Many medical schools throughout the world have integrated the study of the humanities in their undergraduate curricula through disciplines such as philosophy, ethics, literature, theater, and the arts. Concurrently, there is a strong tendency in medical education to insist that any learning activity should contribute to the students' development of concrete and measurable competencies, whether skills, knowledge, or attitudes. This tendency in medical education is in line with the general focus on outcomes-based education that has been advanced in medical education in the United States, Canada, and Europe1 and which in a European context is promoted through the comprehensive Bologna process.
As of now, few, if any, aspects of medical education are able to produce empirically based evidence of their indispensability in the course of the education of a physician. Furthermore, when it comes to the humanities in medical education, the quest for measurable learning outcomes may not always be easily compatible with the generally antireductionist approach in the humanities. Many articles claim that humanities may contribute significantly to the formation of humane and holistically oriented doctors, and although the humanities have gained ground in medical education, they are still “new kids on the block” when compared with, say, gross anatomy. In any context, newcomers usually have to prove their value or legitimacy to be accepted. Likewise, we presume that empirical evidence and/or other kinds of good arguments presented in support of the humanities' positive contribution to the education of future doctors validate the presence of the humanities in the curriculum. It is, however, very difficult to measure with any certainty to what extent the inclusion of humanities in medical curricula makes better doctors. Are attempts to produce empirical evidence for any such effect even worth making? After all, the purpose of including the humanities in medical education really may not be to produce specific measurable outcomes.
It is outcomes-based education, though, that is currently on the agenda,1 so a lack of empirical evidence may hinder the humanities in gaining and keeping a firm position in medical education. The purpose of this study was to perform a systematic literature review to investigate the extent to which the literature on humanities in medical education is concerned with evidence of the impact of this teaching. To fulfill this purpose, we constructed a meaningful typology of the publications we found. We distinguish between articles that predominantly (1) contain arguments in favor of the general relevance or necessity of integrating humanities in undergraduate medical education, (2) describe and/or evaluate specific medical humanities curricular activities, (3) report empirical findings that provide evidence for the impact of humanities in undergraduate medical education on future doctors' actual knowledge, behavior, and/or attitudes toward patients in real-life doctoring, or (4) voice reservations or question expectations as to the outcome of integrating humanities studies in undergraduate medical education. The articles in the third category are few but interesting in their attempts to look beyond the curricular activities and their immediate reception among the students to any positive effect these activities might have on future doctors' knowledge, behavior, and/or attitudes toward patients in real-life doctoring.
We searched Medline for all publications relating to the humanities in undergraduate medical education. Primary search terms were Education, medical, undergraduate or Curriculum in MAJR (main subject heading) combined (AND) with Humanities in MeSH (subject heading). All search terms were “exploded,” meaning that any publication indexed with one of Medline's many subheadings under these terms would also be found. In that way, searching for publications indexed under humanities in MeSH also finds publications indexed under approximately 100 subheadings including, for instance, art, ethics, history, and literature. So as not to overlook humanities-related publications that might not have been indexed with the appropriate MeSH terms, we expanded the search to include articles with any of the words anthropology, art, communication, creative writing, culture, drama, drawing, epistemology, ethics, history, humanities, literature, philosophy, poetry, or religion in the title. Publications from nursing or dental journals were excluded, as were any articles published before January 1, 2000. We checked reference lists of a random selection of the retrieved publications to identify any missing references and significant journals. A few additional references were found and added to the dataset. However, manually checking the references did not indicate any bias in the search strategy, such as the possible systematic omission of articles from specific journals. The search was first conducted in September 2007 and repeated in January 2009 to identify all publications from September 2007 to December 2008.
One thousand twenty publications met the search criteria. All publications were sorted manually following the inclusion and exclusion criteria indicated in Table 1. We deemed 775 articles irrelevant, the majority because they were not concerned with undergraduate medical education or because of their obvious irrelevance. Examples of the latter included a commentary on supervisors possibly neglecting to ensure that student projects are approved by relevant research committees,2 an article on how college undergraduates studying to be human service professionals could help to bridge the gap between thanatology researchers and practitioners,3 and a piece on the value of experiential education in dietetics.4 Articles discussing ethical questions relating to medical education but not dealing with an ethics curriculum as such were also excluded,5,6 as were anecdotes or memoirs such as, for example, Edwards'7 account of a “humanistic role model.” This left 245 articles for review.
We read all articles included for review, although in some cases only the abstract was read thoroughly. On the basis of our examination, all articles were labeled with tags indicating (1) the type of publication, (2) the sector of the major field of humanities treated, (3) any suggested benefit derived from the specified curriculum, and (4) the general tone, attitude, or message of the publication. The tags are described in greater detail in Table 2. All publications were coded with at least one term in each of the four categories.
We developed the codes through a continuing iterative process aimed at making them sufficiently detailed yet manageable as a set. As we developed and attributed the codes, we compiled a substantial set of “field notes” on particularly interesting or notable formulations or assumptions serving to facilitate further interpretation and the development of an adequate typology.
The typology presented below distinguishes between articles categorized as primarily
- Pleading the case: Publications predominantly containing arguments in favor of the general relevance or necessity of integrating humanities in undergraduate medical education. Also, publications predominantly arguing how humanities should be taught in undergraduate medical education, relying on a fundamental approval of the humanities' raison d'être in medical education, or stating how impediments to the integration of the humanities should be overcome.
- Course descriptions and evaluations: Publications predominantly centered around descriptions of specific curricular activities or series of activities. Descriptions may be accompanied by evaluations, whether in the form of typical student surveys, an instructor's estimation of the quality or success of the curricular activity in question, or some measurement of the immediate impact of the curricular activity in terms of students' (sometimes self-reported) gain in knowledge, skills, or attitude.
- Seeking evidence of long-term impacts: Publications reporting empirical findings that provide evidence for the impact of humanities in undergraduate medical education on future doctors' actual knowledge, behavior, and/or attitudes toward patients in real-life doctoring.
- Holding the horses: Publications not necessarily unfavorably disposed toward humanities studies in medical education, but pointing out difficulties, voicing reservations, or questioning expectations as to the outcome or impact of integrating humanities studies in undergraduate medical education.
On the basis of these classifications, articles reporting surveys of students' and/or faculty's immediate responses to the activity in question, or reporting the results of before-and-after tests, were categorized as “course descriptions and evaluations.” On the other hand, articles reporting attempts to measure whether the humanities activity led to any (possibly self-reported) long-term change in students' attitudes, behaviors, or knowledge were categorized as “seeking evidence of long-term impact.” On the basis of this demarcation, Anandarajah and Mitchell's8 article on a spirituality and medicine elective, for instance, was categorized as being primarily descriptive and evaluative, despite the fact that this study offers data on how the course may have influenced students' knowledge on spirituality and medicine. However, Peters and colleagues'9 evaluation of the outcomes of a new curriculum on behaviors and attitudes related to humanistic medicine among young doctors was categorized as primarily seeking evidence of long-term impact.
The articles analyzed in this study present a wide variety of curricular activities oriented toward the humanities in undergraduate medical education. Not surprisingly, reports on well-established fields such as ethics and literature were numerous. In addition, we found many articles about humanities-based curricular activities, ranging from philosophy and epistemology to gender studies and anthropology to drama, film, history, and creative writing (for a comprehensive list, see Table 2).
