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Program in Medical Humanities and Arts

Purpose: The UC Irvine School of Medicine Program in Medical Humanities and Arts (PMHA) is designed to integrate arts and humanities-based materials into medical education and to promote student research in the medical humanities.

The program’s goal is to show medical students how humanities and the arts can help them develop both critical thinking and empathy to better understand their patients’ illness experiences, the doctor/medical team-patient/family relationships, physician self-care, and various other aspects of healthcare.

Curriculum

The program has developed both required and elective curriculum in all four years of medical school. Over the years, PMHA has initiated a wide range of curricular initiatives including required curricular components in the Clinical Foundations courses, as well as the Family Medicine, Internal Medicine and Pediatrics clinical clerkships.

PMHA has also introduced several first-year electives:

  • Patient Stories/Doctor Stories
  • Examine the Painting/Examine the Patient
  • History of Medicine), an optional creative projects reflection in the Anatomy course
  • Art of Doctoring, a popular fourth-year elective capstone course that enrolls approximately half the graduating class

PMHA also has sponsored many professional conferences, symposia, lectures and dramatic performances examining various aspects of medical humanities for audiences of medical students and faculty.

Representative curricular activities include:

  • Participating in a "clinical correlate" in the first-year Anatomy course that brings family members of donors to interact with the students who have just completed dissection
  • Observing a  theatrical performance of “Good Doc/Bad Doc” to introduce first-year students to geriatric medicine
  • Telling stories about patients and about doctors during an Internal Medicine clerkship session
  • Performing medically themed plays on the Family Medicine clerkship to explore patient, family member, physician, and other health professionals’ perspectives on care
  • Writing reflective essays about difficult medical student-patient interactions on the Family Medicine clerkship
  • Reading a poem about a doctor breaking bad news to a patient, then discussing its implications for real world care
  • Creating original art and poetry as part of the first year Anatomy course, the second-year Student Senior Partners’ Program, and the third-year Pediatric clerkship to reflect on dissection, the patient/family’s encounter with illness and medical student experiences in clinical training
  • Attending a “Night at the Movies” session to view and discuss a medically themed movie
  • Participating in an optional workshop teaching improvisational theater skills as they apply to clinical encounters
  • Visiting a local art museum to practice visual interpretation with special emphasis on implications for patient care
  • Conducting original medical humanities research to develop familiarity with relevant scholarship in this area and to engage in arts/humanities-based practices, such as writing poetry or creating graphic medicine with relevance for clinical encounters.

Journal of Arts and Humanities

PMHA sponsors Plexus, the UC Irvine School of Medicine's journal of arts and humanities, which provides students, faculty and staff with an outlet for creative original work.

Graduation with Distinction in Humanities/Arts; Medical Humanities Awards

PMHA works with the Office of Medical Education to recognize outstanding student contributions in medical humanities through the designation of graduation with distinction in the humanities/arts awarded annually to three or four meritorious graduating fourth-year students.

Through the Office of Medical Education, the program also presents a monetary award to a graduating student for achievement in the arts and humanities; and funds one or two summer stipends for first-year students to conduct original research in medical humanities.

Learn more about PMHA course opportunities:

Year 1 »

Kindness Curriculum

Ralph Clayman, MD; Aaron Kheriaty, MD; Johanna Shapiro, PhD; Julie Youm, PhD

Course description

The purpose of the kindness curriculum, which is a required component of Clinical Foundations 1, is to give students a space to think about the role of kindness, empathy and compassion in clinical interactions. Students also learn different facets of these attributes by examining the constructs from a variety of disciplinary perspectives.

The kindness curriculum consists of eight (8) required hours in the first year.

Course objectives — Year 1

At the end of this curriculum, students will be able to:

  • Describe the history of kindness in medicine
  • Compare and contrast the construct of kindness as situated within various ethical traditions
  • Specify key components of the neurobiology of empathy and kindness
  • Demonstrate specific performative and narrative techniques that communicate kindness to others
  • Demonstrate baseline  skills in communicative verbal and nonverbal empathy in an OSCE-type interaction with a standardized patient

Anatomy Creative Projects: Human Gross Anatomy and Embryology

Johanna Shapiro, PhD; Jamie Wikenheiser, PhD

Course description

This optional creative project has been incorporated into the Human Gross Anatomy and Embryology Course. It provides an opportunity for students to express their experiences in anatomy creatively through media such as poetry, prose and art.

