The State of the Art(s) in Medicine
By Allan D. Peterkin and Anna Skorzewska
Image credit: '634738' by Kevin Laminto. CC0 Public Domain via Unsplash.
For some time now, in the United States, the United Kingdom, and Canada, the inclusion of programs in the medical humanities as well as mandatory humanities curricula in undergraduate medical education has become widespread. The offerings by medical/health humanities divisions in medical schools are currently rich and diverse. They include watching films, learning to interpret paintings, performing close readings of literary texts, and reflective and creative writing. They can also include personal reflective portfolios, seminars about the interface between the arts and medicine, and the arts for health movement. Quite excitingly, they often invite trainees to develop an artistic practice themselves, which can afford new forms of creative expression and reflection but also encourage learning with both sides of the brain. They honor thoughts and feelings, the subjective and the objective. These endeavors can help reduce the gap between biomedicine and the human sciences, such as philosophy and history. They can facilitate interdisciplinary and interprofessional teaching and research, model a patient-centered approach to medical care, challenge biomedical arrogance, and equip doctors to meet the moral challenges of practice not covered expressly (or adeptly) by medical education.
Sadly, such initiatives fall off in many residency programs when they are most needed. The humanities can help counteract burnout and cynicism which we know increase during residency training (in conjunction with declining empathy levels1). Reflective, creative practitioners take better care of their patients, but they also take better care of themselves, because they have new tools to challenge their assumptions and to sustain their personal values and sense of purpose while providing optimal care.
Recently, in both Canada and the United States, there has been a shift to competency-based models of medical education. Of the seven competencies described in the current Canadian CanMeds model, for example, a majority have to do with the so-called soft, non-scholarly skills of medicine including communication, collaboration, and professionalism2. Interestingly, although these competencies comprise five of the seven, only a very small percentage of explicit curricular time is currently devoted to them. This is in part due to the difficult task of determining how to teach these competencies which are not so much “soft” as complex and difficult to teach. More sophisticated educational approaches are clearly needed rather than the simple transmission of knowledge and skill. Read more about how this can be achieved by looking at how social sciences are taught to trainees during residency with this freely available chapter.
As William Carlos Williams has said, “it takes time to become a doctor.” Medical students are busy mastering the basic tools of medicine: both the knowledge and the skills. Gaining this mastery is stressful enough, and complexity and nuance can only be grappled with once the basics are in place. Once these are “mastered” and trainees move on to postgraduate training, they enter a world in which they have much more independence and autonomy. It is at this moment that all of the uncertainty, the gray areas and murkiness in medicine, emerge. It is here that generalities, laws, rules, and norms are helpful but insufficient to make thoughtful and timely decisions. It is here that understanding cultural differences, a patient’s individual situation, and the beliefs and values of patients must be incorporated into decisions in the care plan.
1Neumann M. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996–1009.
2Canada RCoPaSo. CanMeds Physician Competency framework. 2016. http://canmeds.royalcollege.ca/en/framework.