Medical humanity: how do we learn it?

Medical humanity, as ambiguous and inclusive as the concept seems at first glance, is broadly defined as an interdisciplinary field in humanities, social science and the arts, involving such extensive fields as ethics, history, religion, cultural studies, sociology, psychology, literature, etc., and their application to medical education and practice.1 In the United States, Europe and Canada, many medical universities have integrated the learning of medical humanities in their curricula, which many scholars claim may help medical students to build up a humane and holistic orientation in the future.2 In China, the integration of medical humanity courses in medical universities has come rather late compared with western countries. In recent years, however, the calling for humanity has surged across society after frequent news of patient-physician conflicts in medical practice. It is a big challenge in China when it comes to understanding and appreciating this broad concept,3 which is believed to be of particular significance for medical students, who are more likely to be classroom and library oriented. Medical humanity education appeals to more intuitive and interactive teaching methods, and it is believed that different approaches are very much needed for us to better appreciate humanity, which are beyond our textbooks and outside the classroom experience. With extensive literature searches and investigations, the authors hereby provide a general review of medical humanity education in western and Chinese medical universities, and novel approaches are introduced in the following case illustrations as well. Background of medical humanity education in foreign countries For a long period of time in the history of medicine, a doctor's basic pattern of thinking was based upon medical science, which was deemed as the only explanation of a certain disease and its treatment strategy. However, a lot of unscientific factors also played a significant role in the general outcome of a treatment. With the great advances in modern medicine, many ethical, social and psychological problems began to emerge, for example, a patient's quality of life is now considered equally, if not less, important than extending the patient's survival. Consequently, since the 1950s, western developed countries began to realize the significant need for alterations in medical education following the changes in medical patterns, i.e. from a biosocial model to a biopsychosocial model, and they have started to realize the importance of humanity education in medical universities. In the 1980s, the education system in the United States stated in their report concerning future medical education development, that the humanity and social science education for medical students should be further promoted. In 1989, medical students from Berlin even challenged the authorities to integrate humanity courses with medical courses by boycotting lectures.4 From then on, medical humanity education has developed extensively owing to the reform of medical education.5 The advancements of humanity education in western countries can be concluded into three parts: (1) A new goal for education, emphasizing building a new conception of medical science and society; advocating medical practitioners to care for and respect life; and promoting verbal language skills for medical students and enhancing their ability to communicate, cooperate and innovate. (2) Reasonable curriculum integration. Western universities set up many courses related to humanity and optimize the curriculum plan. Take the Harvard Medical School as an example, there are over 110 elective courses concerning humanity. Compulsory courses include human rights and doctors, society history, health and disease, and many others. Besides, a new pathway curriculum, launched in 1985, was designated to help students in handling the difficulties in the doctor-patient relationship, communication skills, and the best-accepted ways to deliver bad news to patients and their families. (3) Actively searching for a better teaching method and abundant teaching resources, which involves problem-based learning, case-based learning, task-based learning and online teaching and learning. Over time, a lot of innovative ideas appeared in the wave of the reform. Some of the cases are introduced as follows. Internet modernizes humanity education There is a tendency for fewer teachers in the university who still use the blackboard to help demonstrate their lessons; instead, PowerPoint slides, DVDs and videos are used for teaching, as well as laptops and iPads that are becoming more popular in class. It is predictable that modern technology, such as online teaching materials on the internet may be used as a platform for students and teachers to exchange ideas and acquire the latest knowledge. In Stanford University, a website is integrated into the teaching process (visit humanexperience.standford.edu for more information). The information, including articles, research, activities, and videos, can also be shared with friends on Twitter, Facebook and YouTube on the website. The internet serves as an incredible tool that extends the teaching of humanity not only to students, but also for every person in the learning community. This kind of community is commonly seen in American colleges and universities, and can also be found in Europe. In China, learning community online is relatively new but it definitely deserves our attention. Nature purifies the soul of humanity In spring and autumn, students and teachers in Dalhousie University Faculty of Medicine, Canada, will set out to the countryside or some nice place in the province to have a reading party in the open air every month.6 Humanity can be learned in the hospital or in society, but nature has its unique stories for people to discover. And a reading party here is the best way to combine humanity education with a relaxed lifestyle. Sunshine, tall trees, green grass, pleasant conversation and smiling faces, they all come from our life and can transfer positive energy to people just as humanity does. The casual talk and consultation between students and teachers often helps each other to better understand what is justified when facing different medical situations. What we have done to improve humanity education in China Compared with foreign universities, medical humanity education was a rather late-comer in China, but it has witnessed extensive development over the past decades. Medical curricula on humanism accounted for less than 5% during the total period