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Bedside Minor

ONU’s new medical humanities minor gives allied-health students a leg up on the competition.

In “Edna’s Star,” author and registered nurse Chris Grant writes, “Becoming the best nurse possible begins with just being a good nurse.” It’s the final sentence in a story about professional and personal epiphany, and it eloquently proposes that medical training is only part of, perhaps even the lesser part of, what ultimately makes a person a good medical practitioner.

The human body is a complex biological machine that demands rigorous study to understand. There is an incredible amount of information that medical practitioners need to learn to meet even the minimum level of competency. Mastery of this information should translate equally to its application. It stands to reason that the best doctor would be the person who knows the most about how the body works. This, however, is not always the case.

The challenge medical professionals face is that biology is only part of what makes us who we are. A living human body is more than a machine. It’s a person. It has a distinct personality and location in society that matters just as much to health as any genetic predisposition to disease. However, the American health care educational system’s emphasis on the hard sciences has increasingly outpaced training in the so-called soft sciences to the point where the American Association of Medical Colleges, the body that administers the Medical College Admission Test (MCAT), began testing students on their knowledge of the humanities in 2015.

“The MCAT changed because people were becoming extremely proficient and smart pre-medical professionals, but they had no bedside manner and did not know where to get it,” says Douglas Dowland, assistant professor of English and coordinator of ONU’s new minor in Medical Humanities.

Bedside manner is the common term for a medical practitioner’s ability to relate with a patient. But in truth, it is more complicated than that. The very best doctors, nurses and pharmacists know not only how to speak to patients, but also how to read them emotionally, culturally and spiritually to provide optimal care.

Not coincidentally, Ohio Northern University introduced a new minor this year: medical humanities. Broadly speaking, this new collection of courses offered through the Department of English presents traditional humanities subjects like literature, philosophy, ethics, history and religion in a medical context that is ideally suited to students majoring in the allied-health fields (pharmacy, nursing, premed, etc.). The interdisciplinary nature of the minor sees the same approach taken with the social sciences (anthropology, psychology, sociology) and the arts (theatre, film, visual arts). These courses satisfy the core general-education requirements that are a hallmark of ONU’s blended liberal arts education, and they do so in a way that actually adds value to the allied-health majors.

When we think about general education, for the most part, students often view it as, ‘These are the things I have to take to graduate.’ Well, that just sucks the passion right out of it,” says Dowland. “What we are trying to do with medical humanities is give our students an option that is directly related to their training to become a pharmacist, doctor, nurse or other medical professional.

One can think of it this way: If an anatomy course can teach a student how the body works, a humanities course can teach him or her about what it means to be human. The humanities teach empathy, they argue on behalf of ethics, and they explain the conditions under which we all live, something that is becoming increasingly important as chronic disease becomes more common in society.

In fact, the entire concept of health and wellness is changing. Health has traditionally been viewed as an individual concern. Now, it’s seen as a communal one. Public health is a field on the rise as sociologists, psychologists and anthropologists discover social, behavioral and cultural connectors to disease.

“We are starting to think of health as a more inclusive concept,” says Rebecca Brooks, visiting instructor in sociology. “It’s not just a biomedical phenomenon. There are lots of discussions about social determinants of disease. Things like age, race, gender and social class can put individuals at increased risk.”

Just as there are social determinants of disease, there also are social determinants of care. Sometimes cultural or religious factors may interfere with a prescribed course of care. A doctor, nurse or pharmacist with the ability to identify a likely conflict and alter his or her treatment course will achieve better results. This is referred to as cultural competency. When health care providers are culturally competent, they listen to what a patient has to say and understand things that aren’t shared willingly, in order to know where to look for problems. As the population gets more diverse, the ability to communicate with patients from different walks of life becomes more important.

Gaining cultural competency doesn’t just happen, and it isn’t necessarily taught outright, but courses like those offered in the medical humanities minor provide the foundation for it to take root. Professional Ethics (PHIL 2401), Literature and Medicine (ENGL 3271), Religions East and West (RELG 1071), Sociology of Mental Health and Illness (SOC 3491), Health Communication (CAMS 2331) and Political Philosophy (PHIL 3201) may not sound like medical school courses, but they will ensure that ONU students who go on to take the MCAT are better prepared than students who aren’t exposed to the humanities, or can’t relate their humanities education to a medical context.

When ONU looked into the possibility of offering the medical humanities minor, a committee of professors, Dowland, Brooks, Dr. Mark Dixon, Dr. Christine North and Dr. Megan Clegg-Kraynok, found that some of the courses already existed throughout ONU’s general education curriculum.

Brooks’ Sociology of Health and Health Care is one such course. In it, students learn about health behavior, illness behavior and health care systems both in the United States and abroad. They also learn about the profession of medicine and other health care vocations as well as topical subjects like public and private health insurance.

We introduce students to the idea that our location in society has a huge impact on our health," says Brooks. "Where you live, whether you are married, how old you are; all those big social locations matter and make a difference.

Clearly, social sciences like sociology, anthropology and psychology have direct connections to medicine and health care, but do the arts? Are there parallels that exist between medicine and, say, literature?

