Arts and Humanities in Undergraduate Medical Education, a Survey of UK Medical Schools

Background: The General Medical Council Outcomes for Graduates demands more from medical graduates than application of biomedical scientific principles (1). Graduates must also have good interpersonal skills, an ability to deal with complexity and uncertainty and the ability to apply psychological and social science principles in care for patients. There is evidence that study of the arts and humanities may help address some of these areas. In a survey of students from five USA medical schools Mangione et al. found that exposure to humanities was correlated with increased empathy, reduced intolerance of ambiguity and reduced emotional exhaustion (2). Currently there are no published data about the extent to which arts and humanities are used within UK undergraduate medical curricula. This study explores the current use of arts and humanities in UK medical schools, including the goals associated with these learning activities, their perceived value within the curriculum, student reception and challenges to delivery.

Methodology: A 26-item (6 required items and 20 optional) survey was developed and circulated to 33 UK medical schools to collect both quantitative and qualitative data about their current use of arts and humanities in their undergraduate curricula. Qualitative data from the survey were analysed through thematic analysis.

Results: Responses were received from 27 out of 33 medical schools (response rate 82%). 70% (19/27) of responding schools have arts and/or humanities teaching within their core undergraduate medical curriculum. 89% (24/27) medical schools reported offering optional arts and/or humanities within their undergraduate medical curriculum. Only two schools (7%) reported not offering any arts or humanities anywhere in their core or optional curriculum. Data were collected about the arts and humanities disciplines included, which years of the curriculum this occurred in, who delivered the teaching and whether it was assessed. Medical schools reported several goals associated with the arts and humanities learning activities within their curricula. Thematic analysis of these responses identified common themes including broadening of student education, improved understanding of patients and their experiences, development of empathy and compassion, improved reflection, improved tolerance of uncertainty and improved student well-being. Arts and humanities seem highly valued by medical schools. Several respondents commented that these learning activities fulfill an essential and otherwise unmet learning need. Student response was described as good or mixed. Examples of both positive and negative feedback were provided by medical schools. Medical schools reported several challenges to implementation or expansion of arts and humanities within their curriculum, with lack of curriculum time being the biggest perceived barrier (21/27; 78%). Despite this over half of responding schools reported plans to expand the presence of arts and humanities within their undergraduate curricula.

Discussion: Arts and humanities elements are included in the core and or optional curriculum of most UK medical schools although there is a great variety in how these are used, and the types of learning activities offered. It is notable that many of the goals for these activities do align with Outcomes for Graduates, including some of the potentially harder to reach areas. All schools perceived challenges to inclusion or expansion of arts and humanities within the curriculum. Given the important goals and the high value reported by respondents, should there be a conversation about whether use of arts and humanities should be promoted and expanded and ideas shared among medical schools?

References:
1. GMC. Outcomes for Graduates. London. 2018.
2. Mangione S, Chakraborti C, Staltari G, Harrison R, Tunkel AR, Liou KT, et al. Medical Students' Exposure to the Humanities Correlates with Positive Personal Qualities and Reduced Burnout: A Multi-Institutional US Survey. Journal of General Internal Medicine. 2018;33(5):628-34.