“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.