By Claire Panosian Dunavan, MD. Illustrations by Parko Polo
The David Geffen School of Medicine at UCLA launches a new humanities curriculum to foster critical thinking and insight into the human condition while educating future physicians to care for themselves as well as their patients.
“Earth to Rich. Earth to Rich,” my medical school pal whispered to her lab partner. Although the room reeked of formalin and our classmates had already gathered into noisy groups of four, the dreamy-eyed boy was lost in another time and place. “Where are you?” Sandy asked, her concern growing. “We need to start. Today, we’re dissecting the face.” “In my head — I was playing in a symphony,” Rich sighed, as if waking from a dream. “It was beautiful.” Then, as his bliss ebbed, he turned his gaze to the embalmed cadaver in a cold, metal box, its remnants worn and ragged after months of educating students about the intricacies of the human body. “Okay, now I’m ready,” Rich said. “Where’s the nose?”
This story from my past — truthful, funny, perhaps a bit sad — will likely resonate with many doctors who studied medicine in the 1970s. To my friend, Sandy, a recently retired pediatrician, it is as vivid today as it was when she first witnessed Rich’s brief escape from yet another grueling stint in gross-anatomy lab. Nor has Rich, a gifted trumpet player who before starting medical school had already vied for a spot with the St. Louis Symphony Orchestra, forgotten his painful choice of medicine over music. Not long ago, I, too, recalled Rich’s plight after speaking with David C. Schaberg, PhD, a scholar of Asian languages and cultures and dean of humanities at UCLA. “I think of physicians — or many of them — as high achievers who proved their abilities in other ways before they became physicians, for example, by brilliantly playing a musical instrument or through other humanistic achievements,” he says. “Among other things, achievements in the arts and the humanities are ways we prove ourselves as young people.
“But what happens to that paideia” — that childhood education that can foster talents and skills — “as you enter a profession? You can lose it,” Dr. Schaberg says. “And I think a lot of people go right ahead and do that. But you can also keep and develop those early elements of excellence and sustain yourself with them.”
Sustaining physicians, nurturing their souls and enhancing compassion and communication with patients are among the reasons why Clarence H. Braddock III, MD, MPH, dean of medical education in the David Geffen School of Medicine at UCLA, made the decision to embed medical humanities within a visionary redesign of the medical school’s curriculum. But to Dr. Braddock, these goals only scratch the surface of what medical humanities can impart to future physicians.
“One would be the skill of observation, developed through the structured and methodical process of studying a sculpture or painting and cultivating a discerning eye,” Dr. Braddock says. “The second would be to recognize the power of stories. Of course, every patient has a story, which typically is about their present illness. But that is part of a larger story, which is a patient’s life narrative. Finally,” Dr. Braddock continues, “I can’t think of any better way to say it than this: Humanities enrich the soul. Medicine is a career that’s very busy and can easily squeeze out anything else. Beyond what little time is left to connect with your family, the role of literature, of film, of theater — you name it — is to encourage renewal and growth, a different part of existence that actually makes the physician more whole and resilient.”
To achieve those goals, Dr. Braddock needed an inspired leader to shape and guide the new humanities-related content. In April 2021, Whitney Arnold, PhD, director of the Undergraduate Research Center–Humanities, Arts and Social Sciences and adjunct assistant professor of comparative literature in the UCLA College, as well as adjunct assistant professor in the school of medicine, was appointed chair of the Medical and Health Humanities Theme. Taking on the role is a humbling and thrilling opportunity, she says. “Medical humanities is such a vital and growing area, and serving as chair is a great opportunity to work with people across the campus, and beyond, who are doing important work in the health community,” Dr. Arnold says.
Four months after her appointment, Dr. Arnold and Mark S. Litwin, MD (FEL ’93), chair of the UCLA Department of Urology, jointly led a session for entering medical students entitled, “Intro to Humanities and Narrative Medicine.” Additional sessions soon followed, including one in which staff of the Hammer Museum at UCLA joined students in the campus’s Franklin D. Murphy Sculpture Garden and led them in exercises focused on observation, perspective and critical reflection. On that same afternoon, a second exercise utilizing theater role-play featured a scene from Wit, a 1999 Pulitzer Prize-winning play.
In it, the two principal characters — one a brilliant, acerbic literary scholar with Stage IV ovarian cancer and the other a medical-oncology fellow who was once an undergraduate in the patient’s class — have their first, clearly fractured medical encounter. Thus, a brave new initiative in medical pedagogy was launched.
