G. Prince is assistant clinical professor, Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, Virginia.
R. Osipov is clinical assistant professor, Division of Hospital Medicine, and research assistant professor, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
Acad Med. 2022 Aug 1;97(8):1151-1157. doi: 10.1097/ACM.0000000000004683. Epub 2022 Jul 21.
Discussion surrounding the role of the humanities as an important analytic epistemology within medical education is generally less robust than literature supporting its value in building empathy and promoting personal reflection and wellness. As such, the humanities have not been considered to be as relevant when teaching medical reasoning or technical skills. Yet, might the humanities offer value in emboldening the analytic thinking of medical learners? This article proposes an integrative conceptual model that links the thought process defining medicine-clinical reasoning-with humanistic analysis in an effort to advance the argument that the humanities offer a complementary and innovative platform that can be used within traditional medical education. The article then discusses preliminary findings from a pilot curriculum based on this model, implemented during internal medicine morning report at the University of North Carolina at Chapel Hill School of Medicine. Preliminary qualitative analysis of transcripts from the pilot curriculum demonstrates that a thought process analogous to that of clinical reasoning can be identified within guided group analyses of humanities works. Participants simultaneously used thought processes that were analytic and intuitive. The emergence of ambiguity/intuition as a theme in the pilot curriculum suggests the humanities could be a powerful tool for exploring and embracing ambiguity in clinical practice. Through the development of an integrative conceptual model, this article helps to demonstrate more explicitly the theoretical link between the reasoning pathways of the humanities and clinical medicine. Though a refined curriculum and more rigorous analysis are needed before arguing for the incorporation of the humanities into traditional graduate medical education on a larger scale, the preliminary findings here support the feasibility and promise of a curriculum based on the proposed integrative conceptual model.
讨论人文科学在医学教育中的作用作为一个重要的分析认识论，通常不如支持其在培养同理心、促进个人反思和健康方面的价值的文献那么有力。因此，在教授医学推理或技术技能时，人文科学并没有被认为那么相关。但是，人文科学是否可以在增强医学学习者的分析思维方面提供价值？本文提出了一个综合概念模型，将定义医学的思维过程——临床推理——与人文分析联系起来，以论证人文科学提供了一个互补和创新的平台，可以在传统医学教育中使用。然后，本文讨论了基于该模型的试点课程的初步发现，该课程在北卡罗来纳大学教堂山医学院的内科晨会上实施。试点课程的初步定性分析表明，可以在人文作品的指导小组分析中识别出类似于临床推理的思维过程。参与者同时使用了分析和直观的思维过程。试点课程中出现的歧义/直觉作为一个主题，表明人文科学可以成为探索和接受临床实践中模糊性的有力工具。通过综合概念模型的开发，本文有助于更明确地展示人文科学和临床医学推理途径之间的理论联系。尽管在更大规模上将人文科学纳入传统研究生医学教育之前需要开发更精细的课程和更严格的分析，但这里的初步发现支持基于拟议的综合概念模型的课程的可行性和前景。
