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“Making Strange”: A Role for the Humanities in Medical Education

Kumagai, Arno K. MD; Wear, Delese PhD

doi: 10.1097/ACM.0000000000000269

Stories, film, drama, and art have been used in medical education to enhance empathy, perspective-taking, and openness to “otherness,” and to stimulate reflection on self, others, and the world. Yet another, equally important function of the humanities and arts in the education of physicians is that of “making strange”—that is, portraying daily events, habits, practices, and people through literature and the arts in a way that disturbs and disrupts one’s assumptions, perspectives, and ways of acting so that one sees the self, others, and the world anew. Tracing the development of this concept from Viktor Shklovsky’s “enstrangement” (ostranenie) through Bertolt Brecht’s “alienation effect,” this essay describes the use of this technique to disrupt the “automaticity of thinking” in order to discover new ways of perceiving and being in the world.

Enstrangement may be used in medical education in order to stimulate critical reflection and dialogue on assumptions, biases, and taken-for-granted societal conditions that may hinder the realization of a truly humanistic clinical practice. In addition to its ability to enhance one’s critical understanding of medicine, the technique of “making strange” does something else: By disrupting fixed beliefs, this approach may allow a reexamination of patient–physician relationships in terms of human interactions and provide health care professionals an opportunity—an “open space”—to bear witness and engage with other individuals during challenging times.

Dr. Kumagai is professor of internal medicine and medical education and director, Family Centered Experience and Longitudinal Case Studies Programs, University of Michigan Medical School, Ann Arbor, Michigan.

Dr. Wear is professor of family and community medicine, Northeast Ohio Medical University, Rootstown, Ohio.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Dr. Kumagai, 7330 Medical Science I SPC #5624, University of Michigan Medical School, Ann Arbor, MI 48109-5624; telephone: (734) 615-4886; fax: (734) 936-2236; e-mail:

© 2014 by the Association of American Medical Colleges