The Impact of the Humanities on Medical School Education

Podcast Transcript

Dr. James K. Stoller:

Hello and welcome to MedEd Thread, a Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Mari Knettle:

Hi, welcome to today's podcast, MedEd Thread, a Cleveland Clinic Education Institute podcast. I am your host, Dr. Mari Knettle, Medical Director of the Center for Health Professions Education here at Cleveland Clinic in Cleveland, Ohio. Today I'm very pleased to have Cleveland Clinic Lerner College of Medicine students, Anthony Onuzuruike and Maeve Pascoe here to join us. Anthony and Maeve, welcome to the podcast.

Anthony Onuzuruike:

Thank you for having us.

Maeve Pascoe:

Yes, thank you.

Mari Knettle:

So why don't we start out with each of you telling us a little bit about yourself, where you're from, what you're studying.

Maeve Pascoe:

So, I'm originally from East Lansing, Michigan. I went to the University of Michigan for my undergraduate degree where I studied honors neuroscience and received a minor in science technology and society from the residential college. And currently I am a medical student at the Cleveland Clinic Lerner College of Medicine getting medical degree and also a master's degree in clinical research.

Anthony Onuzuruike:

So my name's Anthony, and originally from Kansas City. I went to college at the University of Missouri, got a bachelor's in both chemistry and biology. I took a little bit of a break between med school and college and went to the NIH, which is where I think Maeve right now and was able to study a little bit of type two diabetes and pediatrics and after that came to medical school here in Cleveland. Right now I'm currently in M5. My plan is to match into emergency medicine. So while I'm not studying and applying and doing research, I like to paint and draw and try to get some workout (laughs) in every now and then. And also be able to hang out with friends and just have fun.

Mari Knettle:

Great. Well I'm so glad you could both join us. I think we're going to have a fantastic conversation, but as we get started, I think the most important thing to do is let's define medical humanities. A lot of people don't know what we're talking about when we say medical humanities.

Anthony Onuzuruike:

Yeah, so I guess for me, and this is kind of the nerd in me, I think the last time I researched or looked up medical humanities, it's the combination of arts, social sciences and communication, all of that combined trying to apply that to medical education. And you see that a lot in medical schools and even in some other graduate programs. But I think for me, that's probably what I would say as far as, um, medical humanities are the application of the arts into medical education.

Mari Knettle:

Maeve, is there anything you, you would add?

Maeve Pascoe:

Yeah, I would just add that, you know, that's, that's a fantastic definition and not only does that permeate into medical education, but it really extends into practice these concepts and tenants of medical humanities that we learn in medical school and other professional programs we can apply to our practice in the future.

Mari Knettle:

So those are good definitions, but to really drive home what medical humanities means, can you give us an example of your experience in medical humanities?

Maeve Pascoe:

Yeah, so I think in terms of arts or, or communication, I was fortunate to be a student preceptor for the first year medical students and that was an absolute blast. Not only because you're taking all of your experiences and really the, the different arts and crafts that you've done, you know, talking and communicating with patients, but then relaying that same information, that same experience with all of the first years who are brand new to medical school, trying to cram in all this medical knowledge and then trying to learn, oh yeah, I've got to be able to communicate with patients as well because a lot of patients don't necessarily struggle with a lack of education, although that can be a barrier as well, but really a lot of them don't have the same background knowledge in medical education like we do.

And it's the same thing with any other career, you know, whether it's in engineering or it's in law or teaching, that everyone has their own niche. And so what we as medical students are trying to do is trying to not only learn, but also trying to apply that same knowledge for the benefit of the patients that we encounter. So yeah, it was definitely a privilege to be able to take this particular art and communication and try to hopefully help the next generation of physicians be better at taking care of patients.

That's fantastic. I know being in the communications courses in our, you know, preclinical years was so formative for me and actually for me, the medical humanities education that I've had started back in undergrad and I mentioned that my minor with science technology in society and I think a good deal of that too was dealing with medical anthropology. And so we learned about how the science of medicine exists within a much broader context and interacts with other ways of understanding and moving within the world.

