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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 118-124

Experiential teaching learning of humanities in health professions education


1 Department of Periodontology, Christian Dental College, CMC, Ludhiana, Punjab, India
2 Department of Opthalmology, M & J Western Regional Institute of Opthalmology, B. J. Medical College and Civil Hospital, Ahmedaba, Gujarat, India
3 Department of Opthalmology. Kamineni Institute of Medical Sciences, Nalgonda, Telangana, India
4 Department of Medicine, Army Hospital RR, Delhi, India
5 Department of Pharmcology, Christian Medical College; Department of Medical Education, CMC L FAIMER Institute, Ludhiana, India
6 Department of Pharmacology, Adesh Institute of Medical Sciences and Research, Bhatinda, Punjab, India

Date of Submission30-Nov-2020
Date of Decision14-Apr-2021
Date of Acceptance07-Jun-2021
Date of Web Publication20-Dec-2022

Correspondence Address:
Anushi Mahajan
Christian Dental College, CMC, Ludhiana - 141 008, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_161_20

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  Abstract 


Humanities are an integral part of health professions. However, with educational focus shifting gradually toward knowledge, information, evidence-based medicine, and technology, it has taken a back seat and become a part of the “hidden curriculum.” Humanities are hardly ever taught upfront to students of the health profession, let alone its assessment. With the need of its inclusion in health professional education now recognized and established through competency-based education, we need to be aware of the tools and strategies which can be used to teach and assess it. In this article, we share selected tools with relevant readily usable examples for teaching humanities to students of the health profession. Faculty may find it useful to plan sessions around related competencies. Incorporation of such experiential teaching and learning methods can help us achieve the transition from “high-tech” to “high touch” health professions education.

Keywords: Burn-out, caregiver's fatigue, cinemeducation, humanities, medical education, teaching-learning tools


How to cite this article:
Mahajan A, Bhagat P, Babu S, Singhal A, Badyal D, Mahajan R. Experiential teaching learning of humanities in health professions education. CHRISMED J Health Res 2022;9:118-24

How to cite this URL:
Mahajan A, Bhagat P, Babu S, Singhal A, Badyal D, Mahajan R. Experiential teaching learning of humanities in health professions education. CHRISMED J Health Res [serial online] 2022 [cited 2023 Jan 30];9:118-24. Available from: https://www.cjhr.org/text.asp?2022/9/2/118/364531




  Introduction Top


Medicine is referred to as “the most humane of sciences, the most empiric of arts, and the most scientific of humanities” by Edmund Pellegrino. Engagement into humanities offers three benefits essential to physicians for their competence: Methods of inquiry or thought, content of knowledge, and power to revive the spirit.[1] Humanities has always been an integral part of medicine since ages; however, as science and technology progressed, it was taken for granted and became a “hidden curriculum,” in terms of teaching and assessment. The value of humanities in medical education is not challenged but what is of concern is how to fit it into an already loaded curriculum.[2] William Osler stated that – “It is important to know the person who has the disease as it is to know the disease the person has.”[3]

Most doctors fail to realize that our profession is not only to understand the scientific basis of disease and the related technology but also to recognize and appreciate the person who is affected. Patients cannot be regarded as disease-carrying bodies or individuals but have to be understood as members of families, societies, and communities. Too much reliance on scientific knowledge may often get in the way of sound clinical judgment. Doctors are currently more of “bedside technicians” than “scientific healers.”[4] The clinical encounter between a doctor and a patient is something more than a mere diagnosis and treatment of a disease; it constitutes a moment between two people to come together in mutual recognition of all human aspects. This insight along with the scientific and technical knowledge is indispensable for a holistic health profession's education. The various aspects of humanities include attitude, professionalism, ethics and empathy, altruism, and communication skills.

Furthermore, we also need to consider sensitizing health professionals to caregiver's fatigue (from the point of view of a patient's family) and the medical burn out (from doctor's point of view). A doctor is considered next to an artist because serving the ill and the destitute is an art coupled with science; to accept destiny and not to be a victim of high ambition and hopelessness. Medical students are often prone to burnout due to the real picture coming alive, facing the grief, the suffering, and the death. They have to accept that life is not at all perfect and they need to focus and keep space for creativity and imagination for relaxation to prevent burnout. Recently, burnout syndrome has been recognized as an occupational disease characterized by emotional exhaustion, feelings of low self-esteem, and depersonalization leading to a posttraumatic stress disorder and even suicide.[5]

Hence, if we wish to create wiser, more tolerant, empathetic, resilient and competent physicians, we might want to reintegrate the dance, poetry, and art (humanities) in medical education. Keeping these learning objectives and competencies in mind [Table 1]a and [Table 1]b, we introduced health professionals to a month-long process of “experiential learning,” that is, direct experience outside a traditional academic setting through the below mentioned methods:
Table 1:

Click here to view


  1. Depiction through art
  2. Appraisal through case scenarios
  3. Reflection through cinemeducation
  4. Expression through poetry.


