The Kern Institute Hosts a Conference - A Year Late but a Lot More Wise

 From the 4/30/2021 newsletter

Director’s Corner

 

The Kern Institute Hosts a Conference - A Year Late but a Lot More Wise

 

Adina Kalet, MD MPH

 

Today, the Kern Institute hosts the “Understanding Medical Professional Identity and Character Formation,” a conference originally scheduled for April 16, 2020 but postponed by the pandemic. Dr. Kalet reflects on how the havoc wreaked by COVID-19 has sharpened our focus on what matters and provides both challenges and opportunities for the work at hand …

 

 

In the run-up to April 2020, attendees and speakers were readying to fly into Milwaukee from across the country and around the world for a two-day conference on medical professional identity and character formation. The plenary was to be given by Dr. Muriel Bebeau, a moral psychologist and a scholar of professional identity formation. Workshops and poster presentations were firming up. Hotel rooms were booked. Conference rooms were reserved, food had been ordered, and Institute staff were finalizing details like an army prepares for tactical maneuvers. We planned an evening symposium where, over a fine dinner in the Alumni Center, attendees would discuss what they had learned and ponder how this field of study and practice could transform medical education. I was stoked. This was going to be fabulous! 

Planning such an event has much in common with preparing for a wedding or bar mitzvah - both of which I have some experience with and for which I claim no special skills - but without the music and ceremonial component. Working to remain calm, I attended to many details. This would be the Institute’s first large conference and the first of many to come.

 

That was, as we say now, in the “before times.”

 

Then COVID-19 started spreading. Asian and European attendees cancelled their trips as borders closed. Not wanting Dr. Bebeau to fly (after all, she is a “senior” statewoman), colleagues planned to drive her from Minneapolis to Milwaukee.

As the full force of COVID-19 bore down, our excitement turned to dread and then to resignation. After resisting as long as we could, we canceled. Soon, the nation hunkered down, and we learned what it meant to “stay at home.” When it appeared that interstate travel would soon be banned, and with all of the Kern Institute staff working virtually, I boarded a sparsely occupied early morning flight from Mitchell to LaGuardia to shelter at home with my family.

A year later, our conference will finally happen in a virtual space. Since Dr. Bebeau prefers not to talk to her computer screen (how can we blame her?), I will deliver the plenary talk in honor of her contributions to the field.

 

So much has changed

The topic for today’s conference has become much more poignant and important and less simply “academic” as a consequence of the pandemic. The understanding of character and professional development of health professionals has evolved while the public watched physicians and all healthcare workers rush to the front lines. Although data on the public’s level of trust in our profession had been declining up until last year, they have soared as it became clear that we perform our duty, show up, and care in the face of unknowable risks. Health professionals are seen as people who possess talent, energy, resolve, and character. As medical educators, our work is to help students be, not only exquisitely competent, but also brimming with extraordinary sensitivity and humanity.

Many of our exhausted students, residents, and frontline faculty have been through rapid-fire, anguishing, morally ambiguous experiences over the past several months. They have put their own lives - and their families’ lives - at risk. They have witnessed people dying separated from their loved ones. They have seen how social determinants of health impact real people with real names. They have dealt with their own crazy uncles and social media acquaintances who doubt the data. And the pandemic is far from over.

 

The pandemic has changed how we view identity and character formation

Later today, I will speak about how we might ensure that our trainees and faculty possess mature, internalized professional identities, because solidity of identity prepares each of us to hone the character, conscientiousness, courage, and wisdom needed to act in accordance with our principles under highly complex circumstances. While nothing can replace the experiential learning at the bedside and in the clinic, most of the preparation for character development must happen in the classroom. Interactive discussions, reflection, theoretical analyses, and rehearsals best prepare us and our students for unpredictable future events.

This is work we must do, because the alternative is to allow everyone to learn only through experience which means many will simply “react” to situations, without exercising the habits required to make principled decisions under stress. Expecting our trainees to make good choices without helping them develop the tools to act with moral agency is unacceptable. We must try to educate and measure professional identity and character.

 

Hopefully, there will be many chances to talk with the over 120 conference attendees about how to best support the development of practical wisdom in physicians, nurses, respiratory therapists, and others when, for instance, they are deciding how long to stay at the bedside with a terrified spouse or convincing someone they need a vaccine even though they have every reason not to trust the medical establishment.

I am hoping to talk about how we - teachers and students together - determine when a trainee can be “entrusted” to care for patients with less and less supervision. You see, we can measure a student’s competence to do the basic skills of doctoring, but we can’t be absolutely certain that an individual student - when faced with a real-life circumstance - will actually perform competently. As we try to determine whether our students have what it takes to do the right thing every time and when it matters, we make educated guesses buoyed by our experience but, too often, we depend simply on our subjective judgement of their character. I hope to provide a framework for thinking about these “trust judgments” as a matter of both character and competence of both the learner and the teacher.

It is interesting - and worrisome - that our “educated guesses” are very idiosyncratic; we rarely agree on what it means to be a competent physician. Yet, with experience and benchmarked performance metrics in the context of good relationships with our learners, we can make accurate judgments about who will be a trustworthy physician. Identifying trustworthiness and good judgement in a student is a harbinger of their future character, courage, and caring.

 

Challenges and opportunities

While far from over in the US, the pandemic is currently having a devastating impact in India and parts of Africa. Our sister and brother health care professionals in those countries are struggling to do the work they were trained to do under very difficult circumstances. In addition to concrete support, we send them our respect for their courage and professionalism.

I am grateful for the opportunity to host this conference at this inflection point in our understanding of character development and professional identity formation. The pandemic has given us both challenges and opportunities. Winston Churchill once said, “Never let a good crisis go to waste.” I hope that his sentiment will guide our work.

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Remembering H. Jack Geiger, a Role Model and Troublemaker I wish I Had Known

From the 4/23/2021 newsletter

Director’s Corner

Remembering H. Jack Geiger, a Role Model and Troublemaker I wish I Had Known  

This week, Dr. Kalet struggles with her regret at not humanizing her “heroes” when she had the chance ... 

It was with deep regret that I read his obituary because I never had the courage to get to know H. Jack Geiger as a person. Despite having him as a role model for decades, I missed the opportunity to have him as a mentor or friend, and I am poorer for it.  

Geiger, a graduate of UW-Madison, Case Western Reserve, and Harvard, was a physician, civil rights and antiwar activist, journalist, founder of social medicine in the US. He made lots of “good trouble” in his life. He believed that physicians must use their full capacities, their knowledge and skills, and the moral authority that comes with the profession, to improve the social and geopolitical conditions that threatened health. 

Dr. Geiger died this past December, after living for almost a century. While I knew some of his story, the obituaries - and there were many including a beautiful one in the New England Journal of Medicine - pointed out that he excelled at being an iconoclastic rabble rouser. They describe how he was, more than once, sanctioned by his medical institutions for speaking out to “raise the bar” for our profession, but he persistent none-the-less. 

