Integrating humanities in healthcare: a mixed-methods study for development and testing of a humanities curriculum for front-line health workers in Karachi, Pakistan.

Lady health workers (LHWs) provide lifesaving maternal and child health services to >60% of Pakistan's population but are poorly compensated and overburdened. Moreover, LHWs' training does not incorporate efforts to nurture attributes necessary for equitable and holistic healthcare delivery. We developed an interdisciplinary humanities curriculum, deriving its strengths from local art and literature, to enhance character virtues such as empathy and connection, interpersonal communication skills, compassion and purpose among LHWs. We tested the curriculum's feasibility and impact to enhance character strengths among LHWs.We conducted a multiphase mixed-methods pilot study in two towns of Karachi, Pakistan. We delivered the humanities curriculum to 48 LHWs via 12 weekly sessions, from 15 June to 2 September 2021. We developed a multiconstruct character strength survey that was administered preintervention and postintervention to assess the impact of the training. In-depth interviews were conducted with a subset of randomly selected participating LHWs.Of 48 participants, 47 (98%) completed the training, and 34 (71%) attended all 12 sessions. Scores for all outcomes increased between baseline and endline, with highest increase (10.0 points, 95% CI 2.91 to 17.02; p=0.006) observed for empathy/connection. LHWs provided positive feedback on the training and its impact in terms of improving their confidence, empathy/connection and ability to communicate with clients. Participants also rated the sessions highly in terms of the content's usefulness (mean: 9.7/10; SD: 0.16), the success of the sessions (mean: 9.7/10; SD: 0.17) and overall satisfaction (mean: 8.2/10; SD: 3.3).A humanities-based training for front-line health workers is a feasible intervention with demonstrated impact of nurturing key character strengths, notably empathy/connection and interpersonal communication. Evidence from this study highlights the value of a humanities-based training, grounded in local literature and cultural values, that can ultimately translate to improved well-being of LHWs thus contributing to better health outcomes among the populations they serve.

Forming Physicians: Evaluating the Opportunities and Benefits of Structured Integration of Humanities and Ethics into Medical Education.

This paper offers a novel, qualitative approach to evaluating the outcomes of integrating humanities and ethics into a newly revised pre-clerkship medical education curriculum. The authors set out to evaluate medical students' perceptions, learning outcomes, and growth in identity development. Led by a team of interdisciplinary scholars, this qualitative project examines multiple sources of student experience and perception data, including student essays, end-of-year surveys, and semi-structured interviews with students. Data were analyzed using deductive and inductive processes to identify key categories and recurring themes. Results suggest that students not only engaged with the curricular content and met the stated learning objectives but also acknowledged their experience in the humanities and ethics curriculum as an opportunity to reflect, expand their perceptions of medicine (and what it means to be "in" medicine), connect with their classmates, and further cultivate their personal and professional identities. Results of this qualitative study show how and in what ways the ethics and humanities curriculum motivates students past surface-level memorization of factual knowledge and encourages thoughtful analysis and evaluation about how the course material relates to and influences their thinking and how they see themselves as future doctors. The comprehensive qualitative approach reflects a holistic model for evaluating the integration of humanities and ethics into the pre-clerkship medical education curriculum. Future research should examine if this approach provides a protective factor against the demonstrated ethical erosion and empathy decrease during clinical training.

Comparison of Trait Creativity Between Medical Students and Humanities Students.

Background: Students play an important role in developing a country, and attention should be paid to encouraging and supporting students' creativity, especially in higher education. Objective: Creative training is an essential part of medical education and humanities education. The purpose of this study was to compare the trait creativity between students majoring in medicine and humanities. Methods: A cross-sectional online survey of students majoring in medicine and humanities was performed from July 20, 2022, to February 12, 2023. Trait creativity was assessed using the Williams Creativity Scale. Results: There were significant differences between female students and male students in the score of risk-taking (P < .05) and challenge scores (P < .05). No statistical difference was found for the score of trait creativity in four dimensions (imagination, challenging, risk-taking, and curiosity) between medical students and humanities students (P > .05). Conclusions: The study suggested that the overall trait creativity in medical students is equal to that of humanities students. However, gender differences in trait creativity still exist. Future studies should further identify more influential factors of trait creativity among university students.

Understanding the value of art prompts in an online narrative medicine workshop: an exploratory-descriptive focus group study.