As Anthony described, you know, the definition of medical humanities touches so many other realms besides medicine, and that was sort of what we started talking about, you know, looking at medicine through lenses of sociology, politics, philosophy, and in particular, I really love learning about how, you know, diseases can be distinct from illness as diseases, a scientific and medical term, but illness is steeped in social context and a personal understanding of disease as it relates to your life experiences. So that was where it really started. And then here at the Lerner College of Medicine, I've been very lucky to engage in the curriculum as Anthony mentioned, and also in extracurriculars such as the Medical Humanities Journal at CCLCM Stethos, and both of us have been very involved in that throughout our careers here.

Mari Knettle:

So let's dial it back to the beginning of your education and your perception of humanities as part of the medical education curriculum. What was your initial view?

Anthony Onuzuruike:

You know, I'm ashamed to say this, but initially I saw medical humanities and medical education as almost these dichotomies kind of arenas where, you know, one was black, one was white, one could be you sleeping versus one you eating. Right? You know, sleeping and eating is not something you necessarily think of as kind of the similar things. But yeah, I, I kind of saw them as one that I enjoyed doing of as far as activity or a hobby and one that I kind of needed to do in order for me to become a physician.

Maeve Pascoe:

Yeah, I have to say initially I was really excited to see dedicated time for the humanities in the curriculum, but I was nervous to see how other students would respond to having it in the curriculum just because I think many people do have this view of, you know, medical sciences, one field entirely divorced from humanities and fields such as that. So I was excited to see that people did place value on it, but I was anxious to see if other students would place the same value on that curriculum.

Mari Knettle:

So that's really interesting. You both sound like you came from a different perspective where may- maybe Anthony, you were more skeptical about medical humanities and what it might take away from your time studying some of the more scientific aspects of medical education, whereas Maeve, it sounds like you came from a perspective where you had an appreciation for inclusion of this aspect of learning in your medical curriculum.

Anthony Onuzuruike:

Yeah.

Mari Knettle:

So h- how have your perspectives changed over time?

Anthony Onuzuruike:

Well, they, they obviously being on this show, they definitely have changed over time. As you go through medical school and you know, you're studying and, and learning all these different things, you are using all these different mediums to learn the material. I mean, you can definitely read a textbook and those definitely help a lot of people, but oftentimes you're struggling with energy and time and trying to cram a certain amount of information in a short period of time is, is a hard thing to do. But yet you have things like YouTube where you can watch these really short snippets of videos that can kind of have ... that have diagrams to demonstrate what's going on. You have things like sketchy videos, which I'm sure if any medical student is listening to this right now, they know exactly what I'm talking about where they use different pictures as synonyms or analogies, um, or representations of a certain symbol that can help them memorize either medication or remember a particular bacteria.

And then even just mnemonics. I mean I know that for me it's some of my med students was SOCRATES, which is acronym that you can use to basically help you with your history taking. So you know, S stands for kind of the sight of pain, O stands for the occurrence, C stands for the characteristic. In other words, you know, is it a burning pain, is it a sharp pain? R stands for radiation, does that pain radiate? Is it just in the chest or does it go to the back? Does it go to the shoulder? And then you also have A, which is any other associated symptoms. So you could have chest pain but you could also have a fever or you could also have a belly pain. And so that can really help you with your differential as well. And then T is for timing, is it something that is all the time constant or is it something that kind of comes maybe in the morning, in the afternoon, in the evening.

And then E and S, so E is basically anything that makes it I guess exacerbate or anything that makes it worse or better, and then S is basically severity. So for some people, hey this is extremely debilitating. I, it's so bad I can't even get up in the morning or it's so bad I don't feel like eating. It may not always be a one to 10 skill, but sometimes when you hear things when your patients tell you that, that tells you maybe there's some more things I should be looking into that I should be thinking about for, for this patient's care. But, but yeah, I think, I mean I mentioned all these different mnemonics and, and different tools that we're using. But I think in terms of medical humanities, there's no doubt that I probably wouldn't have survived medical school without some of the tools and gifts that it's brought to us.

Maeve Pascoe:

I completely agree. I think from the beginning of my education, I saw medical humanities as something that could help me understand the world of medicine, how it fits into our society and part of what patients may be going through. But I don't think I really appreciated how much it can bring to patient's lives and how much medical humanities touch the patient experience. And as I've mentioned, you know, it's, it's a way to process what you're going through I think that our curriculum, especially in the third year, it was driven largely by small group discussions and reflections on experiences in the hospital. And I think this was really important and hugely helpful for fostering community between students and helping us process some of the most shocking and difficult scenarios we've ever faced.