He was not like most of us.  A preternaturally brilliant, child of immigrant German Jewish parents, who were a physician (dad), and a scientist (mom), he finished high school at fourteen and ran away from home (with his parents’ permission!), to live in Harlem among actors, musicians, and the celebrated authors of the time. He entered the University of Wisconsin as undergraduate and wrote for the Capital Times in Madison before he was eighteen years old. He never took any straight paths, following his instincts and his strong moral compass. 

Both Dr. Geiger and I began at the Sophie Davis School for Biomedical Education (now the City University of New York Medical School) in 1978. I was a college freshman, and he a remarkably accomplished physician, social activist and newly minted Arthur C. Logan Professor of Community Medicine. I wish I had invited him for a cup of coffee or a beer. I never considered it; it was too intimidating I was convinced he would be “too busy”. Later, I wish I had visited him at his home in Brooklyn during his last decades when he stopped traveling, became frail, and had failing vison. I certainly could have. I am now certain that he would have made time to talk with me. He might have even enjoyed meeting a former student. But I never called.  Instead, I took the easier route and had conversations and debates with him in my head. It is hard to learn anything that way!

The problem of being afraid of our role models is this: they remain on pedestals and exist mostly in our imaginations. We try to understand them and learn from their examples. We watch them and read about them, but we never know them in their full humanity, warts and all.  

Of course, this “hero at a distance” is often all that is available to us. Our role models may not be proximate. They may be long gone, or they may be entirely fictional. But I now believe that if opportunities arise to transform role models into mentors, one should take full advantage, even though there might be risks. To truly know a remarkable person is invaluable, and the privilege to be known by someone who has done heroic things is rare. 

When I was in college, we knew only vaguely of his many accomplishments to that point, (he had yet to win his two Nobel Prizes) and we were way too self-absorbed and naïve to truly appreciate how unusual a physician he was. Although we heard him lecture occasionally, we were largely unaware of what a character, in all the senses of that word, he was. Boy, did we miss out! 

In fact, he was redefining what it meant to be a physician just as we were working very hard to become one. His example was destabilizing to our nascent professional identity formation. The lessons he represented, the moral exemplar he was, were lost on most of us.  Admittedly, it might have been difficult for us to truly appreciate what he had to teach us early in our careers, but we should have tried. Missing that opportunity was a great loss. Had we taken the risk and made the effort, we would have been the richer for it. 

How might my medical school have taken better advantage of this giant walking amongst us? I think there are “curriculum” lessons in this. In addition to the occasional lectures from him and about his work, the book chapters and New York Times editorials he wrote (but which we weren’t obligated to read), there should have been a way to understand him beyond the “hero” stories. Had we found ways to engage with him meaningfully as a person, it would have humanized this intimidating, moral exemplar and, perhaps, provided us each with more detailed career maps. What a remarkable “leadership training” program it might have been to talk with him informally, to hear his personal stories, his journey, and his views on his own coming of age! Besides reading about his work and hearing him speak, we would have been able to bring our questions, comments, and fears to him. 

It is also possible we might have been disappointed. That’s okay. After all, no role model is perfect. Many are not even particularly gifted in interpersonal skills. There might have been confrontations and rebukes. He might have initiated intellectual debates that rose well over our college-educated heads. This was a man who talked with Langston Hughes as a 14-year-old! But, had we the courage to engage, we might have learned more of what he had to offer in ways that would have challenged us and given our own embryonic careers direction. 

It is also true that he might have been too overwhelmingly engaged in other activities to be part of such a curriculum. Although he was only in his mid 50s when he came to the Sophie Davis School, he had already traveled to South Africa where he had studied their community health centers. He then brought this approach to the Mississippi Delta, sparking a movement that is credited with bringing basic health care access to tens of millions of Americans. At the same time, he was co-founding two Nobel Prize winning organizations, Physicians for Human Rights and Physicians for Social Responsibility. Sometimes, role models must be just that and nothing more; they have work to do and we should watch from the sidelines and take notes.  

The “writing prescriptions for food” lecture 

Every year, we gathered for the same “Geiger Lecture,” where he told the story of his work in rural Mississippi. The most memorable section was when he described the political battle into which he was drawn when funders realized that the program was writing, and then the federally subsidized community health center pharmacy was filling, prescriptions for food.  Every year he delivered the same punch line, describing how he won the battle. “I told them,” he said, “the last time I checked my textbooks, the specific therapy for malnutrition was, in fact, food.” 

I am ashamed to say that my classmates and I rolled our eyes at this story, much like children sigh at the Thanksgiving table when Grandpa tells the same stories every year. But these stories are our legacy and, at the risk of boring the children, it is through the frequent retelling of these “hero stories” that communal values are transmitted. Of course, now I want to know more. Was he scared or anxious when he need to confront those with the authority to stop his important work? How had he prepared? What would he have done if they had pulled the funding? I would have wanted to hear about his failures and how he delt with those. But now I cannot. 

When my son was little, he was absolutely enthralled with superheroes (still is, I think). Batman and Superman costumes were festooned throughout our home, red capes and black masks everywhere. Through our many conversations about the thoughts and feelings of his role models, we landed on the conclusion that it was easier to know what the right thing to do was than to actually do it.  Our maxim became, “courage means being scared but doing the right thing anyway.”  It would have taken courage to reach out and insisted that H. Jack Geiger talk with me, but the privilege to have known him better would likely have been worth the effort.  

I will be reaching out more and connecting with my heroes. And the Kern Institute will do what it can to create proximity with the “s/heros” of our times, to the benefit of our students, our trainees, and ourselves.  

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Poetry by Rhea Martin - Dear America

From the 4/16/2021 newsletter

Poetry

Rhea Martin

Dear America

I wish I felt loved by you.
I wish I felt safe being with you.
I wish I could trust the promises of hope and progress you keep saying will come.

