Erika Leeman and Emily Baldwin deliver a
presentation at the Aoc Bazaar in April.
Photo by Chris T. Anderson, copyright 2004.

"During my surgery rotation there was a woman who had just been diagnosed with terminal cancer," remembers fourth-year medical student Emily Baldwin. "She was 29 and I was 32 and I was so distraught that I needed to do something for myself in order to go back the next day to talk to her - so I wrote down her story."

"Writing about medicine while learning medicine gives me the chance to reflect on what it means," says Baldwin. "It forces me to step back and think about where the story is, helps me focus on what's important with a patient, and leaves me better able to listen to patients and have a meaningful interaction with them."

Just as Baldwin has found that writing deepens her ability to be an empathetic and engaged physician, other UCSF medical students are mining their interest in music, visual art, dance, anthropology, and sociology as part of UCSF's new Area of Concentration (AoC) program in Medical Humanities. The AoC program, piloted last year and to be fully launched in 2004-05, enables fourth-year students to select elective coursework in one of six interdisciplinary themes.

Part of a national trend, UCSF's Medical Humanities program began with the realization that when they come to UCSF students are already writers and photographers, musicians and anthropologists, says curriculum coordinator Ramu Nagappan. "When we were revising the medical school curriculum, we wanted to find a way to give them mentoring and time and recognition for their accomplishments and a way to connect with each other."

While medical schools have offered some form of humanities coursework for a decade, it's only in the past two years that it has taken off. "The new zeal for the humanities is a return to what some people think of as the founding principles of medicine as a humanistic enterprise, not a purely scientific one," Naggapan explains. "The humanities programs that have been around for many years have often treated literature and the arts as a kind of nice, ancillary hobby for med students. But the more recent trend is to think more specifically about how the humanities can improve the clinical skills of future physicians."

One of UCSF's strategies is to engage as mentors the many faculty who have humanities expertise, such as the UCSF gastrointerologist who is a published poet and currently offers a writing workshop for health care providers, medical students and patients. To ensure a broad range of humanities topics, the Medical Humanities program is also recruiting mentors from the Joint Medical Program, a five-year program shared by UCSF and UC Berkeley.

Participating students are required to engage in a three-stage process of preparatory study, project implementation, and presentation of a final "legacy" in their fourth year. Throughout the process, students are encouraged to see their patients "not just as a case and a chart and set of statistics," says Nagappan, "but as a human with a story placed in an historical, economic and cultural context."

While still a budding program, the Medical Humanities AoC is already inspiring creative ideas. One first year student, a symphony orchestra musician before coming to UCSF, is interested in exploring the relationship between music and medicine-from music as therapy for patients to the toll music making takes on musicians' bodies. Other students have expressed interest in exploring the way the medical field is portrayed in television and film and how such portrayals affect the public's understanding and expectations regarding medicine. Yet other students may explore bioethics, from issues of transplantation to clinical trials in Africa for experimental HIV drugs.

When all is said and done, the question remains: Will Medical Humanities activities make students better physicians? Will they produce physicians more capable of interacting well with their patients in rich and meaningful ways? "It's hard to measure," concedes Nagappan. "If a student writes a book of essays about treating chronically ill patients, how does that change her? But with time we'll start finding out what sort of impact we have."

And yet, even without quantitative evaluation data, over half of medical schools across the country are combining medicine and humanities, believing the mix makes for better doctors. Currently co-piloting her own writing workshop for medical students, especially third year students who are "asked to do so many terrifying things," Baldwin says that students who have taken similar workshops at other schools have overwhelmingly found them a useful way to make sense of their clinical experience.

"Schools want to teach students how to be empathetic," she adds, "and we get talked to a lot about empathy. But rather than saying here's how to be empathic, writing helps us reconnect with why we came to medical school in the first place."

Source: Lisa Zimmerman