Memorial University of Newfoundland Faculty of Medicine, The Medical Humanities in the Clinical Skills Course

Informal efforts to introduce the medical humanities throughout the undergraduate and postgraduate medical curriculum have been ongoing at Memorial University of Newfoundland for more than 15 years, and have mainly involved informal lunchtime discussions and occasional lectures on history, literature, and art. These sessions were led by various medical faculty and by invited guests from related university departments or from the broader community. In 1996 Memorial University moved to a fully integrated program in the undergraduate medical curriculum. Specialized courses were combined to form four major courses in which all undergraduate teaching now occurs. The courses include Clinical Skills, Basic Science of Medicine, Community Health, and the Integrated Study of Disease. Although there is no medical humanities course per se, consistent with the educational philosophy of the medical school the intent has been to integrate throughout the curriculum materials from the medical humanities, ethics, and law. The Faculty of Medicine’s medical historian, two philosopher/ethicists, and a health law expert have worked together with the Departments of English Literature, Anthropology, Philosophy, and History both to develop materials to integrate into the formal curriculum and to continue the tradition of informal instruction. The most significant formal integration to date has occurred in the first-year Clinical Skills course. This course aims to integrate aspects of behavioral science, communication, physical examination, clinical reasoning, health promotion, and related issues. The clinical faculty responsible for this course has collaborated closely with those who provide instruction in the medical humanities. This course now consists of 96 hours of instruction divided between the core components of clinical skills (72 hours) and the foundations of medical humanities, ethics, and law (24 hours). Each successive offering has led to closer collaboration and integration. We now produce a single set of course objectives and evaluative criteria. History, literature, drama, and film are employed as vehicles for expanding our students’ understanding of the complexity of the lives they encounter. Film excerpts of both classic (e.g., Arrowsmith) and more modern (e.g., Patch Adams) vintage motivate small-group discussions. Short literary pieces such as Lacombe’s “Playing God” and Broyard’s “The Patient Examines the Doctor” are juxtaposed with standardized patient interviews to provide another perspective for students to ponder. Journaling has become an important aspect of the students’ humanities education. The expanded use of narrative helps student and instructor alike to recognize our mutual responsibility to protect the integrity of the stories we share with our patients and with each other. For example, while one of the key clinical skills we aim to develop is that of recording an appropriate and accurate patient history, we attempt to frame this activity as a narrative encounter in which student and patient alike enter into and share each other’s story. Students receive feedback at each weekly meeting from fellow students and their facilitators. Written and verbal feedback is given to students at midterm, and again at the end of the course. The course culminates with a formal evaluation interview. We are continuing to expand our formal medical humanities curriculum into the second-year undergraduate program, focusing primarily on the integrated study of disease.

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