Many publications account for the beneficial impact or effect that was supposedly induced by the curricular activity in question. However, more often than not, these “declarations of relevance” were presented in broad terms and were not supported by empirical evidence produced in a systematic manner. Jones and Carson10 state, for instance, that if humanities are integrated into medical curricula in the right way, students will eventually “become ethical, empathic, and educated physicians, the kind of doctor one would be proud to have for one's self and one's family” without any empirical studies supporting the view. Our reading of the articles strengthened the impression that at least some members of the medical education community seem to assume that simply increasing exposure to the humanities will contribute positively to medical students' personal and professional development in the broadest possible understanding and, thus, will eventually benefit both future doctors and their patients. Hence, humanities are perceived as a general means to achieve the goal of fostering the generic “good” (empathic, holistically oriented) doctor.
Some studies do, however, specify expectations regarding concrete, and hence more measurable, learning outcomes. Shapiro and colleagues'11 investigation into whether the arts can be used to enhance medical students' development of “observational and pattern recognition skills” is a very good example of such a study. The goal in the curricular innovation described by Shapiro et al is clear: For good clinical practice (e.g., in diagnostics and in medical decision making), the doctor must be able to combine pieces of information and construct an overall pattern. Looking at and giving meaning to art is thus presumed by the authors to involve similar abilities. This gives rise to the idea presented by Shapiro et al that training medical students in seeing and interpreting art will strengthen their capabilities to observe and to recognize patterns and will eventually strengthen their capability to diagnose and make the right decisions in clinical work.
Pleading the case
Sixty-eight of the 245 articles were categorized as “pleading the case” for the humanities in undergraduate medical education. These articles primarily propose or present hypotheses about why and how humanities should be integrated in medical education. Their origins may differ, but many of the articles in this category emphasize the potential for humanities curricula to rectify an existing problem in the health care environment. For example, Baum12 begins, “there is a widely recognised hazard that an exaggerated emphasis on molecular reductionism may lead to the loss of the essential humanitarian instincts of young doctors,” and goes on to clarify that
the function of teaching arts and humanities to medical undergraduates is […] to ensure that they make better and more humane physicians who would do everything within their power, even to the point of self-sacrifice, to save a life or to succour someone in mortal pain.
Other “pleading the case” articles begin by reporting the outcome of a specific medical humanities activity, thereby resembling the “course descriptions or evaluations” articles discussed below. However, in the “pleading the case” articles, the description is used as a springboard for posing a more universal hypothesis about the benefits of humanities education for students. As an example, DasGupta13 writes an essay based on her experiences with teaching a specific course on women's illness narratives and uses the description to support recommendations for medical students in general. DasGupta claims, for example, that “medical students are […] convinced and coerced by the medical establishment to abandon the needs of their bodies in favor of their minds,” but “by writing about their own bodily experiences, an oftentimes fractionalized bodyself can be healed or in a sense unified by this same empathic process.”
Course descriptions and evaluations
One hundred fifty-six of the 245 articles in this study were categorized as “course descriptions and evaluations” (see Table 3). The course descriptions are in most cases accompanied by an explanation of the course's raison d'être or expected outcome and some kind of evaluation data, in some instances including data on short-term, course-specific outcomes. The account of the course's raison d'être may be either very detailed or it may be more generic or universal. Hampshire and Avery,14 for example, make the generic statement that studying medical scenes in literature “can enable [students] to reflect on their clinical experience and can provide a more profound understanding of the consequences of illness for the patient and their family.” In another example, Shafer et al15 go into some detail about what their literature-and-medicine course may mean to their students. They posit that the course may enable students to empathize with patients' families and to be more aware of what they will encounter as physicians, but they also suggest a broader benefit—namely, that reading literature may help medical students “think more deeply about medicine in a variety of contexts.” The evaluation data offered in this type of article also fall within a very wide range. Some studies simply state that the learning activity was received well by students, while others go into detail about how students rated the course on a series of parameters. An illustration of the latter would include, for instance, Shapiro and Hunt's16 account of how medical students evaluated the experience of attending theatrical performances dealing with serious diseases. Shapiro and Hunt not only report that “feedback […] was extremely positive” but offer detailed data on students' assessments of whether attending the performances improved their understanding of the experiences of, for instance, people living with AIDS, whether the students thought they would be able to incorporate insights from the performances into future interactions with patients, and so on.
Seeking evidence of long-term impact
A third type of article is made up of reports seeking evidence for the impact of humanities in undergraduate medical education on future doctors' actual knowledge, skills, behavior, and/or attitudes toward patients when it comes to real-life doctoring. This type of article includes any study that examines whether or not students or young doctors exposed to a humanities course exercise more empathy or act more ethically than do students who have not studied the humanities. These studies may also test whether trainees exposed to the humanities have a better understanding of, for instance, patients living with AIDS than they would have had they not participated in specific, humanities-related curricular activities. We found only 9 out of 245 articles belonging to this category. These articles evaluate the impact, both negative and positive, of integrating humanities in medical education. One example is Peters and colleagues'9 report on an evaluation of “the long-term effects of an innovative curriculum […] on behaviors and attitudes related to humanistic medicine.” In this study, Peters et al compare two groups of Harvard graduates, one from a traditional and one from a more “humanities-oriented” curriculum (the humanities-oriented curriculum is referred to as “new pathway” or NP). Comparing graduates from these two groups, Peters et al conclude that “as practicing physicians, their attitudes and behaviours are similar.” However, they emphasize that “almost ten years after their graduation, we continue to observe significant differences between the NP graduates and their peers in the domain of humanistic medicine.” Here, Peters et al refer to test results showing that NP graduates were more prone to pursue careers in primary care or psychiatry, that they felt better prepared for practicing humanistic medicine, and that they were more confident in managing patients' psychosocial problems when compared with graduates from the traditional curriculum. Hence, the authors “believe that the evaluation makes a convincing case that a humanistic approach to medicine can be taught and learned.”
Another example is DiLalla and colleagues'17 study in which the authors claim that “exposure to educational activities in empathy, philosophical values and meaning, and wellness during medical school may increase empathy […] in medical practice.” DiLalla et al reach this conclusion based on the results of a survey that included assessment of the attitudes of a large group of medical personnel toward empathy, spirituality, and tolerance. These findings were compared with data on, among other things, the respondents' participation in sessions on empathy during their years in medical school.
We point to DiLalla and colleagues'17 study as one of the relatively few examples of studies that purposely seek to investigate whether a possible impact of exposure to humanities during medical education is traceable in the medical practice of future doctors. It is not the purpose here to discuss the validity of the methodologies implied in these studies nor whether or not DiLalla and others produce convincing evidence of the causal connection between medical school empathy sessions on the one hand and empathic behavior among medical personnel on the other.
Holding the horses
Yet another category of articles is constituted by reports, letters, and commentaries conveying more muted attitudes toward the effect of humanities studies in medical education. We found 12 articles in this category. These articles represent a spectrum ranging from blunt skepticism to scientific reluctance about accepting any proposition not yet supported by adequate empirical data. An example of the skepticism would be Caan's18 letter in BMJ, in which he asks, “On what evidence can medical schools ‘plant’ ethical principles anew in students aged 20 and older?” He adds that, instead, students may actually be learning to conceal bad behaviors. An example of scientific reluctance would be Shapiro and colleagues'19 account of a project introducing medicine-related poetry and prose in a third-year medical curriculum. Shapiro, well known in the medical education community as a leading proponent of the use of literature and the humanities in medical education, dryly concludes that although the project “suggests some possibilities for introducing humanities into a family medicine clerkship,” and although “some students may benefit from exposure to literature,” it is also a fact that “a significant number of learners might not perceive much benefit from this kind of curriculum,” and eventually “more research needs to investigate the relationship between exposure to literature and student behaviour in actual clinical settings.”19 Shapiro and colleagues' point is not that this is necessarily a problem for the humanities in medical education; but still her article is one of relatively few examples of a study highlighting the need for further investigation into the actual effects of teaching the humanities in medical education.
