Abstract
Inclusion of the humanities in undergraduate medicine curricula remains controversial. Skeptics have placed the burden of proof of effectiveness upon the shoulders of advocates, but this may lead to pursuing measurement of the immeasurable, deflecting attention away from the more pressing task of defining what we mean by the humanities in medicine. While humanities input can offer a fundamental critical counterweight to a potentially reductive biomedical science education, a new wave of thinking suggests that the kinds of arts and humanities currently used in medical education are neither radical nor critical enough to have a deep effect on students’ learning and may need to be reformulated. The humanities can certainly educate for tolerance of ambiguity as a basis to learning democratic habits for contemporary team-based clinical work. William Empson’s ‘seven types of ambiguity’ model for analyzing poetry is transposed to medical education to: (a) formulate seven values proffered by the humanities for improving medical education; (b) offer seven ways of measuring impact of medical humanities provision, thereby reducing ambiguity; and (c) --as a counterweight to (b) – celebrate seven types of ambiguity in contemporary medical humanities that critically reconsider issues of proof of impact.
Similar content being viewed by others
References
Adorno, TW., E. Frenkel-Brunswik, DJ. Levinson, and RN. Sanford. 1950. The Authoritarian Personality. New York: Harper and Row.
Atkinson, P. 1984. “Training for Certainty.” Social Science and Medicine 19:949-56.
Bates ,V., A. Bleakley, and S. Goodman. 2013. Medicine, Health and the Arts: Approaches to the Medical Humanities. London: Routledge.
Belling, C. 2010. “Commentary: Sharper Instruments: On Defending the Humanities in Undergraduate Medical Education.” Academic Medicine 85:938-40.
Bleakley, A. 2010. “Blunting Occam’s Razor: Aligning Medical Education with Studies of Complexity.” Journal of Evaluation in Clinical Practice 16:849-55.
------. 2013a. “Gender Matters in Medical Education.” Medical Education 47:59-70.
------. 2013b. “Towards a ‘critical medical humanities’.” In Medicine, Health, and the Arts: Approaches to Medical Humanities, edited by V. Bates, A. Bleakley, and S. Goodman, 17-26. London: Routledge.
Bleakley, A., J. Bligh, and J. Browne. 2011. Medical Education for the Future: Identity, Power and Location. Dordrecht: Springer.
Bleakley, A., and N. Brennan. 2011. “Does Undergraduate Curriculum Design make a Difference to Readiness to Practice as a Junior Doctor?” Medical Teacher 33:459-67.
Bleakley, A., R. Farrow, D. Gould, and R. Marshall. 2003. “Making Sense of Clinical Reasoning: Judgement and the Evidence of the Senses. Medical Education 37:544-52.
Bleakley, A., and R. Marshall. 2013. “Can the Science of Communication Inform the Art of the Medical Humanities?” Medical Education 47:126-33.
Bleakley, A., R. Marshall, and R. Brömer. 2006. “Toward an Aesthetic Medicine: Developing a Core Medical Humanities Undergraduate Curriculum.” Journal of Medical Humanities 27:197-214.
British Medical Association (BMA). 2007. “Doctors’ Health Matters.” Accessed June 26, 2013. http://www.bma.org.uk/doctors_health/doctorshealth.jsp?page=6.
Bull, S., and K. Mattick. 2010. “What Biomedical Science should be included in Undergraduate Medical Courses and How is this Decided?” Medical Teacher 32:360–7.
Campo, R. 2005. “‘The Medical Humanities,’ for Lack of a Better Term.” Journal of the American Medical Association 294 (9): 1009-11.
Castillo, M. 2010. “The Uncertainty of Science and the Science of Uncertainty.” American Journal of Neuroradiology 31:1767-68.
Charon, R. 2010. “Commentary: Calculating the Contributions of Humanities to Medical Practice--Motives, Methods, and Metrics.” Academic Medicine 85:35-7.
Dyrbye, LN., MR. Thomas, FS. Massie, DV. Power, A. Eacker, et al. 2008. “Burnout and Suicidal Ideation among U.S. Medical Students.” Annals of Internal Medicine 149:334-41.
Eisner, EW. 1976. “Educational Connoisseurship and Criticism: Their Form and Functions in Educational Evaluation.” Journal of Aesthetic Education 10:135-50.
Elias, N. 2000. The Civilizing Process. Oxford: Blackwell.
Empson, W. 1991. Seven Types of Ambiguity. London: The Hogarth Press.
Foucault, M. 1989. The Birth of the Clinic: An Archaeology of Medical Perception. London: Routledge.