In this article, we discuss the various tools with which humanities can be taught to students of the health profession and the above-mentioned competencies can be attained.

Depiction through art

It is important to bring the left and the right brains back together – for the health of the patient and the physician. Visual art can enhance clinical practice by breaking communication barriers and fostering teamwork. The curiosity aroused when clinicians are presented with an artwork can ignite a similar curiosity and questioning when they encounter patients.[10]

Painting-1 “The Doctor” by Sir Luke Fildes commissioned by Tate. Content is available under CC BY-SA 3.0 [Figure 1].[11]
Figure 1: A classic Norman Rockwell painting (in 1929)

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Setting-A cottage with humble interiors, with two unmatching chairs pulled together to make a make-shift bed has a young child lying listless and desperately ill, his pale face illuminated by a lamp placed on the table.

The doctor, dressed in a well-tailored suit, sits beside the makeshift bed and looks down anxiously at his patient, the child. The boy's father is standing in the background with his hand on his wife's shoulder whose hands are clasped as if in prayer. A half empty bottle of medicine lies on the table, and a bowl and jug on the bench, all perhaps to relieve the boy's fever or pain. The paper bits lying on the floor could perhaps be previous prescriptions made by the doctor. The shaft of daylight perhaps reflects the imminent recovery of the child.

Background – Helpless, grief-stricken parents.

Doctor – A Victorian family doctor with a furrowed brow, hand resting on the bearded chin, gazing intently at his patient, on his home-visit. There is nothing much to be done by him to save the child, but he still is there, just to keep a vigil as the delicate child's breath is getting shallower.

Key point: This painting is a strongly expressive portrayal of what medicine is all about – doctor, patient, and their relationship. The physician is attending the patient, apparently observing and waiting. It teaches us the value of a patient-centered approach. It signifies the commitment and dedication to one's profession.

Practical implications in existing times – Fildes himself believes that this painting is neither historically accurate and nor close to reality. With the advent of technology, there is no longer a need to sit by a patient for extended vigilance. However, it endures to foster empathetic relationships between doctor and patient to avoid the mechanization of medical practice in the present times.

Painting-2 A classic Norman Rockwell painting (in 1929).[12]

Setting – It is a doctor's office and the girl is there for a check-up as the girl is standing in the doctor's office. The doctor's patient, the little girl, is in turn holding her doll as a patient for him to examine.

Background – The doctor has a large black bag lying on the rug on the floor implies doctors made house-calls to visit patients. Perched on top of his desk are thick books, brass candlesticks, and pictures. Behind the books, hanging on the wall, is the doctor's “registration” document.

Doctor – An old, well-dressed doctor, seated in his office, attending a patient from his wooden chair. With his head craned to the right and upward, he concentrates on his patient and examines the doll using a stethoscope. He is pretending to look amused. In fact, the girl has removed her doll's dress to help the doctor closely examine her doll. The doll's dress is held close to her with the elbow.

Key point: This painting intricately brings about the gaps between doctor's perceptions and patients expectations in their first encounters. The patient, slyly testing the skills of the doctor by letting him examine her doll first. Will he pass this test? The doctor is playing it through, to bridge this gap. Trying to win her trust, he opens up the channels of communication with her in a playful manner (Paternalistic model).

Painting-3 A famous painting of Dr. Gross Clinic, by Thomas Eakins (in 1875). Content is available under CC BY-SA 3.0 [Figure 2].[13]
Figure 2: A famous painting of Dr. Gross Clinic, by Thomas Eakins (in 1875)

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The painting is based on a surgery in which Dr. Gross had treated a young man for osteomyelitis of the femur and was witnessed by Eakins. Dr. Gross is pictured here performing an operation.

Setting – Gross clinic defines a scene of an on-going operation. Anonymous patient with an ether mask placed. An anesthesiologist at the head of the table. An incision on the left lateral thigh of the patient to approach the involved part of the femur.

Background – The patient's mother, toward the left, demonstrates her suffering with a raised hand and coiled fingers like a claw. A few students are seen taking notes as the surgeon pauses in between to explain the details of the procedure to his students.

Doctor – The dominating, dignified figure of Dr. Gross, dressed in black, with bright red blood on his right hand, holding the scalpel. Something terrible, unutterable going on in his mind, in the shadowed stony hard face. His eyes reveal the knowledge of sickness and pain.

