In 1992, when the Medical Humanities Program began at Dalhousie University Faculty of Medicine in Nova Scotia, Canada, there were already helpful elements in place. The university had interests in aspects of the humanities, a theme year in the medical school to increase attention to the humanities, and a major symposium on the place of medical humanities in the education program. There was an active medical history society, and a regular clinical teaching series in the department of family medicine (FM) that used literature. Most of the faculty who had involvement in the humanities had not been called on to share their experience with the medical students. We noted that many often kept this private, but they were enthusiastic to have an opportunity to incorporate the humanities into their teaching.
In 1991, a major symposium on the medical humanities was held with 268 attendees, including representatives from every Canadian medical school and a number of American schools. At the end of the symposium there was a dialogue about the greater incorporation of the humanities into medical education. Many of the underlying principles of our program came from that weekend symposium, and we continue to be grateful for the many good ideas from the audience and particularly from Eric Cassel and Richard Selzer.
We articulated the philosophy of the program in an introductory paper, as many initially were uncertain about what the humanities entailed. This discussion paper, “Why the Medical Humanities?,” is given to each entering medical student.1 They also receive an outline of the offerings in the medical humanities over the four years of medical school and in residency training.
Our paper noted that there have been many exciting advances in science, technology, and therapy over the last century, which led to an increasingly biomedical view of illness, specialization, and a technological approach to diagnosis and treatment. This has fostered an emphasis on students’ knowledge and technical skills, with a focus on competence, but with less emphasis on the traditional humane and interpersonal aspects of the practice of medicine.2 We emphasized that the call for the humanities in medical education was not to de-emphasize medical sciences but to achieve a reasonable balance of the humanities and the sciences. Medicine is not a science, but a caring profession that uses science.
We benefited from the earlier ideas of many who advanced the cause of humanities and humanistic studies in medical education,3-7 and from the pioneering programs that led the way.8 Working models were helpful and persuasive when we were attempting to innovate, so the experience of earlier programs provided lessons for us.9 It is sobering to note that during the 1970s and 1980s, a period of increasing activity in the humanities in U.S. schools, there were no identifiable programs in Canada.
Before beginning, we wrote to every medical school in North America to determine their involvement in medical humanities. We learned that most desired a greater balance of the humanities and the sciences, but were struggling to achieve this in their curricula. Schools with a problem-based curriculum had potential opportunities to incorporate the humanities into case studies, but the humanities lost the easier (but perhaps less successful) assignment of blocks of lecture time. Medical educators also acknowledged that incorporating the medical humanities was only one of the challenges in the past decade. They were also struggling to incorporate community-based experiences, ethics, population health perspectives, interdisciplinary experiences, multicultural issues, international medicine perspectives, and the determinants of health.
Beginning a humanities program with a broad perspective without the traditional departmental structure was difficult during the early 1990s, a time of restraint and budget cuts. We decided to start small, avoiding confrontation with departments over time and budgets, and sought to capture whatever students were interested at the time. We looked to current faculty who had a personal interest and involvement in the humanities and encouraged them to serve as volunteer faculty in the program. Retired faculty members were another valuable resource.
The program began in 1992 when I stepped down as dean of the Faculty of Medicine and assumed the position of professor of medical humanities. A number of interested faculty who had commitments to aspects of the humanities were recruited as volunteer teachers, mentors, and supervisors for the students who displayed an interest in the humanities and applied for electives or summer research projects.
We sought links and liaisons with many of the faculty and university programs that had interests overlapping with the medical humanities. We collaborated with the departments of history, biology, French, and English and with the faculties in other local universities, sharing support activities and acting as co-investigators in grant applications. We have been impressed that the other university faculty have been so enthusiastic about collaboration. We take every opportunity to respond to community requests and invite the public to attend many of the programs, performances, and visiting professor lectures.
We liaise with many committees: the Student Advisory Program, the confidential support group (PIETA) that assists medical students with substance abuse or stress problems, the Kellogg Health Science Library, the Office for International Medicine, the Dalhousie Medical Student Society and its committees, the student journal editors, the Dalhousie Society for the History of Medicine, the Medical Museum of Nova Scotia, the Dalhousie Society for the History of Science, and the Faculty of Arts and Social Sciences.
We try not to “own” the humanities; rather, we foster, encourage, respect, attend, and applaud all efforts we see anywhere in the student body, in the departments or in the medical school programs. If we are successful, the humanities will be an integral part of the educational program and the life of the medical students, and a humanities program will be needed only to coordinate and encourage such activity.
The activities in the medical humanities at Dalhousie have taken many forms. Some were planned, and some arose from the individual activities and initiatives of faculty and students. Some activities have become large programs, and we would not have predicted their success, such as the extent of the music program, the involvement of students in art, and the impact of poetry and storytelling. Following is a brief description of some of the program activities.
A busy elective program offers opportunities for experience in any aspect of the humanities. The ones most often selected relate to history, philosophy, literature, music, and art. There are funded opportunities to spend the summer doing a research project in the humanities. We are fortunate to have a number of endowed studentships, and our students have also been very successful in competitive applications to national agencies.