Projects can be exhibited or performed as part of the Anatomy Donor Family session.

Course objectives

Participation in this project is designed to accomplish the following:

  • Provide an opportunity for students to engage in retrospective reflection and personal assessment of their thoughts and feelings about gross anatomy through the use of creative media such as poetry, prose and art.
  • Improve faculty understanding of the anatomy experience from the perspective of students so that course adjustments can be made that enhance student learning as well as professional and personal growth.

Patient Stories, Doctor Stories: The Doctor-Patient Relationship and the Experience of Illness in Literature

Johanna Shapiro, PhD, Tan Nguyen, MD, Monisha Vasa, MD

Course description

This elective uses short selections from literature — including poetry, short stories and role-plays written mostly by doctors, patients or medical students — to help participants deepen their understanding of patients’ experiences of illness, as well as patients’ and doctors’ experiences of each other. Most readings are be done in class, followed by comments and discussion.

Each student is expected to complete a creative project reflecting on some aspect of their experience as medical students at the end of the class.

Course objectives

At the end of this rotation, the student is expected to:

  • Stimulate empathy and understanding for the condition of patients confronted with serious illness
  • Develop insights into the doctor-patient relationship
  • Understand how narrative is useful in addressing ethical issues
  • Be more comfortable with ambiguity, uncertainty, and multiple perspectives
  • Deepen understanding of and respect for colleagues and teachers
  • Use literature as a method for reflecting on and coping with stresses and strains of professional training

Examine the Painting/Examine the Patient

Joel Shallit, MD

Course description

The objective of this elective is to improve the visual skills needed in clinical diagnosis and the emotional sensitivity needed in compassionate care through techniques learned in examining works of art.

Course objectives

At the end of this course, the student will be:

  • Able to develop visual analysis skills related to interviewing, physical diagnosis, communication and clinical reasoning through the study of art
  • Better able to deal with complexity and diagnosis through the examination of paintings
  • Better able to interpret patient emotions and thereby feel empathy and compassion for patients through the study of art
  • Better able to understand patients of different backgrounds through the study of art

History of Medicine

Douglas Merrill MD; Douglas Haynes, PhD

Course description

This elective surveys significant themes in the study of the history of medicine and health care through the prism of the humanities. Each session is devoted to the discussion of one theme.

Each student is asked to lead a session of his or her choice. This entails prior review of articles and other resources, as well as the development of a class plan for discussion.

Preparation and leading one session and completing one written assignment on one of the other topics provides students an opportunity to explore these topics personally and to develop their critical assessment, discussion and writing skills.

Course objectives

Students are expected to be able to:

  • Discern and discuss major themes present in the study of the history of medicine and healthcare, and their relative interactions with one another
  • Develop and articulate — verbally and in writing — their understanding of these themes and their relation to current medical care and healthcare delivery issues
Year 2 »

Kindness Curriculum

Ralph Clayman, MD; Aaron Kheriaty MD; Johanna Shapiro, PhD, and other faculty

Course description

This course, which is a required component of Clinical Foundations 2, emphasizes the development of empathy through a series of professional videos that focus on:

  • The definition and neurobiology of empathyBreaking bad news
  • Dealing with difficult clinical encounters

In addition, each session incorporates a physician and patient to speak from a personal perspective about how these topics have intersected with their clinical care.

The final session focuses on the end of life from both clinician and patient perspectives.

The kindness curriculum offers eight (8) required hours in the second year.

Course objectives, year 2

At the end of year 2 of the kindness curriculum, students are able to demonstrate the following:

  • Identify and demonstrate specific communication skills relevant to breaking bad news
  • Identify and demonstrate specific interactional approaches relevant to  working with patients in difficult encounters
  • Demonstrate knowledge of nonverbal (facial expressions) and verbal (specific language construction) ways of conveying empathy that build on skills introduced in Year 1, including ability to reference relevant research
  • Analyze how breaking bad news and challenging clinical situations are addressed and resolved in actual clinical encounters with patients.
  • Indicate  how end of life issues affect patients, families, and physicians and differentiate between optimal and less-than-optimal interactions at end of life

Reflective Reading and Writing for Medical Students

Johanna Shapiro, PhD

Course description

This elective provides an introduction to reflective readings and writings that link these skills with professional development and patient care. In week 1, an introductory presentation orients students to the theoretical and empirical work on therapeutic and health-promoting aspects of reflective reading and writing.