A summary of the results
To sum up, 224 publications out of 245 either praised the potential effects of humanities studies in medical education or described actual or planned courses with some evidence for short-term impact of these curricular activities. Only 9 studies were found to demonstrate efforts to document long-term impacts on the clinical practice of medical doctors, and 12 articles were found to act as mouthpieces for critical attitudes toward humanities studies in undergraduate medical education or for concerns that the humanities project, although fundamentally sympathetic, may rely on insufficient foundations when it comes to documented effects or impact.
Although the typology proposed above is neither exhaustive nor exclusive, we hope to have illustrated the meaningfulness of the categorization by providing a broad spectrum of examples and citations. Nevertheless, we present the categories themselves as our proposed discursive construction rather than as a mirror of some ontologically inherent essence present in the body of the references studied. Furthermore, we realize there is an element of subjectivity to how each article was categorized. For instance, we categorize Shapiro and colleagues'19 article on how “a spoonful of humanities makes the medicine go down” as a “hold the horses” article, although others might see this particular article as more of a “descriptive and evaluative” or a “seeking evidence of long-term impact” type. And, to add to these admitted uncertainties, using an alternative literature retrieval strategy could have given rise to a different data set, thereby somewhat altering the categories or at least their relative distribution.
However, we assume that these uncertainties do not seriously challenge the overall impression gained from our review of the literature. Clearly, the literature offers a substantial set of course descriptions, as well as reports of short-term impacts, student evaluations, and advocacies of humanities-related curricular activities in undergraduate medical education. More than 9 out of 10 publications reviewed had as their main purpose either to describe specific, humanities-oriented learning activities or to contribute to the discursive construction of humanities as a necessary component of medical education. Very few systematically investigated whether humanities in undergraduate medical education has an observable impact on the attitudes, competences, and practice of future doctors.
We wish to underscore that the lack of articles seeking evidence for long-term impact does not imply, directly or indirectly, that humanities studies do not have the effect claimed by many medical educationists. The apparent lack of empirical evidence can be explained in many perfectly reasonable ways. As Shapiro et al19 explain, conducting research into the effects of any curricular invention is complicated by a number of almost insurmountable methodological obstacles. It is difficult or maybe even impossible to demonstrate any proposed specific outcome of a learning activity because of the vast plurality of possible confounders.
Methodological difficulties aside, some might fundamentally object to the underlying assumption that evidence for the impact of humanities on undergraduate medical education is worth investigating. It could be contended that any attempt to measure the “usefulness” of humanities in medical education would in effect illustrate a thoroughly defective view both of the humanities and of medical education. Cooper and Tauber,20 for example, warn us that “the reductionist-positivist mode of medical education fails to equip physicians with the skills and attitudes to meet the full range of patients' physical and emotional needs.” Therefore, a curricular change is needed, adding more emphasis on “values, ethics, and culture of caring.” Humanities, in other words, is intended to play the role as a safeguard or an antidote to a threatening reductionism. Following that line of argument, it would be a contraindication to insist on evidence-based medical education defined by a demand for proving the long-term impact of any given humanities-related curricular innovation. Further, the composition of all educational curricula takes place in a political and interpersonal milieu in which evidence of impact is only one of many influential factors.
Finally, a foreseeable reaction to our findings could be that the lack of evidence of the impact of humanities-related curricular activities in medical education is simply due to the fact that the implications of humanities-related curricular activities are not measurable, at least not using the assessment tools currently predominant in medical education, as argued by Kuper1 in a review of articles reporting on evaluation tools for courses on literature and medicine.
But notwithstanding any arguments against evidence-based medicine and medical education, it is difficult to disregard the fact that outcomes-based education is currently on the agenda.1 Our study calls attention to the importance of humanities in medicine. Yet, at the same time, it may pose a threat to humanities in medical education if the medical humanities community does not attempt to deliver some kind of substantial evidence of the advantages of integrating humanities in medical education. Reflections over the nature and relevance of humanities in medical education are readily available in the literature and are of indisputable value for the formation and refinement of these endeavors. Likewise, articles with course descriptions and evaluations are inspiring and of substantial value for anyone within the field of humanities in medical education.
However, to defend, maintain, or possibly strengthen the status of humanities in medical education, we anticipate that it is necessary to provide more empirical evidence that these learning activities do, in fact, deliver positive, and if not measurable then at the least noticeable, outcomes. The ultimate question is whether it can be documented that students who are exposed to the humanities eventually become better doctors to the benefit of themselves, their practice, and their patients.
There is a significant and important challenge in developing creative methods for the production of this kind of evidence, including maybe new ways of addressing humanistic competencies and competence as a whole.21 Humanities studies in medical education may flounder if the medical humanities community cannot overcome the difficult (and, to some, perhaps even unsavory) task of providing evidence that humanities in medical education actually contributes to making better doctors for the future.
The results of this literature review revealed that the literature on humanities studies in undergraduate education is dominated by descriptions and evaluations of existing or planned learning activities or by arguments in favor of humanities in medical education. We also noted that there is a shortage of studies reporting evidence of the long-term impact of humanities in undergraduate medical education on the development of medical proficiency. The review offers a typology useful for the discussion of the character and current status of the literature in the field. This categorization reveals that there are numerous interesting and inspiring descriptions of humanities-related curricular innovations in undergraduate medical education. There is, however, a shortage of studies delivering evidence for the impact of these curricular initiatives for doctors and their work with patients. Likewise, there are few articles with a critical stance to the seemingly widely accepted notion that humanities are in some generic way beneficial to future doctors. We suggest that the lack of evidence for relevance to the work of doctors could pose a threat to the continued development of humanities-related activities in undergraduate medical education. The present trend of evidence-based learning, after all, requires that the study of the humanities, like any other curricular activity within medical education, should in principle be able to justify its existence with evidence of its effectiveness.
The authors would like to acknowledge the medical information specialist Johan Wallin, MD, for his help in developing a search strategy. Any flaws or errors in the search strategy or the use thereof are solely the responsibility of the authors.
This study was supported by the Faculty of Health Sciences, University of Southern Denmark.
1Kuper A. Literature and medicine: A problem of assessment. Acad Med. 2006;81(10 suppl):S128–S137.
2Alcolado J, Bennett R. Research or audit? Ethical approval for medical student clinical projects. Med Educ. 2006;40:491.
3Balk DE. Scholarship, students, and practitioners: Bringing scholarship into the expectations of practitioners. Death Stud. 2005;29:123–144.
4Barr AB, Walters MA, Hagan DW. The value of experiential education in dietetics. J Am Diet Assoc. 2002;102:1458–1460.
5Coxe MF. A change in medical student attitudes of obstetrics–gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003;189:1808–1809.
6Wilson RF. Unauthorized practice: Teaching pelvic examination on women under anesthesia. J Am Med Womens Assoc. 2003;58:217–220.
7Edwards D. A humanistic role model in my medical career. Acad Med. 2003;78:1246–1247.
8Anandarajah G, Mitchell M. A spirituality and medicine elective for senior medical students: 4 years' experience, evaluation, and expansion to the family medicine residency. Fam Med. 2007;39:313–315.
9Peters AS, Greenberger-Rosovsky R, Crowder C, Block SD, Moore GT. Long-term outcomes of the New Pathway Program at Harvard Medical School: A randomized controlled trial. Acad Med. 2000;75:470–479.
10Jones AH, Carson RA. Medical humanities at the University of Texas Medical Branch at Galveston. Acad Med. 2003;78:1006–1009.
