UC Irvine’s Program in Medical Humanities & Arts (PMHA) is dedicated to helping medical students recognize how the study of literature and the arts can deepen their compassionate understanding of patients’ experience of illness and develop insights into the doctor-patient relationship. Recent highlights include:
• An evening at the Irvine Art Museum, courtesy of Mr. James Swinden, museum president.
Students reflected on what they could discover by looking at portraits from their patients’ perspectives.
• An afternoon at the Bowers Museum for Art of Doctoring students, which led to a discussion of cultural and generational challenges in patient care and included reflection on how art impacts the students’ understanding of what it means to be a physician.
• This year’s Literature & Medicine students were so inspired, they decided to continue sessions on their own when the class ended.
• The Medical Readers Theater, which uses skits to bring together medical students and residents of an Irvine-based continuing care retirement community to reflect on issues related to aging and end of life, has now involved local high school students in writing scripts for the sessions.
• Plexus, the Journal of Arts and Humanities, continues to publish original stories, poems and visual arts created by students, faculty and staff of UC Irvine.
• Meanwhile, medical students have completed independent humanities-based research projects on older patients’ perceptions of pain and their physicians’ responses to this pain; and stories physicians tell about what inspires and motivates them, interpreted through the lens of classic Shakespearean themes.
As a result of its membership in the UC Medical Humanities Consortium, the Program was able to designate 4 students, 3 graduating 4th years (Jennifer Alloo, Lauren Ross, and Christina Umber) and one 3rd year (Matt Fradkin) to receive awards in humanities research and program development excellence. In addition, one first year student, Nina Narasimhalu received humanities research funding for her project on the application of Shakespearean themes to contemporary physicians’ search for meaning in their work.
The Program also was a co-sponsor of the UCI Dalai Lama Scholars’ Compassion in Medicine undergraduate course, and is participating in research to determine its influence on students’ attitudes of empathy and compassion. Dr. Shapiro was an invited participant in the PRIME (Project to Re-balance and Integrate Medical Education) Conference, in which nationally recognized educators and scholars worked to identify appropriately measurable “benchmark” standards for undergraduate and graduate medical education in medical ethics and humanities. The Dean continued to include student photography as part of the silent auction in the fundraising gala Under the Stars with great success.
2009 was an exciting year for the PMHA. First, in conjunction with UCSF, Berkeley, and Davis, we were officially approved by the UC Office of the President (UCOP) as the UC Medical Humanities Consortium. This designation is not only a prestigious accomplishment, but also provides a small amount of funding to support collaborative research and an annual conference among the four campuses.
In addition, the program initiated a new first year elective, Anatomy of Anatomy, to explore the implications and ramifications of dissection for future professionalism, including the student-physician/patient relationship and emotional detachment/connection. In response to student request, we have introduced a second year elective, Arts and Medicine, in which patients and physicians share their artistic work and discuss how this work is related to illness experience and/or caring for those who are ill.
PMHA also joined forces with Drs. Ron Koons, a bioethicist and medical oncologist, and Elena Bezzubova, a psychiatrist, to provide required small group teaching to third year IM clerkship students on narrative medicine and relationship-centered medicine. Funding from the institution-wide geriatrics Reynolds grant provided funding to develop a required component in the third year Family Medicine clerkship using Medical Readers’ Theater involving students and seniors from a local retirement community in reading and discussing short skits highlighting issues of aging such as loss, loneliness, declining function, dementia, and end of life decisions. Finally, thanks to funding from the Arnold P. Gold Foundation, we were able to install a permanent exhibit of medical student photographs at the UC Irvine Medical Center.
Exactly what is the UC Irvine School of Medicine Program in Medical Humanities & Arts (PMHA)? From humble beginnings (one elective class), today PMHA has required or elective curriculum in all four years of training. The program’s goal is to show medical students how literature and the arts can help them better understand and empathize with their patients’ experiences; and ultimately help them treat their patients more humanely and effectively.
Students enrolled in any given PMHA session may participate in a readers’ theater performance of Wit, a play about a woman dying of ovarian cancer; write a point-of-view poem from the perspective of a patient recently diagnosed with diabetes; make a “parallel chart” note recording all that they notice, imagine, wonder, and feel about their patient which has no place in the formal patient chart; interpret a short story about a patient with dementia and his family; draw a picture representing a difficult patient encounter; or reflect on cultural differences in medicine through a narrative essay.
