Share this article on:

Beyond “Dr. Feel-Good”: A Role for the Humanities in Medical Education

Kumagai, Arno K. MD

doi: 10.1097/ACM.0000000000001957
Invited Commentaries

Although educators embrace the values that are nominally included in the idea of “the art and science of medicine,” the arts and humanities have remained at the edges of medical education. One reason for this exile is the overwhelming emphasis in the curriculum on biomedical science over the social sciences and humanities. Other causes are self-inflicted—a frequent lack of theoretical rigor in the design of educational offerings and, more important, no clear answer to the question of how the humanities can make better physicians. A common justification for including the arts and humanities in medical education—that spending time with literature, music, and the visual arts contributes to student and faculty reflection and well-being—is compelling; however, it risks further marginalizing the field as a soft, feel-good supplement to training.

In this Invited Commentary, the author proposes several unique ways in which the arts and humanities contribute to the development of physicians who practice with excellence, compassion, and justice.

These ways include disrupting taken-for-granted beliefs and assumptions; introducing a pause in perceiving, thinking, and acting; encouraging engagement with complexity and ambiguity; seeing past the surface to historical and societal influences and causes; and encouraging an awareness of the multiple, unique voices and perspectives of patients. Ultimately, the humanities prompt awareness of the space in which physicians care for human beings in their moments of greatest need and bear witness to fundamental changes in their patients and in themselves.

A.K. Kumagai is professor and vice chair for education, Department of Medicine, cross-appointed researcher, Wilson Centre, and F.M. Hill Chair in Humanism Education, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada.

Funding/Support: The author is supported by the F.M. Hill Foundation of the Women’s College Hospital and the University of Toronto.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Arno K. Kumagai, Division of Endocrinology, Department of Medicine, Women’s College Hospital, 76 Grenville St., Toronto, ON M5S 1B2 Canada; e-mail: arno.kumagai@utoronto.ca.

Some years ago, I had the opportunity to design and direct a medical school course based on narratives arising from longitudinal interactions between beginning medical students and families with chronic or severe illness. We explored students’ insights from these interactions in small-group discussions, which in turn were supplemented by brief preparatory writing assignments, short stories, nonfiction books and essays, video clips, interactive theater, and interpretive art projects, all of which were meant to encourage students to explore the human dimensions of illness and health care.1

One day, as I was heading to one of these small groups, I overheard an exchange between two medical students walking just ahead of me.

“So, where are you going?”

“…small group…”

“For what?”

“Oh, you know … to spend some quality time with Dr. Feel-Good.”

Suddenly, the students became aware of my presence and appeared deeply embarrassed. Chuckling, I waved off their apologies and asked that they give my very best regards to the good doctor.

This story brings me to the point of this Invited Commentary. Why the humanities? There is a growing interest in incorporating the arts and humanities—literature, philosophy, the social sciences, and history—into medical education; however, the ultimate goal of introducing these disciplines into a curriculum already packed with biomedical knowledge is often unclear. We hear that exposure to the humanities increases empathy, enhances reflection, and promotes professionalism. At innumerable talks and conferences, I also have heard that participating in book groups or writing workshops or going to concerts or museums—exploring the paintings in an art gallery where the tinkling of wine glasses and the strains of classical music can be heard in the background—contribute to student, resident, and faculty wellness and well-being and somehow connect (or reconnect) us with the larger project of our profession in caring for other human beings. While many of these assertions may be correct, there are risks involved as well—an emphatic focus on the literary Canon or on the Art (with a capital “A”) entombed in museums threatens to reproduce dominant values and perspectives, as well as a certain smug cultural elitism, while silencing those who do not neatly fit into traditional categories of “good taste.” More important, however, I believe that many approaches, and the lack of rigorous theoretical frameworks supporting them, threaten to turn the humanities into mere entertainment and the efforts to introduce them into medical education into the superfluous icing on what Catherine Belling2 has called “the decorative edges of the curriculum.”

So, what then is the role of the humanities in medical education? In other words, how can the humanities make better physicians? Starting off with a negative, I am not of the camp that believes in the “civilizing influence” of literature and art, that the mere exposure to works of art makes people better human beings. After all, as someone quipped at a conference I attended recently, Joseph Goebbels, the Nazi minister of propaganda, had a doctorate in literature; Hermann Göring, the head of the Luftwaffe, was a renowned collector of fine art; and Adolf Hitler himself was a painter. Instead, I suggest that, among many reasons, there are several unique and essential ways in which the arts and humanities can contribute to the formation of physicians who practice with excellence, compassion, and justice. These reasons include creating difficulties and disruption; introducing a pause; encouraging engagement with complexity and ambiguity; providing different lenses through which to see the education and practice of medicine in new and generative ways; and fostering a deep and abiding engagement with the multiple, the unique, and the unknowable. I will discuss each of these in more detail in the following paragraphs.