11Shapiro J, Rucker L, Beck J. Training the clinical eye and mind: Using the arts to develop medical students' observational and pattern recognition skills. Med Educ. 2006;40:263–268.
12Baum M. Teaching the humanities to medical students. Clin Med. 2002;2:246–249.
13DasGupta S. Reading bodies, writing bodies: Self-reflection and cultural criticism in a narrative medicine curriculum. Lit Med. 2003;22:241–256.
14Hampshire AJ, Avery AJ. What can students learn from studying medicine in literature? Med Educ. 2001;35:687–690.
15Shafer A, Borkovi T, Barr J. Literature and medical interventions: An experiential course for undergraduates. Fam Med. 2005;37:469–471.
16Shapiro J, Hunt L. All the world's a stage: The use of theatrical performance in medical education. Med Educ. 2003;37:922–927.
17DiLalla LF, Hull SK, Dorsey JK. Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teach Learn Med. 2004;16:165–170.
18Caan W. A testing time for ethical standards. BMJ. 2005;330:1510.
19Shapiro J, Duke A, Boker J, Ahearn CS. Just a spoonful of humanities makes the medicine go down: Introducing literature into a family medicine clerkship. Med Educ. 2005;39:605–612.
20Cooper RA, Tauber AI. Values and ethics: A collection of curricular reforms for a new generation of physicians. Acad Med. 2007;82:321–323.
21Shapiro J, Coulehan J, Wear D, Montello M. Medical humanities and their discontents: Definitions, critiques, and implications. Acad Med. 2009;84:192–198.
References cited only in the tables
22Acuna LE. Teaching humanities at the National University of La Plata, Argentina. Acad Med. 2003;78:1024–1027.
23Wijesinha SS, Dammery D. Teaching medical history to medical students—The Monash experience. Aust Fam Physician. 2008;37:1028–1029.
24Windish DM, Price EG, Clever SL, Magaziner JL, Thomas PA. Teaching medical students the important connection between communication and clinical reasoning. J Gen Intern Med. 2005;20:1108–1113.
25Winefield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: Does knowledge of empathy increase? Med Educ. 2000;34:90–94.
26Yacoub AA, Ajeel NA. Teaching medical ethics in Basra: Perspective of students and graduates. East Mediterr Health J. 2000;6:687–692.
27Yamada S, Maskarinec GG, Greene GA, Bauman KA. Family narratives, culture, and patient-centered medicine. Fam Med. 2003;35:279–283.
28Yarborough M, Jones T, Cyr TA, Phillips S, Stelzner D. Interprofessional education in ethics at an academic health sciences center. Acad Med. 2000;75:793–800.
29Olick RS. It's ethical, but is it legal? Teaching ethics and law in the medical school curriculum. Anat Rec. 2001;265:5–9.
30Olthuis G, Dukel L. What do medical students experience as moral problems during their obstetric and gynaecology clerkship? J Med Ethics. 2008;34:e2.
31Perakis CR. A humanities orientation to physical diagnosis. Med Educ. 2003;37:1038–1039.
32Peskin E, O'Dell K. Communication skills in women's health care: Helping students clarify values related to challenging topics in ob-gyn. Acad Med. 2001;76:509–510.
33Phillips PS. Running a life drawing class for pre-clinical medical students. Med Educ. 2000;34:1020–1025.
34Platt MJ, Alfirevic Z, Mclaughlin PJ. The ‘critical thinking module’—A grant proposal simulation exercise. Med Educ. 2000;34:951–952.
35Plotnikoff GA, Amano T. A culturally appropriate, student-centered curriculum on medical professionalism. Successful innovations at Keio University in Tokyo. Minn Med. 2007;90:42–43.
36Poirier S. University of Illinois at Chicago, Medical Humanities Program. Acad Med. 2003;78:1062–1063.
37Pullman D, Bethune C, Duke P. Memorial University of Newfoundland Faculty of Medicine, the medical humanities in the clinical skills course. Acad Med. 2003;78:1068–1069.
38Pullman D, Bethune C, Duke P. Narrative means to humanistic ends. Teach Learn Med. 2005;17:279–284.
39Remen RN, Rabow MW. The Healer's Art: Professionalism, service and mission. Med Educ. 2005;39:1167–1168.
40Rhodes M, Ashcroft R, Atun RA, Freeman GK, Jamrozik K. Teaching evidence-based medicine to undergraduate medical students: A course integrating ethics, audit, management and clinical epidemiology. Med Teach. 2006;28:313–317.
41Rhodes R. Enriching the white coat ceremony with a module on professional responsibilities. Acad Med. 2001;76:504–505.
42Rider EA, Lown BA, Hinrichs MM. Teaching communication skills. Med Educ. 2004;38:558–559.
43Rodenhauser P, Strickland MA, Gambala CT. Arts-related activities across U.S. medical schools: A follow-up study. Teach Learn Med. 2004;16:233–239.
44Roff S, Preece P. Helping medical students to find their moral compasses: Ethics teaching for second and third year undergraduates. J Med Ethics. 2004;30:487–489.
45Rosen J, Spatz ES, Gaaserud AM, et al. A new approach to developing cross-cultural communication skills. Med Teach. 2004;26:126–132.
46Rosenbaum ME, Ferguson KJ, Herwaldt LA. In their own words: Presenting the patient's perspective using research-based theatre. Med Educ. 2005;39:622–631.
47Rucker L, Shapiro J. Becoming a physician: Students' creative projects in a third-year IM clerkship. Acad Med. 2003;78:391–397.
48Sammet K. University Hospital Hamburg–Eppendorf, University of Hamburg, Institute for the History and Ethics of Medicine. Acad Med. 2003;78:1070–1071.
49Shankar PR, Dubey AK, Mishra P, Upadhyay DK. Reading habits and attitude toward medical humanities of basic science students in a medical college in Western Nepal. Teach Learn Med. 2008;20:308–313.
50Shapiro J, Morrison E, Boker J. Teaching empathy to first year medical students: Evaluation of an elective literature and medicine course. Educ Health (Abingdon). 2004;17:73–84.
51Shapiro J, Rucker L. Can poetry make better doctors? Teaching the humanities and arts to medical students and residents at the University of California, Irvine, College of Medicine. Acad Med. 2003;78:953–957.
52Shapiro J, Rucker L, Robitshek D. Teaching the art of doctoring: An innovative medical student elective. Med Teach. 2006;28:30–35.
53Sheard S. Developing history of medicine in the University of Liverpool medical curriculum 1995–2005. Med Educ. 2006;40:1045–1052.
54Sherina HN, Chia YC. Communication skills teaching in primary care medicine. Med J Malaysia. 2002;57(suppl E):74–77.
55Silverberg LI. Survey of medical ethics in US medical schools: A descriptive study. J Am Osteopath Assoc. 2000;100:373–378.
56Sirridge M, Welch K. The Program in Medical Humanities at the University of Missouri–Kansas City School of Medicine. Acad Med. 2003;78:973–976.
57Smith S, Fryer-Edwards K, Diekema DS, Braddock CH III. Finding effective strategies for teaching ethics: A comparison trial of two interventions. Acad Med. 2004;79:265–271.
58Spike JP. Developing a medical humanities concentration in the medical curriculum at the University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. Acad Med. 2003;78:983–986.
59Steele G, Greenidge E. Integrating medical communication skills with library skills curricula among first year medical students at the University of the West Indies, St. Augustine. Health Info Libr J. 2002;19:206–213.
60Strickland MA, Gambala CT, Rodenhauser P. Medical education and the arts: A survey of U.S. medical schools. Teach Learn Med. 2002;14:264–267.