The PMHA also sponsors Plexus, the UC Irvine-SOM Journal of Arts and Humanities, which provide students, faculty, and staff with an outlet for creative original work; and recognizes outstanding student contributions in medical humanities with the designation of graduation with distinction in the humanities/arts awarded to a deserving fourth year student. PMHA has produced research and scholarship about narrative; and the effects of exposure to arts and humanities on medical students. PMHA currently works with the Departments of Family Medicine, Pediatrics, Medicine, PM&R, Anatomy, and the Program in Geriatrics. PMHA is a member of the UC Medical Humanities Consortium.
The UC Irvine School of Medicine Program in Medical Humanities & Arts is designed to integrate arts- and humanities-based materials into medical education. To date, this curricular initiative has developed both required and elective curriculum in all four years of medical school and in two of our residency programs.
Activities include humanities and arts projects coordinated with the first year Anatomy course; point of view writing exercises in the second year to explore the patient experience of illness and the doctor-patient relationship; two humanities electives (Literature and Medicine; Reading and Writing the Experience of Illness) offered in the preclinical years; creative projects related to patient encounters as part of the third year Pediatric clerkship; reflective writing linked to sessions on cross-cultural medicine and domestic violence in the Family Medicine clerkship; a fourth year elective on the Art of Medicine; humanities consultations for students enrolled in the fourth year track “Through the Patient’s Eyes”; and a fourth year Humanities research elective that allows for in-depth study of a humanities topic related to medicine.
The Program also offers an informal track in medical humanities to medical students; as well as a designation of “graduation with distinction in humanities/arts” (analogous to the graduation with distinction in research and graduation with distinction in service) for 1-3 graduating students who have excelled in original work in the arts relevant to medicine. Humanities readings and discussions have also been integrated into the Family Medicine and Physical Medicine and Rehabilitation residencies.
Working with the Office of Medical Education, the Program in Medical Humanities & Arts organized the 2001 Tamkin Symposium, addressing the topic “The Role of the Humanities in Medical Education.” The Program also co-sponsored the nationally renowned physician-poet Jack Coulehan as part of the 2004 Tamkin Symposium. A similar faculty development program, “Training the Clinical Gaze: The Role of the Arts in Medical Education,” examined potential contributions of the visual and performing arts to medical training.
The Program also co-sponsored the arts- and literature-themed UC Irvine National Cancer Survivors Day Celebration in 2003. In addition, we have explored the relationship between the performing arts and medicine. “Living in the Bonus Round: Life with AIDS and HIV,” “Deep Canyon: One Woman’s Journey with Ovarian Cancer,” and “Ball” (about testicular cancer) are dramatic performances that have been presented to audiences of medical students, faculty, hospital staff, and patients for discussion and reflection. The program also sponsors Plexus, a student-initiated journal of arts and humanities that publishes the original creative work of student, faculty, and staff members of the College of Medicine community.
The Program in Medical Humanities & Arts has received funding from a HRSA training grant in Family Medicine; the Arnold P. Gold Foundation; the California Council for the Humanities; and the UC Irvine-SOM Office of Medical Education. Several qualitative and quantitative research articles, as well as theory-building and conceptual articles based on the work of the Program have been published in journals such as Academic Medicine, Medical Education, Families, Systems, & Health, Medical Teacher, and Education for Health. Current research interests include analyses of medical students’ anatomy-related creative projects; and medical student poetry.
The Program in Medical Humanities & Arts continues to offer well-received selectives, electives, and course components across all four years of medical school training. The program is proud to be participating with Dr. Marianne Ross from the Office of Medical Education; Dr. Tara Yuan, Department of Psychiatry; and Dr. Desiree Lie, our own family medicine faculty, in a new first year selective, “The Healer’s Art,” as part of an ongoing initiative to humanize the medical education process. A record number of 4th-year students are enrolled in the humanities research elective, for which they are completing innovative research projects in various branches of the humanities and arts.
The Program in Medical Humanities/Arts continues to thrive. At Honors Night 2004, the following graduating students were recognized for distinction in humanities/arts: Marisa Chang (photography), who also received the UC Irvine-SOM Medical Humanities/Arts Award; Michael Doo (poetry); Thanh Truong (mixed media).
Dr. Robert Leonard continues to encourage first year students to reflect on their gross anatomy experience through the use of creative projects, and Marianne Ross and Johanna Shapiro have been joined as faculty commentators on these efforts by Dr. Trung Thai of the UC Irvine Department of Psychiatry & Human Behavior.