Like any love
It is not perfect 
There is beauty as well as sorrow 
To give unconditional love means to have trust
I wish I could trust you America
But I can’t 

and what’s worse 
Is that it breaks my heart to see that people are trying
beautiful, strong, devoted people fight for you
And maybe I’m not strong enough to give 
That trust

That doesn’t mean you are hopeless
Or less beautiful and vibrant and passionate 
Nor is anywhere else going to be perfect
I’m not naive to expect more than what can be given within the current climate 
But maybe we just don’t fit 
and that’s ok
I wish nothing but the best for you

To the man who almost ran me over today
Who didn’t stop
Who didn’t look back 
To the witnesses who walked away 
To the police that drove around my neighborhood pretending to look out for the community

How dare you have the audacity to put the words “Black Lives Matter” in your yards
and in your windows 
and bumper stickers on your cars

To the one POC who witnessed what happened and gave me a ride home and said
Thank you for doing the decent, human thing

“Thank god you had good reflexes”

I know it is not a crime to be 
A women
Queer
Or Black

But America

Stop gaslighting me 

America

Being with you it’s like being with an alcoholic
I don’t know whether to be pessimistic or optimistic that recovery is in your future
There are so many programs and so many resources
Your casual slurs and liveliness at parties used to be fun
And I know I can be easily accused of not being virtuous enough to see you through and see you get better
I feel like it is on my back to make it my responsibility for you to get better

You have made it so many people's responsibility to call you out on your history and your lack of transparency of your habits habits you keep and how you destroy communities
But you are like my family
I would not be who I am without you
To have criticism does not mean I don’t see you for who you are
More
So much more than a simple word 
A moment 
A feeling 
I get so mad when others treat me better
Because I want to feel that love and acceptance 
from you

Show me I can believe in you
I want to trust you 

I want to walk down the street and feel safe
As a queer
Black 
Women
I google, safest places to live In America
Then I remember 
Back space 
Safest places for black queer women to live in America
Because there is a difference

Am I the problem
And I the problem in this relationship?
You shrug your shoulders
And I guess it depends

What am I wearing 
Where are you from
Did I say what I said the right way
Do I care too much?
Are you on your period?
Are my standards a little bit too high

I don’t know
But I’ll keeping working on things that are in my control
I am still standing today
I know about us right now, let’s take a break

Rhea Martin is a Public Ally with Public Allies MKE and an Intern with the MCW Office of Diversity and Inclusion. Rhea reflects on their relationship with America as a queer person of color. This work was shared during the Spring 2021 MedMoth event at MCW. 

‘Take 3’ Question and Answer: Report on a Human-Centered Design Sprint for the MCW Curriculum Re-imagined

 From the 4/16/2021 newsletter

  MCW Curriculum Re-imagined

 

‘Take 3’ Question and Answer:  Report on a Human-Centered Design Sprint for the MCW Curriculum Re-imagined

Dr. Wendy Peltier and second year medical student, Lauren Stippich, share their experience from participating in the first Virtual Design Sprint Workshop on the proposed MCW Curriculum, sharing perspectives through the eyes of a student and senior faculty.

 

The Kern Institute’s Human-Centered Design Lab facilitated a virtual design sprint last week with 77 participants, representing students, faculty, residents and staff from across our MCW community.  Amy Prunuske, PhD, and Travis Webb, MD provided a high-level overview of the key principles of the proposed curriculum, which involves development of learning communities and implementation of longitudinal, case-based and experiential teaching formats for foundational knowledge. The design sprint, led by Karen Marcdante, MD, Chris Decker, MD, and Julia Schmitt, provided an opportunity for participants to work in small groups to provide in-depth feedback on the curriculum proposal. This format ensured that every participant’s feedback was recorded, and all the information  has been qualitatively organized for the Curriculum Steering Committee’s use.   

The curriculum proposal would involve a major shift from our current, ‘2 by 2’ structure of separating basic science course work from clinical rotations. A potential timeline for approval, and detailed summary of background work over the last two years leading up to this proposal was provided. Dr Webb and Pronuske shared, ‘The goal of our curriculum is to produce competent well-rounded physicians who will be excellent clinicians in any specialty and are prepared to practice in the future health care environment’.

They acknowledged the contributions of many in developing this proposal, including Bill Hueston, MD, Jeff Amundson, PhD, and Jennifer Hinrichs.

 

1) What surprised you most about the session?

Lauren:  I was shocked by the high emotion from many of the participants! As students, we only see the ‘end product’ when a curriculum has been implemented, and I did not appreciate all the pre-work and planning that stands behind our course offerings.  It was eye-opening to hear the various worries and hesitations of key faculty for embarking on such a major change in teaching formats.  Frankly, it worried me that some of the comments seemed to go a bit too far, and without recognition for the immense amount of work that went into this workshop and the proposal itself .  This was my first time being part of such a broad group, and I quickly saw how important it will be to have buy-in from all our stakeholders to implement this change.

Wendy:  Must say, I anticipated the high emotions, having been at MCW during  the transition to the Discovery Curriculum, and from my experience with change management.  Hearing the plans for the first time in considerable detail, I was surprised and excited about the spirit behind bringing this new, student-centered approach to adult learning that is explicitly tied to promoting inquiry and innovation in our learners.

 

2) Did you feel your voice was heard?

Lauren:  The small group process really created an authentic, ‘safe space’, to both talk and listen, and we had enough time to review things in detail.  There was a basic science faculty in my group, and I developed an understanding for concerns that previously I did not appreciate even existed.  Some participants complained that the breakouts were too small with only three members each, stating they wanted to hear more opinions, but I understood the rationale behind this.  It is so important to hear all perspectives, and smaller sized groups help to ensure the collected conversations are representative of everyone, not just the most vocal members of a group.  This seems even more important in the virtual setting.  Being part of the workshop planning group, I also saw how the detailed feedback would be gathered, allowing the program leaders to have a full appreciation of all concerns.

Wendy:  My experience echoed Lauren’s.  The more ‘intimate’ breakout sessions created opportunity for in-depth discussion of the guided questions.  It was important to hear both the excitement for a new structure, but also concern and worry over the ‘heavy lift’ involved in implementing such a major change.  A strong theme that came through was need for culture change and to explicitly identify ways to honor educators in our community with protected time and recognition for teaching AND administrative efforts.

 

3) As we reimagine the MCW curriculum, what do you see as important     measures of success?

Lauren:  The new curriculum really excites me, particularly in the thoughtful and deliberate structures that promote student connection and support, as well as the spiral or ‘catch-up’ weeks, where students can take a breath, or refine and review important topics.  As a second year student, I can reflect on what a huge transition it was to enter medical school, and how the 4C Coaching program provided amazing support during this challenging time. I consider my participation in this program the most impactful activity of my M1 year—and I can see how the learning communities and small group activities will help that shine through in the new curriculum.  I would hope that students being more connected, and the environment continuing to be collaborative rather than competitive, despite our large class size, could be key outcomes. After participating in this workshop, I would also hope that all the faculty who contribute to teaching will feel supported, prepared and confident in launching the new changes.

Wendy:  My hope for success would first be a true, institution-wide, commitment to change with resources to manage the transition.  Success will be tied to students and faculty learning together, and for many of us, stepping outside our comfort zone.  The evidence behind the need for change, which is robust, indicates that this will be a much needed and important investment in preparing our graduates for future practice.  This year has certainly been one that highlights the challenges to our profession and current health delivery systems.  To me, training physicians who are prepared to speak up when needed, to care for themselves, and to seek innovation in their daily work, is something to promote and support.

