by Barbara Sibbald, Editor, News and Humanities, CMAJ
Educational standards for physicians in Ontario originally included eight roles. When these morphed into the CanMeds physician competency standards there were only seven. The one lost competency was ‘physician as person’, said Dr. Brian Hodges in a keynote to 120 attendees at the Creating Space IV Symposium in Ottawa, Apr 25–26.
Proponents of the medical humanities, a burgeoning movement aimed at restoring the art, to the art and science of medicine, is all about that lost role.
Hodges leads the AMS Phoenix Project, A Call to Caring, an initiative to rebalance the technical and compassionate dimensions of health care. “Phoenix is trying to leverage change in education and the health care system to balance compassion and technical components,” said Hodges, who is a professor in the faculties of medicine and education at the University of Toronto, Ont. AMS supports the Hannah History of Medicine Chairs, fellowships, innovative projects and scholarly endeavors (including the Creating Space IV Symposium).
Hodges was speaking to an audience of the converted at the symposium, which was associated with the Canadian conference on medical education, but raised extensive discussion when he asked whether the medical humanities makes a meaningful contribution to health care and improving the lives of patients and health care providers. The consensus seemed to be yes, but it could do so much more if it was embedded into core curriculum, instead of being an elective, which de facto has less importance and credibility.
Medical humanities must be a department, like the department of neuroscience or orthopedics, said Dr. Jeff Nisker, another keynote speaker. Nisker, a professor at Schulich School of Medicine and dentistry at Western University in London, Ont., said first year students should get 200 hours in humanities beginning in the first week.
At least two attendees seemed to doubt that humanities would ever gain a place in the core curriculum due to lack of funding and lack of will. “How do we get health professionals to come out and play?” asked Hartley Jafine, who uses theatre to teach communication and team work to health professionals.
Inserting medical humanities into the core curriculum undoubtedly presents challenges including, breaking down barriers to other faculties, improving pedagogy and developing a robust research agenda.
But it’s essential, said another keynote speaker, Alan Bleakley, an internationally recognized expert in medical education and humanities, otherwise, we’re “just playing around the edges and it’s bad luck to those who don’t take it up.” Bleakley started a core integrated medical humanities program at Plymouth University in the UK, and is now a professor of medical humanities at Falmouth University in Cornwall.
Humanities are necessary, said Bleakley, to help cope with symptoms such as the increase in errors, moral erosion and poor self-care. Sensibility lies at the core of Humanities. By this, Bleakley means how we use our senses and how we develop a sense of what is useful, ethical and what is pleasing or disturbing. “Medical students have been rendered insensible,” said Bleakly. “They can’t think or sense for themselves. They are told what they should pick up when they go on a ward round or in the classroom.”
“Why shouldn’t patients or students talk back to the system and say this isn’t right?” Bleakley tries to teach medical students to be dissenters, to provide other options.” He said the major role of medical humanities and the arts is, in Jerome Bruner’s words, to allow people to “traffic in human possibilities, rather than settled certainties.”
The two-day symposium also featured sessions on writing, reflection and curriculum, and brought the arts to participants through writer- and poet-in-resident activities as well as a field-trip to the National Gallery to explore visual thinking strategies.
Creating Space V Symposium will be held next Apr. 25–28, 2015 in Vancouver, British Columbia as an associated event with the Canadian Conference on Medical Education.