61Tang TS, White CB, Gruppen LD. Does spirituality matter in patient care? Establishing relevance and generating skills. Acad Med. 2002;77:470–471.
62Tang TS, Adams BS, Skye EP. Playing the role of a bioethics committee: Creative approaches to teaching culture and bioethics. Acad Med. 2002;77:469–470.
63Tapajos R. HIV/AIDS in the visual arts: Applying discipline-based art education (DBAE) to medical humanities. Med Educ. 2003;37:563–570.
64Torke AM, Quest TE, Kinlaw K, Eley JW, Branch WT Jr. A workshop to teach medical students communication skills and clinical knowledge about end-of-life care. J Gen Intern Med. 2004;19(5 pt 2):540–544.
65Towle A, Hoffman J. An advanced communication skills course for fourth-year, post-clerkship students. Acad Med. 2002;77:1165–1166.
66van Dalen J, Kerkhofs E, van Knippenberg-Van Den Berg BW, van Den Hout HA, Scherpbier AJ, van der Vleuten CP. Longitudinal and concentrated communication skills programmes: Two Dutch medical schools compared. Adv Health Sci Educ Theory Pract. 2002;7:29–40.
67Van Groenou AA, Bakes KM. Art, Chaos, Ethics, and Science (ACES): A doctoring curriculum for emergency medicine. Ann Emerg Med. 2006;48:532–537.
68Vinas-Salas J, Carrera J, Abel F. Teaching through clinical cases: A good method to study bioethics. Experience at the Lleida Faculty of Medicine. Med Law. 2000;19:441–449.
69Wagner PJ, Lentz L, Heslop SD. Teaching communication skills: A skills-based approach. Acad Med. 2002;77:1164.
70Wang WD, Lue BH. National Taiwan University College of Medicine, the design of medical humanities courses for clerkships. Acad Med. 2003;78:1073–1074.
71Waters JR, Van Meter P, Perrotti W, Drogo S, Cyr RJ. Cat dissection vs. sculpting human structures in clay: An analysis of two approaches to undergraduate human anatomy laboratory education. Adv Physiol Educ. 2005;29:27–34.
72Wear D. The medical humanities at the Northeastern Ohio Universities College of Medicine: Historical, theoretical, and curricular perspectives. Acad Med. 2003;78:997–1000.
73Weber CM, Mascagna KB. Hospice arts: An elective in medical humanism. Fam Med. 2008;40:704–706.
74Weiss SC. Humanities in medical education: Revisiting the doctor–patient relationship. Med Law. 2000;19:559–567.
75Wellbery C, Gooch R. A Web-based multimedia medical humanities curriculum. Fam Med. 2005;37:165–167.
76Haq C, Steele DJ, Marchand L, Seibert C, Brody D. Integrating the art and science of medical practice: Innovations in teaching medical communication skills. Fam Med. 2004;36(suppl):S43–S50.
77Have HT, Borovecki A, Oreskovic S. Master programme “health, human rights and ethics”: A curriculum development experience at Andrija Stampar School of Public Health, Medical School, University of Zagreb. Med Health Care Philos. 2005;8:371–376.
78Hawkins AH, Ballard JO, Hufford DJ. Humanities education at Pennsylvania State University College of Medicine, Hershey, Pennsylvania. Acad Med. 2003;78:1001–1005.
79Hoffman A, Utley B, Ciccarone D. Improving medical student communication skills through improvisational theatre. Med Educ. 2008;42:537–538.
80Houston S, Ray S, Chitsike I, et al. Breaking the silence: An HIV-related educational intervention for medical students in Zimbabwe. Cent Afr J Med. 2005;51:48–52.
81Howell JD. University of Michigan Medical School, Program in Society and Medicine. Acad Med. 2003;78:1063–1064.
82Hull SK, DiLalla LF, Dorsey JK. Student attitudes toward wellness, empathy, and spirituality in the curriculum. Acad Med. 2001;76:520.
83Jacobsen T, Baerheim A, Lepp MR, Schei E. Analysis of role-play in medical communication training using a theatrical device the fourth wall. BMC Med Educ. 2006;6:51.
84Jameton A, Aita V, Anderson R, Schonfeld T. University of Nebraska College of Medicine, section on humanities and law, Department of Preventive and Societal Medicine. Acad Med. 2003;78:1065.
85Jones T, Verghese A. On becoming a humanities curriculum: The Center for Medical Humanities and Ethics at the University of Texas Health Science Center at San Antonio. Acad Med. 2003;78:1010–1014.
86Kalet A, Pugnaire MP, Cole-Kelly K, et al. Teaching communication in clinical clerkships: Models from the Macy initiative in health communications. Acad Med. 2004;79:511–520.
87Kanter SL, Wimmers PF, Levine AS. In-depth learning: One school's initiatives to foster integration of ethics, values, and the human dimensions of medicine. Acad Med. 2007;82:405–409.
88Karkabi K. Visual thinking strategies: A new role for art in medical education. Fam Med. 2006;38:158.
89Kessel AS. Public health ethics: Teaching survey and critical review. Soc Sci Med. 2003;56:1439–1445.
90Kiessling C, Muller T, Becker-Witt C, Begenau J, Prinz V, Schleiermacher S. A medical humanities special study module on principles of medical theory and practice at the Charite, Humboldt University, Berlin, Germany. Acad Med. 2003;78:1031–1035.
91King DE, Blue A, Mallin R, Thiedke C. Implementation and assessment of a spiritual history taking curriculum in the first year of medical school. Teach Learn Med. 2004;16:64–68.
92Kirklin D. The Centre for Medical Humanities, Royal Free and University College Medical School, London, England. Acad Med. 2003;78:1048–1053.
93Kopelman LM. The Brody School of Medicine at East Carolina University, Department of Medical Humanities. Acad Med. 2003;78:1066–1067.
94Krackov SK, Levin RI, Catanese V, et al. Medical humanities at New York University School of Medicine: An array of rich programs in diverse settings. Acad Med. 2003;78:977–982.
95Kritzinger A, Louw B. Clinical training of undergraduate communication pathology students in neonatal assessment and neonate–caregiver interaction in South Africa. S Afr J Commun Disord. 2003;50:5–14.
96Kumagai AK. A conceptual framework for the use of illness narratives in medical education. Acad Med. 2008;83:653–658.
97Laidlaw TS, MacLeod H, Kaufman DM, Langille DB, Sargeant J. Implementing a communication skills programme in medical school: Needs assessment and programme change. Med Educ. 2002;36:115–124.
98Lancaster T, Hart R, Gardner S. Literature and medicine: Evaluating a special study module using the nominal group technique. Med Educ. 2002;36:1071–1076.
99Lazarus CJ, Chauvin SW, Rodenhauser P, Whitlock R. The program for professional values and ethics in medical education. Teach Learn Med. 2000;12:208–211.
100Lazarus PA, Rosslyn FM. The arts in medicine: Setting up and evaluating a new special study module at Leicester Warwick Medical School. Med Educ. 2003;37:553–559.
101Leblang TR. Southern Illinois University School of Medicine, Department of Medical Humanities. Acad Med. 2003;78:1062.
102Lepicard E, Fridman K. Medicine, cinema and culture: A workshop in medical humanities for clinical years. Med Educ. 2003;37:1039–1040.
103Lewin LO, Cole-Kelly K, Greenfield M. A year-long course for third-year students on ethics, professionalism, and communication. Acad Med. 2001;76:511.
104Lie D, Rucker L, Cohn F. Using literature as the framework for a new course. Acad Med. 2002;77:1170.
