As a pedagogical enterprise, the field of medical humanities has historically centered on undergraduate medical education. More recently, it has expanded in the United States and abroad to include premedical undergraduates who have relatively more leisure time to reflect on humanities-based lessons than their medical school counterparts who are simultaneously studying gross anatomy and other basic sciences in their first- and second-year courses.1–6 Graduate medical school curricula have also engaged humanities faculty in student education, though their appropriate role continues to be a matter of negotiation.7–11
With the exception of three programs implemented in the 1980s and 1990s at the University of Medicine and Dentistry of New Jersey, the University of Rochester School of Medicine and Dentistry, and the University of Montana, what is still lacking in the field of medical humanities is sustained attention to practicing midcareer health care professionals.6,12–18 For decades, career development theory has identified a stage that occurs at midlife and is commonly associated with “crisis,” characterized by a pressing desire to escape from the status quo or by a hunger for new ventures and modes of being.19 In medicine, this midcareer developmental stage has been described as a time when professionals, having been esteemed by their peers for placing service to others before self-care, begin to feel ennui from the repetitiveness of daily work.20,21 Medical humanities educators have likely not focused on this demographic because the existing burdens on overworked physicians make it difficult for them to commit to any sort of extra engagements, particularly to a course that requires preparation (e.g., reading) outside of class or to a retreat or sabbatical devoted to humanities work. That said, it is increasingly clear that physicians and other health care workers—particularly those in mid- or late career—are yearning for ways of thinking that move them beyond their quotidian responsibilities and open them up, or return them to, ideas and activities outside the discipline of medicine.12
Studies show that between 30% and 40% of physicians suffer from burnout at a level sufficient to affect personal and professional performance,21–23 and similar challenges are well documented with nurses.24 Little is known about how best to mitigate burnout in medical training and practice, but researchers have identified a need for new curricula that can help health care professionals assess personal well-being and develop and sustain the health habits needed to promote resilience throughout the course of a medical career.25,26 Innovative medical humanities curricula could conceivably help to mitigate the restlessness and general frustration expressed by midcareer health professionals while also providing new knowledge bases and diverse cognitive and creative processes that add value to existing professional skill sets. Concerted efforts toward individual reinvigoration could potentially seed rejuvenation of the health care system, which could ultimately benefit both practitioners and their patients.
To address the paucity of engagement between midcareer health professionals and the medical humanities, the Department of Humanities at the Pennsylvania State University College of Medicine and the Milton S. Hershey Medical Center has designed and piloted a series of annual humanities mini-courses that are open to faculty and staff throughout the college and medical center. This article provides an overview of the eight inaugural mini-courses and their primary goals; describes the various methodologies and outcomes of the series; and reports the results from initial evaluations of the participants, who assessed the benefits of the courses in their professional lives, and of faculty, who developed and taught the courses. Finally, we offer substantive questions to aid colleagues who are interested in designing such a series for their own institutions.
Initial Mini-Course Overview
The prototype for the mini-courses in this series was the Penn State Hershey Physician Writers Group that was founded and is facilitated by the primary author of this paper (K.R.M.). Independent of one another, several midcareer physicians in diverse specialties approached her about working with them on original, reflective, creative writing.
Now comfortably proficient in their daily work as clinicians, these physicians sought a new outlet that would challenge them to think in novel ways, see things from different perspectives, and, thus, more meaningfully integrate the science and art of medicine.27–29 She responded to this emergent desire—or “need,” as some physicians characterized it—by inviting a small group to convene every other week for three months in the fall of 2009 to explore writing in six genres: personal reflection essay; imagist poetry and haiku; free verse poetry; sonnet or villanelle; flash fiction; and “Medicine and the Arts” commentary. The aims of the Physician Writers Group were
- to teach participants the finer details of a new discipline through experiential learning;
- to provide an outlet for introspection and creative expression;
- to create a safe space for open discussion of professional issues that have personal consequences;
- to foster new skills that would enhance the physicians’ practice of medicine and job satisfaction; and
- to extend the professional community by writing high-quality literature worthy of publication in medical journals.