Actually, there are. The physician-writer dates back to Ctesius in the fifth century B.C., and notable physician-writers since include François Rabelais, John Keats, Anton Chekhov, Sir Arthur Conan Doyle, Michael Crichton and Robin Cook. However, it should be noted that most, if not all, of these authors and poets never wrote about being a physician. It is more recently that the physician-writer, or the nurse-writer, or even the medical-student-writer, has looked inward to tell stories of practicing medicine. There have even been some very successful patient-writers recently, such as David Small, whose graphic novel memoir Stitches tells the story of his travails with pediatric cancer. Courses wouldn’t fit into the medical humanities minor if they didn’t use medically relevant material such as the anthology Intensive Care, a collection of stories written by medical professionals in which “Edna’s Star” appears.

“I could assign the Death of Ivan Illyich by Tolstoy and talk about death that way, but I want to give my students contemporary texts that they can see themselves in, so that they are engaged and we can get into things like real-world literary language,” says Dowland. “It is a much more active learning environment this way.”

“I’m already interested in the material just knowing that it’s written by a nurse,” says Lynn Kelly, a sophomore nursing student from Mason, Ohio. “I can relate to it. I’ve known nurses who have told me that one patient will change your experience, and so reading about a nurse who had that experience makes me just more excited to become one.”

When students discussed “Edna’s Star” in Dowland’s class, not only was there a lively discussion, but many students had strong reactions to some of what the author had written. In the story, the narrator – a new, highly confident nurse – admitted that, “her nursing talent would surely be wasted” on an elderly patient.

“That really bothered me,” says Makayla Wells, a third-year pharmacy student from Olean, N.Y. “If I have a medical problem, it is obviously important to me. I want my nurse to think that ‘Okay, I’m going to do everything I can, because her problem is now my problem.’”

Kelly’s and Wells’ responses show that these students not only engaged with the material, but also related it to their own life experiences and to their expectations of the health care industry, something educators refer to as schema theory.

“Active readers generally make connections with text on at least three levels: a personal level, with other texts, and to the real world (Keene and Zimmerman, 1997). The more cross-connections we make as readers, the more we understand and can apply what we’re learning,” says Diana Garlough, chair of the Department of Education at ONU.

Critical thinking is at the core of the medical humanities minor. A course like general chemistry doesn’t allow one to approach the information from a particular point-of-view. The material isn’t really up for debate. But in the humanities, perspective is not only relevant, it’s important.

For example, Brooks explains that in the field of sociology, there are multiple theoretical perspectives. Students who have received training from sociology courses are already in the habit of looking at things from multiple perspectives. They might ask themselves, “How would a functionalist explain it? How would a conflict theorist explain it?’ But now, with more hard science students taking these courses, there are new angles to explore.

“These students might think about things from the practitioner’s side, which will be good for discussions. I have some pharmaceutical business students in my class this semester, so it’s interesting to hear their opinions on the topics we cover, especially the cost of prescription drugs in our country as it relates to overall national health,” she says.

This idea that medical professionals need to be more than just technicians is unlikely to go away. Neither is the need for them to do so. The 2010 U.S. census showed that the demographic of Americans age 65 and older was growing more rapidly than the entire U.S. population. With life expectancy continuing to increase, that number is only going to rise.  

For years, ONU’s Raabe College of Pharmacy has taught its students many of the patient-interaction skills that the new medical humanities minor is addressing. With pharmacists being the most accessible health care provider to most Americans, having a good rapport with patients is more than an asset, it’s a necessary skill. As student pharmacists develop, a significant part of that development is learning the skills of analysis, observation and empathy.

“While students do need to understand the science behind how the body functions and how disease impacts that function, the best pharmacists also understand that each patient is different and that it is critical to customize care based on the needs of that patient,” says Dr. Kelly Shields, assistant dean of the College of Pharmacy.   

ONU graduates who go on to medical school – and there have been many over the years – haven’t received that training. Now, if they minor in medical humanities, they will. Dr. Nicole (Fortier) O’Brien, BS ’97, believes this new program will help students understand the full scope of a career in medicine at an earlier age.

I believe giving students the opportunity to focus on the humanities as they relate to medicine while at ONU will serve them very well as they progress in their educational endeavors," she says. "From the outset, a greater understanding of the comprehensive nature of medicine will be evident.

O’Brien’s path in medicine is notable in that her career has been so influenced by the human side of practicing medicine. After graduating from Northern, but before enrolling in the Medical College of Ohio, she traveled to the Ivory Coast, where she spent a year as a medical missionary. That year abroad changed her life forever, and today she and her family live in the Democratic Republic of the Congo (DRC), leading a nonprofit organization they founded called Restore Elikia, which helps orphaned children in the region.

“The orphanages in the DRC are poorly funded, and, as such, the kids are not healthy in any way – physically, mentally, emotionally or spiritually,” she says.

O’Brien’s career in medicine has shown her that there are many facets to health and wellness. Had she simply relied on her technical knowledge of the human body, it’s unlikely she would be where she is today.

“Most of the early years of my training necessarily focused on learning and understanding the science of medicine – anatomy, physiology, pathology, pharmacology. However, the further I get into my career, the more and more I appreciate the importance of practicing the art of medicine well,” she says.

If art is the application of skill and imagination, then healing people truly is an art form. Solving problems in something as complicated as a human body takes all of one’s abilities, even those refined through reading stories in a book. From “Edna’s Star” to the DRC, the bedside manner that the medical humanities minor instills makes students not only better health professionals, but it makes them better global citizens and more ethical, literate people. In short, it gives them the tools to be more than good. It will help them to become their best.