------. 1991. “Governmentality.” In The Foucault Effect: Studies in Governmentality, edited by G. Burchell, C. Gordon, and P. Miller, 87-104. Chicago: University of Chicago Press.
Fox, RC. 1957. “Training for Uncertainty.” In The Student-Physician, edited by RK. Merton, G. Reader, and P. Kendall. Cambridge: Harvard University Press.
Fox, R. 1997 (new ed.) Experiment Perilous: Physicians and Patients Facing the Unknown. New York: Transaction.
Garden, R. 2010. “Telling Stories about Illness and Disability: the Limits and Lessons of Narrative.” Persp Biol Med 53:121-35.
Genn, JM. 2001. “Curriculum, Environment, Climate, Quality and Change in Medical Education – A Unifying Perspective.” Medical Teacher 23:337-344 (Part 1), 445-454 (Part 2).
Greenhalgh, T. 1999. “Narrative based Medicine in an Evidence based World.” British Medical Journal 318:323.1
Guattari, F. 1995. Chaosmosis: An Ethico-Aesthetic Paradigm. Bloomington: Indiana University Press.
Hillman, J. 1976. Re-Visioning Psychology. New York: Harper & Row.
Gunderman, RB. 2005. “Education and the Art of Uncertainty.” Radiology 237:801-2.
Hunter, KM. 1991. Doctors’ Stories. The Narrative Structure of Medical Knowledge. Princeton: Princeton University Press.
Kidd, MG., and JT. Connor. 2008. “Striving to do Good Things: Teaching Humanities in Canadian Medical Schools.” Journal of Medical Humanities 29:45-54.
Kirklin, D., J. Duncan, S. McBride, S. Hunt, and M. Griffin. 2007. “A Cluster Design Controlled Trial of Arts-based Observational Skills Training in Primary Care.” Medical Education 41:395-401.
Kohn, M. 2011. “Performing Medicine: The Role of Theatre in Medical Education. Medical Humanities 37:3-4.
Kohn, LT., JM. Corrigan, and MS. Donaldson. 1999. To Err is Human. Washington: National Academy Press.
Kumagai, AK. 2012. “Perspective: Acts of Interpretation: A Philosophical Approach to Using Creative Arts in Medical Education.” Academic Medicine 87:1138-44.
Levine, D., and A. Bleakley. 2012. “Maximising Medicine through Aphorisms.” Medical Education 46:153-62.
Lingard, L., K. Garwood, CF. Schryer, and MM. Spafford. 2003. “A Certain Art of Uncertainty: Case Presentation and the Development of Professional Identity.” Social Science and Medicine 56:603-16.
Ludmerer, KM. 1999. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. Oxford: Oxford University Press.
Luther, VP., and SJ. Crandall. 2011. “Commentary: Ambiguity and Uncertainty: Neglected Elements of Medical Education Curricula?” Academic Medicine 86:799–800.
Macneill, PU. 2011. “The Arts and Medicine: A Challenging Relationship.” Medical Humanities 37:85-90.
McManus, IC. 1995. “Humanity and the Medical Humanities.” The Lancet 346: 1143-5.
Montgomery, K. 2006. How Doctors Think: Clinical Judgment and the Practice of Medicine. Oxford: Oxford University Press.
Muller, D., and N. Kase. 2010. “Challenging Traditional Premedical Requirements as Predictors of Success in Medical School: the Mount Sinai School of Medicine Humanities and Medicine Program.” Academic Medicine 85:1378-83.
Naghshineh, S., JP. Hafler, AR. Miller, et al. 2008. “Formal Art Observation Training Improves Medical Students’ Visual Diagnostic Skills.” Journal of General and Internal Medicine 23:991-7.
Neumann, M., F. Edelhäuser, D. Tauschel, M. Fischer, M. Wirtz, C. Woopen, et al. 2011. „Empathy Decline and Its Reasons: A Systematic Review of Studies with Medical Students and Residents.” Academic Medicine 86:996-1009.
Norman, G., and K. Eva. 2009. “Diagnostic Error and Clinical Reasoning.” Medical Education 44:94-100.
Nussbaum, M. 2010. Not for Profit: Why Democracy Needs the Humanities. Princeton: Princeton University Press.
Ousager, J., and H. Johannessen. 2010. “Humanities in Undergraduate Medical Education: A Literature Review.” Academic Medicine 85:988-98.
Perry, M., N. Maffulli, S, Willson, et al. 2011. “The Effectiveness of Arts-based Interventions in Medical Education: A Literature Review.” Medical Education 45:141–8.