To learn more about the MCW Curriculum Re-imagined and Human-Centered

Design:

1. Discovery Curriculum Exploration Project

2. Human-Centered Design Lab

 

Lauren Stippich is a Wisconsin native currently in her second year of medical school with interest in medical education and the Humanities.  Lauren is a student member of the Human-Centered Design Lab and this was her ‘first dive’ into a curriculum re-design process.  In her free time, Lauren enjoys reading books, time together with friends and a good game of spike-ball.

Wendy Peltier, MD is an Associate Professor of Neurology and Medicine, in the Division of Geriatric and Palliative Medicine at MCW. She is also a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. In her free time, she enjoys yoga, reading books and home-cooked meals by her husband and son.

Opening the Drawer

From the 4/16/2021 newsletter

Medical Humanities reflection

Opening the Drawer

 Amy Domeyer-Klenske, MD

Dr. Domeyer-Klenske write about how engagement in the humanities makes students and residents better doctors, active listeners and more resilient humans …

I have long been interested at the intersection of humanities and medicine and felt challenged in my efforts to braid them together. I recall my enthusiasm to become a Doctor/Writer when I was a medical student and had an opportunity to interact with physician authors at the Examined Life Conference, held annually at University of Iowa. In one of these conversations, I was told I could put my writing interest in a metaphorical drawer during residency. I could allow myself to focus intensively on my training with the plan to re-open the drawer when I’d completed training. I left the conversation feeling a sense of freedom; I didn’t feel guilt or pressure to be too many things at once. Instead of Doctor/Writer I could just be Doctor.

I proceeded throughout my training giving little thought to writing. I’ve since reflected on this advice and my decision to follow it. I’m certain that I write less now than I did as a student. I wonder if something was lost in the drawer, if recovering interests becomes more difficult the longer they are locked away. 

I had the opportunity to share this advice and discuss strategies for remaining active in the humanities with Dr. Zack Schoppen, an OB/gyn resident, and a group of students during the M4 Humanities Elective on March 24, 2021. 

We discussed how the metaphorical drawer can be freeing when we are stressed. Alternatively, we discussed the option of planned engagement and disengagement where we use our time to actively check in on our humanities interests (writing a poem or an essay, reading a novel) but also allow ourselves time to actively “check out” (binge-watch television, nap, spend time with family and friends). The second strategy allows ongoing engagement, but on our own terms. 

This conversation refreshed me. I hope it did the same for our students. Inevitably, becoming a “good doctor” isn’t solely about how many articles you read or how much time you spend in the hospital. Engagement in the humanities can make us better doctors, active listeners and more resilient humans.

Amy Domeyer-Klenske is an Assistant Professor in the Department of Obstetrics and Gynecology at MCW. 

Holding a Virtual Storytelling Event: MCW’s MedMoth

From the 4/16/2021 newsletter

Holding a Virtual Storytelling Event: MCW’s MedMoth

Scott Lamm - MCW-Milwaukee Class of 2022

Mr. Lamm is one of the student leaders of MCW’s MedMoth, a live storytelling event inspired by The Moth and Milwaukee’s Ex Fabula. He reviews the most recent gathering and looks toward the future … 

One year ago, I had no idea how we could make MCW’s MedMoth storytelling event virtual. While yes, storytelling can be accomplished on various platforms, I struggled to grasp how we could take an intimate night of face-to-face interaction and connection and build the same atmosphere from the comfort of one’s home. It was a task, though, that the MedMoth team was prepared to undertake to continue the program.

In the runup to the main event, we held two virtual workshops facilitated by staff at Ex Fabula, a Milwaukee-based storytelling community. Working with other participants, our storytellers developed their narratives and honed their presentation skills. 

What we witnessed on April 8, 2021 was a celebration of stories connecting faculty, residents, staff, and students alike in ways we couldn’t have even imagined. We had eight wonderful storytellers sharing accounts ranging from how they bonded with the supply robots at Children’s to responding to a horrific trauma event as an EMT. Each storyteller brought their own experience and vulnerability on journeys that were both familiar and astonishing. 

About sixty people were in attendance from all aspects of healthcare and all points of the training spectrum. It was absolutely incredible to see a virtual group so engaged in everyone’s stories and, hopefully, they left wanting more. As we believe that there is intrinsic value to these types of narrative opportunities, we gathered data from both the participants and the audience on their experiences. 

As we continue to build the MedMoth program, we hope we can inspire more storytellers and listeners as each of us have a story to tell. It’s just a matter of when will you share it.

Please feel free to follow MCW MedMoth on Instagram (@mcwmedmoth) for updates on future events. We will be back in the Fall with more workshops and storytelling events. If you have any questions or would like to join our team, please feel free to reach out to me (Scott Lamm) at slamm@mcw.edu.

MedMoth is graciously sponsored by the Kern Institute. We would like to thank the entire institute for its continued support.

Scott Lamm is a third-year medical student at MCW-Milwaukee. 

“Ah! Bach!” and other Confessions of a “Humanities in Medical Education” Cynic, Converted

From the 4/16/2021 newsletter

Director’s Corner 

“Ah! Bach!” and other Confessions of a “Humanities in Medical Education” Cynic, Converted

Adina Kalet, MD MPH

In this Director’s Corner, Dr. Kalet admits to her own early arrogance about the introduction of the humanities in medicine and challenges us to find a rich and inspiring way forward using a character and caring framework …

Did you know that M*A*S*H, the comedy-drama television series that ran on CBS from 1972 to 1983 and based on a movie of the same name, is one of the most highly rated US television shows in history? For the few who are unfamiliar, this remarkable ensemble piece told the fictional story of the 4077th Mobile Army Surgical Hospital, in Uijeongbu, South Korea, during the Korean War (1950–53). It ran for eleven seasons, spanning the final years of the Vietnam War and into the Cold War. There were 256 thirty-minute episodes. It was a literal modern War and Peace. As does most great art, M*A*S*H grappled with the most controversial political and humanistic issues of all times. The theme song, “Suicide is Painless,” is an indicator of how deeply philosophical the writing was, and how accessible the insights. In my estimation, it is the best medical drama ever written and performed. To each his/her own, right? 

For me, a child of the 1960s and 1970s, M*A*S*H was formative. I wanted to be “Hawkeye” Pierce. Even though he was a womanizing, sarcastic, sometimes cruel practical trickster, he was also an artfully skilled, lifesaving, courageous, compassionate, and empathic physician and colleague. I was drawn to his deliciously complex character - both in the theatrical and philosophical sense - and strong moral presence. In one of my most memorable episodes, Hawkeye gives seduction advice to Walter “Radar” O’Reilly, the eerily perceptive, dewy-eyed, camp administrative savant, farm boy from Ottumwa, Iowa. Hawkeye coaches him on how to fake his knowledge of classical music to win the affections of a nurse (nurses were all women) in camp by saying “Ah! Bach!” with a dreamy look and expressive hand motions. The superficiality of the gesture has me on the floor laughing even now. Will they stop at nothing to get the girl into bed?

