Introducing the Humanities into physiotherapy education

This post has been modified and published on The Conversation: Africa as Physiotherapy students have much to learn from the humanities.

I’m increasingly drawn to the idea of integrating some aspect of the Humanities into undergraduate physiotherapy education. We focus (almost) all of the curriculum on the basic sciences and then the clinical sciences, which has a certain pragmatic appeal but ignores the fact that a person is more than an assemblage of body parts. We spend a lot of time time teaching anatomy and biomechanics (i.e. bodies as machines), and then exploring what we can do to bodies in order to “fix” them. While we pay lip service to the holistic management of the patient, there is little in our curriculum that signals to the student that this is something that we really care about.

“Science is the foundation of an excellent medical education, but a well-rounded humanist is best suited to make the most of that education.”

Empathy is critical to the development of professionalism in medical students, and the humanities – particularly literature – have been touted as an effective tool for increasing student empathy. In addition, there is some evidence that training in the Humanities and liberal arts results in health professionals with improved professionalism and self-care. In other words, health professionals who are exposed to the arts as part of their undergraduate education may demonstrate an increased ability to manage themselves and their patients with more care.

The relationship between emotion and learning has also been explored, with findings from multiple disciplines supporting the idea that emotion is intimately and inseparably intertwined with cognition in guiding learning, behaviour and decision making. The introduction of the Humanities in health professions education therefore has another potential impact; by using the arts to develop an awareness of emotional response, educators and students may find that exposure to the Humanities might lead to improvements in learning.

As I started looking into these ideas in a bit more detail, I realised that there are several examples of how art and literature are being explored formally by some very prominent medical schools.

• Johns Hopkins Medical School is one of the best in the word and it’s telling that they have a department of Art as applied to medicine.
• Stanford School of Medicine (also one of the best in the world) has a programme for Medical Humanities and the Arts. See also this post in the Stanford Daily, on The humanities and medicine.
• The Cleveland Clinic Arts and Medicine Institute, “created for the purpose of integrating the visual arts, music, performing arts and research to promote healing and to enhance the lives of our patients, families, visitors and employees”.
• When the University of Cape Town’s Medical School decided on the topic for their first ever MOOC, they chose Medicine and the Arts as the theme.

I was disappointed – although not surprised – not to find any good examples of physiotherapy departments who have formally integrated the Humanities into their curricula. However, I did find several papers (all by the same author with various colleagues) that describe a process of integrating these concepts into an undergraduate physiotherapy programme over a period of time, and these are listed in the references below.

Over the past year or so, I’ve tried to bring some of these ideas into my Professional Ethics module, using the assignments for students to explore the Humanities (art, literature, theatre, music, dance, etc.) as a process of developing a sense of awareness of empathy in the context of clinical education. They can interpret the assignment in any way they want, for example, by writing a poem, drawing a picture, taking a photo, or re-interpreting a song. However, the important part is the reflection that they attach to the piece. Here are some examples of previous student work in this module, without the more personal reflections that accompany them.

• Eleven hundred hours – poem by a student
• The mind of the innocent – poem by a student
• I’ve had two students provide videos of interpretive dance sessions used as methods to try and present an embodied experience of what it might be like to live with a disability.
• Photovoice assignments (see below for examples): in these assignments students took photos of people and places and then reflected on how those experiences had informed their personal and professional development as ethical practitioners.

I’m hoping to get some experience with this process as part of these little experiments I’m running in the classroom, and that over time we can start building something more formal into the curriculum. Watch this space.

Additional readings

• Artino, A. R., & Naismith, L. M. (2015). “But how do you really feel?” Measuring emotions in medical education research. Medical Education, 49, 138–146.
• Bolton, G. (2003). Medicine, the arts, and the humanities. The Lancet, 362(9378): 93-94.
• Foster, W., & Freeman, E. (2008). Poetry in general practice education: Perceptions of learners. Family Practice, 25(4), 294–303.
• Glatter, R. (2013). Can studying art help medical students become better doctors? Forbes.
• Kandel, E. Why art evokes empathy: http://bigthink.com/in-their-own-words/theory-of-mind-why-art-evokes-empathy.
• Mc Ateer, M.F. & Murray, R. (2005). The Humanities in a Course on Loss and Grief. Physiotherapy, 89(2): 97-103.
• Murray, R. (1998). Measurement of the Effect of Participation in a Medical Humanities Group on the Practice of Physiotherapists. Physiotherapy, 84(10): 473-479.
• Murray, R. & Thow, M.K. (1995). A Medical Humanities Roadshow: ‘Spreading the Word’. Physiotherapy, 81(2): 95-102.
• Panda, S.C. (2006). Medicine: Science or Art? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190445/ (link to full text article)
• Peloquin, S. (1996). Art: An Occupation With Promise for Developing Empathy. American Journal of Occupational Therapy, 50:655-661.
• Schwartz, A. W., Abramson, J. S., Wojnowich, I., Accordino, R., Ronan, E. J., & Rifkin, M. R. (2009). Evaluating the Impact of the Humanities in Medical Education. Mount Sinai Journal of Medicine, 76, 372–380.
• Shapiro, J., Morrison, E., & Boker, J. (2004). Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Education for Health, 17(1), 73–84.
• Smith, S. Molineux, M. Rowe, N. & Larkinson, L. (2006). Integrating medical humanities into physiotherapy and occupational therapy education. International Journal of Therapy & Rehabilitation, 13(9): 421-427.
• Thow, M. & Murray, R. (1991). Medical Humanities in Physiotherapy: Education and practice. Physiotherapy, 77(11): 733-736.