonates with me.
  • 00:46:21
    Gene Corbett, the original Brady physician.
  • 00:46:26
    Absolutely shocked me with his teaching style,
  • 00:46:31
    which was to create a safe environment
  • 00:46:34
    and then basically set his students up to fail.
  • 00:46:38
    Give them a task
  • 00:46:40
    that they weren't quite ready for.
  • 00:46:44
    And then after that, they were ready to hear
  • 00:46:47
    for his help and the theory.
  • 00:46:50
    And I wonder
  • 00:46:52
    if that has something to do with,
  • 00:46:54
    why the students, were,
  • 00:46:59
    less enthusiastic about the theory that you talked
  • 00:47:02
    about in the first part of the course.
  • 00:47:06
    Maybe it didn't disrupt them enough.
  • 00:47:08
    You're saying the theory?
  • 00:47:11
    No. That they needed
  • 00:47:13
    to be disrupted before they heard the theory?
  • 00:47:16
    Yeah, yeah.
  • 00:47:17
    So I think, I don't know a ton about transformative
  • 00:47:22
    learning theory, but it's a educational theory
  • 00:47:25
    that suggests that, just telling people
  • 00:47:31
    things is not enough to actually change their behavior.
  • 00:47:35
    You have to tell them things
  • 00:47:36
    and then sort of like, shake them up.
  • 00:47:38
    You have to disrupt them.
  • 00:47:39
    The the classic is the disorienting dilemma,
  • 00:47:42
    which is very much what you're describing.
  • 00:47:46
    And that
  • 00:47:48
    makes sense to me because if we think about, just intuitively,
  • 00:47:51
    our own lives, things that have really impacted
  • 00:47:55
    and changed us, they're usually not like a lecture we attended.
  • 00:48:01
    It's usually something more challenging
  • 00:48:03
    and disruptive than that.
  • 00:48:05
    And so on the one hand, I'd love to like, move
  • 00:48:10
    all of the health humanities content into the clerkships.
  • 00:48:15
    Like, I'm actually really intrigued by that idea.
  • 00:48:17
    If it's it's probably not possible.
  • 00:48:19
    But conceptually,
  • 00:48:21
    I think part of me would really like to move
  • 00:48:23
    the whole curriculum into the clerkship phase
  • 00:48:25
    so that we could have that disruption.
  • 00:48:27
    And so the students would,
  • 00:48:28
    when they're learning about race as a,
  • 00:48:30
    and when they're learning about, like
  • 00:48:33
    how concepts are socially constructed
  • 00:48:34
    in that theory heavy first course,
  • 00:48:37
    they would maybe be more tolerant of it if they're seeing
  • 00:48:39
    some evidence of it earlier in the day in clerkships.
  • 00:48:42
    But at the same time, we also saw on our data students
  • 00:48:45
    talking about how they needed some,
  • 00:48:47
    like foundation of knowledge,
  • 00:48:48
    that the foundation of knowledge before was really important.
  • 00:48:53
    So I'm not sure what to do about that.
  • 00:48:54
    I mean, maybe we, we like split
  • 00:48:56
    the difference and sort of have some pre and some during.
  • 00:49:00
    I'm not sure.
  • 00:49:03
    I don't think they want to be, disrupted and uncomfortable,
  • 00:49:07
    but that might still be the who does this thing, right?
  • 00:49:11
    Yeah.
  • 00:49:12
    Yeah.
  • 00:49:13
    I'd like to make sure that people in the, virtual world
  • 00:49:18
    also know that you're welcome to ask questions in the chat.
  • 00:49:21
    And, and while we're doing that, I have another question.
  • 00:49:26
    Oh. Oh, go ahead and ask the question. Yeah.
  • 00:49:28
    If you don't mind.
  • 00:49:28
    So I have a question.
  • 00:49:31
    One of the thoughts, and this may be a little unformed,
  • 00:49:36
    I wrote down that it's hard to have value based
  • 00:49:40
    conversations in the settings of medical education, meaning.
  • 00:49:44
    And sometimes I think that is because,
  • 00:49:47
    particularly in the preclinical curriculum,
  • 00:49:51
    the emphasis is really on a lot of just intellectual learning.
  • 00:49:56
    You know, just packing your head with the scientific knowledge.
  • 00:49:59
    Rita, Sharon, offers this balance between
  • 00:50:03
    what she clumsily calls logical scientific knowledge
  • 00:50:06
    and narrative knowledge, both of which being essential
  • 00:50:10
    to medicine and its practice.
  • 00:50:13
    One of the things that happens with narrative knowledge
  • 00:50:17
    is that it does have a high emotional quotient to it.