WHAT IS MEDICAL HUMANITIES, ANYWAY? THE ANSWER ISN’T SIMPLE. A definition from a 2010 article in the journal Hippokratia reads: “Medical humanities is a multidisciplinary field, consisting of humanities (theory of literature and arts, philosophy, ethics, history and theology), social sciences (anthropology, psychology and sociology) and arts (literature, theater, cinema, music and visual arts) integrated in the ... curriculum of medical schools.” The authors, all faculty at medical schools in Greece, then buttressed their case for adding humanities to a modern medical education. For starters, they state, decades of burgeoning scientific knowledge have required modern medical students to spend far more time than ever before in a day-in, day-out, mind-numbing routine of memorizing and processing information. The resulting mental overload can produce burn-out and, at the same time, detract from a “deeper seeing” of patients and ethical dilemmas.
A grounding in humanities provides a counterweight by adding aesthetic depth, yielding insights about human emotions and fostering imagination. The article also linked desirable ends to specific activities and studies, as summarized below:
A final rationale for medical humanities is this: Incorporating humanities into medical school curricula can help open the door to discussing the emotional pain that sometimes accompanies clinical practice. Prior to our current, life-changing pandemic, heavy emotional burdens borne in silence arguably were among health care’s biggest “elephants-in-the-room.”
Several years ago, Dr. Schaberg, whose mother was a senior nurse on the oncology board of a Boston university hospital, explored this topic with UCLA Health interns, and he recounted for me some key take-aways. “Medical professionals — especially in American culture — can enter a zone where they’re not able to account for their own human needs,” Dr. Schaberg says. “In the talk I was having with these interns, we reflected on potential hidden burdens that anyone who’s been in a serious medical profession for a while has to be carrying. For example, ‘Did I make the right decision in that case?’ ‘Am I responsible for that?’ ‘How do I deal with possible injuries connected to having such a heavy responsibility for other people?’
“Today, any of us who enters a doctor’s office notices how hard it is,” Dr. Schaberg adds. “My doctor’s glancing at his chart as he tells me about the progress of whatever disorder I’ve got. It’s an impaired human interaction.”
His conclusion: “If medical humanities can help doctors to better handle the daily demands of interacting with patients, doctors will preserve their own humanity in a less-wounded way.”
Dr. Braddock went even further. “Death, medical mistakes — all these things can be deeply traumatic. And then the question is, how do we make sense of them when they happen? We make sense of them through personal reflection and reflection with others, through a sense of being supported. The other antidote is feeling that — even at those dark moments — you have meaning and purpose.”
MEANING, PURPOSE AND SUPPORT WERE ALSO PART OF DR. ARNOLD’S PLAN when she intentionally wove “shared ref lection” into several medical-humanities activities during this past academic year. For one first-year student, the approach has already proved helpful. After rotating in a student-run clinic for patients who were homeless and realizing how unequipped she was to help them, Grace Yi was concerned that she and other first-year students had been unwittingly complicit in a system that sometimes “places the brunt of medical training within underserved communities.” Yi explored her feelings in a medical-humanities writing assignment that she later shared in a small-group meeting with her peers.
“Initially, students were more resistant and were more on the side of, ‘Why are we spending three hours of our afternoon discussing things like this?’” Yi acknowledged. “But then, a lot of people shared similar concerns and turbulent feelings, and that led to a sense of solidarity and comfort when we sensed that others felt this way, too. It helped people grapple with those feelings, and also for them to start to think about what they could prioritize in order to help make change. I don’t think that would have happened organically. So, I do think that components of the medical-humanities curriculum have opened the door to having these more-frank conversations with classmates.”
Sentiments like these are affirming for Dr. Arnold, who has actively sought feedback from students during her inaugural year chai r ing the Medical and Health Humanities Theme. As she sees it, “The wonderful thing about this curriculum is that it has to be collaborative because it is basically about drawing forth individual voices and stories. And, so, it can’t just be me [who is] creating the curriculum; we need to get as many voices and perspectives as possible,” she says. “It’s been wonderful to collaborate with faculty, but it’s been really wonderful to collaborate with students, as well, because they are in the midst of it. In the process, they’re telling me what questions they have, what they’ve been wondering about and what has been difficult for them.”