This represented how I felt, as a medical student and resident about the rather clumsy early efforts made by medical educators in the 1980s to seduce medical students into self-awareness through incorporating the “arts and humanities” into medicine. 

Not every humanities experience is meaningful for medical students 

Curricula which required engagement with selected works of art to view or read without much guidance or structure, felt like a manipulative and superficial ploy to get me to feel something I did not (or would not) and do something I could not yet do. I am not proud of this; I know now I was wrong. I was young and insecure. But it is still a common point of view of trainees. 

As Art Derse shares in his history of the humanities in medicine at MCW I, too, have occasionally heard students say, “I didn’t come to medical school to read poetry (insert: write stories, look at art, or watch movies).”  I think that these students are right and, yet, deeply wrong. 

They are right because medical training is hard enough and – given the great variation in how each of us prefers to access our own humanity, empathy and compassion – being required to engage with a particular work of art is too vague. Students who hold this view are deeply wrong because they misunderstand the point of the exercise. 

I personally have great difficulty connecting with poetry. For me, it is hard work and, therefore, not entertaining enough. But, of course, I now know I must do the hard work to reap the most profound lessons the humanities have to offer. And it is almost impossible to do this work on our own. We need facilitators and guides. The work of art is just the “trigger” for reflection, a starting point to get oneself to challenge assumptions, see the wart’s, face the fears. This is both hard work and not guaranteed to lead to the intended learning. 

“If you haven’t read Thomas Mann’s Magic Mountain you should not be allowed to be a physician!” 

I heard this repeatedly from one of the most erudite and revered clinicians in my department in New York City in the 1990s. What he meant to communicate was that physicians should read great literature in order to develop empathy for and access to the deepest, most complex and conflictual aspects of the “illness experience.” But what he said and represented, sounded crude, insensitive and, frankly, terrifying to my modern ears. Would this powerful man really limit access to the profession based on this one book? I believed he would. I tried to talk with him about it many times. He dismissed my concerns and was openly derisive when I insisted that we focus on skills building and personal reflection as a path to ensuring all physicians have the communication skills – including empathy – to elicit the patient’s story and to build a therapeutic rapport. He absolutely despised any mention of Standardized Patients (SPs). He felt – without any direct experience, by the way - that using professional actors trained to portray patients, assess trainees’ communication skills, and provide them feedback was “fake” and manipulative. 

Given his great love of using the arts to instill empathy, this perplexed me. In my experience, SPs are highly disciplined artists willing to engage with our trainees to ensure that all patients have caring and competent physicians.  He also dismissed my choices of “great” literature, which ran more toward Toni Morrison, Alice Walker, Margaret Attwood, Jamaica Kincaid, Alice Munro, Marilynne Robinson, Tillie Olsen, Virginia Woolf, than toward Thomas Mann (as of a month ago, I have yet to get past page 300 of Magic Mountain. I am still struggling, though). And this was the leader of our Humanities in Medicine program. 

Initially, I rebelled. We needed more than simply a trigger for deep thought that was unguided and self-congratulatory.  Over the years, with many pedagogical advances and an openness to a broader range of humanities, my view has softened. My colleague was a man of his times; what other choice did he have? But we must make other choices, expand the canon, and make use of the humanities to open our minds and hearts. Not easy.   

So, where do we begin?

This past Sunday morning, my husband left the New York Times on the table opened to the Op Ed entitled “A Once-in-a-Century Crisis Can Help Educate Doctors.” I “girded my loins,” ready for a diatribe, another “humanist” telling us in medical education what we must add to an already overwhelming experience of medical training. 

But I was relieved. In this piece, Molly Worthen, a historian at UNC-Chapel Hill who writes about higher education, points out that the pandemic has given us an opportunity to transform medical education because it has forced health professionals and medical schools to look beyond the particulars of modern medicine and think more broadly about how we prepare doctors. She says, and I agree, that COVID has provided us “a pilot project to demonstrate that the humanities are an essential part of what a medical education should be — not just a luxury, but foundational.” 

She celebrates the strides we have made away from the early “humanities in medicine” days of museum visits and the “great novels,” as we move toward a true integration of the humanities at many medical centers and in many programs. The humanities force practitioners to be clear eyed even as they evaluate seemingly empirical data. “Humanists take evidence so seriously that they emphasize viewing it from multiple vantage points and recognizing one’s own limited perspective.”  

Worthen finishes, reminding us all of where we began our medical journeys days, years, or even decades ago. She says our students “grasp intuitively that medicine is not a science but an art that uses science as one of many tools.” 

Embracing Ambiguity

There is so much work to do. In this and in the last issue of the Transformational Times, we have highlighted the many ways these efforts are happening at MCW and beyond. Despite this, there is no clear path to integrate the humanities into medicine. Yet, maybe not knowing exactly how, yet embracing, the ambiguity of that task will bring us closer. Maybe that is the point. Ah! Bach!

In his own way, even Hawkeye knew that the humanities were important while working in the M*A*S*H unit. He once told an interviewer that he brought every single book ever written in English with him when he was sent to Korea. How? Well, he responded, “I brought the dictionary. I figure it's got all the other books in it.” Not a very high brow answer for a man named after Benjamin Franklin and nicknamed after a character from James Fenimore Cooper’s The Last of the Mohicans. I can’t say I agree with everything Hawkeye said, but this, at least, was right on target.  

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

The MCW Medical Humanities Program and Medical Education - Where We’ve Come, Where We’re Going

From the 4/16/2021 newsletter

The MCW Medical Humanities Program and Medical Education - Where We’ve Come, Where We’re Going

Arthur R. Derse, MD, JD FACEP - Director of the MCW Medical Humanities Program.


Dr. Derse describes the development of medical humanities in medical education at MCW, including the MCW Medical Humanities Program...

Recently, the London newspaper, the Daily Telegraph, announced breaking news that according to research published by the Royal Society of Medicine, “Shakespeare should be included in training for medical students so they can improve their empathy towards patients.” The medical journal article showed how by studying William Shakespeare’s insights into humanity, physicians could learn to empathize better with patients.  

This should come as no surprise to physicians who have read or revisited any of Shakespeare’s works – or to anyone familiar with the growing body of evidentiary support for the benefit to physicians and medical students of utilizing various forms of medical humanities.

The Journey to Medical Humanities in the MCW Curriculum

As an English major, I knew literature and poetry could open vistas of insight, and knew that physician-essayists such as Lewis Thomas, physician-storytellers such as Richard Selzer, and physician-poets such as William Carlos Williams, had important experiences of their lives as physicians and scientists to share. Robert Coles, MD, had written about using stories in teaching, engaging what he termed, “the moral imagination.” But 25 years ago, though every medical school had some instruction in medical ethics, medical humanities programs were rare, and the body of evidence for its use in medical education was more aspirational than established. 

