"It's not fair". Arts and humanities in medical education and their presence (or absence) in medical school promotional literature.

Background: There is increasing presence of arts and humanities in medical education with some suggesting that there should be a national curriculum in the UK (1). In a 2018 survey of UK medical schools 93% of respondents reported that there was arts and/or humanities within their undergraduate curriculum (2). A survey of students from five USA medical schools found that exposure to humanities was correlated with increased empathy, reduced intolerance of ambiguity and reduced emotional exhaustion (3). These outcomes align well with the GMC Outcomes for Graduates. However, there is also some resistance to the inclusion of arts and humanities within medical education (4, 5). Some students responded that the inclusion of arts and humanities within their medical curriculum was “unfair” as it differed so much from their expectations of medical school (6). These reports and unpublished survey data that we have collected (2) suggest that at times there is a clash between the aims of those providing arts and humanities learning activities to medical students and student perceptions and expectations. Can this clash be resolved by considering and addressing students’ expectations? We have examined all websites and prospectuses for UK medical schools to see whether there is any mention of arts and humanities based teaching within literature that is aimed at prospective new students.

Methodology: UK medical school websites were accessed between January-April 2018. All publicly accessible pages relating to applications to medicine and the medical course were read and the content analysed. This included any videos or downloadable documents presented within these pages. Sections of websites aimed at current students were excluded. Any mention of arts or humanities learning activities were noted. Prospectuses (academic year 201819) were read looking for any content relating to arts or humanities. Large prospectuses were analysed by applying a list of search terms relating to arts and humanities followed by close reading of relevant areas of the document. Particular attention was paid to sections presenting a summary or overview of the course and highlighted course features. Where references to arts or humanities related teaching were found, the specific form of activity and the context in which it was mentioned were noted.

Results: Approximately two-thirds (24/33) of medical schools make some mention of a form of arts and/or humanities somewhere on their website and/or prospectus. In most cases (19/24) this was limited to a very brief mention such as appearing within a list of course content or potential options for student selected components (SSCs) or intercalated degrees with no further information. In 13/24 cases this mention was only found by following links to other pages such as more detailed course descriptions or lists of optional learning activities. The most commonly mentioned discipline was “sociology” or “social sciences”. Only three medical schools highlight arts and humanities within their curriculum as an important feature on their websites and prospectuses. Five medical schools presented more detailed information about the place of arts and humanities in medical education and the intended benefits for medical students. However, in four cases this was only visible if following links to a page about a specific intercalated degree. Only one medical school presented this information in relation to the core medical course.

Discussion: Based on the content of medical school websites and prospectuses it would be reasonable to conclude that most potential students would not expect to encounter arts and humanities at medical school. Does this matter? It does if the dissonance between expectation and reality prevents students from engaging with teaching and interrupts learning opportunities. We plan to carry out focus groups with students to find out more.

References:
1. Gillies J. Compassion, medical humanities and medical education. Education for Primary Care. 2018;29(2):68-70.
2. Revell LJ, Blythe A. Arts and Humanities in Undergraduate Medical Education, A Survey of UK Medical Schools. Unpublished.
3. 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.
4. Knight LV. A silly expression: Consultants' implicit and explicit understanding of Medical Humanities. A qualitative analysis. Medical Humanities. 2006;32(2):119-24.
5. Wear D, Zarconi J. A Humanities-Based Capstone Course in Medical Education: An Affirming and Difficult Look Back. Journal for Learning through the Arts. 2006;2(1):1-13.
6. Shapiro J, Coulehan J, Wear D, Montello M. Medical Humanities and Their Discontents: Definitions, Critiques, and Implications. Academic Medicine. 2009;84(2):192-8. p.193