Medical Humanities and Medical Education: How the Medical Humanities Can Shape Better Doctors PDF
Preview Medical Humanities and Medical Education: How the Medical Humanities Can Shape Better Doctors
Medical Humanities and Medical Education Thefieldofthemedicalhumanitiesisdevelopingrapidly.However,therehasalso been parallel concern from sceptics that the value of medical humanities educa- tional interventions should be open to scrutiny and evidence. Just what is the impactofmedicalhumanitiesprovisionupontheeducationofmedicalstudents? Inaneraoflimitedresources,issuchprovisionworththeinvestment?Thisinno- vative text addresses these pressing questions, describes the contemporary territory comprising the medical humanities in medical education and explains how this field may be developed as a key medical education component for the future. Bleakley,adrivingforceoftheinternationalmovementtoestablishthemedical humanitiesasacoreandintegratedprovisioninthemedicalcurriculum,proposes amodelthatrequirescollaborationbetweenpatients,artists,humanitiesscholars, doctorsandotherhealthprofessionalsindevelopingmedicalstudents’sensibility (clinicalacumenbasedonclosenoticing)andsensitivity(ethical,professionaland humane practice). In particular, this text focuses upon how medical humanities input into the curriculum can help to shape the identities of medical students as futuredoctorswhoarehumane,caring,expressiveandcreative–whoseworkwill betechnicallysoundbutconsiderablyenhancedbytheirabilitiestocommunicate well with patients and colleagues, to empathize, to be adaptive and innovative, and to act as ‘medical citizens’ in shaping a future medical culture as a model democracywheresocialjusticeisakeyaspectofmedicine. Making sense of the new wave of medical humanities in medical education scholarshipthatcallsfora‘criticalmedicalhumanities’,MedicalHumanitiesand MedicalEducationincorporatesarangeofcasestudiesandillustrativeandprac- ticalexamplestoaidintegratingmedicalhumanitiesintothemedicalcurriculum. It will be important reading for medical educators and others working with the medicaleducationcommunity,andallthoseinterestedinthemedicalhumanities. Alan Bleakley is Professor of Medical Humanities, Falmouth University, UK; Emeritus Professor of Medical Education and Medical Humanities, Plymouth University Peninsula School of Medicine; Visiting Scholar, the Wilson Centre, Toronto,Canada;andPresident,AssociationforMedicalHumanities.Hisrecent publications include Patient-Centred Medicine in Transition: The Heart of the Matter and Medicine, Health and the Arts: Approaches to the Medical Humanities. Routledge Advances in the Medical Humanities New titles: Medicine, Health and the Arts Approaches to the medical humanities Edited by Victoria Bates, Alan Bleakley and Sam Goodman Suffering Narratives of Older Adults A phenomenological approach to serious illness, chronic pain, recovery and maternal care Mary Beth Morrissey Medical Humanities and Medical Education How the medical humanities can shape better doctors Alan Bleakley Forthcoming titles: Doing Collaborative Arts-based Research for Social Justice A guide Victoria Foster Learning Disability Past, present and future C. F. Goodey The Experience of Institutionalisation Social exclusion, stigma and loss of identity Jane Hubert Digital Stories in Health and Social Policy Listening to marginalized voices Nicole Matthews and Naomi Sunderland Medical Humanities and Medical Education How the medical humanities can shape better doctors Alan Bleakley Firstpublished2015 byRoutledge 2ParkSquare,MiltonPark,Abingdon,OxonOX144RN andbyRoutledge 711ThirdAvenue,NewYork,NY10017 RoutledgeisanimprintoftheTaylor&FrancisGroup,aninformabusiness ©2015AlanBleakley TherightofAlanBleakleytobeidentifiedasauthorofthisworkhasbeen assertedbyhiminaccordancewithsections77and78oftheCopyright, DesignsandPatentsAct1988. Allrightsreserved.Nopartofthisbookmaybereprintedorreproducedor utilizedinanyformorbyanyelectronic,mechanical,orothermeans,now knownorhereafterinvented,includingphotocopyingandrecording,orin anyinformationstorageorretrievalsystem,withoutpermissioninwriting fromthepublishers. Trademarknotice:Productorcorporatenamesmaybetrademarksor registeredtrademarks,andareusedonlyforidentificationandexplanation withoutintenttoinfringe. BritishLibraryCataloguing-in-PublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloging-in-PublicationData Bleakley,Alan(AlanDouglas),author. Medicalhumanitiesandmedicaleducation:howthemedicalhumanities canshapebetterdoctors/writtenbyAlanBleakley. p.;cm.