We host an ongoing series of talks on the medical humanities, with presentations made by students, faculty, other university faculty or visitors. The talks are open to all interested parties, and we have been impressed by the regular attendance of administrative staff.
In the fall, when the autumn colors are particularly resplendent in Nova Scotia, we have a reading weekend in an inn or resort somewhere in the province. The literature, a mixture of novels, biography, essays, short stories, and poems, is given to attendees in the late spring so they can read the material over the summer.
The Dalhousie Society for the History of Medicine has a monthly dinner meeting at which two papers are delivered by faculty, community physicians, historians, and visiting scholars. The dinner meeting has been another important opportunity for the students to present their research in the medical humanities.
The program has a regular dinner roundtable for physician writers to discuss and read their latest unpublished works. Physicians attending are essayists, novelists, biographers, playwrights, poets, and travel, short story, and humor writers. Medical students who are interested in writing attend and read their work.
We provide students with many opportunities to present their work. This has in turn influenced other students who are interested in their classmates’ projects in history, art, music, and other aspects of the humanities. We assist students to travel to a number of national meetings to present papers on their humanities projects and research.
Music has been a part of the student life at Dalhousie since Dr. Bernard Badley started the Tupper Band 25 years ago. The Tupper Concert Chorale has over 100 students, faculty, and friends who also practice every Wednesday evening under the direction of Dr. Ronald Stewart; they perform frequent local concerts and have toured in Pittsburgh, Los Angeles, and the Maritime Provinces.
The art program has also expanded beyond our expectations. It began as a project revolving around the work of artist Robert Pope, a young man who developed Hodgkin’s disease and, after a few difficult years of therapy, began a series of 96 paintings exploring the experience of illness from the patient’s perspective. Although he has since died, his paintings and ideas continue to have an effect at our school and the many schools in North America and Europe where his works have been exhibited. One of the roles of the foundation subsequently established in Pope’s name is to support the medical school’s Medical Humanities Program. Students have increasingly developed their own art projects relating to medicine. One student, Jonah Samson, developed a major annual art project that exhibits student art around a theme such as transplantation, Alzheimer’s disease, attention deficit hyperactivity disorder, or sexual dysfunction. The art program has received a good deal of community and national media attention and was recently adopted by the University of Manitoba.
The artist-in-residence program is in its 10th year. There have been artists who work in various media, a muralist, a poet, a storyteller, and a writer-translator. Each has been able to link with the students in a unique way. Further programs have been born out of the relationship with the poet and storytelling groups, and their performances have a prominent place during the medical school year. The artist-in-residence program has received grant support from the Canada Council.
Successes and Challenges
The major challenge for the program has been to find its place alongside the traditional medical disciplines so that it is not seen as a peripheral phenomenon. The program’s major strengths are the interest and background in the humanities that students bring to medical school, interests that used to be set aside when they were immersed in the medical sciences. They are enthusiastic to learn that continuing involvement in literature, history, philosophy, music, or art is encouraged and valued. The second major strength is the talented volunteer faculty.
A key element to our success has been the influence on other students of those involved in the Medical Humanities Program. Increasingly, another measure of success has been the spontaneous generation of ideas and projects from the students when they see that the medical school values the humanities. We encourage as much or more activity by the faculty and the students than we ourselves create, and we have learned to avoid turf consciousness.
As I step down after 11 years as professor of medical humanities, I regard my term as the program’s first phase, the initial spadework that achieved some interest, recognition, and legitimacy for the medical humanities within the fabric of the medical school. Phase II will focus on further incorporating the humanities into the curriculum. Phase III will be the development of a graduate program in the medical humanities to train more faculty who will incorporate the humanities into their teaching and the development of education programs.
We are most grateful for the support of Deans John Ruedy and Noni MacDonald, and the time, enthusiasm, and expertise of the many talented faculty members and students who keep the program growing. Special recognition must go to Roxy Pelham, assistant to the director, who has been there from the beginning and is the cheerful central focus of all activities in the program, able to make everything happen.
1.Murray TJ. Why the Medical Humanities? Dal Med Students Journal, 1999;1:18-22.
2.Charon R, Banks JT, Connelly JE, et al. Literature and medicine: contributions to clinical practice. Ann Intern Med. 1995;122:599-606.
3.Pelligrino ED. Humanism and the Physician. Knoxville: University of Tennessee Press, 1979.
4.Pelligrino ED. A Philosophical Basis of Medical Practice: Towards a Philosophy and Ethic of the Healing Process. New York: Oxford University Press, 1981.
5.Pelligrino E. The humanities in medical education. Mobius, 1982;2:133-41.
6.Thomasma DC. Beyond Medical Paternalism and Patient Autonomy: A Model of Physician Conscience for the Physician-Patient Relationship. Ann Intern Med. 1983;98:243-248.
7.Rogers DE. On Humanism in Medicine. Pharos. 1981;44:30-35.
8.Barnard D, Clouser KD. Teaching medical ethics in its contexts: Penn State College of Medicine. Acad Med. 1984;64:743-46.
9.Cassel EJ. The place of the humanities in medicine. New York: The Hastings Center, 1984.