105Liu KE, Flood C, Capstick V. Is an interdisciplinary session on ethics and law in obstetrics and gynaecology effective? J Obstet Gynaecol Can. 2005;27:486–490.
106Llano A. Medical ethics education in Colombia. Med Law. 2000;19:415–423.
107Losh DP, Mauksch LB, Arnold RW, et al. Teaching inpatient communication skills to medical students: An innovative strategy. Acad Med. 2005;80:118–124.
108Louis-Courvoisier M. Medical humanities: A new undergraduate teaching program at the University of Geneva School of Medicine, Switzerland. Acad Med. 2003;78:1043–1047.
109Lypson ML, Hauser JM. Talking medicine: A course in medical humanism—What do third-year medical students think? Acad Med. 2002;77:1169–1170.
110Magwood B, Casiro O, Hennen B. The Medical Humanities Program at the University of Manitoba, Winnipeg, Manitoba, Canada. Acad Med. 2003;78:1015–1019.
111Marusic A, Marusic M. Teaching students how to read and write science: A mandatory course on scientific research and communication in medicine. Acad Med. 2003;78:1235–1239.
112Mathibe L. Guidelines for using Lance Armstrong's novel to teach cytotoxic drugs. Med Teach. 2006;28:486–487.
113McFarland K, Rhoades D, Roberts E, Eleazer P. Teaching communication and listening skills to medical students using life review with older adults. Gerontol Geriatr Educ. 2006;27:81–94.
114McHarg J, Kneebone C. All the world's a stage. Med Educ. 2005;39:520–521.
115McMenamin PG. Body painting as a tool in clinical anatomy teaching. Anat Sci Educ. 2008;1:139–144.
116Miyasaka M, Yamanouchi H, Dewa K, Sakurai K. Narrative approach to ethics education for students without clinical experience. Forensic Sci Int. 2000;113:515–518.
117Molewijk AC, Abma T, Stolper M, Widdershoven G. Teaching ethics in the clinic. The theory and practice of moral case deliberation. J Med Ethics. 2008;34:120–124.
118Montgomery K, Chambers T, Reifler DR. Humanities education at Northwestern University's Feinberg School of Medicine. Acad Med. 2003;78:958–962.
119Moodley K. Teaching medical ethics to undergraduate students in post-apartheid South Africa, 2003–2006. J Med Ethics. 2007;33:673–677.
120Morton R. Special study modules in medical illustration in the undergraduate medical curriculum. J Audiov Media Med. 2000;23:110–112.
121Murray J. Development of a medical humanities program at Dalhousie University Faculty of Medicine, Nova Scotia, Canada, 1992–2003. Acad Med. 2003;78:1020–1023.
122Newell GC, Hanes DJ. Listening to music: The case for its use in teaching medical humanism. Acad Med. 2003;78:714–719.
123O'Toole TP, Kathuria N, Mishra M, Schukart D. Teaching professionalism within a community context: Perspectives from a national demonstration project. Acad Med. 2005;80:339–343.
124Oguz NY. The narrative approach in teaching medical ethics: The Turkish experience. Med Law. 2000;19:421–431.
125Ahlzen R, Stolt CM. The Humanistic Medicine program at the Karolinska Institute, Stockholm, Sweden. Acad Med. 2003;78:1039–1042.
126Anandarajah G, Mitchell M, Stumpff J. Evaluation of a required spirituality and medicine teaching session in the family medicine clerkship. Fam Med. 2007;39:311–312.
127Anderson R, Schiedermayer D. The Art of Medicine Through the Humanities: An overview of a one-month humanities elective for fourth year students. Med Educ. 2003;37:560–562.
128Andre J, Brody H, Fleck L, Thomason CL, Tomlinson T. Ethics, professionalism, and humanities at Michigan State University College of Human Medicine. Acad Med. 2003;78:968–972.
129Arya N. Peace through health II: A framework for medical student education. Med Confl Surviv. 2004;20:258–262.
130Baldor RA, Field TS, Gurwitz JH. Using the “Question of Scruples” game to teach managed care ethics to students. Acad Med. 2001;76:510–511.
131Bardes CL, Gillers D, Herman AE. Learning to look: Developing clinical observational skills at an art museum. Med Educ. 2001;35:1157–1161.
132Barnett KG, Fortin AH. Spirituality and medicine. A workshop for medical students and residents. J Gen Intern Med. 2006;21:481–485.
133Belling C. The “bad news scene” as clinical drama part 2: Viewing scenes. Fam Med. 2006;38:474–475.
134Ber R, Bar-El Y. Faculty of Medicine of the Technion–Israel Institute of Technology, Humanities in Medicine. Acad Med. 2003;78:1071–1072.
135Brainin-Rodriquez JE. A course about culture and gender in the clinical setting for third-year students. Acad Med. 2001;76:512–513.
136Burrows S, Moore K, Arriaga J, Paulaitis G, Lemkau HL Jr. Developing an “evidence-based medicine and use of the biomedical literature” component as a longitudinal theme of an outcomes-based medical school curriculum: Year 1. J Med Libr Assoc. 2003;91:34–41.
137Casey MA, Flannery MA. Utilizing the past in the present curriculum: Historical collections and anatomy at the University of Alabama School of Medicine. J Med Libr Assoc. 2003;91:85–88.
138Centeno AM, Campos S, Primogerio C. Addressing ethical issues during assessment of internship. Med Educ. 2004;38:565–566.
139Chambers T, Watson K. Enhancing reflection. Hastings Cent Rep. 2005;35:6.
140Chibnall JT, Cook MA, Miller DK. Religious awareness training for medical students: Effect on clinical interpersonal behavior. South Med J. 2005;98:1255.
141Childress MD, Connelly JE. University of Virginia School of Medicine, Program of Humanities in Medicine. Acad Med. 2003;78:1068.
142Cohen D, Rollnick S, Smail S, Kinnersley P, Houston H, Edwards K. Communication, stress and distress: Evolution of an individual support programme for medical students and doctors. Med Educ. 2005;39:476–481.
143Cohn F, Lie D. Mediating the gap between the white coat ceremony and the ethics and professionalism curriculum. Acad Med. 2002;77:1168.
144Collett TJ, McLachlan JC. Does ‘doing art’ inform students' learning of anatomy? Med Educ. 2005;39:521.
145Cotton P, Smith P, Lait M. The ethics of teamwork in an interprofessional undergraduate setting. Med Educ. 2002;36:1096–1097.
146Coulehan J, Belling C, Williams PC, McCrary SV, Vetrano M. Human contexts: Medicine in Society at Stony Brook University School of Medicine. Acad Med. 2003;78:987–992.
147Couper J, Hawthorne L, Hawthorne G, Tan ES, Roberts A. Communication skills and undergraduate psychiatry: A description of an innovative approach to prepare Australian medical students for their clinical psychiatry attachment. Acad Psychiatry. 2005;29:297–300.
148Crowshoe L, Bickford J, Decottignies M. Interactive drama: Teaching aboriginal health medical education. Med Educ. 2005;39:521–522.
149del Pozo PR, Fins JJ. The globalization of education in medical ethics and humanities: Evolving pedagogy at Weill Cornell Medical College in Qatar. Acad Med. 2005;80:135–140.
150Deloney LA, Graham CJ, Erwin DO. Presenting cultural diversity and spirituality to first-year medical students. Acad Med. 2000;75:513–514.
151Deloney LA, Graham CJ. Wit: Using drama to teach first-year medical students about empathy and compassion. Teach Learn Med. 2003;15:247–251.
