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Abstract
Humanities are increasingly taught in medical schools based on the premise that sensitive and educated human beings may become better physicians. There have been few reports of what is offered in Italian medical schools and we have not been able to identify any published survey of student opinions.
- humanities
- patient physician relationship
- medical school
- non-medical books
- medical education
- medical humanities
Statistics from Altmetric.com
- humanities
- patient physician relationship
- medical school
- non-medical books
- medical education
- medical humanities
An anonymous questionnaire was given to students during a seminar on the patient physician relationship during a fourth year nephrology course at San Luigi Medical School, Turin, Italy. The questionnaire asked students about their individual reading habits, their interest in, and views regarding, humanities in the medical school, and for suggestions regarding the type and setting of teaching they preferred.
Sixty eight per cent of fourth year students completed the questionnaire. Nearly 68% of the students had read at least one non-medical book in the last month or during the last week, eight had read at least one non-medical book in the last six months, and only 8.8% had read none in the last semester. Preferences were for novels and short stories (25 out of 31); half recalled at least one book regarding medicine or physicians. The majority of students considered that humanities should be included in mandatory medical courses (31 out of 34) or in optional ones (three out of 34). All suggested dedicating a section of the medical school library to non-medical books regarding non-medical aspects of medicine and physicians.
Humanities are increasingly taught in medical school based on the premise that sensitive and educated human beings may become better physicians. This seems to be a feature of medical schools with an Anglo-Saxon cultural background, while, possibly because of the different cultural milieu, such courses are less extensively offered in Mediterranean Europe in general and in Italy in particular.1,2
The latest editions of the two major textbooks of internal medicine define the medical profession as a “calling” and underline the ethical aspects it has in common with all the “learned and humane” professions. Uncertainties about the physician’s role were underlined, however, in the last decade by a growing number of papers, which highlighted the potential for conflict between increasingly complex medical technology and a humane and holistic medical practice.3–6
Nephrology teaching in medical schools is particularly suited to demonstrating the interactions between technology and care. Chronic haemodialysis was one of the starting points for the birth of applied bioethics, when it attempted to face, for the first time in medicine, the problem of limited resources for a life sustaining chronic and expensive therapy.7–9 Furthermore, the recent appraisal of early predialysis follow up, in a model of care which sees therapy as a continuum from the early phases of renal disease to dialysis and to renal transplantation, underlines the importance of a close and personal relationship between patients and caregivers, in the attempt to optimise the outcomes of care.10
One of the pioneers of dialysis has recently underlined the need for physicians to go back to their roots as teachers and healers, suggesting a need for discussing the multifaceted patient/physician relationship together with the technical aspects of renal replacement therapy and the implications of both in clinical practice.11
For these reasons, the role of the humanities in medicine has been discussed in the context of seminars dedicated to the patient/physician relationship and in interactive teaching sessions dedicated to practical aspects of nephrology, dialysis and transplantation in a 4th year nephrology course at the San Luigi Medical School, University of Turin, Italy. To assess the students’ views about this pilot experience in nephrology, students were given an anonymous questionnaire about their opinions on the role of the humanities in the medical school during an optional seminar on the patient/physician relationship in nephrology. As far as we know, this is the first inquiry performed in an Italian medical school about the role of the humanities in medicine.
MATERIALS AND METHODS
The nephrology course
In Italy students undertake a course in nephrology during the fourth year of medical school. It consists of mandatory and of optional teaching sessions. The San Luigi Medical School has about 50 students per year. Each student has four hours of lectures and 10 hours of interactive small group teaching. Students can also take 20 hours of optional teaching sessions, including four hours on the clinical aspects and four hours on ethical and decision making aspects of dialysis and transplantation, and four on the patient/physician relationship; all were attended by at least 50% of the fourth year students. The humanities, the patient/physician relationship and ethical problems were discussed in lectures and interactive small group teaching, as well as in the dedicated optional seminars.
The questionnaire
All students attending an optional seminar on the patient physician/relationship were asked to complete an anonymous questionnaire (34 students, 68% of the students attending the fourth year of the medical school) and return it at the end of the seminar. Questions included: What is, in your opinion, the relationship between general culture and medicine? What was the last book you read? When did you read it? Have you ever read non-medical books dealing with physicians or medicine? Do you remember their titles? Do you think the humanities should be taught in the medical school? In what kind of course? Do you think the library of the medical school should dedicate some space to non-medical books on medicine and physicians?
RESULTS
Overview
All 34 students returned the questionnaire. All students considered that a good physician is a person whose interests are not limited to technology; three commented that this should apply to all professionals and not only physicians.
