The Program in Medical Humanities at the University of Missouri-Kansas City School of Medicine

Abstract

The University of Missouri-Kansas City School of Medicine opened officially in 1971, offering a combined BA/MD in a six-year program. The program has a defined goal of offering humanities courses throughout the curriculum. The Sirridge Office of Medical Humanities was established in 1992, and it assumed the responsibility of developing conveniently scheduled courses in medical humanities, making more specific requirements for such courses in the medical curriculum. The goal of these courses has been to provide students a different way of looking at things by giving them insight into the ways that reading literature and writing stories helps medical students better read patient experiences. A course entitled “Literature: A Healing Art” was first offered in 1992. In 1994, The Body Image in Medicine and the Arts course was added. With the help of a Culpeper grant in 1995, five interdisciplinary undergraduate courses were created. In 1999 Medicine, Literature, and Law was developed from two previous courses. Bioethics is offered as part of a series called Correlative Medicine and in a required course, Behavioral Science. The present director of the Office of Medical Humanities has resigned and at present there is a search for a replacement. A new director may decide to change some of the offerings and add new activities. The medical school remains committed to supporting the office and its programs in keeping with the goals of the original academic plan to educate safe and caring physicians.

The University of Missouri-Kansas City (UMKC) School of Medicine opened officially in 1971, offering a combined BA/MD in a six-year program. From the very beginning, one of the important principles guiding the curriculum was the providing of both arts and sciences and medical educational experiences throughout the six years. Whereas most universities house their medical humanities programs within medical schools and involve medical faculty and students only, our unusual BA/MD program allows us to include students and faculty members from a large number of arts and sciences disciplines as well as the School of Medicine. To ensure this principle’s development, a humanities committee was appointed that met regularly for several years to help develop ways for students to take advantage of diversified curricular opportunities.

From the beginning, the School of Medicine’s Academic Plan directed that during the first two years of the curriculum, three fourths of the student’s time be taken up with arts and science courses (including appropriate humanities offerings) and one fourth of the student’s time in each year be spent in a hospital setting with a physician-docent/mentor and a psychiatrist. In the latter experience, students were introduced to important behavioral issues of the physician-patient relationship. In the remaining four years, the plan provided for about one fourth of the student’s time each year to be spent in arts and science courses and three fourths in medical basic science courses and clinical experiences. Because the College of Arts and Sciences operates on the semester system and the medical school uses month-long rotations, under this system it was difficult to provide adequate opportunities for students to enroll in appropriate humanities offerings.

Early Developments

Gradually, through the Sirridge Office of Medical Humanities that was established in 1992, the medical school began to develop conveniently scheduled courses in medical humanities and to make more specific requirements for such courses in the medical curriculum. The goal of these courses has been to provide students with insight into the ways that reading literature and writing stories helps them to better read patient experiences by developing understanding and true compassion for each patient’s story of illness.

The first of such offerings were month-long courses, one of which was required for students in their last two clinical years. A course entitled “Literature: A Healing Art” was first offered in 1992, and it has since been offered once or twice a year with variable enrollments. The themes of the course have varied, but in each a defined group of literary selections has been assigned to the students who meet daily for two hours of in-class discussion and writing. Occasionally, appropriate lectures are held, and there are a series of written assignments that have resulted in many well-written and thoughtful journal essays. These writing assignments ask students to describe their responses to selections and include their personal experiences that have relevance to the readings. There have been no complaints about the writing assignments and the requirement of an essay final examination, all of which have been helpful in evaluating the students’ learning experience and in planning future courses. Undergraduate students can receive humanities credit toward their BA degrees.

In 1994 and 1995, an ethnographic study of medical students who were enrolled in the Literature: A Healing Art course was undertaken.^2-4 The fact that these students were required to take the course made them a notable sample because similar courses elsewhere are usually taken as electives, thereby drawing more students who are already captivated by the course’s content. From the results of the study, it was evident that reading, discussing, and writing all contributed to broadening these students’ understanding of what it means to be a doctor. They seemed to recognize that being a good doctor does not always necessarily entail finding the right diagnosis or picking the right multiple-choice answer, but also “reading” a particular medical situation to discover what is going on at that particular moment.

