HEAL
Humanities, Economics, Arts and the Law
About the Program
Rationale: The Liaison Committee on Medical Education (LCME) has clear recommendations regarding medical student instruction in ethics, and the American Society for Bioethics and Humanities has a developed a model curriculum project on humanities and medical ethics to address ACGME competency guidelines. Keck School of Medicine’s educational program goals state that graduating students must be able to identify alternatives in difficult ethical choices, and to act in a manner that takes into account the complexities of those choices. As does ethical decision-making, several other of Keck’s ten overarching goals demand narrative competence, what Rita Charon defines as “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” (JAMA 2001) Students must be able to listen and communicate clearly with patients, families and health care team members using effective non-verbal, verbal, and writing skills. They must be able to obtain and to interpret a patient’s story or history. As physicians in training they must be able to effectively respond to the many factors that influence health and disease, including the socio-cultural, familial, psychological and spiritual aspects of their patients’ lives. Students must develop the capacity for self-awareness in their growth as professionals, reflecting upon their limits, strengths, weaknesses, and personal vulnerabilities.
We believe that we are best able to educate for narrative competence through a program that incorporates the study of humanities. As Lisa Dittrich writes in Academic Medicine (October 2003): “The study of the humanities can illuminate human interactions and concerns in a way that the genome maps or nanomedicine cannot. Stem cell research, advances in organ transplantation, genetic markers, and other innovations and new knowledge, all raise fundamental questions that human beings have grappled with in one way or another through the ages. And the questions raised are not only ethical ones; they are questions about what makes us human, what defines us as individuals, how we reconcile the needs of individuals with the needs of the community, what gives meaning to our lives, how we define a ‘good life.’ These questions are the humanities’ milieu, and while the humanities cannot provide answers any more than the sciences can, they are the best resource to turn to help us ‘live the questions.’” Through engagement with the humanities, students will be encouraged to explore ethical decision-making, cultural differences in worldview, and the complexities of the interpretive act—the “multiple ways of knowing—” that are essential to the effective practice of the healing arts.
Program Goals: In the service of fostering the narrative competence of medical students, this program will:
- Provide longitudinal, integrated instruction in health care ethics and ethical decision-making
- Foster capacity for the analysis and formulation of policy in light of the economic, legal, social, as well as the ethical dimensions of health care
- Provide instruction in systems-based approach to patient safety
- Stimulate imagination, curiosity, skills of close observation, and careful interpretation through engagement with the arts and humanities
- Enhance empathy for patients and colleagues
- Promote reflection on experience and its meaning
- Create a community of discourse as an essential component of professional development and clinical practice
Program Components of the Four-Year Humanities, Ethics, Arts, and Law (HEAL) Curriculum:
Year I
Autobiographical essay: Students write autobiographies that share their perspectives on their personal development, cultural context, and family history.
Cultural competence: Students write about their culture, on how culture has played a role in shaping who they are.
Narrative self-evaluation: At mid-year and end-of-year, students reflect on their progress in terms of skill development and professional growth.
Narrative reflection: Students are asked to write reflectively about their ICM patient encounters, and about their work in PPM.
Medicine and the Arts Focus Experience: Through structured museum or gallery visits, students enhance their visual and interpretive skills (skills essential for best clinical practice) through engagement with art.
Ethics I: Introduction to Ethical Principles in Health Care: Students are introduced to the principles of medical ethics in the context of an excerpted clinical scenario from the award-winning television drama, “House.”
Ethics II: Principles of Ethical Decision-Making: After a presentation on models of ethical decision-making, students apply these models to ethical dilemmas that they have encountered and written about in preparation for this session.
Ethics III: Ethical Decision-Making When Values Clash: Students participate in a discussion about situations in which value systems may conflict. They then take part in an interactive activity designed to stimulate consideration and discussion of students’ own values regarding what constitutes a life worth living.
Ethics IV: End-of-Life Treatment Ethics: Through discussion of a case, students acquire knowledge of the ethics committee as an instrument to provide illumination and moral alternatives when a dilemma develops among care givers, patients and/or their families.
Year II:
Ethics V: Imparting Bad News and End-of-Life ethical dilemmas: By participating in a standardized patient encounter where they are charged with imparting bad news, students are able to experience what can be an emotionally challenging interaction. Medical Humanities: Students watch the HBO film adaptation of Margaret Edson’s Pulitzer Prize winning play, “W;t,” and then meet with a panel of physicians, social workers, and cancer patients to discuss the film.
Year III-IV Clerkships:
Ethics Education by Clinical Role Models: Clinicians with interest and education in ethics conduct formal teaching sessions for clerkship students that address particular ethical issues that arise in their specialty.
- Internal Medicine: informed consent, negligence, allocation of resources, end of life
- Pediatrics: ethics case discussions (terminally ill child; emancipated minor)
- Family Medicine: medical error/truthful disclosure
- Ob-Gyn: ethics case discussions (delivery options, pre-term ethical issues, beneficent deception, pt’s refusal of c/s delivery) and values clarification exercise
- Psychiatry: religion and medicine
- Neurology: coma and brain death
- Surgery: death and dying, veracity
Year III Issues in Clinical Practice and Intersessions: In addition to the core clerkship ethics curriculum, the Issues in Clinical Practice course also addresses topics in ethical decision-making, as well as cultural competency and professionalism. Beginning in 2011-2012, during two one-week intersessions in Year III, students will complete a project on health policy analysis, and will participate in interactive sessions on patient safety and the prevention of medical error, professional responsibility, and medical humanities.
Year IV:
Electives in Medical Humanities, Arts, and Ethics: Students are able to choose from a number of electives, including Narrative Medicine, Law and Medicine: Social Determinants of Health, and History of Medicine.
Extracurricular Program in Medical Humanities, Arts, and Ethics
A rich array of “extracurricular” activities in Medical Humanities and the Arts is available to KSOM students:
- Student and Faculty Art Gallery, two shows exhibited each year
- Participation in Visions and Voices events
- Art Education workshops
- Lingual Verve reading group
- Styloid Process writing group
Faculty and Staff Contacts
Pamela Schaff, MD
Director, Program in Medical Humanities, Arts, and Ethics
Chair, HEAL Curriculum Committee
1975 Zonal Avenue, KAM 307, Los Angeles, CA 90089
Telephone: 323-442-1763 Fax: 323-442-1521
Email: pschaff@usc.edu
Curriculum Office
Keck School of Medicine of USC
1975 Zonal Avenue, KAM 314
Los Angeles, CA 90089-9023
(323) 442-1763
curroff@usc.edu