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Dien Ho

First of its Scope: MCPHS Faculty Co-Authors Research Publication on Health Humanities in Medical Schools

  • MCPHS Program Director and Professor Dien Ho, PhD, co-authored an international study of medical schools to measure the presence of health humanities in their curricula.

    An appreciation for the humanities and its positive impact in healthcare has been increasing in many areas of medicine, including medical practice, research, and education. MCPHS Director of the Center for Health Humanities and Professor of Philosophy and Healthcare Ethics Dien Ho, PhD, together with several other scholars around the world, performed a study to investigate the prevalence of health humanities further: "Do medical schools teach medical humanities? Review of curricula in the United States, Canada, and the United Kingdom". Wiley, an academic-focused publishing company, published their research paper in the Journal of Evaluation in Clinical Practice.

    The co-authors, whose home nations span the three countries examined, came together over mutual academic interests. Dr. Ho says that senior author Jeremy Howick, PhD, reached out to him with the project idea about a year ago, because they had previously been corresponding about placebo studies. Dr. Howick is Director of the Oxford Empathy Programme at the University of Oxford, where he is also an Impact Fellow and Executive Secretary of the Philosophy and Medicine Network—in addition to being a researcher, consultant, and writer. He and Dr. Ho brought in the other authors, one of whom is MCPHS alum Brenna McKaig, BS (Premedical Health Studies) ’19. Of McKaig, Dr. Ho says, “She did a lot of leg work, a lot of brainstorming, too. She was instrumental in how that paper came together.”

    Another author, Jason Oke, PhD, is a statistician at the University of Oxford, Medical Sciences Division. Although the group’s primary objective was to determine the presence of humanities in medical school curricula, Dr. Oke also examined the relationship between average medical school ranking and inclusion of medical humanities offerings. They used the world university rankings of US News & World Report and UK-based Times Higher Education. Dr. Ho says it was difficult to normalize the data because the two ranking systems use different criteria. Consequently, their ranking considerations included rates of students passing board exams and publication rates of faculty but had to exclude any medical schools without undergraduate programs.

    The results show an inverse relationship between school ranking and presence of health humanities. The indication of higher-ranked medical schools having fewer health humanities offerings is that these schools, which tend to be larger than mid- and low-ranked schools, are slower to adjust their curricula. In addition to their size enabling them to be timely with institutional changes, Dr. Ho suspects that smaller schools adapt to ideals of emerging importance faster because they want to be more competitive. It is important to distinguish that the rankings do not necessarily represent the quality of education offered. Dr. Ho says that smaller medical schools can offer students a better education than some of the top-ranked schools by virtue of the fact that they recognize the importance of humanities in medical education: “The administrators are aware of the fact that to be a good doctor, you need to do way more than just know the sciences and spend the time in your rotations. It’s just not enough. You need to have a basic understanding of how it is to observe, to problem-solve, and so on.” According to their study, the most common humanities class taught in medical schools for all three countries is general medical humanities. They also saw frequent occurrences of history and literature in the United States and Canada, and sociology/social medicine and art in the UK.

    To decide their parameters, Dr. Ho and Dr. Howick had to define what constitutes humanities offerings for the purpose of their study. For example, they chose to omit healthcare ethics, since the subject has less relevance to the patient narrative, and because it is so commonly included in medical school curricula that it could skew the results. Dr. Ho and Ms. McKaig were responsible for collecting a substantial portion of the data, since they were responsible for reviewing the curricula of the United States medical schools. The researchers based their model on a similar study performed in Spain and Italy; however, their project was much larger since it covered schools in the United States, Canada, and the United Kingdom. “This is the first study of this scope in the world, as far as we know,” says Dr. Ho. “. . . Our hope is to continue and cover medical schools internationally.” Dr. Ho says the challenge of a worldwide study would be twofold: navigating language barriers and accounting for varying standards of medical schools in different countries. They purposely chose the United States, Canada, and the United Kingdom for their study due to the common language and cultural similarities. However, despite these common grounds, there were still discrepancies between the countries. The United States had the leading number of medical schools to include medical humanities in their curricula (80%), followed by the United Kingdom (73%) and Canada (56%) respectively. Some reasons that the United States is ahead of the curve are resources and competition. Dr. Ho explains, “Medical schools are slow-moving machines that take a while to change direction. In the United Kingdom, the inertia of tradition is even more powerful than it is here.”

    Part of the shifting focus on medical humanities in the United States is due to schools reacting to changes in the Medical College Admission Test (MCAT), which has pivoted to include more humanities and prioritize critical reasoning in the score. “If you look at the number of programs that offer training in health humanities, there’s been exponential growth in the last ten years,” says Dr. Ho. Students who major in health humanities systematically outscore science students on the MCAT, and the major with the highest acceptance rate to medical school is philosophy. Medical schools look for students who distinguish themselves, which is why Dr. Ho thinks MCPHS students in the Bachelor of Arts in Health Humanities program have an advantage. MCPHS is the first and only college in New England to have a free-standing Bachelor of Arts in Health Humanities degree; furthermore, its focus on interprofessional education gives students well-rounded experience. He stipulates that it is not enough to incorporate health humanities into the first years of medical school alone; students must sustain their understanding of humanities throughout residency and their medical career.

    Dr. Ho argues that a background in humanities prepares one to become a better clinician and researcher, because the lessons of those courses—such as conceptualization and critical thinking—are at the heart of medicine. In terms of clinical experience, literature in medicine is shown to help physicians be more empathetic and observe in a way they would not otherwise be taught. For example, Harvard Medical School takes students on a museum tour guided by art historians to look at paintings; this kind of training improves students’ diagnostics skills, just as sociology helps students better understand human conditions and the line between pathology and human variant. In modern healthcare, the relevance of understanding medical humanities such as social determinants of health and the issue of race in medicine has never been greater. Dr. Ho says, “A pandemic attacks the fact that we are social animals that have built an interconnected world. There is no better time to appreciate the humanistic components of medicine and public health than now.”