A second month-long interdisciplinary course for medical students and other junior- and senior-level undergraduates was added in 1994. Entitled “The Body Image in Medicine and the Arts,” the course is co-taught by a physician, an art historian, and an English/medical humanities professor. It encourages students to focus on their own bodies and those of others to see how perspective influences behavior. Literature, photography, art, anthropology, art history, cultural studies, feminism, modernism, and medicine are all employed to encourage students to consider broader cultural interpretations of the human body. The central purpose of the course is to teach students how to understand the differences and similarities between the “artistic and medical gaze” by better conceptualizing and diagnosing their own feelings and biases. The course has been very popular and has continued to be offered annually. It has been described in detail in Medical Humanities.⁵ At present, we are hoping to develop and publish an anthology to be used in the course and to make it available for others to use. We hope to include both appropriate literature and art reproductions.

Culpeper Grant Developments

With the help of a Culpeper grant in 1995, we were able to initiate the development of five interdisciplinary undergraduate courses in the medical humanities that would be available to all prehealth sciences students in the university as well as medical students in our program. In December 1997, the faculty of the College of Arts and Sciences approved an academic minor, “Healing and Humanities.” To fulfill this minor, students must complete 15 designated hours (nine must be medical humanities). The first of these courses, Writing, Healing, and Humanities, was specifically designed as a required sophomore-writing course for students planning careers as health care professionals. It utilizes classroom discussion, academic research, and revision to consider the role of North American medicine in our lives and our society. Issues of health and illness are discussed in relation to how they influence the way we understand and are understood during provider/consumer encounters. A unifying theme originally created was the topic “being human.” Consciousness of self is evaluated incrementally, beginning with personal stories, moving to community issues, transitioning to moral-choice reflections, and concluding with creative works. This version of the course is described more fully in Approaches to Teaching Literature and Medicine.⁶ Since its inception, the course has evolved into a composition-based course specifically designed for any prehealth science student at UMKC. Because the courses now contain a diverse range of prehealth science students, there is interdisciplinary discussion and debate. The primary texts used for the current teaching of the course are the recent anthology, Life in Medicine, ⁷ edited by Coles and Testra, and Education and the Significance of Life, by Krisnamurti.⁸

The second course, Healing and the Arts, has also continued to be offered annually. It is an interdisciplinary course that is available to all upper-level undergraduate students as well as health science students to fill a humanities requirement or as an elective. It is taught in the evening at the medical school, and its basic premise is to give students a practical and theoretical understanding of how the arts can be a healing element in people’s lives. Healing is a powerful learning concept to employ as the central metaphor of any course because the arts have always functioned as a positive force in healing mind, body, and spirit. When students can connect to the mainstream of human experiences, they can find that health and illness are larger themes that encompass all of society, not just the world of medicine. The course helps students consider patients as “almost whole and well” rather than as “sick” because the focus is on positive aspects of healing. Experiential art experiences, lectures, and discussion of readings provide the students with material for writing assignments. A description of the course has been submitted for publication.

A third course, Healing and Cultural Diversity, was taught for three consecutive years with success, but funding for the necessary interdisciplinary faculty became unavailable. The course was designed to encourage the development of communication skills for both providers and receivers of health care to help both deal with barriers and, thus, enable healing processes. Multicultural influences (e.g., race, gender, age, nationality, religion) affecting the process of healing were presented and discussed. More recently, a fourth course in health communication that also emphasized diversity has been offered. An interdisciplinary faculty from philosophy, sociology, physics, and medicine offered Perspectives in Science and Healing for two years. Students were given the opportunity to develop critical thinking skills by looking at theories, paradigms, models, and practices that relate to the science and healing perspectives of modern health care practices. Again, funding was a problem for continuing the course.

A fifth course, Values, Policies, and Practices in Health care, was taught once as a night course at the medical school and was successful, drawing a large number of students. In this interdisciplinary cluster course, students engaged in a critical examination of some of the underlying assumptions and cultural values that have shaped and informed past and current U.S. health-related practices and policies. Some of the questions discussed in this course were topics such as “How did we develop the western biomedical view of what it means to be human?” and “What values should I examine to inform my own philosophy of practice and/or health care?” Several members of the faculty who helped develop the course left the institution and, unfortunately, there has not yet been an effort made to reestablish this unique course. Plans are currently being made to develop another course at the medical school that focuses primarily on spirituality and the conflicting values of medicine.