Students’ reading habits
Twenty three students (67.7%) had read at least one book in the last month (13 of them during the last week), eight had read at least one in the last six months (23.5%), and three (8.8%) had not read a non-medical book in the last semester.
Among students who had read at least one book in the last six months, the majority (25/31, 80.6%) had read novels and short stories (25/31, 80.6%), with only six students (19.4%) reading reports of direct experiences (non-fiction) or essays.
Sixteen students (51.6%) reported reading at least one book involving medicine or medical doctors (see Box 1).
Box 1: Students’ recent reading
G Strada: Pappagalli Verdi [Green Parrots]
P Skrabanek, J McCormick: Follies and Fallacies in Medicine
O Fallaci: Letter to a Child Never Born
M Winckler: The Case of Doctor Sachs
P Adams: Health
I Allende: Paula
Medicus Medicorum (pseudonym): Camici e Pigiami [Overall and Pyjamas]
O Sacks: The Man who Mistook his Wife for a Hat
G Flaubert: Madame Bovary
M Bulgakov: The Master and Margarita
M Bulgakov: The Heart of a Dog
M Bulgakov: White Guard
A Camus: La Peste
N Gordon: The Last Jew
N Gordon: The Physician
N Gordon: Shaman
D Pennac: Petite Marchande de Prose [Write to Kill]
Educational interventions preferred
Thirty one students (91.2%) believed humanities should be studied in dedicated mandatory courses in Italian medical schools; the remaining three students believed they should be discussed only in optional courses.
All students would like to have a section of the medical school library dedicated to “non-medical” books about medicine and physicians (see Box 2 for suggested books).
Box 2: Some suggested books for the non-medical section of the medical school library
A Camus: La Peste
M Bulgakov: The Master and Margarita
M Bulgakov: The Heart of a Dog
M Bulgakov: White Guard
D Lapierre: Five Past Midnight in Bhopal
A Chekov: The Cherry Orchard
A Chekov: Uncle Vanya (all the plays)
F Dostoyevsky: The Idiot
L Tolstoy: The Death of Ivan Ilich
A Munthe: The story of San Michele
N Gordon: The Last Jew
N Gordon: The Physician
N Gordon: Shaman
D Pennac: Petite Marchande de Prose [Write to Kill]
However, three students also identified deficiencies in the medical books held by the library and pointed out that several “non-medical” books regarding medicine and physicians are available in the public libraries and therefore questioned the necessity of having a separate section in the medical school library.
DISCUSSION
Several authors consider teaching humanities within medical education as an interesting tool for educating new physicians in a holistic approach to disease and patients.12–14 In this small study in an Italian medical school where, in the context of the nephrology course, time was dedicated to ethical and cultural aspects of medicine, this opinion was shared by all our students. Despite the lack of courses dedicated to ethics or humanities in our medical school, all the students considered that an ideal physician should develop interests beyond the technical ones, and none of them saw any competition between the humanistic and the technical aspects of medicine. While the majority of the students (31/34; 91.1%) considered that humanities should be a part of the core medical curriculum, a small minority of them (3/34; 8.9%) emphasised that cultural interests are essentially personal and that they would therefore prefer optional courses.
The high number of books read during the last semester of the medical school: (over two thirds of the students had read at least one book in the last month) suggests that students consider a wider cultural education important. The choices of reading material were various and reflected individual interests, novels and short stories being the most preferred forms of reading. It is interesting but not unexpected that books about physicians and medicine were commonly read: almost half of the students recalled reading at least one on this subject. Among them, one of the favourites was Pappagalli Verdi [Green Parrots] by Gino Strada, a war chronicle widely discussed by the Italian media; this may also suggest an interest in new behavioural models of holistic physicians operating in peculiar social contexts.15
Our findings are in keeping with other reports from other European settings (in a recent study carried out in Newcastle upon Tyne, about 40% of the medical students read on average one book per month) which suggests a spontaneous interest in these subjects, even in the absence of dedicated courses.16
The interest in the physician as a character in literature is also reflected in the suggestion that a section of the medical school library should be dedicated to non-medical books about medicine and physicians. In their free text comments, three students added that the cost of a basic library of “good books for doctors” would be low and that the reasonable expense of 500 Euros (about 500 US dollars) may allow buying 40 to 50 books in paperback editions.
This option may be seen as less challenging by European medical schools, than the development of dedicated programmes or courses, and may indeed represent an interesting starting point for the introduction of the teaching of the humanities into medical education.
Acknowledgments
We wish to acknowledge the help of the students of the San Luigi Medical School who took part in this study.