Each subsequent week (2-9) consists of in-class readings by medical student and physician-authors, focusing on the socialization experience of medical students, professionalism and the doctor-patient relationship. These readings also provide models for different writing approaches.

In addition, most sessions include an in-class writing assignment examining such features as voice and point of view, parallel charting, free writing and write-it-thrice techniques.

Students are expected to come prepared to discuss readings and participate in writing exercises and class discussions that link writing to their ongoing patient care experiences.

A final session (Week 10) summarizes the course and presents student writing projects.

Course objectives

After participation in this elective, the student is expected to:

  • Understand and be able to explain theoretical and empirical evidence for the therapeutic value of reflective reading and writing
  • Be familiar with and be able to practice various reflective writing techniques
  • Understand and be able to explain how to use reflective reading and writing such as:
    • Methods of observing and paying attention to patients
    • Tools to reduce frustration, anger, helplessness and burn out
    • Ways of developing increased empathy for the patient's perspective
    • Means of developing additional insights into patients.
Year 3 »

Humanism through Humanities: Pediatric Clerkship

Penny Murata, MD; Johanna Shapiro, PhD

Session description

In this required component of the Pediatrics Clerkship, students are required to complete a "humanities" reflection project for a student conference held near the end of the six-week course.

The project may be based on child advocacy, ethics, the physician-patient-family relationship, or any other aspect of the clinical experience. Students may choose the format. They may work individually or in groups, as long as each student participates.

After each presentation, other students are free to comment. Comments and discussion points are made or facilitated by the director of Medical Humanities and the Pediatrics Clerkship director.

Projects can be presented in a variety of formats — poetry, skits, song, point-of-view narrative, patient education pamphlets, a scrapbook, an artistic collage of pediatric patient experiences, a narrative, drawings and readings.

Students are expected to discuss their feelings about taking care of patients (including patients with chronic medical conditions and victims of abuse), interacting with parents and caregivers, being students, interacting with residents, as well as ethical issues.

Session objectives

At the end of this session, students are expected to be able to:

  • Produce original creative works that reflect on their clinical experiences in Pediatrics
  • Give examples of how such reflective practices promote empathy for pediatric patients and their families
  • Describe ethical issues in pediatrics and analyze ways of resolving these dilemmas
  • Analyze, interpret, and problem-solve various other issues in clinical pediatrics, such as doctor-parent relationships, cultural and language differences, and the medical student role.
  • Show how arts-based approaches can improve child advocacy by making educational materials more accessible, involving, and informative
  •  Use the arts to enhance self-awareness as a medical student and develop insights into pediatric patients and their families

Reflective Practice: Difficult Student-Patient Encounters and Cross-Cultural Issues: Family Medicine Clerkship

Johanna Shapiro, PhD

Session description

This required component of the clerkship involves a writing assignment and discussion session that focus on difficult student-patient encounters and practicing medicine across cultures. It is incorporated as part of the four-week Family Medicine clerkship.

The nine to 10 students rotating through the clerkship each month must first complete a written assignment reflecting on various issues, including language and culture, that can complicate the patient encounter.

Students subsequently participate in a facilitated two-hour session to exchange and examine different points of view, and to interrogate their own assumptions and biases.

Session Objectives

At the end of this session, students are expected to be able to

  • Demonstrate greater self-awareness and reflection skills
  • Illustrate ways in which medicine is its own culture
  • Examine and challenge their own unconscious assumptions about patients from diverse backgrounds
  • Explore different ways of addressing encounters that they perceive to be frustrating, including those characterized by cultural and language differences, which can result in barriers to optimal healthcare
  • Identify positive and negative physician role-models and what they can learn from each in terms of managing challenging clinical interactions

Medical Readers Theater: Family Medicine Clerkship

Johanna Shapiro, PhD

Session description

Readers’ theater (RT), a required clerkship component, is a minimal form of theatrical performance in which there are no or negligible sets or costumes, and scripts are used in staging. It has been used in a variety of educational settings. More recently, medically-themed readers’ theater (MRT) has generated interest in medical education circles as a method of engaging students and other learners with the human side of medicine.

