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.