The first year selective, Patient Stories/Doctor Stories, has enrolled a full complement of students; and second year students who participated in the selective last year have formed a reflective/creative writing group this year. Under the direction of Dr. Penny Murata, the 3rd year Pediatric Clerkship continues to use art and poetry to help students reflect on their experience in Peds. Pat Lenahan and Johanna Shapiro have introduced a multi-media humanities-based session on intimate partner violence to the 3rd year Family Medicine clerkship. The Art of Doctoring elective, facilitated by Drs. Dan Robitshek of the Department of Medicine and Johanna Shapiro, continues to help 3rd and 4th year students develop specific skills to treat others with compassion and kindness while they learn to nurture themselves.
This year’s student editor of Plexus, Brian McMichaels, promises a beautiful and moving mixture of poetry, essays, photography, and art for this year’s issue. Finally, several theoretical and research articles regarding the use of humanities with student learners have been published in a range of medical education and family medicine journals.
The UC Irvine School of Medicine Program in Medical Humanities & Arts is completing its 7th year. Both elective and required curricular offerings for medical students and residents are ongoing, including the popular first-year literature and medicine selective which has been taught this year by Dr. Johanna Shapiro with the invaluable assistance of Dr. Sharon George and our own Chief Resident, Dr. Virany Kreng. The program has also und,rtaken some interesting new initiatives. Second year students Salina Lee and Gail Wong have started a Student Interest Group (SIG) for Humanities and the Arts which held an inaugural meeting using innovative readers’ theater exercises.
Under the leadership of editor-in-chief second year student Meghann Kaiser, Plexus has expanded student involvement and outreach to the SOM community. Editor Nick Athanassiou has even added an audio component! The journal’s editorial board is co-sponsoring this year’s Winter Formal, contributing an exhibition of poetry and art masks to the festivities. Dr. Shapiro and Pat Lenahan, MSW, are working with Dr. Georganne Novak to develop a humanities-based domestic violence module for the third year clerkship.
PMHA has developed a required humanities component for the Problem-Based Learning sessions for second year small groups. An integrated humanities presence continues on the Internal Medicine, Pediatrics, and Family Medicine student clerkships, and in the Family Medicine and PM&R residencies. With Dr. Ali Duke, I will be presenting results from the FM clerkship’s adventures in humanities at the 36th annual STFM conference, which is also sponsoring a seminar on teaching medical humanities.
Publications related to PMHA teaching appeared in Academic Medicine and Medical Education. The Program also organized a well-received faculty development conference “Training the Clinical Gaze,” exploring uses of visual and performing arts in medical education. The PMHA is collaborating with faculty from the UC Irvine School of the Arts through the newly formed DaVinci Research Center to explore uses of art in patient care and medical education.
Dr. Johanna Shapiro was named Director of the Program in Medical Humanities & Arts for the UC Irvine School of Medicine, a position that enables her to continue efforts to introduce humanities-based teaching into medical school and residency curricula. This past year Dr. Shapiro worked closely with Dr. Ali Duke to develop humanities readings for the new family medicine clerkship. She also worked with Dr. Jerome Tobis in PM&R to initiate a monthly humanities seminar.
Dr. Shapiro presented a paper on cultural competence at the 35th annual STFM conference, and helped organize an STFM Theme Day on Research in Medical Humanities. She published several papers in peer-reviewed journals, including one on implications of narrative therapy for family physicians in Family Medicine, and one on teaching empathy to medical students and residents that appeared in Academic Medicine. She served as faculty advisor to Plexus, the student-initiated journal of arts & humanities, and worked with the UC Irvine Chao Family Comprehensive Cancer Center to organize a performance of a one-woman show about ovarian cancer for members of the UC Irvine SOM community.
The medical humanities initiative is flourishing at UC Irvine School of Medicine. The remarkable curricular progress made in this area could not have been possible without the support of the Department of Family Medicine, and in particular its chairman, Dr. Joe Scherger; the encouragement of the Office of Curricular Affairs (especially Drs. Dessiree Lie, Lloyd Rucker, Elizabeth Morrison, and Associate Deans Al Manetta and our own Mike Prislin); and funding from the HRSA departmental training grant. Medical humanities teaching now spans the spectrum from undergraduate through medical student and resident training to faculty development. Below is a brief synopsis of current and projected activities.
Undergraduate: This spring I taught (with several guest faculty from family medicine, including Drs. Lie, Prislin, Bent, Vega, and Mosqueda, as well as Dr. Jeff Kuo from radiation oncology) an honors freshman seminar on literature and medicine, which received very positive reviews.
