The medical humanities at United States medical schools: a mixed method analysis of publicly assessable information on 31 schools

INTRODUCTION

There have been increasing efforts to integrate the arts and humanities into medical education, particularly during undergraduate medical education (UME). Previous studies, however, have focused on courses and curricular programming without rigorous characterization of the associated paracurricular environment or infrastructure enabling or facilitating these offerings.

METHODS

To assess opportunities for students to engage the arts and humanities during their medical education as well as the institutional resources to support those opportunities, we developed the Humanities and Arts Programming Scale (HARPS): an 18-point scale involving eight sub-domains (Infrastructure, Curricular Opportunities, Extracurricular Engagement, Opportunities for Immersion, Faculty Engagement, Staff Support, Student Groups, and Scholarship). This scale was used to evaluate the top-31 ranked United States medical schools as determined by US News and World Report's (USWNR) Medical School Research Rankings using information derived from public-facing, online information.

RESULTS

Mean cumulative HARPS score was 11.26, with a median score of 12, a standard deviation of 4.32 and a score range of 3-17. Neither USWNR ranking nor private/public institution status were associated with the cumulative score (p = 0.121, p = 0.739). 52% of institutions surveyed had a humanities-focused center/division with more than 70% of the schools having significant (> 5) faculty engaged in the medical humanities. 65% of schools offered 10 or more paracurricular medical humanities events annually, while 68% of the institutions had more than 5 medical humanities student organizations. While elective, non-credit courses are available, only 3 schools required instruction in the arts and humanities, and comprehensive immersive experiences in the medical humanities were present in only 29% of the schools.

CONCLUSIONS

Although there is a significant presence of the medical humanities in UME, there is a need for integration of the arts and humanities into required UME curricula and into immersive pathways for engaging the medical humanities.

Historical and social science perspectives on food allergy

This article provides an overview of the insights social scientists, historians and other health humanities scholars have made to our understanding of food allergies. It shows how humanities and social science scholars have tended to address three pivotal issues related to food allergies: first, they have addressed the epidemiology of food allergies, including the apparent rise in the rate of food allergies and the emergence of theories that purport to explain why food allergies may be increasing. These include theories related to changes in food consumption and the hygiene hypothesis. Second, humanities and social science scholars have researched how risks related to food allergies have been constructed, understood, experienced and mitigated. Third, humanities and social science scholars have investigated the experiences of food allergy sufferers and those who care for them, providing valuable qualitative insights that can inform how we respond to food allergy and our understanding of the aetiology of food allergy. The article concludes with three recommendations. First, there should be a more interdisciplinary approach to food allergy research that involves social scientists and health humanities scholars. Second, humanities and social sciences scholars should be more willing to unpack and scrutinise the theories put forward to explain the aetiology of food allergies, rather than accepting them at face value. And finally, humanities and social sciences scholars can play a major role in ensuring that the experiences of patients and their carers are articulated and fed into debates about food allergy, including its causes and how to respond to it.

The Brain Disorders Debate, Chekhov, and Mental Health Humanities

The contemporary brain disorders debate echoes a century-long conflict between two different approaches to mental suffering: one that relies on natural sciences and another drawing from the arts and humanities. We review contemporary neuroimaging studies and find that neither side has won. The study of mental differences needs both the sciences and the arts and humanities. To help develop an approach mindful of both, we turn to physician-writer Anton Chekhov's story "A Nervous Breakdown." We review the value of the arts and humanities as a coequal partner with natural sciences in the creation of a robust mental health humanities.