In the first week of each of the six cycles (each meeting and the time between it and the next meeting constitute a cycle), the facilitator presented an overview of the genre and samples of several published works in that genre. This format provided participants new or refreshed knowledge of a scholarly field outside biomedicine as well as exemplars of each genre that were enjoyable to read and discuss in a relaxed, collaborative setting. Because all readings were medically related, participants were simultaneously part of a broad contingent of professionals writing about sentinel issues and a more intimate cadre of colleagues within their own institution.
In addition to a general discussion of the issues raised in the readings, participants also carefully examined the writers’ specific choices (e.g., diction, syntax) and deliberated about the relative effectiveness of each choice according to literary conventions and the authors’ agendas. The process of literary analysis—which is both methodical and intuitive, with particular attention paid to subtle nuances of connotation, style, and tone—helps to sharpen the cognitive processes inherent in medical diagnosis and treatment that are vital to effective doctor–patient communication and narrative competence.30,31 The format of these meetings also afforded participants the opportunity to witness how their colleagues derived meaning from various texts and how they formulated an appropriate response to each. Such concentrated effort provided rare insight into the analytical and intuitive—the scientific and artistic—skills of one’s colleagues and contributed to a better understanding of one’s peers and their respective abilities. Moreover, inasmuch as physicians tend to seek a single right answer—or, at most, a few—based on an interpretation of the data in front of them (as is the case with a differential diagnosis or, in this case, the text at hand), this exercise provided a refreshing opportunity for open-ended responses, multifaceted interpretations, and communal meaning-making, which contributed to an esprit de corps, especially as participants attempted proficiency outside their area of expertise.
After the first-week session of each cycle, each participant wrote an original piece in the genre studied. This solitary period of creative thinking and writing invited participants to exercise higher-order thinking skills of synthesis and evaluation (as originally delineated by Benjamin Bloom and now labeled, respectively, “evaluating” and “creating”)32 in uncustomary ways. During the second week of each cycle, participants read and reflected on each piece that had been written by their colleagues. The ensuing meeting functioned as a workshop in which participants and the facilitator worked through the writing process that they had modeled previously using published works. Because the two-hour group meetings were insufficient to address each person’s piece fully, participants also met individually with the facilitator outside of class, sometimes four or five times per genre, to discuss their work in greater depth and then revise what they had written based on these meetings. One-on-one analysis encouraged a different kind of engagement that deepened both participants’ understanding of the events that they wrote about and their commitment to the artifacts that they had created. The subsequent weeks in particular provided participants time to reflect, from several vantage points, on the impact of the sentinel events and images from their own practice of medicine.33
At the end of the mini-course, each participant had a portfolio of well-honed creative work, much of which they successfully submitted for publication to various professional journals, both general (e.g., Academic Medicine, Annals of Internal Medicine, Journal of the American Medical Association) and specialized (e.g., Journal of Clinical Oncology, Medical Humanities). Experiencing such public success in a new academic discipline gave participants a sense of achievement, pride, and, indeed, excitement.
Participants reported overwhelming satisfaction with the Physician Writers Group, and, as a result of the fruitful collaboration with both practicing and teaching clinicians, in 2010, the chair of the Department of Humanities asked each faculty member to design and offer a mini-course open to health care professionals throughout the institution. Such a program could conceivably help further the departmental goals of encouraging reflection amongst health professionals within an academic medical center using content and methodologies from the humanities. Whereas some previous programs hosted by our department—such as humanities retreats for health professionals—had failed because of time and logistical issues, there was a sense that a mini-course format developed along the lines of the Physician Writers Group could more effectively serve the needs of the medical community and our faculty.
Expansion of the Mini-Course Series
Each humanities faculty member at Penn State Hershey was charged with developing a mini-course based either on his or her academic expertise or on a personal interest. The faculty created eight mini-courses and publicized them through the institutional intranet and via posters and flyers that were displayed across the campus. The courses were offered free of charge but required advance registration. Participants received one continuing medical education (CME) credit for each hour of attendance. The Department of Humanities paid a flat fee for combined CME credits, which were granted through the central CME office of the medical center.