152DuBois JM, Burkemper J. Ethics education in U.S. medical schools: A study of syllabi. Acad Med. 2002;77:432–437.
153Elcin M, Odabasi O, Gokler B, Sayek I, Akova M, Kiper N. Developing and evaluating professionalism. Med Teach. 2006;28:36–39.
154Ellis P, Green M, Kernan W. An evidence-based medicine curriculum for medical students: The art of asking focused clinical questions. Acad Med. 2000;75:528.
155Fatovic-Ferencic S. The history of medicine teaching program in Croatia. Acad Med. 2003;78:1028–1030.
156Feigelson S, Muller D. “Writing About Medicine”: An exercise in reflection at Mount Sinai (with five samples of student writing). Mt Sinai J Med. 2005;72:322–332.
157Fins JJ, Gentilesco BJ, Carver A, et al. Reflective practice and palliative care education: A clerkship responds to the informal and hidden curricula. Acad Med. 2003;78:307–312.
158Fjellstad K, Isaksen TO, Frich JC. Art in undergraduate medical education [in Norwegian]. Tidsskr Nor Laegeforen. 2003;123:2316–2318.
159Flood DH, Soricelli RL. Drexel University College of Medicine, Medicine and the Arts online. Acad Med. 2003;78:1067.
160Fortin AH, Barnett KG. STUDENTJAMA. Medical school curricula in spirituality and medicine. JAMA. 2004;291:2883.
161Frich JC, Jorgensen J. Medicine and literature—Interpretation and discussion of literary texts in medical education [in Norwegian]. Tidsskr Nor Laegeforen. 2000;120:1160–1164.
162Frich JC, Fugelli P. Medicine and the arts in the undergraduate medical curriculum at the University of Oslo Faculty of Medicine, Oslo, Norway. Acad Med. 2003;78:1036–1038.
163Fried C, Madar S, Donley C. The Biomedical Humanities program: Merging humanities and science in a premedical curriculum at Hiram College. Acad Med. 2003;78:993–996.
164Fryer-Edwards K, Wilkins MD, Baernstein A, Braddock CH III. Bringing ethics education to the clinical years: Ward ethics sessions at the University of Washington. Acad Med. 2006;81:626–631.
165Goldie J, Schwartz L, Morrison J. A process evaluation of medical ethics education in the first year of a new medical curriculum. Med Educ. 2000;34:468–473.
166Goldie J, Schwartz L, McConnachie A, Morrison J. Impact of a new course on students' potential behaviour on encountering ethical dilemmas. Med Educ. 2001;35:295–302.
167Grant VJ. University of Auckland, Faculty of Medical and Health Sciences, medical humanities courses. Acad Med. 2003;78:1072–1073.
168Graves DL, Shue CK, Arnold L. The role of spirituality in patient care: Incorporating spirituality training into medical school curriculum. Acad Med. 2002;77:1167.
169Gude T, Anvik T, Baerheim A, et al. Teaching clinical communication to medical students in Norway [in Norwegian]. Tidsskr Nor Laegeforen. 2003;123:2277–2280.
170Hackler C. University of Arkansas College of Medicine, division of medical humanities. Acad Med. 2003;78:1059.
171Selvakumar D, Joseph LB. The importance of including bio-medical ethics in the curriculum of health education institutes. Educ Health (Abingdon). 2004;17:93–96.
172Shrank WH, Reed VA, Jernstedt GC. Fostering professionalism in medical education: A call for improved assessment and meaningful incentives. J Gen Intern Med. 2004;19:887–892.
173Sierpina VS, Kreitzer MJ, Mackenzie E, Sierpina M. Regaining our humanity through story. Explore (NY). 2007;3:626–632.
174Sokol DK. Perspective: Should we amputate medical history? Acad Med. 2008;83:1162–1164.
175Spaeth GL. Teaching and learning ethics. Arch Ophthalmol. 2003;121:1342.
176Stern DT, Cohen JJ, Bruder A, Packer B, Sole A. Teaching humanism. Perspect Biol Med. 2008;51:495–507.
177Suchman AL. Advancing humanism in medical education. J Gen Intern Med. 2007;22:1630–1631.
178Sulmasy DP. Should medical schools be schools for virtue? J Gen Intern Med. 2000;15:514–516.
179Taquette SR, Rego S, Schramm FR, Soares LL, Carvalho SV. Ethically conflicting situations experienced by medical students [in Portuguese]. Rev Assoc Med Bras. 2005;51:23–28.
180Tavakol M, Murphy R, Torabi S. A needs assessment for a communication skills curriculum in Iran. Teach Learn Med. 2005;17:36–41.
181Tervalon M. Components of culture in health for medical students' education. Acad Med. 2003;78:570–576.
182Thulesius HO, Sallin K, Lynoe N, Lofmark R. Proximity morality in medical school—Medical students forming physician morality “on the job”: Grounded theory analysis of a student survey. BMC Med Educ. 2007;7:27.
183Tilburt J, Geller G. Viewpoint: The importance of worldviews for medical education. Acad Med. 2007;82:819–822.
184Tsai DJ. Community-oriented curriculum design for medical humanities. Kaohsiung J Med Sci. 2008;24:373–379.
185Tundidor Bermudez AM. Proposals for the introduction of history, art and literature issues on the urology subject [in Spanish]. Actas Urol Esp. 2008;32:868–871.
186Volandes A. Medical ethics on film: Towards a reconstruction of the teaching of healthcare professionals. J Med Ethics. 2007;33:678–680.
187Wlasienko P. Ethical and legal aspects in teaching students of medicine. Sci Eng Ethics. 2005;11:75–80.
188Wolf G. Portrayal of negative qualities in a doctor as a potential teaching tool in medical ethics and humanism: Journey to the End of Night by Louis-Ferdinand Celine. Postgrad Med J. 2006;82:154–156.
189Bleakley A, Farrow R, Gould D, Marshall R. Making sense of clinical reasoning: Judgement and the evidence of the senses. Med Educ. 2003;37:544–552.
190Bleakley A, Marshall R, Bromer R. Toward an aesthetic medicine: Developing a core medical humanities undergraduate curriculum. J Med Humanit. 2006;27:197–213.
191Boutin-Foster C, Foster JC, Konopasek L. Viewpoint: Physician, know thyself: The professional culture of medicine as a framework for teaching cultural competence. Acad Med. 2008;83:106–111.
192Brajenovic-Milic B, Ristic S, Kern J, Vuletic S, Ostojic S, Kapovic M. The effect of a compulsory curriculum on ethical attitudes of medical students. Coll Antropol. 2000;24:47–52.
193Braunack-Mayer AJ, Gillam LH, Vance EF, et al. An ethics core curriculum for Australasian medical schools. Med J Aust. 2001;175:205–210.
194Breen KJ. Professional development and ethics for today's and tomorrow's doctors. Med J Aust. 2001;175:183–184.
195Browne J. A CD-ROM on medicine in literature. Health Info Libr J. 2001;18:156–158.
196Caldicott CV, Faber-Langendoen K. Deception, discrimination, and fear of reprisal: Lessons in ethics from third-year medical students. Acad Med. 2005;80:866–873.
197Carrese JA, Marshall PA. Teaching anthropology in the medical curriculum. Am J Med Sci. 2000;319:297–305.
198Carson AM. That's another story: Narrative methods and ethical practice. J Med Ethics. 2001;27:198–202.
199Cohen JJ. Viewpoint: Linking professionalism to humanism: What it means, why it matters. Acad Med. 2007;82:1029–1032.
200Donohoe M, Danielson S. A community-based approach to the medical humanities. Med Educ. 2004;38:204–217.