Narrative medicine is an interdisciplinary field that complements and expands on conventional healthcare training by supporting narrative competence skills and creativity derived from the arts and humanities domains to address the needs of healthcare providers and receivers. With the COVID-19 pandemic having had a profound impact on the healthcare workforce with an already high burn-out rate, multimodal arts interventions may help address the holistic dimensions of well-being. While empirical evidence supports the use of arts-based interventions in promoting healthcare workers' well-being and personal growth, art prompts are underexplored and underused in narrative medicine. Moreover, protocols and frameworks adopted in extant research on this topic are inconsistent, resulting in replication and validation challenges. These issues have motivated this exploratory-descriptive study with 11 narrative medicine practitioners to examine the use of short art prompts in an online narrative medicine workshop.The art prompts leveraged art therapy's Expressive Therapies Continuum (ETC) model, which uses the inherent properties of art materials, media and methods to elicit specific levels of information processing and creative experiences. The study aimed to understand how art prompts differ from writing prompts and explore the value art prompts could add to narrative medicine if any. Qualitative analyses revealed that art prompts in narrative medicine increase positive feelings and promote creativity and insight. Specifically, art prompts allowed participants to use sensorimotor functions, enter a flow-like state, be challenged and inspired by novelty and uncertainty, and experience a sense of play and personal discovery.

The physician healer track: educating the hearts and the minds of future physicians.

Calls to reform medical education recommend explicit training in professional identity formation to promote the development of humanistic, compassionate physicians. The authors report their experience offering The Physician Healer Track, a 500-contact-hour curricula integrated over 4 years, focusing on self-awareness, reflection, being-with-suffering, communication and professional identity development. The voluntary scholarly-concentration program comprises 4 years of monthly dinner meetings with faculty mentors, a two-month preceptorship in the first year, a one-month immersion course in MS4 and one elective. Training in mindfulness, cognitive behavioral therapy, nonviolent communication, motivational interviewing, spirituality in healthcare, wellness, equanimity, and 'being with suffering' is reinforced across all 4 years. Community building and reflection are integral to the training both in the monthly sessions and the immersion courses. Enrollment has grown from 26 students in the first year (11% of class) to a total of 258 students across our first 6 years (average of 20-26% of each class). Graduates in our first two cohorts of PHT have exceeded the numbers in the eight other scholarly concentrations offered at UTMB. Among students participating in the summer preceptorship, there has been less than 1% attrition. In serial assessments, students report continued growth in personal development, professional development, and the ability to empathize. Offering PHT has resulted in the growth of training for our medical residents, faculty, physical therapy students and the creation of a student healer association. Despite the demands on student's time, they are voluntarily participating in a challenging program of integrated training with the intention of keeping them connected to their humanity during the rigors of medical school training.

Integrating Medical Humanities into medical school training.

Medical teaching must include new knowledge and technologies and how these affect patient care. The Medical Humanities can contribute to a more holistic and caring view of health and disease.

Medical themes in a literature classroom: An alternate perspective on Medical Humanities pedagogy in India.

This article examines the transferability of conversations in literary studies to a more sensitive, holistic, ethically informed, medical education. The article begins with a discussion of a class assignment on medical humanities in a literature course. The assignment enabled an immersive engagement with medical discourse by diverse students through different modes - through textual analysis, direct, and reflective encounters with communities of patients, caregivers, health professionals. The effort was to suggest that literature and medicine be studied as continuous shared strategies of reading and narrating lived experiences of health and illness. The insights of such learning should ideally be integral to the curriculum of medical students in India. Though the Medical Council of India's mandate for the humanities is inadequately sketched out, it nevertheless provides an opportunity to demand a larger citizenship and broader base of social sensitivity and knowledge for medical humanities.

Humanities in the undergraduate medical and midwifery curriculum: a descriptive Italian comparative study.