  • 00:50:22
    It arouses emotion.
  • 00:50:23
    It its goal is to move the physician
  • 00:50:26
    to act on behalf of the patient.
  • 00:50:29
    And so in some of my teaching, I have explicitly said,
  • 00:50:34
    you know,
  • 00:50:36
    I'm here to help you engage both your head and your heart
  • 00:50:39
    in what we're doing here.
  • 00:50:41
    And I found I ended up having to move away often
  • 00:50:44
    from theoretical texts like George Engels landmark 1977
  • 00:50:49
    article about the doctor, you know, and and things
  • 00:50:54
    because students couldn't tolerate and could engage
  • 00:50:57
    with reading something that was a theoretical
  • 00:51:00
    and written in a scientific and
  • 00:51:03
    scientifically acceptable style.
  • 00:51:05
    They wanted and needed to be moved to get it.
  • 00:51:09
    Why this stuff was important.
  • 00:51:11
    The other thing that I'm intrigued
  • 00:51:14
    with, issue thoughts about moving
  • 00:51:16
    to the moving into the clinical spaces
  • 00:51:20
    where I think it is
  • 00:51:21
    possible to have some value based conversations,
  • 00:51:24
    although often these may not be best convened
  • 00:51:28
    by practicing clinicians,
  • 00:51:31
    but perhaps, as NYU did years ago,
  • 00:51:34
    they brought in people, faculty and graduate students
  • 00:51:37
    from the social work program to talk with medical students
  • 00:51:42
    weekly
  • 00:51:44
    about what they were seeing and doing on their clerkships.
  • 00:51:46
    I think that is one of the fundamental challenges of
  • 00:51:50
    health humanities
  • 00:51:51
    teaching and learning, which is that the faculty
  • 00:51:54
    with expertise in this area tend not to be physicians.
  • 00:52:00
    And so, they're used to teaching in a classroom setting.
  • 00:52:04
    And so that so they've done what they're used to doing,
  • 00:52:08
    which is a pre clerkship classroom setting.
  • 00:52:11
    And that it's,
  • 00:52:13
    it's there's sort of like a philosophical barrier kind of
  • 00:52:16
    to getting those people into the more clinical settings.
  • 00:52:19
    Yeah.
  • 00:52:20
    Thank you for your comments.
  • 00:52:25
    So my next question, doctor, will be,
  • 00:52:28
    we had some conversations last night.
  • 00:52:32
    And it seemed like most of the people were feeling
  • 00:52:37
    like they wanted to practice humanistic medicine.
  • 00:52:42
    And as you said, sometimes we run up against
  • 00:52:47
    systems that make it hard to practice that way.
  • 00:52:50
    And, and I think that's a reason,
  • 00:52:53
    for burnout.
  • 00:52:57
    I'm trying to think about, you know, like,
  • 00:52:59
    who needs the humanism education the most?
  • 00:53:02
    Is it
  • 00:53:03
    our, very empathetic and humanistic
  • 00:53:07
    medical students, or is it the health system
  • 00:53:11
    and the insurance system and the political system?
  • 00:53:16
    Yeah.
  • 00:53:17
    Well, I think as I alluded to at the end, what I want to do
  • 00:53:19
    is just have all the faculty,
  • 00:53:23
    I, I want all the faculty to go through
  • 00:53:25
    a really nice health humanities curriculum,
  • 00:53:28
    maybe not the one that's been built for, right.
  • 00:53:31
    But the one that is sort of re
  • 00:53:32
    rejiggered for faculty,
  • 00:53:35
    so that we can have high level faculty.
  • 00:53:37
    But but in order to do that,
  • 00:53:38
    we need university buy in health system, buy in.
  • 00:53:42
    You know, we need buy in from
  • 00:53:43
    the people who write the paychecks.
  • 00:53:45
    But yes, I agree with you.
  • 00:53:48
    I often feel with medical students
  • 00:53:50
    that we're preaching to the choir, because it's newer.
  • 00:53:53
    Come in wanting to do this, of course.
  • 00:53:56
    Of course, is why you came into medicine for the most part.
  • 00:53:59
    And then
  • 00:54:01
    other stuff happens, and,
  • 00:54:03
    like, my systems and everything get in the way.
  • 00:54:13
    Thank you so much for your time.
  • 00:54:15
    Thanks for having me.
  • 00:54:16
    Thanks for the discussion.
Tags
  • Health Humanities
  • Medical Education
  • Empathy
  • Humanistic Practice
  • Curriculum Development
  • Critical Consciousness
  • Institutional Support