201Eddey GE, Robey KL. Considering the culture of disability in cultural competence education. Acad Med. 2005;80:706–712.
202Engel MF. Achieving “narrative flow”: Pre-medical education as an essential chapter of a physician's story. J Med Humanit. 2005;26:39–51.
203Feuillet-Le MB. Ethics education in medical schools: The role of jurists. Med Law. 2000;19:403–407.
204Friedman LD. The precarious position of the medical humanities in the medical school curriculum. Acad Med. 2002;77:320–322.
205Gesundheit B, Shaham D. A syllabus for Jewish medical ethics in the context of general bioethics. Isr Med Assoc J. 2008;10:397–400.
206Giardina S, Catananti C. The dialogue between literature and medicine in the education of medical students [in Italian]. Med Secoli. 2004;16:557–568.
207Goldie JG. The detrimental ethical shift towards cynicism: Can medical educators help prevent it? Med Educ. 2004;38:232–234.
208Gordon J. Arts and humanities. Med Educ. 2005;39:976–977.
209Goulston SJ. Medical education in 2001: The place of the medical humanities. Intern Med J. 2001;31:123–127.
210Graham HJ. Patient confidentiality: Implications for teaching in undergraduate medical education. Clin Anat. 2006;19:448–455.
211Gregg J, Saha S. Losing culture on the way to competence: The use and misuse of culture in medical education. Acad Med. 2006;81:542–547.
212Gull SE. Embedding the humanities into medical education. Med Educ. 2005;39:235–236.
213Herfs PG. A good medical curriculum takes the religious beliefs and cultural background of the students into consideration [in Dutch]. Ned Tijdschr Geneeskd. 2006;150:2720.
214Hodgson K, Thomson R. What do medical students read and why? A survey of medical students in Newcastle-upon-Tyne, England. Med Educ. 2000;34:622–629.
215Hongladarom S, Phaosavasdi S, Taneepanichskul S, Tannirandorn Y, Wilde H, Pruksapong C. Humanistic learning in medical curriculum. J Med Assoc Thai. 2000;83:969–974.
216Hood K, Jacobson L, Houston H. Medicine and self-image in literature. Lancet. 2002;359:981.
217Jackson M. Back to the future: History and humanism in medical education. Med Educ. 2002;36:506–507.
218Jones T. Ending in wonder: Replacing technology with revelation in Margaret Edson's W;t. Perspect Biol Med. 2007;50:395–409.
219Kao A, Witlen R. Pausing for professionalism. Am J Bioeth. 2004;4:49–51.
220Karina R, Nooriah S. Critical appraisal—Is there a need to train medical students how to read the literature? Med J Malaysia. 2002;57(suppl E):78–82.
221Kidd J, Patel V, Peile E, Carter Y. Clinical and communication skills. BMJ. 2005;330:374–375.
222Kuczewski MG. The soul of medicine. Perspect Biol Med. 2007;50:410–420.
223Lewin LO, Olson CA, Goodman KW, Kokotailo PK. UME-21 and teaching ethics: A step in the right direction. Fam Med. 2004;36(suppl):S36–S42.
224Macnaughton J. The humanities in medical education: Context, outcomes and structures. Med Humanit. 2000;26:23–30.
225Melley C. Clinical ethics consultation in Germany: A philosopher's prognosis. HEC Forum. 2001;13:306–313.
226Musick DW. Medical ethics education must include students' moral dilemmas within the clinical setting. Acad Med. 2000;75:215.
227Neely D, Minford EJ. Current status of teaching on spirituality in UK medical schools. Med Educ. 2008;42:176–182.
228Neitzke G. Ethics in medical education [in German]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008;51:872–879.
229Notzer N, Abramovitch H, Dado-harari R, Abramovitz R, Rudnick A. Medical students' ethical, legal and cross-cultural experiences during their clinical studies. Isr Med Assoc J. 2005;7:58–61.
230Notzer N, Zisenwine D, Oz L, Rak Y. Overcoming the tension between scientific and religious views in teaching anatomical dissection: The Israeli experience. Clin Anat. 2006;19:442–447.
231Ravindran GD. Medical ethics education in India. Indian J Med Ethics. 2008;5:18–19.
232Remen RN, O'Donnell JF, Rabow MW. The Healer's Art: Education in meaning and service. J Cancer Educ. 2008;23:65–67.
233Roex A, Degryse J. Introducing the concept of epistemological beliefs into medical education: The hot-air-balloon metaphor. Acad Med. 2007;82:616–620.
234Russell C, O'Neill D. Ethicists and clinicians: The case for collaboration in the teaching of medical ethics. Ir Med J. 2006;99:25–27.
235Schneider GW, Snell L. C.A.R.E.: An approach for teaching ethics in medicine. Soc Sci Med. 2000;51:1563–1567.
236Carufel-Wert DA, Younkin S, Foertsch J, et al. LOCUS: Immunizing medical students against the loss of professional values. Fam Med. 2007;39:320–325.
237Claramita M, Majoor G. Comparison of communication skills in medical residents with and without undergraduate communication skills training as provided by the Faculty of Medicine of Gadjah Mada University. Educ Health (Abingdon). 2006;19:308–320.
238Figueira EJ, Cazzo E, Tuma P, Silva Filho CR, Conterno Lde O. Acquisition of skills in medical ethics in learning-teaching small groups. Comparing problem-based learning with the traditional model [in Portuguese]. Rev Assoc Med Bras. 2004;50:133–141.
239Goldie J, Schwartz L, McConnachie A, Morrison J. Students' attitudes and potential behaviour with regard to whistle blowing as they pass through a modern medical curriculum. Med Educ. 2003;37:368–375.
240Goldie J, Schwartz L, McConnachie A, Morrison J. The impact of a modern medical curriculum on students' proposed behaviour on meeting ethical dilemmas. Med Educ. 2004;38:942–949.
241Goldie J, Schwartz L, McConnachie A, Morrison J. The impact of three years' ethics teaching, in an integrated medical curriculum, on students' proposed behaviour on meeting ethical dilemmas. Med Educ. 2002;36:489–497.
242Klein S, Tracy D, Kitchener HC, Walker LG. The effects of the participation of patients with cancer in teaching communication skills to medical undergraduates: A randomised study with follow-up after 2 years. Eur J Cancer. 2000;36:273–281.
243Bignall J. Illiterature and medicine. Lancet. 2001;357:1302.
244Campbell AV, Chin J, Voo TC. How can we know that ethics education produces ethical doctors? Med Teach. 2007;29:431–436.
245Davey G. Illiterature and medicine. Lancet. 2001;358:765.
246Geis PA. Belittlement and harassment of medical students: Remedial training—Ethics and sensitivity. BMJ. 2006;333:809.
247Goldie J. Review of ethics curricula in undergraduate medical education. Med Educ. 2000;34:108–119.
248Holte K, Hoye S. How to teach ballet to a swat? [in Norwegian]. Tidsskr Nor Laegeforen. 2000;120:3770–3772.
249Lynoe N, Lofmark R, Thulesius HO. Teaching medical ethics: What is the impact of role models? Some experiences from Swedish medical schools. J Med Ethics. 2008;34:315–316.
250Marshall RJ. Knowledge is a call to action. Med Educ. 2005;39:978–979.
251Wachtler C, Lundin S, Troein M. Humanities for medical students? A qualitative study of a medical humanities curriculum in a medical school program. BMC Med Educ. 2006;6:16.
252Wear D, Aultman JM. The limits of narrative: Medical student resistance to confronting inequality and oppression in literature and beyond. Med Educ. 2005;39:1056–1065.