The PID Odyssey 2030: outlooks, unmet needs, hurdles, and opportunities - proceedings from the IPOPI global multi-stakeholders' summit (June 2022)

IPOPI held its first Global Multi-Stakeholders' Summit on 23-24 June 2022 in Cascais, Portugal. This IPOPI initiative was designed to set the stage for a stimulating forward-thinking meeting and brainstorming discussion among stakeholders on the future priorities of the PID community. All participants were actively engaged in the entire Summit, bringing provocative questions to ensure a high level of discussion and engagement, and partnered in identifying the outlooks, unmet needs, hurdles and opportunities of PIDs for 2030. The topics that were covered include diagnosis (e.g., newborn screening [NBS], genomic sequencing- including ethical aspects on the application of genomics on NBS, the role of more accurate and timely diagnostics in impacting personalized management), treatment (e.g., the therapeutic evolution of immunoglobulins in a global environment, new therapies such as targeted therapies, new approaches in curative therapies), the interactions of Primary ID with Secondary ID, Autoinflammatory Diseases and other diseases as the field experiences an incessant evolution, and also the avenues for research in the field of humanities and human sciences such as Patient-Reported Outcome Measures (PROMs), Patient-Reported Experience Measures (PREMs), and Health-Related Quality Of Life (HRQoL). During this meeting, all participants contributed to the drafting of recommendations based on our common understanding of the future opportunities, challenges, and scenarios. As a collection of materials, perspectives and summaries, they are succinct and impactful and may help determine some of the next key steps for the PID community.

Inside the Bell Jar of Social Media: A Descriptive Study Assessing YouTube Coverage of Psychotropic Medication Adherence

The global mental health crisis is a longstanding one that impacts a multitude of patient populations worldwide. Within this crisis, psychiatric medication adherence is yet another complex public health challenge that continues to persist and contribute towards the chronic nature of the increased incidence and prevalence of psychiatric morbidities, which in turn result in the sequalae of substantial costs to humanity, the healthcare system, lost productivity, functioning and disability among patients with mental disorders. Psychotropic medication adherence is a significant part of psychiatric care and treatment across severity levels of mental illness. This health behavior is also filled with complexities, given the abundance of social and behavioral determinants as well as intrinsic and extrinsic factors that surround this health behavior. Examining contexts for promoting this health behavior change is crucial in determining directions for addressing it more optimally. There have been several published studies on considerations and interventions to address this health behavior; however, to date, no studies have been published on assessing coverage and directions of content across social media platforms, which trend as a rising health communication medium in our digital era. The present study is the first of its kind to dive into exploring the nature of widely viewed content and deliverers of this content on a prominent social media platform, YouTube, as the basis to determine potential directions for future intervention that can extend to reaching more patients struggling with this high-risk health behavior across the world, given the global reach of social media.

The quantified analysis of the correlation between medical humanities curriculums and medical students' performance

BACKGROUND

A high-quality medical humanities (MH) education program is essential to developing a successful medical practitioner and can influence clinical performance. It is also vital to improve the evaluation of MH education to restore harmonious mutual relationships in medical care. However, studies have yet to discuss the correlation between the learning quality and quantity of medical humanities curriculums (MHC) and medical students' scores of clinical curriculums and clinical performance. The study aimed to assess the correlation between the learning quality and quantity of MHC and medical students' performance.

METHODS

We conducted a retrospective cohort study by analyzing a dataset of students' learning records. After excluding students with missing demographic information (n = 1) and overseas Chinese students (n = 15), the study included six- and seven-year program medical school students (n = 354) at National Yang-Ming University who were admitted between 2012 and 2014. The correlation between learning quality and quantity in MHC and students' following performance was evaluated by multivariable-adjusted regression analyses.

RESULTS

After adjusting for potential confounders (gender, residential area, age at enrollment, type of administration, and school program), the number of MHC with good learning outcomes was significantly correlated with clinical curriculum scores (p < 0.05), clerkship performance (p < 0.001), and weighted average mark (p < 0.001).

CONCLUSIONS

Our study found a correlation between MHC with good learning outcomes and medical students' following performance. A future study of improving the quality of MH education is warranted.