Other Medical Humanities-related Courses

A one-month course, Medicine and Law, was offered once a year for medical students in their clinical years from 1994 until 1998. It was taught by a lawyer who served as counsel for one of the school’s teaching hospitals. In 1999 Medicine and Law was combined with the Literature: A Healing Art course, and since then both medical and legal faculty have taught the new course, Medicine, Literature, and Law. Providing comprehensive coverage of the dynamics of the law applied to the health care profession, the course covers in detail the relationships among physicians and lawyers as they deal with the many problems in the health care environment. The course asks students to (1) examine the interface of the physician, the health care system, and law, using both literary and traditional law texts; and (2) become aware of the role of the humanities in demonstrating human relationship issues in medicine and law, especially in relation to end-of-life issues. The course has been a very popular choice among sixth-year students, and it is the opinion of the curriculum council that it should be available to all students if this could be arranged. The possibility of offering it online is being considered.

Another course, History of Medicine, has been offered every year to second-year students in the summer, and last year the Office of Medical Humanities assumed responsibility for it. It meets for an hour and a half twice weekly during the summer session. The most recent textbook used in the course is Medicine’s 10 Greatest Discoveries.⁹ The course needs further development, and the placement of the course in the curriculum may be changed in the future.

From the start of the medical school’s history, bioethics has been offered as part of a series called Correlative Medicine that occurs weekly for two hours for all students in years three and four. The goal of the bioethics section is to have students critically examine central ethical features of the patient-physician relationship by attending lectures and participating in small-group discussions of case studies. The coordinator is a bioethicist from the philosophy department who has a joint appointment in the medical school. He also teaches bioethics as part of a required one-month rotation in behavioral medicine in year four. The goal of this course is to facilitate the development of reasoning skills in bioethics and to help students become familiar with ethical terminology, principles, and theories that are necessary to address ethical dilemmas. In the winter of 2001, a course entitled “Bioethics in Literature and Practice: Parents and Children,” which focused on discussions of bioethical issues relating to children (e.g., genetic screening, caring for AIDS patients, organ donation), was taught. This extremely popular and thought-provoking course has not been retaught since one of the primary faculty members took a position at another institution, but we hope it will be.

The director of the Office of Medical Humanities also offers Readings in Medical Humanities monthly and is willing to supervise students who want to substitute international medical experiences for the required courses. Readings and papers are required for the students to receive credit for these experiences.

There is a new addition to the medical humanities offerings that is in the planning stage. We hope to offer several humanities Clinical Correlation sessions in the newly developed Structure/Function course that starts in the second semester of year two and lasts for seven months.

The Office of Medical Humanities annually publishes The Human Factor,¹⁰ which contains prose, poetry, photography, and art work submitted by students, faculty, staff, and alumni. It was first published in 1999 and is funded by the Jazz Night fundraiser held in March each year.

There are at least two medical humanities grand rounds each year and other conferences are often arranged when speakers are available. Several joint events with the Midwest Bioethics Center of Kansas City and Truman Medical Center, one of the medical school’s primary teaching hospitals, have been arranged and continue to take place. Truman Medical Center has its own Center for the Healing Arts that uses arts and humanities to enrich the healing work and educational requirements at the center. There is also a Personal and Professional Development Enrichment series for residents, fellows, and their spouses that focuses on educational areas not typically covered in the formal education of physicians (e.g., substance abuse by physicians, stress management, personality profiles, and temperament types). This course is for all residents and is sponsored by St. Luke’s Hospital, one of the school’s major teaching hospitals. There is a Medical Humanities Conference Room in the medical school for students and faculty that contains a library, as well as artwork and a comfortable place for meetings and study.

The present director of the Office of Medical Humanities has resigned, and at present there is a search for a replacement. A new director may decide to change some of the offerings and add new activities, but the office will continue to offer Readings in Medical Humanities. The school remains committed to supporting the office and its programs in keeping with the goals of the original academic plan to educate safe and caring physicians.