Vinod Pallath

Humanising medicine: taking our first step

What problems were addressed? Whereas medicine is a science, the practice of medicine is an art. Over the years, medical practice becomes increasingly dehumanised. Medical schools assess their students mainly on medical knowledge and clinical skills, and neglect the humanist aspects of medicine. This approach will not facilitate the development of clinicians who can express themselves clearly, and who listen attentively to their patients, show empathy and possess good bedside manners. Although humanist qualities are powerful healing tools that can help in the cultivation of strong patient–doctor relationships, there is, sadly, an absence of humanism in the culture of modern medicine. Changes in medical training are required. What was tried? Our medical school provides an early introduction to the humanities in medicine with the aim of educating students in humanism and the art of medicine. In our revised medical curriculum, the ‘Language in Medicine’ component is introduced at the commencement of Year 1. Four themes are highlighted in this component: Icons in medicine; Good science, bad science; When there is no doctor, and Death and dying. The first theme introduces students to local and international icons in medicine. The second theme exposes students to uncertainty and scepticism in medicine. The third theme emphasises that the provision of health care represents a team effort and exposes students to health care that does not involve doctors. In the fourth theme, students are introduced to palliative care and end-of-life issues. They learn about compassion, empathy and the art of breaking bad news. Blended learning is facilitated through activities on an e-learning platform, lectures and show-and-tell sessions in which patient volunteers share their experiences. Interspersed with this, students visit six centres, including an emergency department and a community clinic. Communication skills workshops equip students with essential skills for communicating with patients. Students are encouraged to reflect on their activities throughout the week and to write about their experiences as a group. Learning is supported by feedback provided through online forums, online resources and formative assessments. What lessons were learned? The introduction of Language in Medicine has raised awareness among students of the humane aspect of medicine. Group assignments hone students’ team skills and communication skills training enhances their ability in history taking and interpersonal interaction. The Death and dying theme emphasises the fact that although doctors cannot always heal, they can always care. Tutors in subsequent basic science blocks commented that the revised curriculum has made students more inquisitive and has improved communication between tutors and students. Despite the efforts and enthusiasm contributed by everyone involved in implementing the many useful activities, some students commented that the time might be better spent on learning medicine. After a review, the 12-week component was condensed to 8 weeks for subsequent cohorts. Curriculum review and transformation helped us to humanise our undergraduate medical curriculum. Over time and with continuous feedback for improvement, a change in the student learning experience is slowly taking shape.