Mari Knettle:

So now that you have had the opportunity to see what medical humanities have done for you in your education so far, what would you say to someone who doesn't see the place for humanities in medical education?

Anthony Onuzuruike:

Well, I would say just personally I think speaking to those who are in medical training, you know, most of us, you know, have some sort of picture or drawing hung up in our house or we, you know, we have photos of our family members or friends, we listen to music. We more or less have a favorite outfit or a t-shirt. I mean, we have a favorite pair of shoes, and a lot of ways art is an expression or communication to the world in regards to our personality, what we care about what we support, what we're against. And if you look at, for example, medical textbooks, you know, we rely, even though they're associated more with print a lot of medical textbook companies rely on artists to draw out the diagrams that we need so that we can be able to visualize and see what's going on from an anatomical perspective. Even from a, from an engineering or computing standpoint, a lot of anatomy courses are using these 3D models where you're combining a scientific knowledge, engineering and art all to benefit us as future physicians in training.

And I think for me particularly, what I have found as someone who's kind of been newly intrigued about this kind of adult pedagogy or someone who's intrigued about really teaching adults, whether it be medical students or even just patients, for me, I feel like that's something that, again, you can see medical humanities really throughout all of these particular fields and all these things that I've, examples that I've given. And I'll admit, you know, I'm not necessarily here to change anyone's artistic inclination I guess, but I do think that, you know, we are all made differently and I'm really appreciative of that. And I think if everyone really looks deep enough you can really see and appreciate the benefits of, of medical humanities. So I, I guess that's probably my, my take on that.

Maeve Pascoe:

Yeah, I think at the heart of medical humanities is the human, it's relating to other people using different methods to relate to other people. And personally, I think that the best doctors aren't necessarily those who have every single biochemical pathway memorized to a T but the people who can be with a patient through their illness and be there for them. And that kind of caring goes beyond surgeries and medication and it requires people to be in touch with their own humanity. And I believe a formal education in the ways in which we can relate to people fosters that connection.

Mari Knettle:

I think that's absolutely true. You make such a good point and I, I know that as somebody who's a consumer of healthcare as we all are. I have felt that connection, you think about who's the best doctor you've been to or you know, making the best of a bad situation. It's not always a positive situation. It's always been that physician who can empathize with the patient and their family, whether or not they're from a similar perspective or background. Couldn't agree with you more. What experience so far do you think has changed you the most as a future doctor?

Anthony Onuzuruike:

So I'm gonna cheat a little bit and, and not to sound bland or anything, but I don't think there has been any specific experience that I have gone through, but rather been, it's a culmination of, of experiences that it's helped kind of shape who I am today. Each day or each stage of my development has required the previous ones for me to kind of get to where I am right now. But I will say in terms of a, a thought process, you know, as a student, you know, you're kind of thinking of, okay, well I've got to have my, you know, self-care, I've got to have different things that I do to kind of make sure that I'm still sane, but really I think the change occurred slowly but surely as, no, it's not just me as a student, you know, getting better and preparing myself to be a physician. It's me as a person. I'm Anthony and that's never gonna change.

And so the switch from how I, how do I become a better student doesn't really fully realize itself. And so I became more consent with accepting my journey as an individual. And in other words, looking at myself and saying, what are my strengths? What are my areas for improvement? To give a little bit of a Lerner shout out terminology and really being able to understand that and say, here, this is my journey and not comparing myself to anyone else, these are the things that I like to do. These are things that I want to get better at. And all of those things I think in some way or another has helped me become a better physician in training.

Maeve Pascoe:

I'm so glad you led with that as well, Anthony, because I was going to say something very similar. I think it's an aggregate of experiences and reflecting on those experiences that have changed me the most. And I think those experiences kind of what we were talking about Dr. Knettle, those experiences where perhaps I don't have the technical skill as a medical student to provide something very specific to a patient's care, but to just give them my time, to give them a listening ear when they need someone the most. Those experiences with patients have been the most formative for me because I think their appreciation for your time and empathy is almost palpable in these situations. And I've seen it really ... how it really changes a patient's experience with the healthcare system and with their illness and even the most difficult encounters can resolve with everyone feeling appreciative for the conversations and connections that have been made when healthcare providers lead with empathy. And ultimately, that's the kind of physician I would like to be someday someone who leads with empathy in every encounter.

