Course Descriptions

Medical Humanities in Patient-Doctor II:
Required Course Component and Linked Elective
(1999 - 2001)

Desiree Lie, M.D. MS.Ed., Course Director
Johanna Shapiro, Ph.D. Medical Humanities Content Area Expert

Description: Patient-Doctor II is a year-long, required course for all second year medical students (n = 92). The course is organized into eight modules, each of which is built around a patient case. Students working in small learning groups interview a Standardized Patient and then identify specific learning issues that will help them to better understand and care for the patient. Content areas include behavioral science, cross-cultural medicine, palliative care, complementary and alternative medicine, environmental and occupational medicine, epidemiology, ethics, medical economics, medical informatics, nutrition, and sexuality, as well as medical humanities.

Medical humanities are integrated into the PDII course through a required literary selection that reflects the topic for each of the given modules, which are organized around different organ systems or patient categories (ie., mental health, heart, pulmonary, liver and abdomen, pregnancy and gynecologic exam, pediatric illness, neurology, and geriatrics). Each module also includes a required point-of-view writing assignment, in which students use the humanities reading to write a brief essay that describes and expands on patient, family member, and physician points of view. This exercise incorporates an element of graduated complexity by starting with straightforward patient point of view and progressing to interactions among patient, family member, and physician perspectives.

Participants: 92 second year students

Faculty: Desiree Lie, M.D., MS.Ed, Course Director; Johanna Shapiro, Ph.D., Director of Medical Humanities in Family Medicine

Objectives: At the end of the course, students will be able to

Use creative imagination to understand the experience of illness
Enter into other points of view
Demonstrate understanding of the uses of language and tone
mpathically analyze complex interactions between physicians and patients as portrayed through literature
Use writing as a tool to reflect on and organize experience

Format: Each module has a required literary reading assignment to be completed by students and small group co-leaders. These are typically very brief (a single poem, a short short story, or excerpts) and reflective of issues raised in the module. Students are required to respond to the selection by completing the written point-of-view essay described above. Explicit directions for this assignment, as well as examples of other students’ writing, are provided at the start of the course. Co-leaders provide written feedback on the assignment by suggesting additional or alternative aspects of point of view that the student might consider. Students and co-leaders also incorporate discussion of the literary selection into the final group discussion of the module.

Required reading (all excerpts):

Module 1: Darkness Visible William Styron; The Legacy Judith Minty

Module2: Heartsounds Martha Lear; EKG Paula Tatarunis

Module 3: The Patient Examines the Doctor Anatole Broyard; I Stepped Past Your Room Today Gerry Greenstone

Module 4: Imagine a Woman Richard Selzer; F.P. Rafael Campo

Module 5: If The River Was Whiskey T. Coraghessan Boyle; Two Suffering Men Eugene Hirsch

Module 6: Autobiography of a Face Lucy Grealy

Module 7: On Being a Cripple Nancy Mairs; Nursing Home Barry Spacks

Module 8: Dr. Cahn’s Visit Richard Stern; Foreign Body Vincent Hanlon

Evaluation: The medical humanities component of the course is evaluated through an interstation exercise during an OSCE (Objective Structured Clinical Examination) evaluation at the end of the year. In this computerized exercise, students first read a brief fictional work, then write a response designed to elicit both empathic understanding of patient and physician perspectives as well as coping responses. The criteria for evaluating this writing assignment include assessment of key words connoting emotional language and analytic ability, as well as a global appraisal.

Elective Link: A medical humanities second year elective is thematically linked to the PDII course.

Description: This elective is thematically linked to Patient-Doctor II in that its content closely parallels that of the larger course and meetings occur monthly after each final module session of PDII. The class is intended to supplement exposure to the medical humanities for students with a particular interest in this area. Readings consist of poetry, role-plays, and brief excerpts from longer works that will help participants deepen their understanding of patients’ experience of illness, and patients’ and doctors’ experience of each other..

Participants: 10 second year medical students

Faculty: Johanna Shapiro, Ph.D., Director of Medical Humanities in Family Medicine; Desiree Lie, M.D., M.S.Ed., Course Director, PDII; various guest physician faculty

Objectives: At the end of this elective, students will

Develop increased empathy for people experiencing illness
Develop increased empathy for physicians
Improve their ability to pay attention to language, tone, and point of view
Be better able to explore personal feelings evoked by different illness experiences and different doctor-patient relationships
Develop new insights into understanding doctor-patient dynamics

Format: Students meet monthly with faculty for a total of eight sessions 1 ½ hours in length to discuss readings. No outside reading is required. Typically, a role-play, an excerpt from a short story, or poetry is read aloud. A discussion guide is provided to stimulate comments if necessary.

Reading:

Module 1: An Unquiet Mind Kay Redfield Jamison; Therapy John Wright; The Legacy Judith Minty; The Bell Jar Sylvia Plath

Module 2: Epstein Philip Roth; The Senescent Heart Michael Gravanis; Intensive Care Diane Ackerman; The Woman Who Could Not Live With Her Faulty Heart Margaret Atwood

Module 3: The Cancer Match James Dickey; Here and There Helene Davis; What the Doctor Said Raymond Carver; Chemotherapy Aimee Grunberger

Module 4: AIDS Test Ellen Samuels; How To Watch Your Brother Die Michael Lassen; F.P. Rafael Campo; Gay Men’s Chorus Paula Tatarunis; H.I. Vato Alberto Aontonio Araiza

Module 5: Two Suffering Men Eugene Hirsch; She Was My Mother Bless Her Soul Jane, ACA; The Power of Inclination Jack Coulehan; The Spirits Funnel Mladen Seidl

Module 6: Children Like These Lorrie Moore; Fathering Bharati Mukherjee; Sugar Barbara Anderson; How To Win Rosellen Brown

Module 7: Sal doesn’t shake Richard Donze; Spastics Vassar Miller; Stroke Susan Rea; Love for the Dog Gerald Stern

Module 8: Lousy on Admission Michael Crichton; Aging Gratefully John Graham-Pole; Forsythia James Sedwick; Nursing Home Barry Spacks

Evaluation: A class evaluation is completed at the end of the year. In addition to assessing faculty knowledge, commitment, and performance, the evaluation asks students to estimate to what extent the elective has increased their ability to empathize with patients; improved their ability to understand language, tone, and point of view; helped them to imaginatively recreate the lives of patients; and helped them to locate disease within the context of the patient’s life.