There is an increasing emphasis on humanized care in obstetric and midwifery practice. The goal of this paper is to investigate if and how medical humanities content was present in the undergraduate medical syllabus and how similar or different this is from the undergraduate midwifery program in Italy. A review of the 2017-18 curriculum for Italian Schools of Medicine and of Midwifery was carried out through institutional websites or mailing requests. The following details were collected for each program: the type of humanities content; the academic credits allocated, whether it was taught as a stand-alone (independent) topic or not, and the year(s) of the program when it was provided. Programs were included for 39 Schools of Medicine and 36 Schools of Midwifery. All midwifery schools included at least one subject with humanities content. Five medical schools (12.9) did not appear to have any subjects in this area. Psychology and ethics/bioethics were the most frequently found topics in both disciplines, but, apart from history of medicine, midwifery was much more likely than medicine to include other humanities topics, and especially pedagogy, anthropology, sociology and communication studies, philosophy and cross-cultural studies were rarely or never included in either discipline. A greater breadth of humanities studies was included in midwifery schools. However, their relative importance appears to be low, given the low level of academic credits and lack of presence as independent subjects.

Maintaining Balance in Medical School through Medical Humanities Electives.

The amount of scientific and medical information students are expected to master is ever increasing. This may draw attention away from the human aspect of medicine - the reason most enter medical school in the first place. Medical humanities may help students remain empathetic, self-aware and reflective as they work to become excellent physicians.

Medical Humanities Teaching in North American Allopathic and Osteopathic Medical Schools.

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools' websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 (as of June 2016) member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on required and elective humanities content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools (145 AAMC; 31 AACOM). 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean (MD 45.4; DO 37.1) and 30 (MD 29; DO 37.5) median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students.

Medical student mandala making for holistic well-being.

The objective of this qualitative research study was to discover how creating mandalas (art made in reference to a circle) might provide medical students with an opportunity for reflection on their current psychological state. As part of their year 3 family medicine rotation, medical students participated in an art-making workshop, during which, they created mandalas based on their current emotional state. Afterwards, they engaged in reflective writing and discussion. The responses of 180 students were analysed and coded according to the mandala classification framework 'Archetypal Stages of The Great Round of Mandala'. The results indicated that students were actively struggling in integrating conflicting perspectives as they were attempting to reconcile their professional identity as doctors. Additional results pertaining to psychosocial characteristics included navigating difficult emotions, requiring nurturance, handling endings, contemplating existential concerns and managing stress. The study has implications for making use of mandala making within a Jungian framework as means for medical students to reflect on their emotional state and achieve psychological balance.

[Medical Humanities--the Historical Significance and Mission in Medical Education].

In this paper we consider the significance and mission of medical humanities in medical education from the following six viewpoints: (1) misunderstanding of the medical humanities; (2) its historical development; (3) the criteria for the ideal physician; (4) the contents of current Medical Humanities education; (5) the basic philosophy; and (6) its relation to medical professionalism. Medical humanities consists of the three academic components of bioethics, clinical ethics and medical anthropology, and it is a philosophy and an art which penetrate to the fundamental essence of medicine. The purpose of medical humanities is to develop one's own humanity and spirituality through medical practice and contemplation by empathizing with patients' illness narratives through spiritual self-awakening and by understanding the mutual healing powers of human relations by way of the realization of primordial life. The basic philosophy is "the coincidence of contraries". The ultimate mission of medical humanities is to cultivate physicians to educate themselves and have a life-long philosophy of devotion to understanding, through experience, the coincidence of contraries.

Learning collaborative teamwork: an argument for incorporating the humanities.

A holistic, collaborative interprofessional team approach, which includes patients and families as significant decision-making members, has been proposed to address the increasing burden being placed on the health-care system. This project hypothesized that learning activities related to the humanities during clinical placements could enhance interprofessional teamwork. Through an interprofessional team of faculty, clinical staff, students, and patient representatives, we developed and piloted the self-learning module, "interprofessional education for collaborative person-centred practice through the humanities". The module was designed to provide learners from different professions and educational levels with a clinical placement/residency experience that would enable them, through a lens of the humanities, to better understand interprofessional collaborative person-centred care without structured interprofessional placement activities. Learners reported the self-paced and self-directed module to be a satisfactory learning experience in all four areas of care at our institution, and certain attitudes and knowledge were significantly and positively affected. The module's evaluation resulted in a revised edition providing improved structure and instruction for students with no experience in self-directed learning. The module was recently adapted into an interactive bilingual (French and English) online e-learning module to facilitate its integration into the pre-licensure curriculum at colleges and universities.

Eager 'weavers': designing assessment for an online environment.