Mari Knettle:

That's excellent to hear. Now, we're nearing the end of our time for this podcast. So I want to ask each of you, is there anything that I didn't ask you that you feel is important for our listeners to know or something else you'd like to add?

Maeve Pascoe:

Honestly, there's not much to say other than I feel extremely appreciative for all of the experiences that we've had at the Lerner Colleges of Medicine and all of the time and effort and care that's put into our medical humanities curriculum. And I would urge anyone debating about whether it's worth it to dedicate that time for medical students, to really delve into medical humanities topics and give time to those issues, that it, that it is worth it and it's really made a difference for me and it sounds like for Anthony as well and for our other classmates.

Anthony Onuzuruike:

Absolutely. Yeah. I'm, I'm glad you, you love with that as well because I'll kind of do the same thing and, and say very similar things. To me, it's not about whether others see a place for humanities and medical education. I believe very similar to what Maeve mentioned earlier, medical humanities is innately woven in human nature. To me, the only difference between someone seeing the use of medical humanities or not is whether the educator or curriculum explicitly states that. And I think we're fortunate in that we have a curriculum that explicitly carves out time for us to fully appreciate it. But I don't know, I think in the same way that, you know, when you, when you think about, for example, caring for patients, often the most important exam is observation. You can't take too much from it obviously, but it does tell you a lot. When you go in and you see a patient, you know, you may see a, a big, big fat ring on their finger and you could say, okay, this person's either married or maybe recently widowed.

What is their line of work if you see paint on their hands? You can probably tell someone's maybe working in construction. Do they smoke? You know, oftentimes you can smell that when you walk around people, the kind of the cigarette smoke. what is their vision like? Is someone wearing glasses? Are they wearing an eye patch? That obviously tells you a lot. Even their mobility. You know, if you see a crutch or a walker or a cane, maybe the patient's amputated, maybe they've got some wasting going on and they've got some very, their legs are kind of smaller than their upper body. And that tells you a lot.

Even their psychiatric condition. Are they smiling when you walk in? Do they kind of have more of a flat effect or are they crying? You know, those are all things that you can pick up extremely fast just from observing. And, and these are the same skills that we have developed since we were little. It's not as if someone has taught us any of these skills. This is human nature, these are human skills that we've picked up and all we're simply doing, at least from a medical humanities perspective, is simply applying the very human touch that again, everyone has pretty much already preface to our line of work.

Mari Knettle: 

That's a, an excellent way to end this conversation, but I'd like to ask you just one more question. What do you like best about Cleveland or Northeast Ohio?

Anthony Onuzuruike:

Yeah, so I'm originally from Kansas City, as I probably have already mentioned that beforehand. And so in, in a weird way, Cleveland's actually very similar to, to Kansas City in the sense that it's a, it's a small big city. You've got all your, your amenities, whether it be sports, whether it be restaurants, whether it be different areas you can go to downtown. There's not a lot of things that you can find in bigger cities that you could necessarily do here in Cleveland. You may not have as many options, but I think for me, one of the things I love to do, and my favorite things about Cleveland is the restaurants. I love to eat, and so I, I feel like that's one of the things I really enjoy about Cleveland and, and really hanging out with my friends.

Maeve Pascoe:

Yes, restaurants are definitely a huge (laughs) part of the draw to Cleveland and I love that there's so many things to do no matter what your interests are. So if you like sports, there are plenty of games to watch. If you like the outdoors, we have the metro parks, we have the lake. If you like, you know, just hanging out with friends and, you know, going downtown there are plenty of attractions for, for food, for entertainment. I love the versatility of it and I love that there are so many nice places, very close to the city that you can live. So we can go to medical school basically and route to downtown, but nearby, there are beautiful places with lots of greenery to live. And coming from Michigan, it's an environment that I was very used to, I suppose. So it was nice to go somewhere that had very similar amenities, but just more of them and a, a really great community.

Anthony Onuzuruike:

I'll add one more thing too, and being from Kansas City, we're basically more inland. Cleveland has a beach and for me that's been a, a delight to have. Um, you don't necessarily get to enjoy it all year on, but especially now in the summertime, it's, it's beautiful and an amazing place to go and take as a, as a respite.

Mari Knettle:

Well, thanks for that perspective. Cleveland is fortunate to have both of you. Thank you so much Anthony and Maeve. This has been a great podcast. To our listeners, thank you very much and we'll see you on our next episode. Have a wonderful day.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.