Humanities for Third Years

During this elective, third year students will recognize their own expectations for the clinical years in a small group setting 2-3 times weekly over a 2 week period. They will have assigned readings applicable to clinical care and will come prepared to discuss and reflect upon how the readings do or do not relate to their expectations. In a final essay writing assignment, students will reflect upon the ways the readings have altered or supported their expectations for the clinical years.

Course Learning Objectives:

Participants will be able to...

• use the written experience of mentor physicians to approach difficult situations in medicine^4,9
• reflect on challenging patient or educational encounters to foster willingness and acceptance of their feelings^7,10
• empathically discuss patient interactions to gain understanding for and acceptance of those they serve^5,6
• analyze professional scenarios and their reactions to discover patterns in our own attitudes toward medicine⁷
• formulate nuanced attitudes towards professional and ethical standards in today’s practice^1-4,6-10

Course Materials and Readings:

The Other End of the Stethoscope

“Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection”

We all have a vision of what a doctor should be. And as you develop into that ideal, it is important to be frequently reminded of who you are, where you are, and how close you are to realizing that vision. But, sometimes that is difficult to do in medical school. Though standardized tests and memorization of triads teach you to think like a doctor, it is much harder to learn how to act like one.^1-5 Perhaps discussing literature will be more effective than a science textbook here.^5-8 Over our sessions, we aim to hone our skills of observation, first of our patients and then of ourselves, with a particular focus on discovering our feelings towards medicine and becoming better professionals.^6-8 Who knew sharing feelings could make you a better doctor?

This colloquium will use texts from physician authors as our guides to self-awareness: sometimes fiction, but often memoir or non-fiction.⁹ This is not a literature course nor is it creative writing, although both these disciplines can influence your own appreciation of our discussions.¹⁰ You do not have to have a background in the arts or humanities to participate as these tools will be taught just as we teach physical diagnostic maneuvers or clinical reasoning skills.

Each seminar will rely on a reading from a physician that will serve as a thematic focus for that session’s discussion. Students will come to meetings with a written reaction to the reading and formulate discussion questions to share with the group.⁴ Our discussions will begin with moderator-led questions focusing on the author’s environment, the author’s attitude towards patients and medicine, and your reactions to these views based on your experience of patients, medicine, and society. Your own memoirs are welcomed but not required.

1. The Role of Doctor

• Text: “Lives of a cell” by Lewis Thomas

  • Physician and frequent New England Journal essayist Lewis Thomas frames the world as a giant cell, complete with the atmosphere as a membrane and humans as sentient organelles. Topics for discussion may include existential crises of the healer, the wondrous simplicity and complexity of cells, and appearance vs. reality of medicine.

    As an introduction to the course we will spend a few minutes reading Ernest Hemingway’s “Indian Camp” to introduce the skills we will build in this course. This fictional short story (written by the son of a physician) features the experience of a young boy who helps his father deliver a baby at a local Native American village. In our prescriptive discussion, we will focus on the loss of innocence that comes with learning medicine.

2. Feeling M.D. Inside

• Text: “Bogus Doctor” from Intern by Sandeep Jauhar
  • Dr. Jauhar, a cardiologist whose memoirs on his medical training have been published in the New York Times and New England Journal, reflects on his first few weeks as an intern. Topics for discussion may include feelings of guilt and inadequacy, the role of grades in medical school, and the feeling of being the least-educated person on the team.

3. Great Power, Great Responsibility

• Text: “Scared Witless” from How Doctors Feel by Danielle Ofri
  • Dr. Ofri reflects on the most personally challenging experiences as a resident and young attending, reflecting on the risks and benefits of treating patients with fear on her side. Topics for discussion may include the nature of fear in doctors, exercising self-compassion, and the need for supportive superiors.

4. Fighting Death

• Texts: “Mercy” by Richard Selzer & “On the Ward” from Hospital Sketchbook: Life on the Ward Through an Intern’s Eyes by Elspeth Cameron Ritchie
  • Dr. Selzer, a surgeon, and Dr. Ritchie, a psychiatrist and GW alumna, discuss their terminal patients and approach the tragedies very differently. Topics for discussion may include the different ways doctors view their relationship with death, self-preservation in the face of illness, and becoming comfortable with treating terminal illness.