In 1996 I added poetry and nonfiction essays to the M2 Medical Ethics and Palliative Care course that I directed (over the misgivings of my co-director who understandably had doubts about their usefulness in medical education). The student feedback about the benefit in helping them better understand medical ethical issues was positive for a supermajority, with the remaining either bemused or negative. One student wrote, “I didn’t go to medical school to read poetry.” Point taken. Nonfiction and fiction narratives are more straightforward instructional techniques, though poetry such as Raymond Carver’s “What the Doctor Said” has its place in medical education. 

I presented the results at a national bioethics and medical humanities conference, and received encouragement from fellow medical ethics and humanities teachers, so with this arguably auspicious start, I was on my way.

Fortunately, due to a confluence of factors, the time was right at MCW to solidify efforts to introduce and expand medical humanities. The Department of General Internal Medicine had a monthly newsletter, Grapevine, with contributions of essays from faculty and residents, edited by Jack Kaufman, MD, that ran from 1989-2001. Several faculty had strong interests in the humanities and had begun various initiatives including Herbert Swick, MD, who worked with students to publish the first issue of Auscult, the annual literary publication, and Richard Holloway, PhD, who became its publisher and was instrumental in the launch of the white coat ceremony and MCW’s Gold Foundation humanism awards. Ruric (Andy) Anderson, MD, and David Schiedermayer, MD, started an M4 elective in medical humanities in which I taught. Julia Uihlein, MA, who taught bioethics, was impressed by the medical humanities program established at Northwestern. When Dr. Anderson moved from MCW, he asked me to assume leadership of the M4 elective, which I did with Ms. Uihlein’s help. She and I received a grant to launch a formal program in medical humanities. We met with directors of 4 leading medical humanities programs to learn about them: Rita Charon, MD, PhD, at Columbia, Kathryn Montgomery, PhD, at Northwestern; Audrey Shafer, MD, at Stanford, and Ann Hudson Jones, PhD, at the University of Texas Medical Branch.

A Formal MCW Medical Humanities Program is Launched with Cornerstone Curricula 

In 2006, Julia Uihlein and I launched the MCW Medical Humanities Program, dedicated to the goals of professionalism, communication, empathy and reflection, with the support of MCW leaders President T. Michael Bolger, JD and Dean Michael J. Dunn, MD. The program sponsors, supports, and affiliates with curricular and extra-curricular initiatives at MCW.  The cornerstones of the program are the founding medical humanities courses in the MCW curriculum. 

The M4 Art of Medicine through the Humanities course, now in its 22nd year, features seminars by faculty on aspects of medical humanities including essays and stories (both non-fiction and fiction), medical history (and the history of MCW), sociology, anthropology, and other subjects related to medical practice and personal health, including advocacy, careful observation and mindfulness. Students examine creative works such as artwork, films and plays, and engage in creative processes in music, painting, improvisation, and photography. Artistic experiences in the course include trips to the Milwaukee Art Museum, the Milwaukee Symphony Orchestra, the Milwaukee Repertory Theater, and the Milwaukee Institute of Art & Design. The students also create individual final products for presentation and publication with guidance from Chris McLaughlin, an editor and writer with experience in medical journal publication.

The course has 44 faculty seminar presenters from MCW, Milwaukee and beyond – the stars in our MCW Medical Humanities constellation. Dr. Anderson, Dr. Schiedermayer, and former medical students, Dr. Brittany Bettendorf and Dr. Elizabeth Fleming return from out of town each year to teach in the course, and Dr. Holloway returns to teach remotely.

Ms. Uihlein and I were trained in 2007 to become directors for the M1 Healer’s Art course that we introduced to MCW, now offered in all 3 of our campuses as well as in the majority of medical schools. Founded by Rachel Remen, MD, at UCSF, the elective course advances wholeness, compassionate listening, self-care and service. Julie Owen, MD, MBA underwent training and has recently assumed the associate course director role on the Milwaukee campus. Erin Green, MD, leads the Green Bay course, and Linda Bluestein, MD, leads the Central Wisconsin course.

Our MCW Medical Humanities Program also established an annual medical humanities lectureship. When physician-writer Abraham Verghese, MD, inaugurated the MCW Medical Humanities program in 2006, he told our audience that the doctor-patient relationship should be at the center of the goals for medical humanities.  Academic analyses were fine, but ultimately what mattered was caring well for patients.  Since his inaugural address, many prominent figures in medical humanities have given us insights and encouragement in our journey, including physician-writer Danielle Ofri, former U.S. poet laureate, Ted Kooser, Anne Fadiman, author of The Spirit Catches You and You Fall Down, Arthur Kleinman, MD, director of Harvard’s medical humanities program, physician-poet Rafael Campo, MD and Richard Kogan, MD, psychiatrist and Julliard-trained pianist.

Arthur Kleinman gave us valuable advice. He told us that it is very easy to begin medical humanities initiatives with enthusiasm, but the hard part was keeping them going year after year. We are fortunate that our 2 cornerstone humanities electives have withstood that test now for decades. 

Initiatives and Partners in the MCW Curriculum 

We worked with Bruce Campbell, MD, who had already been writing essays for publication, to offer curricular opportunities in reflective writing and creating residency application statements, as well as in creating the M4 Narrative Medicine and Reflective Writing elective. Dr. Campbell, who completed his certificate in narrative medicine and has been part of our initiatives from early days, and has created and led new ones, became associate director of the MCW Medical Humanities Program after Julia Uihlein retired in 2019. We worked with Carlyle Chan, MD, to offer MCW Muses, a daylong celebration of the arts and humanities that ran for over a decade and expanded a lectureship for bioethics that his family donated to our Center to include medical humanities.  We also offered additional lectures in medical humanities, supported by a gift from the Class of 1956.

The medical humanities have been integrated into our MCW Scholarly Pathway in Bioethics and Medical Humanities for M1s, M2s and M3s that Cynthiane Morgenweck, MD, MA and I direct. Our pathway reflects a national trend of medical school scholarly pathways that combine medical ethics with medical humanities, as has been done at Stanford, Brown, and Johns Hopkins. As an example, students from our pathway spearheaded the recent revision of MCW’s Oath recited at medical school graduation and wrote an academic article about the rationale and process. 

With course directors, I worked to incorporate medical humanities topics and techniques into the Medical Ethics, Law and Medical Humanities Curricular Thread in the MCW Discovery Curriculum, including M1 Clinical Human Anatomy, M1 & M2 Bench to Bedside, M2 Foundational Capstone, M3 Continual Professional Development, and M4 Capstone courses. K. Jane Lee, MD, MA and Ellen Blank, MD, MA worked with others to introduce a technique called the Reader’s Theater to educate students about pediatric ethics issues. 