First, disruption. Although I do support the use of the arts for wellness, contrary to the notions implied in the student’s Dr. Feel-Good comment, one of the principal functions of the humanities in teaching physicians is precisely the opposite—to disrupt, to complicate, and to unsimplify and, in so doing, to disturb the tendency that we have as medical educators and as health care providers to believe that there is one answer, one authority, one way of looking at or doing things.2 The humanities serve, as Delese Wear and Julie Aultman3 have said, to “create difficulties everywhere.” They teach us how to look beyond the surface; to question taken-for-granted assumptions, biases, and ideas; to think of how to look at people and situations with fresh eyes and open minds. Borrowing a concept from modern art, the visual arts and literature also can be used in medical education “to make strange”—that is, to distort our perceptions of common objects, relationships, ideas, identities, or beliefs to force us to look at them anew.4 These disturbances are not important for their ability to shock per se; instead, encountering new or unfamiliar (or made-unfamiliar) ideas, experiences, or perspectives prompts reflection on the self, others, and the world and, in doing so, gives rise to more open and inclusive worldviews.4

Second, the arts and humanities help us to pause, to step back and stand still and look and listen and think deeply about human beings and their lives. This pause slows things down5 and interrupts the automaticity of thought and action; it allows us to step carefully and think about different forks in the road, about different choices and alternatives, as well as about their potential consequences. This slowness also allows us to deal thoughtfully with complexity and ambiguity, with all of the details and intricacies of working in what Donald Schön6 calls the “swampy lowland” of actual practice.

Third, the arts and humanities help us to engage a sociological or historical imagination when we consider the issues confronting our patients. They help us to peel back the different layers making up ideas, institutions, conditions, or practices to understand them through the lens of history, ideology, and power.7,8 Although this approach may appear to be obtuse and abstract, it is not. The concept of the hidden curriculum, which has attracted so much attention from medical educators, is taken directly from education and sociology.9 Understanding the forces affecting the lives of our patients in this way helps us to formulate solutions that recognize and act on the root causes of their illnesses, as well as on society’s ills.

Fourth, the arts and humanities, literature and film in particular, have the unique ability to allow us to slip vicariously into someone else’s skin and look at the world through her or his eyes. They compel us to honor the narrative and to lean in with such close attention to our patients and their stories that, as Rita Charon so eloquently put it, “our heads touch.”10 Literature introduces us to a plethora of voices, perspectives, habits, tics and quirks, and feelings. It represents the cacophonous diversity of everyday life. Disease is often described by its proximity to or divergence from the norm or the typical (e.g., typical presentations, typical findings, typical responses, typical clinical courses). Stories, on the other hand, resist simplification and celebrate the unique. They confer individuality to both their protagonists and their tellers, and texture and difference to populations, categories, and demographics.

Finally, the arts and humanities expand the spectrum of human expression and understanding. Alan Bleakley11 has argued that the humanities introduce a new vocabulary to medical education and clinical practice. In addition to words such as communication, treatment, prognosis, and outcomes come words like authoritarian, aesthetic, emancipation, sensibility, beauty, and power. I would extend this idea by adding that the humanities also introduce a new vocabulary of very old words, words like wonder and mystery.

The philosopher Martin Heidegger wrote that, in contemplation of Being, one enters into a clearing—that is, into an open space in which Being becomes other than what it is.12 By shining through the distractions that come from the numbers and noises and technology and competencies, the arts and humanities beckon us to be aware of the fact that, in caring for other human beings during times of great vulnerability, we enter into a clearing, a sacred space in which people (including ourselves) change in fundamental and often permanent ways. This awareness of bearing witness to and participating meaningfully in those events that make us human is what breathes life into the professional ethos of being a physician.

Back to Top | Article Outline

References

1. Kumagai AK. A conceptual framework for the use of illness narratives in medical education. Acad Med. 2008;83:653–658.
2. Belling C. Commentary: Sharper instruments: On defending the humanities in undergraduate medical education. Acad Med. 2010;85:938–940.
3. Wear D, Aultman JM. Creating difficulties everywhere. Perspect Biol Med. 2007;50:348–362.
4. Kumagai AK, Wear D. “Making strange”: A role for the humanities in medical education. Acad Med. 2014;89:973–977.
5. Wear D, Zarconi J, Kumagai A, Cole-Kelly K. Slow medical education. Acad Med. 2015;90:289–293.
6. Schön DA. The Reflective Practitioner: How Professionals Think in Action. 1983.New York, NY: Basic Books.
7. Jones DS, Greene JA, Duffin J, Harley Warner J. Making the case for history in medical education. J Hist Med Allied Sci. 2015;70:623–652.
8. Metzl JM, Howell JD. Great moments: Authenticity, ideology, and the telling of medical “history.” Lit Med. 2006;25:502–521.
9. Hafferty FW. Beyond curriculum reform: Confronting medicine’s hidden curriculum. Acad Med. 1998;73:403–407.
10. Charon R. Commentary: Our heads touch: Telling and listening to stories of self. Acad Med. 2012;87:1154–1156.
11. Bleakley A. Medical Humanities and Medical Education: How the Medical Humanities Can Shape Better Doctors. 2015.New York, NY: Routledge.
12. Heidegger M. Anderson JM, Freund EH. Conversation on a country path about thinking. In: Discourse on Thinking. 1966.New York, NY: Harper Perennial.
© 2017 by the Association of American Medical Colleges