As more and more Australian universities move their courses into blended learning environments (BLEs), it is important that strategies be devised to monitor teaching practices and student learning. In 2008, five large Australian universities were given an ALTC (Australian Learning and Teaching Council) grant to address the area of teacher peer review (PR). This paper shows evidence from one of the universities (The University of Technology, Sydney) where a case study was undertaken to optimise teacher peer review in a BLE. The project involved an innovative approach of interdisciplinary PR between an academic from the Faculty of Nursing, Midwifery and Health and an academic from the Faculty of Arts and Social Science (FASS). As a result of this collaboration, the online assessment in the nursing subject was radically changed with a greater percentage of the marks awarded to online activities. The design took more 'up front' effort by the coordinator, as is usually the case in online preparation, but results have shown that students who had previously relied heavily on directions from their tutors throughout the semester, were now taking on more responsibility for their own learning and for the learning of fellow students.

Dramatic insights: a report of the effects of a dramatic production on the learning of student nurses during their mental health course component.

Drama, like nursing, concerns itself with the human condition and finds its resonance in an empathetic response to the person-to-person connection. As part of their clinical experience in the mental health component of their undergraduate nursing course, 80 student nurses attended the play Bearing Witness written by the authors and produced as a joint Faculty production between the Faculty of Nursing and the Department of Drama at the University of Alberta, Edmonton, Canada. The play charts and interweaves the paths to healing of two people following incestuous abuse for one, and political torture for the other, and poses questions to the audience concerning the intent and effects of abuse, and the place and value of forgiveness and forgiving. Some 4-5 months afterwards the students were invited to participate in hour-long, semi-structured interviews to investigate the persistent impressions of the play, the students' perceptions of the themes and relevance and the effect of the play on their learning and development as nurses. The seven students who took part in the interviews expressed that their feelings of empathy and identification with the situation of the characters in the play had a greater impact on their learning than other methods of instruction they had evaluated, particularly in terms of the persistence and processing of the subjective experience. Other notable themes were that of forgiveness, its value in healing and the implications for nursing, and an appreciation of the 'spiritual component' of the total learning experience.

Holistic health promotion: putting the art into nurse education.

The role of the arts in health care and health promotion is enjoying belated attention as a way of promoting people's mental health and well-being. Canterbury Christ Church University offers a course which examines how nurses can use the arts to enhance the health care experience for both staff and patients. The Holistic Health Promotion course is compulsory for all final year pre-registration Bachelor degree students in Adult and Child Nursing. The content and process of the course are described, and the findings from the evaluation data are discussed. Through the use of autobiographical literature, active learning in the classroom, visiting speakers and visits within the local community, the course provides a positive learning experience for many students and broadens their perceptions of how to carry out mental, emotional and spiritual health promotion.

The humanities interface of nursing and medicine.

In the 1970s, the field of medical humanities developed and included ethics, literature, history, integrative medicine, and other topics, most often described from a physician's perspective. During this same period of revolutionary changes in health care, nursing curricula did not seek to emphasize content in humanities, perhaps because stereotypical views of nursing as the "caring profession" made such coursework seem redundant. In 2001, as a result of the Institute of Medicine's call for all health professionals to be educated in interdisciplinary teams, there was a new focus on the importance of interdisciplinary education. Collaborative experiences in the humanities can foster professional relationships that lead to professional growth, promote collaboration, and enhance patient-centered care. The purpose of this article is to describe the relevance of humanities to the interdisciplinary education and practice of health care providers. This article extends the thinking about the value of interdisciplinary education beyond the traditional dimensions of evidence-based practice, quality improvement, and informatics to humanities. Ways to provide nurses and physicians with interdisciplinary humanistic experiences are illustrated through an overview of projects jointly developed by the School of Nursing and the College of Medicine at The Pennsylvania State University.

Music education and performing arts medicine: the state of the alliance.

As a group, musicians tend to be somewhat disembodied; their awareness of their whole selves extends almost exclusively to the parts involved directly with musical technique. Even though many consider musicians to be small muscle athletes, it is unusual to see a group of beginning musicians working out or warming up on their practice field, or having a trainer present to supervise their movements or their mental performance orientation, as one would in sports. Several questions come to mind. How has this state of things come about? What do musicians know about the mental, spiritual, and physical attributes they bring to music making? What do music teachers teach students about wellness? How can a collaboration of the fields of music education and rehabilitation medicine approach these issues? This article addresses these questions.