The enigma of Sir William Robert Wills Wilde (1815-1876)

William Wilde, father of Oscar Wilde, made a significant contribution to ophthalmology and otology. Qualified as a surgeon. educated in statistics and showing sympathy for the Irish population, Wilde was appointed a Commissioner for the 1851 Census, which covered the time of the Irish Famine (1845-1852). Wilde, steeped in Irish mythology, used his knowledge to develop a close rapport with the Irish peasantry. However, his life was a paradox; he supported the British Government's approach to the Famine and at the same time he showed humanity to the Irish peasantry. In his personal life he was implicated in an abortive libel case involving a young female patient who had accused him of rape. Wilde lived as though he had two separate lives: on the one hand the successful surgeon, famine Commissioner and cataloguer of Irish antiquities, and the other a countryman and disciple of Irish mythology. Wilde was highly preceptive especially in his views on the recording of medical data and outcomes in clinical practice. We argue that Wilde was probably unmatched in the variety of his talents but was also perplexing in the various actions he took during his life and that indeed Wilde was an enigma.

P26-A125 Donation medicine: a change of paradigm in procuring ocular tissues for transplantation

PURPOSE

To reflect on the implementation of the concept of 'Donation Medicine' as a substitute for 'Procurement' to describe the Foundation's activities in the procurement of ocular tissue and donor selection, considering that the prevailing connotation of procurement (the action of obtaining materials, goods and services necessary to the functioning of a productive activity) did not express satisfactorily all the social, human and medical implications of a programme aimed at promoting ocular tissue donation and recovery. Moreover, in medicine the term 'Procurement' is generally associated with the worst therapeutic outcome, which is the end of a human life.

METHODS

A retrospective evaluation of the main indicators pertaining to activities in 2021 was performed, with particular regard to donor screening ,tissue recovery, and the human and professional relations with donor families and hospital staff. The results were assessed by an interdisciplinary team, composed of eye bank and healthcare personnel, regulators and experts in medical humanities.

RESULTS

In 2021, in light of 2944 non-oppositions to donation (opting out system), 891 consultations of the national SIT donor registry were performed (Sistema Informativo Trapianti), with 2551 clinical charts reviewed, 4332 related phone consultations performed, and 2032 nasopharyngeal swabs for SARS-CoV-2 nucleic acid tested; as a consequence, 2213 condolence and gratitude letters were sent to donor families, of which 57%(1269) conveyed the outcome of donation, along with 115 gratitude letters sent in instances of the non-recovery. 24 families requested, and were granted, the opportunity to visit the eye bank.

CONCLUSION

A consensus was reached on the evidence that the term 'Procurement' has obvious limitations in the long term nurturing and maintenance of the motivation of the eye bank and healthcare personnel. As a consequence, the concept of 'Donation Medicine' was implemented to define and develop the activities related to the promotion of donation, the recovery of ocular tissues for transplantation, and internal/external relations with healthcare personnel, thus changing the meaning of 'Procurement', from a process at the end of a life to the realization of a new pathway of care that takes into account both donor families and recipients. Donation medicine begins with the re-opening of the donor clinical chart, the interaction with donor relatives and the recovery of a precious gift for use in the restoration of sight of patients.

T-cell immunity to SARS-CoV-2: what if the known best is not the optimal course for the long run? Adapting to evolving targets

Humanity did surprisingly well so far, considering how unprepared it was to respond to the coronavirus disease 2019 (COVID-19) threat. By blending old and ingenious new technology in the context of the accumulated knowledge on other human coronaviruses, several vaccine candidates were produced and tested in clinical trials in record time. Today, five vaccines account for the bulk of the more than 13 billion doses administered worldwide. The ability to elicit biding and neutralizing antibodies most often against the spike protein is a major component of the protection conferred by immunization but alone it is not enough to limit virus transmission. Thus, the surge in numbers of infected individuals by newer variants of concern (VOCs) was not accompanied by a proportional increase in severe disease and death rate. This is likely due to antiviral T-cell responses, whose evasion is more difficult to achieve. The present review helps navigating the very large literature on T cell immunity induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination. We examine the successes and shortcomings of the vaccinal protection in the light of the emergence of VOCs with breakthrough potential. SARS-CoV-2 and human beings will likely coexist for a long while: it will be necessary to update existing vaccines to improve T-cell responses and attain better protection against COVID-19.