Perhaps not coincidentally, Yi is among a growing number of students entering medical school who already have earned a graduate degree or who have major life experience under their belts. After double-majoring in cognitive science and history of science, medicine and public health at Yale University, Yi began a master’s program in public health and spent a year in Macao, China, doing mental-health research among migrant workers in the Pearl River Delta. Her fieldwork entailed “hours of in-depth interviews with Filipina domestic workers — hours of unstructured conversations about daily routines, major life events and experiences, relationships with children and family, love from a distance,” Yi told me. She also wrote in an email to me: “I’ve found humanities to be deeply embedded within many scientific disciplines I’ve pursued. [I appreciate how] winding conversations and self-reflection add richness to understanding communities and individuals.”
Lauren Taiclet and Katie Thure, two second-year students who have regularly met with Dr. Arnold to discuss future directions for the medical-humanities theme and served as mentor-educators for firstyear students, also arrived at the David Geffen School of Medicine with unique backgrounds. First drawn to literature and philosophy in high school, Taiclet attended Dartmouth University, where she majored in neuroscience and also played competitive basketbal l. (The multiple injuries she sustained from the sport inspired her to start a disability-studies group in medical school at UCLA). She then moved to New York to work as a clinical-research- trials coordinator at New York-Presbyterian/ Columbia Hospital, finally capping off her East Coast chapter by enrol l ing in Columbia’s well-known program in narrative medicine.
“At Columbia, I was really enjoying my team and my work as a coordinator,” Taiclet says. “But sometimes I was a little unsure about the conversations around end-of-life care. We were working with rare cancers, and patients were traveling from all over the country, sometimes from overseas. So, at the same time the team was focusing on clinical information — which was their primary job — I felt that a lot of the patients’ stories went unexplored.”
She says that she pursued her masters in narrative medicine “because I wanted to explore end-of-life care and bioethics and patient-physician communication, the role of art in medicine, things that I wouldn’t have previously thought of. It’s been really helpful to have this completely different lens when I go through my courses now or when I interact with patients.”
Thure, on the other hand, came to higher education as a “first-gen” student. She grew up in the Antelope Valley, on the western tip of the Mojave Desert north of Los Angeles; her father was an ironworker and her mother didn’t earn a high school diploma until Thure was 6 years old. “But my mom’s thing was always making sure my brother and I had school. She was very militant about making sure we sat at the front of the class, finished our homework and were always asking questions to ignite a passion for learning. She didn’t really care what we did in terms of picking a major; she just wanted us to keep learning.”
After Thure graduated from UCLA with a degree in microbiology, immunology and molecular genetics and began a master’s in public health at Emory University, her mother was diagnosed with esophageal cancer, and she died three years later. Her mom’s illness, Thure now realizes, was her first intimate experience with medicine. Soon after, she took a job with the Tennessee Department of Health, tracking health care-associated infections and antimicrobial resistance. When she entered medical school at UCLA, Thure acknowledges that she had no real training in the humanities — but she definitely had instincts.
“I knew I wanted more human stuff in the curriculum. Not less science, but more human stuff to complement it. Seeing people not just as a decision tree, but as a human making a decision. That ties into humanities.”
Discussing her own journey, Thure circled back to a personal touchstone. “We are learning about complex medical decisions. In our doctoring course, we’re learning how to ask questions in empathetic ways. But I often think no one does a really good job of teaching us how to save ourselves. What the humanities curriculum offers, and Dr. Arnold has put in place in other sessions as well, is built-in self-reflection. That is important, because learning to give, for example, bad news does take a toll on us as human beings. Telling somebody that they’re going to pass away or that there’s not much more that can be done for them is emotionally taxing. It’s important to give students a space to write it out in a judgment-free zone.”
ALMOST 20 YEARS AGO, OXFORD UNIVERSITY PRESS PUBLISHED A BOOK BY RITA CHARON, MD, PHD, entitled Narrative Medicine—Honoring the Stories of Illness, and, in 2016, a second book, The Principles and Practice of Narrative Medicine, which she coauthored. An internist who also holds a doctorate in English literature, Dr. Charon began Columbia University’s narrative-medicine program in 2000, and she is widely credited with launching a style of medicine, that, in Dr. Charon’s own words, is “practiced with … skills of recognizing, absorbing, interpreting and being moved by the stories of illness,” thus enabling doctors to better engage with experiences and emotions that impact patients’ health. In August 2021, Dr. Arnold and Dr. Litwin inaugurated UCLA’s new curricular theme built around Dr. Charon’s framework for the Class of 2025 with their session, “Intro to Humanities and Narrative Medicine.” They were natural partners. Dr. Arnold, whose academic career has focused on autobiographical texts, literary histories and accounts of health and illness, has always been drawn to narratives and stories, and Dr. Litwin has loved writing since, as a high school student, he wrote a fictionalized story based on interviews with a survivor of the Holocaust.