Mary Ann Gilligan, MD, MPH and I, with grant support from the Macy Foundation and the Gold Foundation instituted a national multi-institutional curriculum for faculty to advance their teaching of humanistic behaviors to our trainee and students, including caring and communication. 

Theresa Maatman, MD, instituted a graphic medicine (i.e., medical cartooning) course as an M4 elective. Teresa Patitucci, PhD, and Jeff Fritz, PhD, instituted written reflections as part of the M1 Clinical Human Anatomy course.  Recently added modules in MCW’s curriculum include 2 programs that I had the privilege of mentoring through the Kern Transformational Ideas Initiative (TI2): Visual Thinking Strategies led by Valerie Carlberg, MD, Stephen Humphrey, MD, and Alexandria Bear, MD, and Medical Improv, led by Erica Chou, MD, and Sara Lauck, MD. These initiatives from emerging educational leaders are indeed transforming our curriculum through the use of medical humanities. 

Other MCW Medical Humanities Program Resources

The Medical Humanities Program is also the home of MCW’s Chapter of the Gold Humanism Honors Society, and we partner with MCW President and CEO John R. Raymond, Sr., MD, to select and award the annual President’s Prize in Creative Medical Writing, and partner with the library on the selection of books and journals for MCW’s Julia A. Uihlein Bioethics and Medical Humanities Library. 

Extracurricular Opportunities

At this time, a student entering the Medical College of Wisconsin has many required sessions and an array of elective opportunities in medical humanities.  These are supplemented by an even wider choice of extracurricular offerings in medical humanities, such as the Moving Pens (our MCW writers group for students, trainees and faculty), the Physicians for the Arts, the Medical Humanities Student Interest Group, the MCW Common Read, MedMoth, the MCW Art Club, the MCW Orchestra, Chordae Harmonae, Kaleidoscope, and the newest addition, the Virtual Medical Humanities Journal Club. 

Transformation and the Path Ahead

With the Kern Institute’s focus on competence, caring and character, a new exploration of medical humanities can be used to help to advance these goals. For instance, Visual Thinking Strategies can enhance competence in diagnostic skills. Medical humanities approaches help advance empathy and compassion, essential for the humanistic caring of patients that Abraham Verghese proclaimed (as did Francis Peabody, MD, a century ago). 

Virtue-based character strengths, such as creativity, curiosity, perspective, perseverance, equanimity and practical wisdom, so necessary to our professional identity formation, may be advanced through medical humanities.

The Kern Institute’s Philosophies of Medical Education Transformation Laboratory (P-METaL), led by Fabrice Jotterand, PhD, MA will be examining ways that techniques such as narrative and attention to the philosophical foundations of the practice of medicine can advance vital character strengths based in virtues.

As MCW engages in transformation of its medical school curriculum, opportunities will arise to incorporate medical humanities in the fabric of the cases and integrated illness scripts that may be the core of the new curriculum. 

The AAMC and others have recognized that medical schools need more incorporation of the medical humanities to educate physicians who will be empathetic and compassionate in their care of patients, who communicate well with them, and who understand their professional obligations.

MCW has joined the more than fifty medical schools with a formal program in medical humanities. Whether writing reflections on essays about patient encounters, carefully observing art to build observation skills, or reading Shakespeare to deepen empathy and compassion, medical humanities has been an essential part of medical education at MCW for over a quarter of a century. The MCW Medical Humanities Program will continue to sponsor, work with, and support those who integrate medical humanities in the curriculum for year to come.

Arthur R. Derse, MD, JD FACEP is Julia and David Uihlein Chair in Medical Humanities, Professor of Bioethics and Emergency Medicine, and Director of the Center for Bioethics and Medical Humanities and Founding Director of the MCW Medical Humanities Program. He is faculty in the Kern Institute for the Transformation of Medical Education.

Changing the Curriculum: How Adding a Narrative Assignment Increased Empathy and Connection with People Unlike Ourselves

From the 4/9/2021 newsletter

Perspective/Opinion

Changing the Curriculum: How Adding a Narrative Assignment Increased Empathy and Connection with People Unlike Ourselves

James Warpinski, MD – MCW-Green Bay

Dr. Warpinski’s M2 course brings medical students into contact with people and groups with whom they might never have before interacted. By adding a narrative assignment, students found new and remarkable connections …

I am the course director for an M2 Course on Continuous Professional Development at MCW-Green Bay. Through personal experience, I have found narrative medicine very helpful in improving my understanding of the individual patients. Writing sharpened my observation skills and forced me to pay closer attention to the nuances of the patient’s words, dress, and actions. 

Our course addresses the knowledge, skills, and attitudes needed to improve the health care experience of older adults, persons with disabilities, and those from non-majority groups. In earlier years, these topics were covered with lectures and slide presentations provided by a professional representative of these groups. This approach strengthened the students’ knowledge but didn’t necessarily impact their attitudes or skills. 

To counteract this, the curriculum needed to change. Preparation for the session covered much of the session’s information and challenged the students to consider potential biases and attitudes. The professional speaker’s remarks were shortened and individual members of the patient groups were recruited. The sessions became highly interactive with guests and small groups of students having face to face conversations. The guests shared deeply personal details of their lived experiences with providers and the health care system. Students were then required to submit a short reflective writing piece based on one of the course sessions.

This kind of writing comes more naturally to some students than others, but each essay offers the opportunity for the student to describe learning something new about themselves or their patients. Some students described being moved to tears by the experience of meeting these individuals face to face or how the experience challenged long-held beliefs about these patient groups. Several wrote about how these patients helped them better understand their own family members with disabilities. A few students wrote poems capturing some detail of the session while others reflected on the nature of the physician-patient relationship. 

Regardless of the specific form of their reflection, the students are able to see and hear their patients in deeper ways, and learn about themselves in the process.

James R Warpinski, MD is an Adjunct Assistant Professor and CPD course director at MCW-Green Bay. 

Integrating the Humanities into Medical Education

From the 4/9/2021 newsletter

Editor’s Corner

Integrating the Humanities into Medical Education

Bruce H Campbell, MD FACS - Transformational Times Editor

Dr. Campbell writes about how building observational and representational skills through the humanities translates into more empathetic and effective patient care …

Stories are the primordial means through which we make sense of, and convey the meaning of, our lives.

- Rita Charon and Craig Irvine

 My medical student group gathered to debrief and discuss their very first experiences observing physicians caring for patients.  One student presented a case of a teenager she saw in her clinical mentor’s office with mild muscle aches. This teen had a couple of relatives who were afflicted with a rare, devastating inherited disease. The boy’s few vague symptoms could, possibly, represent the disorder’s very earliest manifestations. Or the symptoms might be nothing, at all.  

“What did you decide to do?” I asked. 

“We told him to exercise and take Advil. We also ordered genetic testing and asked him to come back in a few weeks to check the results.” 