The assistants look dauntlessly at the wound they are holding open. The audience watches the process in order to learn. This is an arena with Eakins portraying Gross as a modern hero. In the background, a woman claws her hands horrified, attempting to cover her face. In contrast, the calm and heroic ability of Dr. Gross to look and see. The woman cringing in distress is in dramatic contrast with the composed professional demeanor of the men surrounding and operating on the patient.

Key point: This painting distinctly exhibits that the entire burden and responsibility of this crucial moment between life and death is in Dr. Gross's slightly disengaged moment of thought – depicting the life of a typical surgeon! Eakins purposely puts both hands (of Dr. Gross and the woman) close to each other to allow the viewer to compare the rational with the emotional. It also conveys the importance of team-work and collaboration between the doctors to achieve a common goal of patient well-being!

Painting-4 A self-portrait by Goya (in 1820) expressing his gratitude for the gift of life, to his friend Dr. Arrieta. Content is available under CC BY-SA 3.0 [Figure 3].[14]
Figure 3: A self-portrait by Goya (in 1820) expressing his gratitude for the gift of life, to his friend Dr. Arrieta

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Setting - The scene is of Goya's bedroom. He is sitting on his bed in a dressing gown, grasping the sheet as if clinging on to life. He is supported from behind by the arm of Dr. Arrieta. The portrait is an empathetic representation not only of Goya but also of the universal patient, personifying the plight of the ill and sick who, withered, limp and unkempt, is reduced to an infantile condition to be comforted, treated and ordered to obey.

Background – Shadowy figures in the background, perhaps of servants and a priest seem to be indicators of impending doom. The intruding shadows witnessing his pending demise.

Doctor – He is holding Goya firmly and stoically administers the medication. The physician is at least kind, warm, and obliging if not overtly hopeful. His embrace reflects his instinct to alleviate pain as well as his incognizance of the risk to himself from proximity to an ill person.

Key point: This painting beautifully portrays the actions of the doctor who is aware of his limitations in reversing the course of illness and who focuses on what is within his ability – to provide comfort and support. His compassion brings about probably the silver lining effect in the dark life of the patient.

Appraisal through case scenarios

The basic aim is to use creativity and self-expression for education and clinical practice to develop attributes of humanities. Practicing medicine requires effective communication skills, empathy, self-awareness, judgment, professionalism, and mastering all contexts of illness and health. Within medicine, “emotional intelligence” is thought to be equally important, particularly in perspective on the cautious administration of feelings required in patient consideration and practice. Emotional intelligence is a psychological “construct.”[15] It has been developed conceptually to represent a characteristic in which individuals differ. “Profession” is derived from the Latin word “Professio,” which means a public declaration with the force of a promise.[16] A professional is someone who can work best when he/she does not actually feel like doing so. Hence, certain case-scenarios were designed to suggest strategies to resolve certain dilemmas in our professional life, abiding by professionalism and ethical values.

  1. Beneficence - is doing good and what is right for the patient. Even if one has any interpersonal rivalry or conflict of interest among his/her colleagues, one needs to get above personal feelings and give the best to patients.[17]

    Case scenario: “You are the unit head having five postgraduate (PG) students. One of your PG student appears to be brilliant and punctual aspiring to take up post-PG fellowship in your department. His sincerity is evident but out of envy, his fellow residents keep complaining about him for sub-optimal professional conduct in managing ward patients. This peer conflict leads to frequent compromise in patient care. As the unit head, how will you manage this peer rivalry among PG students causing potential compromise in departmental functioning and patient care?”
  2. Accountability - is accepting moral responsibility for one's own actions. Doctors and nurses are accountable for the care they provide and their related actions. They must accept all the professional and personal consequences resulting from their actions.[18]

    ”Deception, even by omission, is a powerful betrayer of trust.”

    Case scenario: “You have posted a case for an elective surgery tomorrow. The patient, though rich and affluent, wishes to be operated by you in a government setup because of her faith and trust in you as an expert. In the evening, you get the news that your father has been rushed into a hospital in another city with a medical emergency. He needs to undergo an emergency surgery and your mother would like you to be with her during this difficult time. You have the option of requesting your equally competent departmental colleague to do your planned surgery. What do you do? How would you deal with the patient?”
  3. Justice is fairness - A doctor must be fair in providing care i.e., care must be fairly, justly and equitably distributed among all patients.[19]

    Case scenario: “It comes to your notice that one of your young junior faculty prescribes irrational treatment and investigations to patients to favor certain pharmaceutical companies and laboratories. Your students often come to you to discuss the rationale behind those treatments and investigations. You realize that the faculty is setting up a wrong example for the students. How do you deal with the faculty? What and how do you explain it to the students?”
  4. Nonmaleficence - is doing no harm, neither intentional or unintentional.[20]

    Case scenario: “You are the head of your department. A few students approach you with a complaint that one of your senior faculty asks them to help in his household chores, run his extra errands and take care of his elderly critically ill mother. The students cannot refuse the faculty out of fear of his being a potential examiner. However, they inform that this compromises their study and extracurricular time. How would you manage this situation?”


