Curricular Conundrums: the place of Humanities in Medicine 20 years on

Barbara Brookes and Charlotte Paul

‘The Faculty of Medicine is undertaking major course revision’. This statement is from a 1995 University of Otago memo. Part of this revision focus was a proposal that the Humanities Division provide a suite of Elective papers for third year medical students. There was already a self-directed option on offer, in which—in consultation with a willing staff member—students had 10 hours a week for five weeks to follow a particular interest. As classes had grown in size, this system had become unwieldy and it was suggested that a more systematic programme of Humanities Electives would broaden students’ appreciation of the art, as well as the science, of medicine.

In 1995, the idea of teaching Humanities in the medical curriculum was most advanced in the United States. An Institute of Medical Humanities had been founded at the University of Galveston in 1972.^[1] A University of Otago working party was set up to take advantage of the American experience. Chairperson Charlotte Paul (Preventive and Social Medicine) invited Professor Kathryn Hunter, author of Doctors’ Stories: the Narrative Structure of Medical Knowledge (1991), and Professor Ronald Numbers, Professor of History of Science and Medicine at the University of Wisconsin-Madison, to share their experiences of integrating Humanities subjects into the medical curriculum. As a result of these discussions, Otago decided to follow the model of the Northwestern programme outlined by Professor Hunter. She argued strongly that medical textbooks were about diseases, not patients, and that literature “could turn the focus onto patients and exercise the moral imagination”.  In addition, she suggested “exposure to the Humanities enabled students to question their own discipline and helped question the reductionism of medicine”.^[2] In Doctors’ Stories, she showed that both patients and doctors tell stories: the case history and the patient’s narrative, but they were cast in different modes. The task was to link them. A Humanities perspective, she suggested, can help.

Both Professor Hunter and Professor Numbers were clear that any Humanities component had to be integrated into the medical curriculum rather than competing with the science subjects that students felt were essential for their careers. They also argued that the Humanities should be presented as electives, so that students could make a choice, but that all students should have this exposure. In 1996, Barbara Brookes and Charlotte Paul ran a pilot Elective based on their respective strengths in the History of Medicine and Public Health. The success of that pilot led to the introduction of a suite of Electives in 1997. The Humanities Electives (now ‘Selectives’) have continued to be offered by the Humanities Division ever since. The model makes use of the expertise of staff in the Humanities, and presents these different modes of analysis to the students. Interested parties in the Medical Faculty can also be involved, if paired up with a Humanities academic.

In 2016,  the University of Otago suite of Humanities Selectives for third year medical students included varieties of history, an engagement with poetry or fiction, healing and death in the ancient world, introductions to Buddhist thought, the Graphic Narrative, Myth in French Film, the Politics of Health, and Modern Irish Drama. Humanities staff greatly enjoy this opportunity to engage a small group of students (usually about 15) in their specialist field. Not every medical student enjoys this opportunity but the great majority do, as summarised by the following student comment:

I loved using my brain in a different way.”

Twenty years have passed since that 1996 pilot. Questions are now being raised about an enhanced role for Humanities in the Medical Curriculum, one that reaches beyond the third year Selective programme. If the Humanities, as one student put it, encourages “more lateral and creative” thinking, it can serve to nourish those who embark on challenging careers.

[1] Brian Hurwitz and Paul Dakin, ‘Welcome Developments in UK Medical Humanities,’ Journal of the Royal Society of Medicine 2009 Mar 1; 102(3): 84–85.
[2] Minutes, ‘Medicine and Humanities Workshop,’ in author’s possession.

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Professor Barbara Brookes is co-editor of Corpus.

Professor Charlotte Paul is Professor Emeritus, Preventive and Social Medicine, University of Otago.