In higher education, professors are encouraged to blend teaching with a range of approaches. One such approach might be found in the use of book clubs or, as they are sometimes called, literature circles. Book clubs are a relatively recent social phenomenon with a range of groups springing up in libraries, bookshops, online, and on television. Should book clubs be included in the formal education of healthcare practitioners? They are popular with a whole range of people, but does this mean they have a place in higher learning? Having been used in US schools with greater frequency than in the UK, book clubs, from my experience, are rarely employed at the university level. Despite their scarcity in the higher education, however, book clubs can increase a student’s participation in her own learning, enhance social proficiency, and develop discussion skills.1 Some university professors also believe that the book club format develops a learner’s sense of autonomy, skills of analysis, ability to select useful books, and confidence in discussions.2 Book clubs can also provide opportunities for clinical trainees and practitioners to engage with the narrative of health and social care and human experience—not just the clinical problem. While many of these skills are not discipline specific, they are part of a skill set that makes for a well-rounded learner, with the added value of engaging with the story of people’s health and social needs, exploring contextual factors, and developing less measureable qualities, such as dignity and respect. Of course the skills that participants develop would likely vary according to the format (e.g., face-to-face group vs. an online book club).
Stories and first-person narratives from service users, survivors, and caregivers find increasing interest among professionals and educators in health and social services, including medicine, nursing, social work, mental health, and other healthcare professions. The links and themes between novels, films, and biographies—traditionally the fodder of literary and cultural studies—can yield learning and engagement with the perspectives of the people these professions serve.3 However, these narratives remain subordinate to more traditional peer reviewed articles and scientific knowledge. Personal accounts—whether delivered in a novel, autobiography, or play—are imbued with humanity and immediacy, making them a relevant source for both clinical consultation and service development. It is likely that if such learning were consistently valued alongside scientific approaches and knowledge, it would not replace science but would compliment it.
Using a book club approach seems deceptively simple: select a relevant text and then ask students to read it by a given date. Secondly, coordinate a number of small discussion groups (with a maximum of 10 students), offering them either facilitation or a selection of questions to promote discussion. However, issues will arise. For example, I asked students who were enrolled in a module for counseling and psychotherapeutic studies to read Fitzgerald’s Tender is the night.4 For the purpose of introducing issues of gender and psychiatry/medicine, the asylum and sanatorium/clinic, and social class, the novel seemed ideal. However, the students, as a whole, did not enjoy this novel and most did not finish it.
Following a process of “I choose, we choose, you choose,” I let the students freely select the second text.5 They chose Frey’s A million little pieces,6which is far less formal, set more recently, and written in a more conversational style than Fitzgerald’s novel. Some students were clearly already reading texts beyond their course requirements that kept with their disciplinary interest. A million little pieces is a quasi-autobiographical account of a young man admitted to a dependency rehabilitation unit; in the novel, he describes the methods he found to be therapeutic and his turning points in the rehabilitation process. Not surprisingly, the students loved it. Students preferred the writing style and connected better with the context and story. The unintended and fitting irony of using these two texts together is that while Fitzgerald’s work fared worse among the students, Frey, having admitted to fabrication of large portions of the novel, claimed Tender is the night as one of his favorite novels.
Enjoyment, ability to select books, and level of interest appear to be important factors for younger readers, and this may also be true of university-age students.7 Given the lack of use and evaluation of book clubs in higher learning, our understanding of the value and delivery of a book club relies on the evidence from pre-university schooling and perhaps the cross-over with familiar formats such as the seminar. Listening to student feedback is essential though because, for the purposes of learning, the student must be prepared to venture into a novel that may be initially unsatisfying, from which the learning must be teased out.
Professors are often faced with different levels of engagement in any area of learning, and, to some extent, students manage this themselves. But in the case of Fitzgerald’s novel, while those who did not read the text tended either to not attend or to take a peripheral role in the discussion, some of the more engaged students also declared that they did not read the text. This experience helped me understand that, since medical professionals are most interested in the real patient experience, the use of fiction may be less appealing or even less appropriate than nonfiction—even though fiction, biography, and autobiography have so many crossovers and interconnections. In this instance, it might have been preferable to select a modern nonfiction work as the first text or choose a fictional novella or short story to increase engagement and the chances of the text being read.
However, facilitators will need to find ways to encourage learning when the majority of students have not read the text. When leading the discussion of Tender is the night, it was helpful to manage the discussion in ways that moved from the concrete (the novel itself) to the abstract (what would this mean for the way mental health is seen today?), which meant that students could participate even though they had not completed their homework.
There remains the challenge of fitting the book club format into a curriculum that tends towards the development of professional identity, problem solving, and technical skill. Humanities education, when included in professional education, often plays a secondary role to the larger curriculum. While educators are increasingly interested in the lessons that these narratives yield in the classroom, the arts still possess untapped potential in health curricula. What’s more, one is left wondering how to assess the value of such learning in a health practitioner course and how to adequately reflect its importance within a professional course of study.
Students of the health professions tend to value certain kinds of knowledge in their education. Even when students are engaged in the process of reflection, they often favor knowledge that applies evidence to practice and reflects a scientific ethos. In such a curriculum, student assessments will also favor this ethos, making the introduction of education using arts-based sources bewildering to the students. While these students will admit to enjoying the material, they will often struggle to place what they have learned within the wider context of their education. This difficulty in assessing the value of lessons learned from narrative sources further creates a disincentive for successfully integrating humanities curriculum into already demanding academic schedules. Ensuring that such sources of learning are adequately valued presents a strong challenge in the context of education that focuses on evidence-based medicine, clinical guidance, and therapeutic maneuvers.
- Rehberg Sedo, D. (2003). Readers in reading groups: an online survey of face-to-face and virtual book clubs. Convergence: the International Journal of Research into New Media Technologies 9(66), 66–90.
- Hird, M., & Penson, B. (2007). Book Clubs or Lectures? Facilitating learning in higher education using stories told about mental health problems. Paper presented at the2007 Narrative Practitioner Conference. Retrieved August 24, 2011, from http://www.scribd.com/doc/52017627/The-Narrative-Practitioner-Conference-Proceedings-2007-45.
- Orr, M. (2003). Intertexuality: debates and contexts. Cambridge: Polity Press.
- Fitzgerald, F.S. (1934; 2000). Tender is the night. London: Penguin.
- Campbell Hill, B. (2007). Literature circles and response. Presented at the 2007 NESA Conference. Retrieved August 24, 2011 from http://bonniecampbellhill.com/Handouts/Handouts/NESALitCircleHandoutAthens07.pdf.
- Frey, J. (2003). A million little pieces. London: John Murray.
- Clark, C. & Phythian-Sence, C. (2008). Interesting choice: The (relative) importance of choice and interest in reader engagement. Retrieved August 24, 2011 from the National Literacy Trustwebsite: http://www.literacytrust.org.uk/assets/0000/0541/Interesting_choice_2008.pdf.
WILLIAM PENSON, BSc Psychology (Hon), BSc Psychosocial Interventions (Hon), PGCHE, MA Contemporary Literatures is a teacher fellow and senior lecturer in mental health at Leeds Metropolitan University in the United Kingdom. He teaches in a range of areas, including the use of humanities in health and social care professional education and working with psychosis and cognitive behavioral therapies.