Research in Medical Humanities: is it time for a new paradigm?

Abstract

As heralded in the February 2002 edition of this journal, this month’s edition of Medical Education sees the publication of a new section entitled ‘Arts and Humanities’. Articles published in this section will reflect and investigate the relationship between the arts and humanities and the education of health professionals. We therefore welcome articles on the theme of medical humanities and those investigating the role of engagement in the creative arts in medical and other health professional education. This is a relatively new area in the UK but it has been established for longer in the USA, although this is not to say that the case for medical humanities or arts in health care education has convinced everyone. Before we examine the issue, however, let us first look at what the medical humanities have to offer. How do the papers in this month’s section contribute to this? Martyn Evans’ paper, which we publish as the first in this new section, addresses this point specifically. Evans takes a radical view of the importance of the humanities in medical education, suggesting that rather than representing a mere ‘add-on’ to medical training, the medical humanities should instead represent an essential, core part of the curriculum, and as such, should serve to underpin understanding throughout the rest of the course. To paraphrase his argument, he opines that we human beings are not represented solely by our bodies, and that when medicine tries to intervene in our frailty, it must take account not only of our bodies, but also of our bodily experiences. As the humanities deal with human experience and its interpretation, they are, therefore, an essential part of any medical curriculum. Kneebone adopts a similar approach, arguing that the perspective of medical education should be widened to include the humanities and related social sciences. Lippell’s commentary on creativity quotes educational research to back up her assertion that medicine needs creative lateral thinkers. The value of a historical and, specifically, biographical perspective is described by Mark Jackson. His example, William Hunter, embodies the idea that a ‘deep commitment to, medicine as a humanistic endeavour’ is entirely consistent with impeccable scientific credentials. Indeed, Evans would argue that the two are not just consistent but interdependent. These highlight some of the contributions the humanities might make, but the list is by no means exhaustive. Do these papers make a convincing case for using humanities in medical education? It is clear that what they do not do is take the traditional medical approach to the presentation of ‘research evidence’ in the form of objectives, methodology, results, discussion and conclusion. Evans, in particular, follows the humanities research paradigm. This involves deep thought and reading about a subject, leading to the presentation of a reasoned argument. We can regard this approach as justification rather than as proof of the value of humanities as part of a medical curriculum. Does this make a difference to the way in which this kind of research evidence is valued? Any justification is, of course, open to challenge and interpretation, but reasoned argument, challenge and interpretation are in fact the essence of humanities education, and it is precisely these elements which, some contend, are lacking in medical education. It might be argued that reasoned argument is not as strong as proof, especially in a field where randomized, controlled trials (RCTs) are considered to provide the paradigm of proof. However, we must remember that RCTs themselves are open to challenge and interpretation. Enthusiasts for RCTs may regard them as the essence of proof, but others regard their proof as thin and unconvincing. In attempting to develop a research tradition for educational initiatives that involves the medical humanities, we are left with a dilemma. On the one hand, we are called upon to answer the requirements for proof demanded by a predominantly scientific medical research tradition, even in the field of medical education. On the other, we are dealing here with disciplines whose approach to evidence is open to interpretation and where the evidence itself is presented by reasoned argument. Moreover, when we look at what the medical humanities are trying to achieve, as described by Evans, the educational outcomes we are attempting to investigate are difficult to describe, never mind quantify. They are related to what the GMC describes as the ‘attitudinal objectives’ of a course. Changes and developments in attitude are difficult to study. While we might be able to demonstrate change in the short-term, what really matters is what we can achieve in developing practitioners who are able to sustain their interest in their patients and their profession over a lifetime. Some research work in this field has been attempted. Australian researchers have looked at the job satisfaction of students who came into medicine from a mixed science and arts background and compared it to the job satisfaction of those who entered medicine from a science only background. While it is important that those of us working within this new discipline consider the expectations of our peers in medicine, this does not mean we should commit ourselves to slavishly following the research models favoured by medicine. What is valuable about medicine’s relationship with the humanities concerns that which medical practitioners can learn from the Correspondence: Dr Jane Macnaughton, Centre for Arts & Humanities in Health Medicine, University of Durham Business School, Mill Hill Lane, Durham DH1 3LB, UK. Tel.: 00 44 191 374 1294; Fax: 00 44 191 374 3748; E-mail: jane.macnaughton@ durham.ac.uk Editorials