Mini-courses were scheduled across an eight-month period both to accommodate the schedules of the humanities faculty and to facilitate participation by the largest number of health professionals. Meetings were scheduled at regular intervals (every other day, every week, every other week, or every other month), depending on the preparation time required; the number of meetings varied from three to five per mini-course. With meetings lasting an hour to an hour and a half, three of the mini-courses occurred during the lunch period, and five occurred immediately after standard work hours.
Courses fell into four general thematic categories: reading, reflection, and discussion; creative expression; technology; and ethics (see Table 1). Although each course had its own goal(s), the overarching stated goal of the series was “to provide humanities-related, clinically relevant learning opportunities for practicing clinicians. These may include ethical issues, social and behavioral topics, or the use of arts and literature to illuminate complex clinical relationships.” Participants included physicians, nurses, administrative and support staff, medical and nursing students, and health researchers and scientists.
Although most of the mini-courses were designed to function like a regular class (i.e., with rudimentary concepts serving as the basis for increasingly nuanced ideas that resulted in a fresh understanding of the topic), it was understood that, in all but one mini-course, participants could drop in at their leisure, even if for only one session.
Attendance for these eight mini-courses ranged from 3 to 11 participants; average attendance for a given session was 4.5. Although a core constituency remained stable for most of the mini-courses, professional obligations prevented some participants from attending all sessions.
The participants’ responses to postcourse surveys were uniformly favorable and indicated a high degree of satisfaction with the mini-courses for four principal reasons: (1) learning the tools and methodologies of a new discipline or domain other than biomedicine, (2) using their minds and training in uncustomary ways, (3) forming new alliances with colleagues (which served to lessen the sense of professional isolation),34–36 and (4) enjoying a respite from the stressful flow of the workday. Written comments included “Very new to me but very helpful”; “There were so many different people from different backgrounds, and it led to some pretty good conversations. Thank you for whetting our appetites”; “Wonderful experience, thought-provoking and renewed my enthusiasm for history as a living medium”; and “Looking forward to this hour is the highlight of my week.” Many participants requested that the current mini-courses continue and that new ones be offered. As anticipated from the literature, participants commended the mini-courses because they added practical value to the workplace while also countering burnout and stimulating new—or reviving former—intellectual interests.
Faculty facilitators’ evaluation
The facilitators’ responses to postcourse surveys were initially mixed. One facilitator “was not eager to take on new teaching responsibilities” but decided that “the range of options available to faculty was sufficiently broad that it turned out OK […] as it’s something I enjoy and I’ve wanted to do for a while.” Another concluded, “It wasn’t difficult [because] I knew the material and had it available from other seminars I’ve run with the same population.” From the start, a third facilitator was “enthusiastic about the possibility of doing a course, since I have been wanting to design a course on [the topic] for medical students, and this presented the opportunity to try out some ideas that I hoped would inform my later design of the […] course for med students.” As a group, the facilitators ultimately agreed that the mini-courses had been a positive experience.
Medical humanities courses for midcareer health care professionals are reciprocally rewarding. Whereas clinicians and other health care workers regularly cite the need for leaders at their institutions to pay more attention to faculty development as a means of mitigating burnout and enhancing their ability to deliver optimal care to their patients, faculty in the medical humanities confront their own unique challenges—for example, ensuring that they are integral to their home institutions (e.g., medical center, college of medicine); collaborating with colleagues in other areas of the institution (e.g., clinics and hospital wards); and feeling valued not only for their contribution to undergraduate medical education but also for their scholarly or avocational strengths that are often unknown to colleagues outside their small circle. These mini-courses provide medical humanities faculty with a means of establishing themselves as experts within medical culture and also pave the way for fuller integration of the humanities into the clinical side of medicine. Additionally, they are ideal venues in which to test new ideas, and they open channels for collaboration (e.g., publications, grants) amongst medical humanities scholars themselves and with the midcareer practitioners they meet. For both constituencies, these courses offer an opportunity for intellectual and social “play” in unconventional ways that foster workplace satisfaction and creative, innovative thinking.
