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Some med schools add humanities reqs

Anatomy, pharmacology, microbiology, pathology—these are components to a laundry list of science courses students must pass before delving into the world of medicine.

Some medical schools, however—including those at Yale, Stanford, Cornell and Mount Sinai—are expanding their curriculums to include humanities classes that embrace the notion that medicine is more than a scientific practice.

“I do think that a doctor needs to develop the skill of attending to the human dimension of clinical medicine... to be able to read between the lines of a patient’s narrative,” Dr. Jeffrey Baker, director of Duke’s Program in the History of Medicine, wrote in an email. “This is not an optional skill. One can make big mistakes and waste a lot of money on expensive tests if this aspect of medicine is neglected.”

Currently, the only humanities requirement in Duke’s School of Medicine is a medical humanities workshop in the fourth year. However, third-year students have the option of completing a year-long research project in non-scientific disciplines such as ethics, history, religion or literature, Baker said. This year, four students chose to pursue this track, a number he said is about average.

Erik Becker, a fourth-year medical student, spent his third year exploring his interest in the doctor-patient relationship at the confluence of medicine and theology.

“The vast majority of what a person experiences when they become ill—especially when that illness threatens their [life]—has to do with how they identify themselves, what is valued in their lives, their relationships with others,” Becker wrote in an email. “As a physician, it should be part of my responsibility, my covenant with my patients, to address—or at least acknowledge—all the ways in which their illnesses impact their lives.”

Becker took classes ranging from medical ethics to cross-cultural perspectives on pastoral care during his third year. This curriculum, he said, made him more attuned to the spiritual needs of patients experiencing illnesses in ways not limited to physical pain.

Dr. Margaret Humphreys, Josiah Charles Trent professor of the history of medicine, noted that humanities studies can sensitize medical students and doctors to what they do not know about a patient’s illness.

“In listening to patients we need to be alert for the meaning that symptoms and events have for them, a meaning that may not be immediately clear on the surface,” she wrote in an email. “Literature calls for us to ‘get inside the head’ of a person in the story, a person whose life and experience are alien to our own.”

As both a physician and historian, Humphreys said she knows firsthand about how having a lack of data can affect the conclusions one makes.

“We [historians] are always dealing with incomplete data and have to come to grips with creating accurate accounts in spite of that incompleteness. Doctors must learn to deal with that sort of uncertainty as well,” she said. “While my historical training and medical work both appeal to my fascination with solving puzzles, they likewise require a willingness to go ahead and act even when the knowledge base may be inadequate.”

Colleen Grochowski, associate dean of curricular affairs for the Duke School of Medicine, said currently the humanities is a “curricular thread” that is integrated into other required courses in the first, second and fourth years.

Although Baker said he thinks learning medical humanities is “at least” as relevant as acquiring knowledge of basic sciences for aspiring physicians, especially for those concerned with patient care, he does not foresee Duke making humanities courses required.

“The great challenge at Duke is that the third year is devoted to research. That leaves only one year to cover the two years of pre-clinical work covered in other medical schools,” he said. “Students feel great pressure to master an enormous amount of material. And they have to pass the same boards as everyone else.”

Becker said that although he thinks it is beneficial for medical students to be well-versed in humanities, he does not think requiring humanities courses is necessarily practical.

“I think that the people who are going to get the most benefit from such required coursework would probably be the ones who would seek out opportunities to study the material on [their] own,” he said. “The others will probably roll their eyes and grumble about learning something that’s not on the boards or clerkship exams,” he said.

That recognition, though, does not devalue the role of seeing the patient as being more than his or her symptoms, he said.

“Taking time to connect with the patient about their life and illness, to provide guidance and wisdom from a place of caring, to truly be there for a patient for whom perhaps no other medical interventions are available or possible, should remain the first and foremost duty and obligation of the physician,” he added. “Every student should have the opportunity to be exposed to a curriculum that includes attention to the person who is the patient.”

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