Cognition: from the cosmos down to molecules - and back: The possible demise of humanity on Earth would be just a trivial episode in the grand story of the evolution of cognition in the cosmos: The possible demise of humanity on Earth would be just a trivial episode in the grand story of the evolution of cognition in the cosmos

The evolution of life, cognition and eventually human culture is not improbable but an inevitable result of the increasing entropy of the universe.

The (postcolonial) return of grand theory in American sociology: Julian Go on postcolonial thought and social theory

Julian Go's BJS annual lecture is discussed in reference to his landmark OUP text Postcolonial Thought and Social Theory (2016). Go is one of the most prominent names in a "third wave" of post-colonial thought, now spearheading a post- (or de-) colonial turn in sociological theory, something that has professionally revived the sub-field of "grand" social theory in mainstream US sociology. While endorsing the aims and substantive themes of this turn, the review raises questions about the delayed timing of this post-colonial wave in the discipline, both relative to the humanities more generally, and to the impact of post-colonialism in other national contexts. Go's challenge is, in effect, something quite particular to teaching social theory in the US sociology context. The review goes on to question how effectively the critique speaks to mainstream empirical practitioners, given its lack of focus on transforming technical methods. It concludes by raising concerns about the relationship of Go and other "third wave" decolonial theorists to Marxism and Marxist politics.

Education of History of Medicine for 80 Years: History and Current Status in Republic of Korea

Medical history education enables the medical students to understand the humanistic aspects of medicine and also help to promote the professionalism of doctors. It makes them understand the disappearing or emerging diseases by recognizing the historical changes and trends to respond appropriately. Therefore, it is helpful to study and understand modern medicine. As of March 2023, 22 (55.0%) out of 40 medical schools in Republic of Korea have medical history course as an independent subject and two schools have integrated courses with medical ethics. Compared to 53.1% in 1995 and 56.2% in 2010, similar percentage of medical schools maintained the subject independently. However, the average credits of 18 schools in 2023(2.0) are higher than those of 1995(1.4) and 2010(1.2). The number of full-time professor who specialized in the history of medicine was 2 in 1995, 6 in 2010, and 11 in 2023. Generally, a full-time professor majoring medical history tend to have other duties besides the education and research of medical history, depending on the role of the department to which he or she belongs since they are assigned to the humanities education other than medical history education. Currently, the curriculums that have been recommended by Korea Association of Medical Colleges(KAMC), Korean Institute of Medical Education and Evaluation(KIMEE), and The Korean Society of Medical Education(KSMED), emphasize medical humanities but do not necessarily include the medical history. As a result, medical history courses have increased slightly, but the other humanities classes have increased significantly since 2000. The knowledge of medical history will help students become a doctor, and a doctor with professionalism adapting to the rapidly changing medical environment. Students will also be able to establish the ideas they must pursue in the present era when they come into contact with numerous historical situations. And if they share a sense of history, they will inspire a sense of unity as a profession and will be more active in solving social problems such as health equity. It is hoped that The Korean Society for the History of Medicine will step forward to set the purpose and goal of the medical history education, and organize the contents of the education. Classes should be prepared so that students are interested in them, and education should be focused on how the contents of education will be able to be used in medicine. To this end, it is necessary to establish the basic learning outcomes of history of medicine, and prepare learning materials based on these learning outcomes. It is also necessary to increase the competencies of educators for the history of medicine, such as performing workshops. With the dedication of the pioneers who devoted their energy to the education of medical history, it is expected that medical history will find out what to do in medical education to foster better doctors and provide better education.