in the university. Moreover, research concerning the current situation of humanity education revealed that 55.26% of students chose humanity courses only for academic credits.7 Also, courses related to medical humanity, including medical history, medical ethics and law, patient-physician communication, medical social sciences and so forth, are more often regarded as elective, subsidiary and less important ones. These courses tend to be taught separately, with little integration and no overall consideration of their curriculum arrangement. The faculty in Chinese medical universities is also a big issue, in which the lecturers are more likely to be majoring in law, psychology or social sciences, but rarely in medicine.8 There is no doubt that we are facing many difficulties in humanity education. Nevertheless, teachers and students from the Second Military Medical University are trying to find a new way to enhance the quality of humanity education. Medical humanity blends into the curriculum In universities, especially medical universities, medical humanity education should be involved throughout the whole teaching process. It should not be a separate course, but can be a compulsory part in every medical subject. Taking medical English courses as an example, vocabulary and grammar are usually the focus in our class and they often get most of the students’ attention. Medical terminology, sentence structures, and grammar fill nearly the entire class.9 How to blend humanity into medical English courses? Fortunately, a relatively new teaching method may enable a breakthrough. To elaborate further, a pioneer group project named “facing death” was designed for us students in the Second Military Medical University in Shanghai, China (if interested, please visit http://www.tudou.com/programs/view/9XXHkO4t2uc/for_more_information). A project-based learning (PjBL) method was integrated into the teaching process,10 which helped the students to further recognize those who were on the verge of death from a whole new perspective. In the Department of Emergency, the Department of Oncology and the Department of Traditional Chinese Medicine, students were encouraged to talk directly to the doctors, patients and their families, to better empathize with their feelings and listen to their understanding towards life and death. During the project, the students explained that they “never thought that there were so many stories in the hospital”. Sadness and happiness, optimism and pessimism, defiance and compromise… these emotions were somewhat buried deep underneath a real patient and a real doctor. Facing death is challenging, but we have gained more courage and hope after we finished the project. “We are supposed to be a good doctor. We have to be a good doctor.”-That is the strength the project has given us, urging us to be more than a good doctor in the future. A student forum, a pioneer practice of medical humanity education Over the past five years, the English Forum on Medical Humanities (EFMH), organized by Second Military Medical University11 has been a forum where students, teachers, as well as interns and doctors are fully engaged. The forum was initially launched to arouse people's awareness of medical humanity, as well as to provide a great opportunity for various people to share their ideas and experience. From 2008 to 2013, the past five years have witnessed an increasing calling for humanity during medical practice not only from the patient's perspective but also among medical practitioners and medical students. The forum is a beginning, not just for talking about humanity for one day, but a continuous pursuing and appreciation of humanity. Take the 5th EFMH as an example, some of the participants even started to organize a humanistic group community in their university after taking part in the EFMH. Inside this community, members would advocate the significance of humanity education and organize activities to emphasize the need for humanity. Though the spread of the consciousness of humanity calls for long-time efforts, it is delightful to see the students and teachers taking the first step. Notably, the forum itself has been a form of practical education on humanity. Both the oral and poster presentations were well prepared to share thoughts with other people. It's also a fantastic way to appreciate humanity, especially for medical students who have yet to be enlightened with real case scenarios in the hospital. Discussion and conclusion Humanity is not just an empty theory that we called for after each conflict between patients and doctors. In China, the spread of humanity faces a lot of resistance such as the limitation of teaching resources in universities, the ignorance of the importance of humanity in the medical practice and many other factors. However, there are still many ways that worth our trying. Humanity can be widely spread on the internet, where people may form a community and present their common emotions, values and beliefs to others.12 Humanity can be sincerely appreciated in nature, where students can manage to meet each other, face to face, have a nice cup of tea and enjoy a great sunshine afternoon in the open air. Humanity can be deeply felt during an experience, where we start to realize that to treat the disease alone is far from enough and how significant it is for medical practitioners to practice humanity during diagnosis and treatment. Humanity can be commonly shared in a forum, where we can get an opportunity to exchange our ideas and trigger our interest and inspiration from many diverse subtopics like doctor-patient relationship, medical education, facing death, etc. It is the awareness of humanity that matters, not the form of education. Since there are many differences in the education field between western countries and China, we must create an innovative way to remind our students that what we need is not only knowledge of medical science, but also the integration of medicine and humanity. Medical humanity education has many different forms, each of which contributes to the increasing awareness and objective need of medical humanity education, especially in China.13 As medical students, we are calling for better educational conceptions and a more innovative and interactive learning environment. Hopefully, the cases illustrated above will stimulate ideas for both teaching and learning of medical humanity, which will help to create a better atmosphere in medical education and build a more comprehensive career personality for medical students.

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