Integration of Humanities in a Problem-based

Curriculum

Amos Pasternack

05.09.05

Abraham Flexner 1910•…the practitioner deals with facts of two categories. Chemistry, physics, biology enable him to apprehend one set; he needs a different apperceptive and appreciative apparatus to deal with other, more subtle elements. Specific preparation is in this direction much more difficult; one must rely for the requisite insight and sympathy on a varied and enlarging cultural experience. Such enlargement of the physician´s horizon is otherwise important, for scientific progress has greatly modified his ethical responsibility… It goes without saying that this type of doctor is first of all an educated man.

Chen Kenyon (second year

student) 2003•I have been told that there are two pillars in medicine – science and humanism. As basic scientists build up the first pillar during preclinical years and neglect the construction and maintenance of the second, students learn to treat patients as they might treat an experimental mouse. Idealistic notions of altruism, honesty and integrity that attracted many to the calling of medicine are mentioned in the white coat ceremony, talked about by deans, and actively discouraged through the acculturation process. This is where transformation must take place.

Topics asking for more and special attention

• Ethics

• History of medicine

• Philosophy of medicine

• Litterature and creative writing

• Fine arts, music, theater, movie

• Religion

• Anthropology

• Professionalism and ”multiprofessionalism”

How to teach humanities to medical students

• No evidence as to method of choice

• Measures are needed to break the resistance of faculty

• Needs to be ”smuggled” into the curriculum

• First to be cut down when faculty is short of money

Methods of implementation

• Optional electives

• Compulsory electives

• Compulsory theme-based modules

• Compulsory integrated modules– from ten hours to about three

weeks

Choosing the method

• Experience from voluntary elective ”Arts and medicine”, a series of seminars together with students from the faculty of humanities: medical students participating were those interested in humanities

• Humanities should be offered to all students as a more or less natural part of medicine

• Integrate humanities in the medical curriculum

Integration of Humanities in the

curriculum

• Moderate amount of humanities for all students

• Lectures, seminars, discussions, reading, movies etc

• Topics added to the blocks in a natural way in order to broaden the subjects dealt with and to underline their connection with humanities

IntroductionBlock 1

• Introduction to ethics– Philosophy and practice

• The significance of humanities in medicine

• Health and disease as cultural and social phenomena

• Reading a fragment of a novel and following discussion

Function of the nervous system and perception

(Block 3)

• Development of language

• Development of concepts by the deaf and the blind

Medical knowledge and research

(Block 4)

• Introduction to the philosophy of science

• Ethics of research

• Approaches in humanistic and social sciences

• Principles and methods of biomedical research

• Approaches of clinical research

Locomotion(Block 5)

• Encounter of the deceased at dissections – learning to respect the historical person

• Students elaborating the facing of human death

• Body-image – historical aspects

• Use of organs in therapy – ethical aspects

Nutrition(Block 7)

• Hunger and famine - global and social aspects

• Anorexia and bulimia - actual problems ?

• Food and eating habits in various cultures and religions

• Historical aspects on eating and food in Finland

• Vitamins – historical review

Hormonal regulation(Block 9)

• Endemic goiter and iodine prophylaxis – historical aspect

• Cortisone – discovery, hopes and disappointments – a historical review

• Non-medical use of hormones

Autonomic and integrative functions of

the nervous sustem(Block 10)

• Multiprofessional project: meeting of cultures in health care

• Cultural and ethnic differences in communication

• Refugees and immigrants as patients at the health-care center

Attack and defence(Block 11)

• Tuberculosis – historical and social aspect

• Eradication of infectious diseases – economic aspect and identification of barriers

• History of epidemics – effects on population

Ageing(Block 12)

• Age and rationing in health care – facts and discussion

• Old people in various cultures and in changing society

• Multiprofessional project. Care of the elderly

• Facing death – attitudes of the elderly

• Ageing in the literature

Prevention(Block 14)

• Screening and prevention – ethical aspects

• Smoking – history and scientific evidence (a model)

Infection(Block 16)

• Ethics in the light of two cases:– patient with HIV-infection in

surgery– SARS and hospital doctors

Chest pain/Shortness of breath(Block 17)

• Treatment of myocardial infarction and heart failure – historical aspect

• Reading of text and discussion

Diagnostics and therapy(Block 19)

• Autonomy and rationing in health care

• Health economy and medical ethics

• Philosophy of placebo

• Self-induced disease – ethical aspect

• Evidence-based medicine - ethical aspects, applicability and limimations

Coping(Block 20)

• Reading about depresssion followed by discussion– ”Darkness visible” by William

Styron

• Madness– historical and anthropological

aspects

Arthralgia(Block 22)

• Multiprofessional project -nurses, physiotherapists, social workers

• Backpain as a social problem – social and economic aspects

Emergency situations(Block 23)

• Ethical aspects on:– brain death and procurement of

organs– organs on the market– intensive care– end-of-life therapy– suicide– euthanasia