—(Routledgeadvancesinthemedicalhumanities) Includesbibliographicalreferences. I.Title.II.Series:Routledgeadvancesinthemedicalhumanities. [DNLM:1.Education,Medical.2.Humanities.W18] R737 610.71’1—dc23 2014038105 ISBN:978-1-13-877868-9(hbk) ISBN:978-1-315-77172-4(ebk) TypesetinSabon byFiSHBooksLtd,Enfield Contents List of figures viii Acknowledgements ix Foreword by Arno K. Kumagai x Introduction 1 Forewarned 1 Shaping the fabric of the sensible through medical education 2 The role of the medical humanities in addressing symptoms of a malfunctioning medical education 5 Realizing Osler’s vision 10 1 Where do the medical humanities come from and where are they going? 12 The medical humanities in North America 12 The medical humanities in the United Kingdom 23 The medical humanities internationally 33 2 What are the ‘medical humanities’? Definitions and controversies 40 Defining the medical humanities: ‘what’s in a name?’ 40 A multidisciplinary or interdisciplinary field? 45 Carrying the burden of the medical humanities 51 What does the future hold for the medical humanities? 54 3 The distribution of the sensible 60 Introduction 60 The distribution of the sensible is a historical phenomenon 62 Inattentional blindness 64 The social organization of perception 66 The meeting of aesthetics and politics in the distribution of the sensible 66 vi Contents The ‘police’, ‘politics’ and ‘dissensus’ 68 The redistribution of the sensible through a new medical education that draws on the medical humanities 72 The production of insensibility can be aligned with authoritarianism and intolerance of ambiguity: Donald Winnicott and Martha Nussbaum 73 The redistribution of the sensible can be aligned with promotion of a tender-minded medicine 76 4 Empathy and its discontents 78 Introduction 78 The death of Hector: pity in Homer, empathy in medical education 85 Conclusions: empathy ancient and modern 97 5 Towards a medical aesthetics: creativity and imagination in medical education 100 Weasel words 100 Think improvisation! 100 Towards a medical aesthetics 105 Reflecting on ‘creativity’ 106 Philosophies of lack versus philosophies of abundance 107 Constructions of creativity 110 A typology of creativities 116 6 Close noticing 132 Sensibility and sensitivity 132 Kinds of reasoning in the senses 133 Arts-educated observation 138 Making sense of diagnosis 142 Can exposure to the arts hone observation? 144 Artists and doctors collaborate in ‘thinking aloud’ 152 Democratizing the medical gaze in medicine 155 Aesthetic ways of knowing in healthcare 156 Abductive judgement 158 Resemblances 160 The poetic imagination 161 The visual rhetoric of clinical practice 163 Contents vii 7 Can narrative medicine take the strain? 164 Essential, not desirable 164 What is a narrative? 164 Against narrative 175 Two kinds of thinking? Narrative and science 180 The subjunctive mood and narrative tension 181 Genres 184 8 Writing out prescriptions: hyper-realism and the chemical regulation of mood 187 Introduction 187 Prescription culture 189 Deconstructing drugs 195 The value of literary deconstruction in understanding health interventions 201 Coda: development of a humanities-based formulary 203 9 Evaluating the impact of medical humanities provision 206 Introduction 206 Measuring the immeasurable? 207 Are there other, more pressing, issues than measurement of impact? 208 William Empson’s seven types of ambiguity 211 Empson’s seven types of ambiguity transposed to medical education 212 Issues of ‘impact’: seven types of resistance to ambiguity 215 Seven types of ambiguity that question the value of current medical humanities impact studies 221 Bibliography 228 Index 252 Figures 6.1 Bamboo spine (ankylosing spondylitis) 141 6.2 Apple core lesion (colonic carcinoma) 141 6.3 Strawberry gallbladder: fatty deposits in the gallbladder resemble a ripe strawberry in appearance 155 Acknowledgements Overtheyears,Ihavebeeninspiredandsupportedbyacoregroupofclini- cians, medical humanities scholars and artists engaged with the medical humanities internationally. This group includes: Pamela Brett-MacLean, Allan Peterkin, Brian Hodges, Lorelei Lingard, Pippa Hall, Abraham Verghese, Arno Kumagai, Tess Jones, Robert Marshall, David Levine, Julie Thacker, Ian Fussell, Tim Dornan, Neville Chiavaroli, Jeffrey Bishop, John Bligh, Julie Browne, Christine Borland, David Cotterrell and Roger Kneebone. I also wish to acknowledge the commitment, enthusiasm and talentofthemanymedicalstudentsatPeninsulaMedicalSchoolwhoconsis- tentlydemonstratedovermorethanadecadethatacoremedicalhumanities curriculum‘works’andthattheideaspresentedinthisbookcanbeapplied successfullytotheundergraduatemedicineandsurgerycurriculum. This book is dedicated to my growing family, which offers a constant sourceofsupport,inspirationandamazement;andinparticulartomywife Sue, who has patiently put up with both the enthusiasms and frustrations that accompanied the shaping of the unruly manuscript as it developed from mewling child to grumpy, growling and insistent adult.
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