“We live in stories in many ways,” Dr. Arnold says. Whether it is reading literature, seeing a play or going to a movie, “stories affect us. But I’m also interested in broader life stories — the stories we tell ourselves, the stories we tell about others, the societal stories, the cultural stories that we may or may not even think of as stories but that influence how we think and how we act.”
Dr. Litwin’s passion for storytelling has carried over to his life as a physician and teacher. (In the summer of 2010, he attended the famed Iowa Writers’ Workshop in order to polish a medical essay that was later published in The New York Times under the title “A Young Life Passes, and a Ritual of Birth Begins.”) To this day, it’s a passion he shares with students. “I love to be in a room with brand new students who don’t know anything about medicine, but who hopefully know a little bit about human interaction,” he says.
His principal joy comes in talking to them about the importance of narrative and writing and history. “You learn to take someone’s raw, unvarnished story — his or her history, their grand mural with all its colors and textures and tensions, if you will — and put it together in a way that captures their story and helps us to understand and process the information that is most important to what we’re meant to do clinically to benefit the patient. That, too, is a part of our job,” he says.
Dr. Schaberg, the UCLA humanities dean, summarized a further rationale for weaving humanities into medical education. “Humanities points to the human thing we demand but aren’t quite getting from medical practice,” he says. “It might be the ethics. It might be the caring touch. It might be the linguistic or cultural understanding that we’re not getting. It might be any of these things. It’s as if, by declaring medical humanities, we’re saying there’s a piece for more humanity in medicine that is still undefined.”
Last year, when her appointment was announced, Dr. Arnold observed this hunger for something more first-hand. “I was, frankly, stunned by the outpouring of response from people who were genuinely excited about it,” she says. Those who contacted her fell into two groups. “There were the people who wrote just to say, ‘What a great role,’ ‘This is so exciting,’ ‘This is so needed.’ And there were those who specifically asked, ‘How can I become involved?’ or who brought up aspects that weren’t yet included in the curriculum but that they thought should be because this area of humanistic care is really broad.”
She recognizes that the program is in its infancy, and “there is still so much we can do to continue to build and expand the curriculum.” Ultimately, Dr. Arnold believes that students who engage in this work will grow to be physicians with “enhanced communications skills vital for patient-centered care, including an increased awareness of the diversity and manner by which people perceive and make meaning of their individual experiences of illness.”
FINALLY, DR. BRADDOCK SEES MEDICAL HUMANITIES AS FAR MORE THAN “SOMETHING NICE TO ADD TO OUR DIDACTICS.” In his vision, it is “central to preparing students for a career in medicine.” While acknowledging that the fruits of the medical humanities theme and the broader curriculum within which it is embedded are still too new to be measured, “I can tell you that we’re already seeing a profound impact,” he says “Once we start talking to potential applicants about this different vision, we get a qualitatively different kind of applicant.”
Further evidence? This past year’s entering class had perhaps 20 students with an announced interest in bioethics, medical history, humanities and literature and medicine, including many who had already earned master’s degrees, he says. Along with his cutting-edge ideas of what future graduates of the David Geffen School of Medicine might contribute to today’s multicultural and interconnected world, Dr. Braddock also shares a specific goal with all applicants: “We want you to be an outstanding physician, and — the ‘and’ is what they fill in. It could be ‘and scientist’; it could be ‘and author’; or it could be ‘and something entirely different.’ Mainly, we consider that it is important for them to believe they have the ability to be something in addition to a physician taking care of patients over the course of their career.”
Whatever that “and” is, Dr. Braddock’s sights are aimed high for the future healers who pass through the doors of the David Geffen School of Medicine. “We want the young women and men we train to be the kind of physicians who are going to transcend the traditional role of taking care of patients,” he says. “We want for them to be physicians who influence health and who impact the human condition — to be the voices of medicine in the world.”
Dr. Claire Panosian Dunavan is a UCLA infectious-diseases specialist and a medical writer who earned a degree in humanities before deciding on a career in medicine. Her writing has been published in the Los Angeles Times, The New York Times, The Washington Post, Discover magazine and Scientific American, among others.