 “Thanks. That was a very complete presentation,” I responded. “Does anyone have any questions?” Someone wanted to know more about the genetic testing. Someone else asked about other potential diagnoses. We discussed those. 

“A couple more questions,” I said. “Did the doctor find out how all this might be affecting the young man? Is he aware that he might have the same disease his relatives have? What’s do you think is going on inside his head?”   

The student’s eyes widened. “I don’t know. We didn’t ask.”

I could not help but wonder whether the students might have been more curious about this teenager’s underlying story had they heard it a few months before they started medical school instead of a few months after. 

Empathy levels will decrease. How soon does that happen? 

As a profession, we lose our “vicarious empathy,” or our ability to have a visceral empathic response to another person’s stressful experience, very early on. A 2008 study from the University of Arkansas for Medical Sciences (UAMS) demonstrated significant drops in empathy during medical school, especially during the first and third years. Men (like me) who chose surgical specialties had the greatest loss of vicarious empathy. 

Of course, no one plans to jettison their empathy along the way from being a normal person to becoming a physician. The losses likely occur as we seek to model ourselves after people who are a step or two ahead of us along the path. When I talk to first year students in MCW’s Healer’s Art course, they all affirm that they will listen to their patients, think first and foremost of the patient’s well-being, and always act with justice and equanimity. Yet, some would not recognize the people that they will become once they emerge, transformed, from residency a few years later.

Professionalism vs. Humanism

How do we address this nearly imperceptible transformation from empathic lay person to crusty physician? 

One way is to reflect on the values of both “Professionalism” and “Humanism.” In medical schools, we strive to nurture professionals, which we might define as “physicians with attributes, skills, and demeanors with which they will practice high-quality medicine with integrity and empathy.” This is, of course, an admirable goal. “Humanism,” on the other hand, is broader than professionalism. These are the qualities we hope every physician brings to the table from childhood and that must be nurtured and enhanced, not lost, throughout the process of becoming a physician. 

This is where integrating the humanities into medical education and training comes in. 

Broadly defined, the medical humanities are interdisciplinary endeavors that draw on the creative and intellectual strengths of diverse disciplines, including the humanities, social science, and the arts in pursuit of becoming a good physician. They tap into literature, art, creative writing, drama, film, music, philosophy, ethical decision making, anthropology, and history. It’s basically the intersection of Medicine with Everything Creative. The goal is to draw on the humanities to expand a physician’s capacity to be humanistic, compassionate, and empathetic. 

Think of an example from your own life: 

Remember a novel you read and loved in high school. If the narrative grabbed you, you dove into the protagonist’s story and couldn’t put the book down. You didn’t worry that you “cared too much” for the protagonist or their struggles. You actively attempted to understand what each character was thinking, and you figured out why they did the things they did, even when their actions might have seemed, at first, inexplicable. Your heart rate soared when you anticipated danger and you wiped your eyes when they suffered. Your blood boiled when they were betrayed. When you finished the book, you encapsulated the arc of the story and shared it with your best friend. You paid attention to the story. You were able to retell it to others. It changed you. 

Ideally, as physicians, we should be similarly curious and fearless as we delve into our patient’s narratives. We safely encountered narratives in the library. We should be able to do it at the bedside, as well.  Right?

Yeah, but does reading a novel really make me a better doctor? 

It does, actually. In an 2013 article in Science entitled, “Reading Literary Fiction Improves Theory of the Mind,” the authors studied people who read literary fiction, popular fiction, nonfiction, or nothing at all. They discovered that those who read literary fiction demonstrated improved “theory of the mind,” that is, “the human capacity to comprehend that other people hold beliefs and desires and that these may differ from one’s own beliefs and desires.” The article further showed that the same readers had stronger “theory of the mind” in both cognitive (the ability to understand others’ beliefs and ideas) and affective (the ability to understand others’ emotions or have empathy) realms. These were exactly the attributes that were lost during medical training in the UAMS study. 

Narrative Medicine: Attention. Representation. Affiliation.

Rita Charon, MD PhD, and her colleagues at Columbia University developed the field of Narrative Medicine over twenty years ago bringing their “close reading” approach to clinics, classrooms, patients, ICUs, and bedsides. Participants first read and discuss a short story, poem, piece of artwork, or other creative work. Then for a few minutes, they each respond in writing to a simple but ambiguous prompt “in the shadow” of the piece they shared.  Then they each read aloud what they have created and discuss as a group what they have learned through this process. 

Dr. Charon teaches that these short, group-based exercises sharpen learners’ listening capacities and drive the “self” to engage in new ways with the “other.” “Reading and listening are muscular acts,” Dr. Charon writes. “It makes us wonder about the spaces between the lines and forces us to join with the storyteller to enter the world they describe.” 

I have shared close reading exercises with MCW medical students, residents, and faculty over the years. These opportunities to read and write together have been gratifyingly well received. Other faculty, staff, and students have developed programs featuring writing, storytelling, art, improv, music, and other creative endeavors. 

Many students embrace these approaches, and faculty members deeply enjoy the engagement, but we still struggle, as have many other medical schools, to truly integrate the humanities into medical education for all our trainees. 

Where do we begin to integrate the humanities into medical education?

In 2020, the Association of American Medical Colleges (AAMC) released a report on the Fundamental Role of Arts and Humanities in Medical Education. The AAMC recognizes that the “arts and humanities are essential to the human experience,” and by “integrating arts and humanities throughout medical education, trainees and physicians can learn to be better observers and interpreters.” The report offers resources and examples for students and educators who want to explore the topic. As Deepthiman Gowda, MD, the Assistant Dean for Medical Education at the Kaiser Permanente Bernard J. Tyson School of Medicine has said, “Humanities have a role in addressing the problems in health care.” 

There is, too often, a chasm between physicians and patients, and medical training, paradoxically, seems to widen that chasm. The humanities, well used, can assist in bridging this gap. Substantively integrating the humanities into medical education could sustain and enhance the empathy students bring to medical training and provide them tools to remain resilient, deeply compassionate, attentive caregivers. 

Curricular change is hard. We will know we have succeeded when our youngest colleagues hold onto their empathy even when it sometimes seems easier to let it go. 

 For more reading:

Principles and Practice of Narrative Medicine. Rita Charon, Sayantani DasGupta, Nellie Hermann, Craig Irvine, Eric R. Marcus, Edgar Rivera Colón, Danielle Spencer, and Maura Spiegel, eds. Oxford Press. 2016

Howley L, Gaufberg E, King B. The Fundamental Role of the Arts and Humanities in Medical Education. Washington, DC: AAMC; 2020.

Bruce H. Campbell, MD FACS is editor of the Kern Transformational Times. He is a Professor of Otolaryngology & Communication Sciences and is on the faculty of the Center for Bioethics & Medical Humanities at MCW. He is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.