The Companion Curriculum: medical students' perceptions of the integration of humanities within medical education

Background

The contributions of arts and humanities to medical education are known in the medical education community, but medical schools' offerings vary. The Companion Curriculum (CC) is a student-curated set of optional humanities content for medical students at the University of Toronto. This study evaluates integration of the CC to identify key enabling conditions for medical humanities engagement.

Methods

A mixed-methods evaluation gauged usage and perceptions of integration of the CC among medical students using an online survey and focus groups. Narrative data underwent thematic analysis, supported by summary statistics of quantitative data.

Results

Half of survey respondents were aware of the CC (n = 67/130; 52%), and, once prompted with a description, 14% had discussed it in their tutorial groups. Of students using the CC, 80% reported learning something new regarding their roles as communicators and health advocates. Themes were the perceived value of the humanities, internal student barriers, institutional neglect of the humanities, and student critiques and recommendations.

Conclusion

Despite participants' interest in medical humanities, our CC remains underused. To improve humanities' visibility in the MD curriculum, our results indicate that greater institutional support, including faculty development and early curricular integration, is required. Further study should explore reasons for gaps between interest and participation.

Virus versus humanity - Do vaccines tilt the scale?

S Srinivasan in his article "The vaccine mandates judgment: Some reflections", in this journal, analyses a judgment of the Hon'ble Supreme Court of India in summer this year [1]. Therein, he underscores significant points of interest, the logic behind them, a few points of contention, their scientific basis and areas where logic defies rationality and prudence. Nevertheless, certain relevant points about vaccination are overlooked in the article. Under the subheading, "Vaccine mandates and the right to privacy", the author states that the order "finally zeroes in on this proposition…and that is that the risk of transmission of the Severe Acute Respiratory Syndrome (SARS-CoV-2) virus from unvaccinated individuals is almost on par with that from vaccinated persons". Therefore, when the immunisation does not serve the social purpose of stopping propagation of the infection, why should the authorities mandate people to accept vaccination? This is the argument put forth by the author.

The "Greenberg Controversy" and the Interdisciplinary Study of Global Linguistic Relationships

This paper examines the controversy that followed the 1987 publication of Joseph Greenberg's book, Language in the Americas, attending to the role of language and linguistic research within overlapping disciplinary traditions. With this text, Greenberg presented a macro-level tripartite classification that opposed then dominant fine-grained analyses recognizing anywhere from 150 to 200 distinct language families. His proposal was the subject of a landmark conference, examining strengths and weaknesses, the unpublished proceedings of which are presented here for the first time. For specialists in the anthropological and comparative-historical study of Indigenous American languages, Greenberg's intervention highlighted the tension between language, conceived as an abstract object of study, and languages, understood to be carriers of specific cultural knowledge. For physical anthropologists and archaeologists, his theory was initially fortuitous on programmatic, substantive, and methodological grounds. The essay will show how interdisciplinary appeals were figured by supporters as a virtue, and by critics as a vice. The essay further highlights ethical reasons for integrating historical narratives of science and the humanities.

Negotiating humanity: an ethnography of cadaver-based simulation

Human body donation (HBD) serves an essential function in many medical schools, particularly in institutions where people engage in cadaver-based simulation (CBS) as a pedagogical approach. The people who facilitate HBD and CBS have a highly specialized skill set, yet their expertise remains largely unacknowledged, and takes place out of sight from the broader medical school community. This manuscript, based on a two-year practice-based ethnography (Structured Observations n = 68 h, Unstructured Observations n = 150 + hours; Interviews n = 24; and Document/Policy Analysis n = 14) illuminates the complex work of HBD. We identify three primary functions of HBD and CBS (1. Cadaver Intake & Administration, 2. Cadaver Preparation, and 3. Cadaver-Based Pedagogy). We describe how medical educators involved in CBS have developed a skillset specific to their role: negotiating humanity.