Reflection through cinemeducation

Medical education has often been criticized for not focusing enough on empathy, altruism, and inter-relational skills. The way forward is converting this “high-tech” to “high-touch” medicine, by re-humanizing medicine. A humanistic approach “considers people in their intra- and inter personal, cultural, political, economical, spiritual, and historical contexts.” It is imperative to give importance to the emotions of both patients and physicians. Patients should not be considered only as biological bodies but also as physical and psychological respectful individuals. Medicine be defined as a “fundamentally inter-subjective practice,” bringing a focus to the patient-care provider interaction with a tone of “mutual respect,” “empathy,” and “compassion” between patient and health-care provider rather than detachment and dehumanization.

The first report about the use of cinema in medical education was published in 1979 when viewing of movies followed by thoughtful discussion was used in psychiatry residency education. They bring dry content to life and help convey difficult topics and concepts and stimulate open discussion. The term “cinemeducation” was coined by Alexander et al. to refer to the use of clips from movies and videos for educating medical students about the psychosocial aspects of medicine.[21]

Movies and the health humanities: Cinemeducation has been mentioned as a unique and enjoyable narrative medical approach to the teaching-learning of health humanities. In group settings, it can be helpful in brainstorming, creating useful ideas, and sharing perspectives about the scenes and characters in the movie from different perspectives. The experience of films consists of a double empathetic sharing: The first with the characters and the second with others present physically or virtually during the screening. Furthermore, the ability of films to engage learners in discussions is a part of the active learning process in which learners build concepts or ideas from preexisting foundations.

Movies play an important role in the medical humanities and have been used to address various subjects such as medical ethics, professionalism, doctor–patient relationships, clinical research, and mental illness. Movies involve the affective domain and promote reflection and experiential learning. Movies can teach empathetic behaviors, self-reflection, compassion, and other skills [Table 2].
Table 2: List of movies that can be used for cinemeducation

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Expression through poetry

Poetry can be a powerful tool in teaching interpersonal and scientific aspects of medicine. Advantages of using poetry include emotional intensity, succinct, portable formulations and communication of encompassing, “existential” truths. Limitations include learners' lack of familiarity with the medium of poetry, and the need to negotiate multiple, complex meanings.[22] Poetry can be used in active (that is by writing) or in passive (by analyzing) to express an emotion, develop relations with patients, their families and future colleagues, convey thoughts and provide emotional and psychological faith, reducing physician burn-out as it is a means of vent-out. One of the poems written by the one of the authors of this article (AM), in this regard-

  • Looking through the eyes of cinema
  • I am in a state of enigma.
  • Where is the line …
  • Between humanity, technicality and reality?
  • Taking a robot out of a human
  • Or instilling a human into a machine.
  • What is that we want to redeem?
  • Be it “End of life”
  • Or apprehensions to continue life
  • Whether it is to relieve them of their physical pain
  • Or to give them an emotional gain
  • What comes in a doctor's domain?
  • To feel and reduce the suffering the patients contain
  • A rendezvous of humanism and medicine one can obtain.
  • A new hope that would be enough.
  • for the patients to sustain!!”



  Conclusion Top


Humanities are an integral part of the health profession. This profession mandates that a humane approach toward patients is as necessary as is the knowledge and clinical skill. The month long discussion on the various aspects of humanities proved fruitful for FAIMER fellows who were sensitized to train their health profession students and faculty in their respective institutions. The incorporation of experiential teaching and learning methods can help us achieve the transition from “high-tech” to “high touch” health professions education.

Acknowledgments

We would like to acknowledge the contribution of all fellows, advisors, and faculty of CMCL FAIMER during the moderation month of the fellowship.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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12.
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13.
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Ambrose AJ, Andaya JM, Yamada S, Maskarinec GG. Social justice in medical education: Strengths and challenges of a student-driven social justice curriculum. Hawaii J Med Public Health 2014;73:244-50.  Back to cited text no. 19
    
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21.
Alexander M, Lenahan P, Pavlov A. Cinemeducation: A Comprehensive Guide to Using Film in Medical Education. 2005. p. 14. Radcliffe Publishing Ltd. Available from: https://www.researchgate.net/publication/237829512_Cinemeducation_A_Comprehensive_Guide_to Using_Film_in_Medi. [Last accessed on 2022 Nov 29].  Back to cited text no. 21
    
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    Figures

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    Tables

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