MRT is an effective way of bringing together individuals with different backgrounds and life experiences and getting them to share their perspectives on various topics.

In collaboration with the UC Irvine Program in Geriatrics and residents from a local retirement community, we have incorporated a required MRT session as part of the Family Medicine clerkship.

Nine to 10 students participate in each session. Students meet for one hours with facility residents to participate in a brief skit that highlighs issues of importance to older patients, including ageism, multiple and chronic health problems, disability, dementia and Alzheimers disease, and end-of-life issues. The role-plays are followed by facilitated discussion.

Session objectives

At the end of this session, students are expected to be able to:

  • Describe examples of the health problems and life-transition issues older people face and how they deal with them
  • Interview and interact with older patients skillfully and more empathically
  • Demonstrate skills of active listening
  • Use literature and theater as a resource for broadening their understanding of various end-of-life issues

Relationship, Ethics, and Communication as Components of Clinical Practice: Internal Medicine Clerkship

Ron Koons, MD; Johanna Shapiro, PhD; Elena Bezzubova

Session description

This required one-hour clerkship component uses intimate, small group settings with a 2:1 student/faculty ratio to engage in narrative medicine, i.e., telling stories about memorable patient encounters. Students are expected to present patient care situations that troubled, angered, confused or inspired them.

Subsequent discussion explores in a nonjudgmental way various relational, ethical and communication issues raised. Emphasis is on self-awareness, reflective practice and translation of values into language and behavior.

Session objectives

By the end of the session, students are expected to be able to:
  • Reflect constructively on their own thoughts and emotions in relation to clinical care
  • Reflect on, analyze and interpret difficult clinical situations
  • Effectively problem-solve difficult clinical and professional encounters
  • Express more nuanced insights into patients and families
  • Demonstrate specific ways of forming positive relationships with patients and families
  • Regulate strong emotions that can arise in difficult clinical situations
  • Clarify their professional identity as student-physicians
  • Address important aspects of patient-care ethics
  • Question their initial assessments of clinical care dilemmas
Year 4 »

699E — Research Elective in Medical Humanities and Social Sciences

Johanna Shapiro, PhD

Course description

Medical humanities encompasses a broad range of subjects and activities, including history, ethics, literature, visual and performing arts. This elective provides an opportunity for students to explore and engage in the analysis of various clinical issues in medicine through the development of a specific medical humanities-based project related to the art of medicine.

Course objectives

At the end of this rotation, the student is expected to be able to:

  • Participate in a meaningful way in the implementation and completion of a humanities creative project/research project related to the art of medicine
  • Understand and be able to state the intellectual basis for developing this humanities project as an aspect of medical education
  • Complete a written document describing the goals and outcomes of the project
  • Identify an appropriate mentor, an expert on the topic of choice who can evaluate and guide the student's work

647 — The Art of Doctoring

Johanna Shapiro, PhD; Matt Butteri, MD; Ron Koons, MD

Course description

The Art of Doctoring is a longitudinal experience intended to enhance the physician-patient relationship, expand students' communication skills, teach team-building skills and provide strategies to promote compassion and empathy as core physician values.

The class uses reflective practices, role-modeling, readings and case-based, problem-solving discussions.

Course objectives

At the end of this elective, students are expected to:

  • Understand the usefulness of reflection and imaginative perspectives in
    • Cultivating compassion and empathy for patients, patients' family members, peers, self and others
    • Developing insight into how best to convey compassion and caring in the doctor-patient relationship
  • Be able to identify and assimilate compassionate attitudes and behaviors modeled by others.
  • Know how to use mindfulness and other re-centering techniques to maintain an attitude of compassion in difficult and stressful situations.
  • Know how to use reflective writing and other humanities-based techniques to develop and maintain compassion and empathy.
  • Implement these strategies to enhance physician-patient communication and improve patient care.
  • Implement strategies to promote self-awareness and to enhance their own career satisfaction.

For more information, please contact:

Johanna Shapiro, PhD,
Director, Medical Humanities and Arts program
Professor, Department of Family Medicine
Phone: 949-824-3748
jfshapir@uci.edu
plexusjournal@gmail.com