As Dr. Arno K. Kumagai confirms in Academic Medicine, there’s a growing interest
in the arts and humanities as a part of medical education. This curriculum, though, is still in its infancy. We know this because faculty and students alike don’t quite know what to do with the humanities.
The title of this article comes from Dr. Kumagai overhearing two students on their way to his humanities seminar. One referred to it as going to spend some quality time with Dr. Feel–Good
. The author found this funny, but indicative. Med students have a lot to learn, and most that encounter some kind of non-biomedical training in medical school don’t seem convinced of its value relative to all their other courses.
Faculty and administrators don’t quite know what to do with the humanities, either. There is, at best, a vague sense that art makes better doctors. But vague sense makes for vague curriculum, and Kumagai cites the idea that most humanities exist at the decorative edges of the curriculum
.1
Kumagai discusses several facets of what the humanities can actually accomplish. All of them have to do with the idea that the humanities — and storytelling specifically — can complicate situations. When decisions are at risk of being made too quickly, and scenarios seem simple but in reality require nuance, the humanities bring the complexity of the world to awareness.
It is possible to tell a large, complex story in a few short phrases. The most important elements of any period of time can be selected and strung together. It is also possible to look deeper into events and introduce conflicting elements within the story. The more layers of conflict that exist in a story, the more knots there are to be untied before the story ends. In this view of storytelling, our human tendency to narrate events can work in two opposite ways. We can zoom out and distill a story to its essence. We can also zoom in and look for the ways that things aren’t as simple as they appear.
The first way that storytelling in the humanities works to complicate, and to unsimplify
is what Kumagai calls “disruption”. This is refreshingly not used as the business buzzword, nor is it the academic tendency to problematize. This kind of disruption works to distort our perceptions of common objects, relationships, ideas, identities, or beliefs to force us to look at them anew.
2
T. S. Eliot famously wrote,3
We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
It is difficult to be an expert and simultaneously deal with each instance as if it were the first. Being able to recognize familiar patterns in medicine and then treat each patient with fresh eyes is not easy. It’s one of the gifts that dealing with narrative complexity can give.
Dense narratives can also help decision making by allowing providers “to pause”. As Kumagai writes, in addition to questioning automaticity, this slowness also allows us to deal thoughtfully with complexity and ambiguity
.
Kumagai specifically names dealing with sociology and history. This is also a result of deliberately having to deal with complex narratives, which help us to peel back the different layers making up ideas, institutions, conditions, or practices to understand them
.
In a personal context, this ability means being able to understand someone else’s lived experience. Disease is often described by its proximity to or divergence from the norm or the typical… Stories, on the other hand, resist simplification and celebrate the unique.
One of the functions of any professional education is to teach decision making. This is especially true in medicine, where the patterns of disease, symptoms, and treatment become encapsulated and automatic.
Dealing with people requires this understanding, but also requires a sensitivity to complexity. All individuals, their lives, and their illness are unique in some way. Only a curriculum which deliberately deals with intricacies in narrative can prepare someone for what Kumagai cites as the
.4swampy lowland
of actual practice
Sources
The article reviewed: Kumagai, Arno K. 2017. “Beyond ‘Dr. Feel-Good’: A Role for the Humanities in Medical Education”. Academic Medicine 92 (12): 1659–1660. https://doi.org/10.1097/acm.0000000000001957.
1 Belling, Catherine. 2010. “Commentary: Sharper Instruments: On Defending the Humanities In Undergraduate Medical Education”. Academic Medicine 85 (6): 938–940. https://doi.org/10.1097/acm.0b013e3181dc1820. ↑
2 Kumagai, Arno K., and Delese Wear. 2014. “‘Making Strange’: A Role For the Humanities In Medical Education”. Academic Medicine 89 (7): 973–977. https://doi.org/10.1097/acm.0000000000000269. ↑
3 Eliot, T. S. 1942. Little Gidding. ↑
4 Schön, Donald A. 1983. Reflective Practitioner, The: How Professionals Think In Action. New York, NY: Basic Books. ↑
Featured Image: “Cast Aluminum Doctor with Bandage (New Kensington, PA)”, by Flickr user takomabibelot, this work is in the public domain.