Although the professional demands on both humanities teacher–scholars and their clinical counterparts present challenges to a sustained course format of this kind, our courses uniformly achieved a manageable balance in time commitment from both humanities and medical faculty that proved more tenable than other attempted formats, such as retreats (which are limited by time constraints), sabbaticals (which are often impractical because of inadequate resources), or online learning (which does not foster camaraderie and peer-to-peer learning as effectively as classroom-based courses). The modest commitment of 3 to 5, one- to one-and-a-half-hour sessions is likely feasible for most professionals, especially when schedules are published well in advance and consistent attendance is not a requirement for participation. Using internal advertising approaches to emphasize not only course content but also the modest time commitment and relaxed environment is likely to increase future attendance.
Mini-Course Series Replication
Because medical centers are often affiliated with universities or located in urban areas populated by colleges or universities, our mini-course structure is likely replicable at other teaching hospitals, even those without formally designated humanities departments. Such partnerships will initially require networking between departmental leaders from humanities and medical departments to determine shared objectives and goals as well as the feasibility of potential partnerships. Once this foundation has been established, options for mini-courses can be plentiful and at the discretion of any interested facilitators. Those interested in developing a humanities mini-course series should consider the following questions as guides to curriculum design:
- What are the needs of the medical institution—faculty, patients, administration?
- Who are the intended beneficiaries of each mini-course?
- What institutional resources can be committed to organizing, advertising, and facilitating these mini-courses?
- How do the logistics of time (semester schedule, shift changes, meeting times), space (technology classrooms, seminar rooms), publicity (design, funding), and CME credits impact the design of the mini-courses?
- Should mini-courses be offered ad hoc or as a concerted effort by a group of faculty (e.g., a department of or program in humanities)?
- What happens to intradepartmental morale if some medical humanities faculty members embrace the opportunity to offer mini-courses and others do not?
- Is it appropriate to require medical humanities faculty to add yet another course to their teaching load ex post facto and when they have myriad scholarly and service commitments?
- Should there be a distinction between expectations of untenured versus tenured faculty (in terms of time investment), especially considering the drawback of overcommitment versus the potential benefit of getting to know colleagues from various parts of the institution (potential collaborations, alliances, familiarity important for promotion and tenure)?
- How might such mini-courses contribute to faculty load? Might there be some release time or other incentive (e.g., stipend) for faculty to facilitate a mini-course?
Further, the facilitators of our pilot mini-course series offered the following specific advice to those at other institutions: Encourage creativity in course vision and design; identify potential participants and network beforehand to ensure buy-in; use Doodle (or a similar shared scheduling tool) to establish the most convenient meeting time before the course begins; keep class size small; hold meetings in a space more intimate than a large conference room; involve participants in selecting texts and leading discussions; focus on in-class assignments and minimize homework; and, where appropriate, consider bringing in nonmedical community members to diversify perspectives. With these suggestions in mind, future mini-courses are being designed at Penn State Hershey and in collaboration with faculty at other institutions across the country.
Mini-courses are valuable interventions for midcareer health care professionals seeking variety and respite from the demands of their daily routines, and they also provide medical humanities faculty with the opportunity to devote attention to topics that capitalize on their professional training and/or personal interest and expertise—thus directly enhancing workplace satisfaction for several constituencies. Mini-courses also enable humanities programs to widen their reach within traditional biomedical culture, thereby enriching the workforce with fresh ideas and new ways of thinking while also helping to justify their own existence in fiscally driven institutions. Although they require advance planning, mini-courses proceed on their own momentum and can be positive experiences for participants and facilitators alike. We heartily encourage colleagues in other medical settings to consider implementing such courses that capitalize on local resources to address the particular needs of midcareer health care professionals in their own institutions. Collecting pilot data on pre- and postcourse self-reporting of burnout in health care professionals would significantly contribute to the literature and could help to justify a wider replication of and institutional investment in this format—which, in turn, could ultimately improve the relationship between medicine and the humanities in a mutually enriching way.
Acknowledgments: The authors wish to thank Dan Shapiro, J.O. Ballard, Michael Green, Benjamin Levi, Martha Levine, Philip Wilson, Deb Tomazin, and Lori Coover for their contribution to this project, and especially Paul Haidet for his helpful input on an earlier version of this article.
Other disclosures: None.
Ethical approval: Not applicable.
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