A dose of humanities for medical students
How does exploring drama, art and literature help medical students become more caring doctors? Nora Tong finds out about a pioneering scheme
Since enrolling in the University of Hong Kong's (HKU) medical school five years ago, Lydia Kwong Lee-ting has studied diligently to acquire the knowledge and technical skills to become a good doctor.
But something was missing. All the tests, surgery and treatment just weren't enough to help patients. Kwong says she finally found the missing link when she began taking pilot modules in humanities, launched in 2009 by the medical faculty to help would-be doctors to nurture observation, empathy and self-reflection - interpersonal skills that are just as essential to patient care.
Kwong participated in art appreciation and photography classes, which she says gave her an opportunity to ponder her thoughts and share her feelings with others. She says the ability to reflect and to express compassion is crucial if a young doctor wants to mature. For one of her assignments, she had to take photos illustrating themes such as "suffering", "love" and "perspectives". Kwong's photo, entitled "Distance", shows a few youngsters standing at the top of a flight of stairs, looking at a big, sick tree on a beach.
"We medical students are like these young people. We want to help our frail patients but are not able to," she says. "However, like those in the photo who want to establish a connection with the tree, I remind myself to make my patients feel they are loved."
Another module involved in-depth discussions with cancer patients. Kwong says these interviews were different from the usual ones in which she inquires about the medical condition of a patient and reaches a diagnosis.
"We were encouraged to listen to the patients' stories and understand their concerns and fears, such as why they wouldn't want to undergo a certain kind of treatment," she says. "There is often a reason behind what some doctors may see as stubbornness; a family member or a friend might have suffered from serious side effects from the same treatment. Taking part in this course made me realise that a doctor should take into account the emotional needs of a patient in deciding the type of treatment, and that a lot of times suffering doesn't end with a test or a drug. I will always bear this in mind, and I hope I will be a doctor with a caring heart."
In September, the faculty rolled out a fully fledged programme in medical humanities as part of the university's six-year core undergraduate medical curriculum. Students learn to delve into questions such as "What makes us human?", "What is the nature of suffering?", "What can we do when there appears to be no cure or hope for improvement?" and "How can doctors build resilience and well-being?".
In countries such as Britain and the United States, medical humanities programmes are especially valued at a time when medical students round the world are busy learning an ever-increasing amount of technical information, which has led to concerns they may be neglecting their humane qualities.
"Instead of truly caring about you with the empathy and patience to listen, a doctor might be more inclined to prescribe tests ... without truly inquiring into the problem under the surface and understanding the psychosocial, emotional and other factors in taking care of patients. To understand the human existence and human suffering is a prerequisite," says Professor Lee Sum-ping, dean of the medical faculty.
The mandatory programme, the first of its kind in Hong Kong, is divided into five main themes: doctor and patient stories; culture, spirituality and healing; the history of medicine; death, dying and bereavement; and humanitarianism. Students explore the themes through literature, drama and music, film studies and other visual arts. The programme counts towards 10 per cent of the final grade, and students have to sit the courses throughout their undergraduate studies. They are assessed on how well they do in written assignments and whether they actively participate in the classes and workshops.
The programme also aims to strengthen the emotional capacity of future doctors to deal with suffering and mortality, such as in having to break bad news to a patient or family. Chan Li-chong, the faculty's chair professor of pathology, says the humanities curriculum allows students to understand their own emotions early on and build resilience so they can empathise with patients' pain but still have the emotional strength to help them cope with the situation.
"They need to know the areas in which patients feel vulnerable, that they should not focus too much on, and maybe call in a teammate or wait for another occasion on which to bring up the difficult situation," says Chan.
Julie Chen, assistant professor of family medicine and primary care, says there isn't an absolute right or wrong in many situations, such as whether a doctor should always maintain a veneer of cool professionalism. "Sometimes it's OK to cry. There is a way to do it without undermining yourself," she says, adding it is important for students to come to terms with ambiguity. One goal of the programme is to educate students on how to tackle open-ended questions.
The programme has enlisted support from academics teaching in other HKU faculties as well as partners in the community. The latter include Lynn Yau, CEO of the Absolutely Fabulous Theatre Connection, and award-winning pianist Nancy Loo, both of whom are the children of doctors. Students attending their classes engage in games and activities, from moving to music of different moods, to performing a skit based on a script about a medical situation or a moral dilemma that requires them to describe the emotions of the different characters.
Given the shortage of medical professionals in Hong Kong and their taxing workload, will young doctors be able to apply what they learn from the humanities curriculum in the real world?
For Lee, the answer is an emphatic yes. She adds that the extent would depend on the individual and the environment at that time. "If you don't have the knowledge and capacity to express something, you will never express it," he says.