5. I’m the One Who Jaded You

• Text: Excerpts from The House of God by Samuel Shem
  • In what many consider the first look at the realities of medical training, Shem draws from his experience as an intern at the House of God, a pseudonym for a prestigious Boston hospital, to explore how the emotional burden of healthcare turned him from excited intern to cynical resident. Topics for discussion may include self-preservation, the balance of reality and optimism, and team-building.

6. The Core of Insecurity

• Texts: “Mistakes“ by David Hilfiker
  • Dr. Hilfiker, a rural family doctor, obsesses over the mistakes he’s made throughout his career and discusses the the difficulty of decision-making in medicine. Topics for discussion include living with your decisions, self-healing, and the acceptance of self-doubt.

7. The Inner Game of Medicine

• Text: “A Surgeon’s Life” by Oliver Sacks
  • Rather than an account of one of his many interesting patients, the famed neurologist writes a story about his meetings with a surgeon who suffers from Tourette’s and the lessons he learns about the suffering and hardships of a doctor with disability. Topics for discussion may include the underlying difficulties of being a doctor, passions beyond medicine, and debunking the facade of physician-hood.

8. Learning Empathy

• Text: Excerpts from When Breath Becomes Air by Paul Kalanithi
  • At the cusp of finishing his decade-long training to combat death, neurosurgery resident Paul Kalanithi is diagnosed with metastatic lung cancer at age 35 and chronicles his experience of receiving the bad news all doctors struggle to share with patients. Topics for discussion may include the importance of understanding our views of dying, the help or harm of becoming comfortable with death, and whether physicians can discuss imminent mortality without experiencing it themselves.

1. Haidet P, Jarecke J, Adams AE, et al. A guiding framework to maximise the power of the arts in medical education: a systematic review and metasynthesis. Med Educ. 2016;50:320-31.
2. Dennhardt S, Apramian T, Lingard Lingard L, Torabi N, Arntfield S. Rethinking research in the medical humanities: a scoping review and narrative synthesis of quantitative outcome studies. Med Educ. 2016;50:285-99.
3. Lake J, Jackson L, Hardman C. A fresh perspective on medical education: the lens of the arts. Med Educ. 2015;49:759-72.
4. Curry RH, Montgomery K. Toward a liberal education in medicine. Acad Med. 2010;85(2):283-7.
5. Doukas DJ, Kirch DG, Brigham TP, et al. Transforming educational accountability in medical ethics and humanities education toward professionalism. Acad Med. 2015;90(6):738-43.
6. Charon R, Trautmann Banks J, Connelly JE, et al. Literature and medicine: contributions to clinical practice. Ann Int Med. 1995;122:599-606.
7. Branch Jr WT. The road to professionalism: reflective practice and reflective learning. Patient Educ Couns. 2010;80:327-32
8. Wershof Schwartz A, Abramson JS, Wojnowich I, Accordino R, Ronan EJ, Rifkin MR. Evaluating the impact of the humanities in medical education. Mt Sinai J Med. 2009;76:372-80.
9. McLellan MF. Literature and medicine: physician-writers. Lancet. 1997;349:564-7.
10. Shapiro J, Coulehan J, Wear D, Montello M. Medical humanities and their discontents: definitions, critiques, and implications. Acad Med. 2009;84(2):192-8.

Supplemental Readings:

“The House Officer’s Changing World” & “An Intern Meets Ty Cobb” by Joseph Hardison; “Invasions” by Perri Klass

Dr. Hardison, a longtime medical editorial contributor, reflects on current changes in hospital environment and admits his mistakes just as Dr. Klass recalls the double standards she experienced as a medical student. Topics for discussion include reflection-driven improvement, living up to impossible standards from the past, and feeling inadequate as a young doctor.

2021 Addendum Topic: Physicians and Patients 

We will begin by discussing a few short chapters from Eula Biss’s recently published Having and Being Had, in an attempt to answer the question, “What kind of ‘work’ do doctors do?” Other readings include short stories by doctors (e.g., Atul Gawande) and/or patients that raise important moral, emotional and practical questions about being a physician and/or patient.  Requirements: to formulate two questions for each reading prior to the class meeting and a half page response to the discussion after the class.  We will meet for 1.5 hours three times a week at a time agreed upon by the professor and the students.