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Medical Humanities

Extracurricular Activity or Critical Curricular Component?

 As of 2015, the Medical College Admission Test (MCAT) will change to include new sections on "psychological, social and biological foundations of behavior" and "critical analysis and reasoning skills". The Association of American Medical Colleges (AAMC) suggests the goal of these new, more social-science focused sections, is that "our population is becoming more diverse every day -- and tomorrow's doctors need to be prepared. Those factors [meaning ethics and socio-cultural background, for example] play a major role in shaping what students learn in medical school and what they need to know when they begin". Thus, these proposed changes give weight to the fact that coursework or experiences in the humanities are an invaluable part to a future physician's education. As two non-science major undergraduates who chose to pursue an additional graduate degree in a non-science discipline before going to medical school, we are optimistic about the recognition of the critical role of the humanities in medicine. However, we feel that more than just a change in an admission test is needed to truly integrate humanities and medical education; what is required is a change in medical culture.
 
Matriculating into medical school, we were proud of our humanities roots and felt it made us uniquely poised to become great clinicians. Yet, we have often found that we have had to defend our educational choices to interviewers, advisors and even our peers-- something science majors rarely, if ever, have to do. This is because the medical humanities is often regarded as a "second tier" or an extracurricular interest and not something that is fundamental to the practice of medicine. Medicine, after all, is inherently rooted in science, and as such, the social learning environment in medical school is often not the most hospitable place for students like us who like learning about culture, ethics and patient stories. It becomes difficult, therefore, to share your excitement with classmates who view the subject areas you like the most as "touchy feely," or fail to see what the humanities can teach us about healing just because its dividends can't be measured quantitatively or depicted by a graph. While the unique skills we have acquired from our backgrounds will help us to become more compassionate and empathetic doctors, there are no real venues in the pre-clinical curriculum in which our intellectual strengths can shine or or academic opportunities to build on these skill sets.
 
Courses on ethics and social science are few and far between. To make matters worse, students often do not take these exercises seriously, and these courses are often the ones with the poorest attendance, for example. The opportunities that do exist to learn humanities in medicine exist as extracurriculars or electives. Even in a pass/fail grading system, the time to pursue extracurricular interests is minimal, and often students will drop their outside interests and focus solely on studying medicine. Furthermore, it is difficult to commit to longitudinal extracurricular experience throughout medical school simply because each year differs in terms of its curricular structure.These electives are self-selecting -- students already interested in the humanities will choose to take advantage of these opportunities, while other students, previously unexposed to the medical humanities, will fail to benefit from the of opportunities available to them.
 
Without having time to actively pursue our humanities interests and to truly cultivate our backgrounds, it is unlikely that when these skills are most applicable -- as third year students with patients and beyond -- our skills will still be as strong. Even still, as residency directors and other medical students are not up to speed with the humanities in medicine trend, we often feel like we will need to change ourselves to fit in with other medical students in order to match successfully in residency and to be taken seriously by our peers and "evaluators". For this reason, given the option of doing a thesis or summer research in any discipline, for example, students will almost always chose to do basic or clinical research, instead of studying what they came into medical school passionate about, as ultimately that is what they believe is expected of them to be the best doctor possible. Therefore, to truly respect and integrate the humanities into medicine, the discipline needs to become more than just an extracurricular, and for that to happen, it has to be accepted as more than just "fluff" by our peers, and the medical institutions as a whole.
 
While changing the MCAT is a great start, it is only that -- a start. We hope that over time, more students interested in the medical humanities will matriculate in medical school and one day become physicians that will help shape the education of and practice of medicine for future generations.
 
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Image by Neil Leslie, "Left and Right Brain Function", Wellcome Library, London

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