Petersen, A., A. Bleakley, R. Brömer, and R. Marshall. 2008. “The Medical Humanities Today: Humane Health Care or Tool of Governance?” Journal of Medical Humanities 29:1-4.
Phillip, R., M. Baum, J. Macnaughton, and K. Calman. 2002. Arts, Health and Well-being. London: The Nuffield Trust.
Pilpel, D., R. Schor, and J. Benbassat. 1998. “Barriers to Acceptance of Medical Error: The Case for a Teaching Programme.” Medical Education 32:3-7.
Pinar, WF., and WM. Reynolds. 1992. “Introduction: Curriculum as Text.” In Understanding Curriculum as Phenomenological and Deconstructed Text, edited by WF. Pinar, and WM. Reynolds, 1-16. New York: Teachers College Press.
Polianski, IJ., and H. Fangerou. 2012. “Toward “Harder” Medical Humanities: Moving Beyond the ‘Two Cultures’ Dichotomy.” Academic Medicine 87:121-6.
Rees, G. 2010. “The Ethical Imperative of Medical Humanities.” Journal of Medical Humanities 31: 267-77.
Rosenthal, S., B. Howard, YR. Schlussel, D. Herrigel, BG. Smolarz, B. Gable, et al. 2011. “Humanism at Heart: Preserving Empathy in Third-year Medical Students.” Academic Medicine 86:350-8.
Roter, DL., and J.A. Hall. 2006, 2nd ed. Doctors Talking with Patients/ Patients Talking with Doctors: Improving Communication in Medical Visits. London: Praeger.
Self, DJ. 1993. “The Educational Philosophies behind the Medical Humanities Programs in the United States: An Empirical Assessment of three Different Approaches to Humanistic Medical Education.” Theoretical Medicine 14:221-9.
Shapiro, J., L. Rucker, and J. Beck. 2006. “Training the Clinical Eye and Mind: Using the Arts to Develop Medical Students’ Observational and Pattern Recognition Skills.” Medical Education 40:263-8.
Simeon, D., and J. Abugel. 2006. Feeling Unreal: Depersonalization Disorder and the Loss of the Self. New York: Oxford University Press.
Smith, DW. 2005. “Critical, Clinical.” In Gilles Deleuze: Key Concepts, edited by CJ. Stivale, 182-193..McGill: Queen’s University Press.
Staricoff, RL. 2004. Arts in Health: A Review of the Medical Literature. London: Arts Council England.
------. 2006. “Arts in Health: The Value of Evaluation.” Perspectives in Public Health 126:116-20.
Truog, RD., DM. Browning, JA. Johnson, and TH. Gallagher. 2011. Talking with Patients and Families about Medical Error. Baltimore: The Johns Hopkins University Press.
Urlich, R., C. Zimring, X. Quan, A. Joseph, and R. Choudhary. 2004. The Role of the Physical Environment in the Hospital of the 21st Century. The Center for Health Design. Accessed June 20, 2013. http://www.healthdesign.org.
Wallenburg, I., J. Pols, and A. de Bont. 2011. “Entering the Medical Elite: Reconfiguring Uncertainty in Medical Training.” Paper presented at the 4S Annual Meeting - Abstract and Session Submissions, Crowne Plaza Cleveland City Center Hotel, Cleveland, OH. Accessed October 30, 2013. http://citation.allacademic.com/meta/p517981_index.html.
Wear, D. 1991. “Painters and Patients: How Art Informs Medicine.” Family Medicine 23:531-3.
Wear, D., and JM. Aultman. 2005. “The Limits of Narrative: Medical Student Resistance to Confronting Inequality and Oppression in Literature and Beyond.” Medical Education 39:1056–65.
Wellbery, C. 2010. “The Value of Medical Uncertainty?” The Lancet 375:1686-7.
Wershof Schwartz, A, JS. Abramson, I. Wojnowich, R. Accordino, EJ. Ronan, and MR. Rifkin. 2009. “Evaluating the Impact of the Humanities in Medical Education. Mount Sinai Journal of Medicine 76:372-80.
Weston, G. 2010. Direct Red: A Surgeon’s Story. London: Vintage.
Winnicott, DW. 1971. Playing and Reality. Harmondsworth: Penguin.
Xyrichis, A., and E. Ream. 2008. “Teamwork: A Concept Analysis.” Journal of Advanced Nursing 61:232-41.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bleakley, A. Seven Types of Ambiguity in Evaluating the Impact of Humanities Provision in Undergraduate Medicine Curricula. J Med Humanit 36, 337–357 (2015). https://doi.org/10.1007/s10912-015-9337-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10912-015-9337-5