Medical school: Working through the Patient-Doctor series, we are developing an integrated, progressive medical humanities medical student curriculum that incorporates both required and elective components and stresses applicability to patient care.
Patient-Doctor I: This year for the first time a required literary reading will accompany each PDI module, to be integrated in small group discussions. In addition, first year students will have two point-of-view writing exercises, in which they practice reading a brief literary selection about a patient’s experience of illness, then writing a commentary from the perspective of the narrator.
Patient-Doctor II: This course will continue the use of supplementary literary readings that are thematically linked to each module. As in previous years, co-leaders will be encouraged to incorporate the readings into small group discussions. In addition, each module will require a brief point-of-view writing assignment to stimulate the experience of empathy in learners, and to help them explore the often differing perspectives of patients, physicians, and family members.
Patient-Doctor III: As part of Patient-Doctor III, the IM third year clerkship this year will require two clinical humanities sessions for small groups of eight students each. These sessions, co-taught with Dr. Rucker, provide students with the opportunity to read about and reflect on essays and poetry describing the challenging transition from preclinical to clinical years. Each student must also complete a creative project in a medium of the students choice (i.e., literary, poetic, artistic, musical, photographic, etc.) exploring a significant experience on the clerkship.
Patient-Doctor IV: Starting in 2002, Patient-Doctor IV, imaginatively redesigned by Dr. Rucker and the OCA, will pair students over time with chronically and terminally ill patients. A medical humanities component will be present in the form of expressive journaling about students’ experiences during their final year.
Family medicine residency: Thanks to the support and encouragement of the Director of Behavioral Sciences Pat Lenahan, we continue to pioneer required medical humanities curricula in the form of monthly literature-based discussion groups thematically linked to the behavioral science focus for the month. These sessions complement the more traditional bioscientific approaches to such topics as depression and anxiety by making room for the voices of the suffering patient.
We are extremely fortunate to have had the resources this year to establish a medical humanities website, Adventures in Medical Humanities at UC Irvine-SOM, which summarizes all UC Irvine-SOM activities in this area as well as provides important resources and links. Please go visit it!
Finally, medical humanities has been selected by Office of Curricular Affairs as the focus of the 2001 prestigious Tamkin Lecture. This all-day event, to be scheduled sometime in February and free to all interested faculty and students, will combine stimulating and thought-provoking presentations on the role of humanities in medical education and expressive writing for physicians and patients with small group discussion.
I welcome working with any and all faculty and students in the area of medical humanities. As should be evident from the above summary, medical humanities at UC Irvine-SOM is very much a collaborative enterprise. If anyone has ideas or questions about how literature and the arts might be integrated into some aspect of their teaching or learning, please get in touch or drop in at any of the many exciting sessions that are ongoing on campus and Family Health Center. Medical humanities truly is an adventure!
Medical Humanities is a broad area of study that includes bioethics, health economics, history of medicine, medical sociology-anthropology, spiritual issues, as well as the relationship of literature and the arts to the practice of medicine. With the support of a HRSA federal training grant, the Department of Family Medicine recently has begun to implement a medical humanities initiative for the UC Irvine School of Medicine, with particular emphasis on literature and medicine.
The purpose of reading – and writing – imaginative fiction is to increase empathy for and compassionate understanding of ourselves and others. Literature achieves this goal by developing moral imagination, encouraging awareness of language and its meanings, and stimulating sensitivity to other people’s experiences and points of view. Literature helps us to simultaneously risk emotional engagement and step back to reflect on our experiences, both essential skills in promoting good patient care. Several activities have already resulted from this new initiative. At the medical student level, an eight-week elective for first- and second-year students, “Doctor Stories/Patient Stories,” was developed, approved, and taught last spring.
Currently, I am responsible for the medical humanities component of Patient Doctor II. I have launched a supplementary literature and medicine elective for this second year course that is attended by both students and small group leaders. I am also working with a group of first-year students to design a literature and medicine elective for spring of 2000. In addition, I am assisting Dr. Lloyd Rucker in refining the Internal Medicine clerkship’s clinical humanities sessions, which ask students to produce creative projects that express their feelings and thoughts about patient encounters. A recently conducted needs assessment survey of first, second, and third year medical students will help guide further curriculum development in this area. Other aspects of the medical humanities initiative encompass the educational spectrum from a premedical undergraduate honors elective tocurriculum targeting residents and faculty.