J.T.H. Connor
St. John’s, Newfoundland, Canada

Review of Allan D. Peterkin and Anna Skorzewska, eds., Health Humanities in Postgraduate Medical Education: A Handbook to the Heart of Medicine (New York: Oxford University Press, 2018)

The backbone of this innovative and informative collection is comprised of eleven essays that address the spectrum of the arts and humanities and how they relate to postgraduate medical education. Most of the authors and their experiences are grounded in Canadian medical schools, but the literature they draw from is international and the lessons learned are almost universal.

Two main intellectual strands underpin the collection: first, that the arts and humanities have made inroads within many undergraduate medical curricula, yet their presence at the postgraduate level is minuscule; and second, that the arts and humanities should assist doctors in becoming better on-the-ground clinicians. The editors maintain that “the health humanities incorporate ways of thinking to complement content-based knowledge and practice-based skills.” They can develop critical thinking, foster narrative competence, and enhance the “ability to see—both literally and metaphorically—and to reflect—to step back and learn from past experience so that it can be applied in the here and now.” (10)

Chapters generally follow a template, with each providing a literature review, “theoretical arguments” to help convince academic administrators to make curricular space, sample lesson plans, and lists of resources for further reading. In almost all respects, Health Humanities in Postgraduate Medical Education is truly a useful handbook for instructors. Contributions reflect the breadth and range of the humanities and address topics related to textual analysis, visual imagery, and areas that span both these approaches such as theater and performance. In the first group, narrative medicine and medical history (in particular, the history of psychiatry) are addressed. In the second, cinema and film and their ability to explore subtle aspects of the clinical gaze are explored, as well as the use of the visual arts to sharpen clinicians’ ability to see better, observe more, and interpret in more robust and comprehensive ways. In the final group of chapters, theater is used not only as means to see the world as reflected in spectacle and performance, but also as a “vehicle to engage with complex stories, ethical dilemmas, ambiguity, and themes which are woven into the fabric of medical practice.” (169) Similarly, human interactions, relationships, and working as a team or ensemble cast are key to interprofessional collaborative practice, all of which can be grounded in pertinent aspects of the arts and humanities.

There is also a grouping of other chapters, some of which might be expected for a book of this sort, while others are more innovative. Perhaps not surprisingly there is a chapter on bioethics in which autonomy, social justice, beneficence, and non-maleficence are addressed, but the chapter also contextualizes postgraduate medical education across the four specialties of family medicine, psychiatry, surgery, and pediatrics. The use of numerous text boxes to summarize chapter sections will be helpful to those unfamiliar with teaching bioethics, but this practice tends to be reductionist as a pedagogic technique. While chapter authors recognize the almost universal presence of ethics teaching in the undergraduate curriculum, they assert it remains “haphazard and underevaluated” (104) in postgraduate programs. More unexpected is the chapter on teaching the social sciences in medical residency. On the one hand, purist humanities scholars might find it jarring to include this sister group of diverse disciplines, but on the other hand, it is consistent with the mindset that any field that is not embraced within the clinical or biosciences is lumped together as the humanities. Based on their extensive postgraduate teaching experience at the University of Toronto, the chapter authors make the case for the value of residents grasping the tenets of the social sciences as an underpinning for a more sophisticated understanding of advocacy, professionalism, and cultural knowledge.

Two chapters in this last group stood out as particularly helpful for a practical teaching guide and handbook because the focus topics are often overlooked in discussions for the inclusion of health humanities in the medical curriculum. In her chapter “Difficult Conversations: Evaluating the Medical Humanities,” Martina Kelly highlights the tension typically present between so-called “hard sciences” and “soft skills,” between measuring outcomes that are believed to be quantifiable and objective and those that are more subjective, subtle, and personal. In Kelly’s view a definitive resolution of this tension is probably not achievable, but neither should it be; there probably is no right answer in this debate. Some readers might find the futility of that conclusion frustrating, yet to truly understand how the humanities work is to grasp that the destination is less important than the journey to reach it. In another essay, the late Robert Pierre Tomas outlines potential funding avenues and marketing skills that might be deployed to get a humanities program off the ground and maintain it. Both these chapters are realistic reminders that in some medical settings the humanities can be a hard sell.

As postgraduate medical education continues to change, perhaps an opportunity exists to introduce more arts and humanities into the curriculum. And, further, in a post-COVID-19 world where social distancing will probably become routine and small group learning the norm, the longstanding and effective humanities seminar mode of teaching might be able to make real inroads into the medical curriculum. Health Humanities in Postgraduate Medical Education: A Handbook to the Heart of Medicine is a seminal, encouraging, and forward-thinking guide for medical educators.