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Recent attention to racial disparities in law enforcement, highlighted by the death of Freddie Gray, raises questions about whether medical education adequately prepares physicians to care for persons particularly affected by societal inequities and injustice who present to clinics, hospitals, and emergency rooms. In this Perspective, the authors propose that medical school curricula should address such concerns through an explicit pedagogical orientation. The authors detail two specific approaches-antiracist pedagogy and the concept of structural competency-to construct a curriculum oriented toward appropriate care for patients who are victimized by extremely challenging social and economic disadvantages and who present with health concerns that arise from these disadvantages. In memory of Freddie Gray, the authors describe a curriculum, outlining specific strategies for engaging learners and naming specific resources that can be brought to bear on these strategies. The fundamental aim of such a curriculum is to help trainees and faculty understand how equitable access to skilled and respectful health care is often denied; how we and the institutions where we learn, teach, and work can be complicit in this reality; and how we can work toward eliminating the societal injustices that interfere with the delivery of appropriate health care.

Categories are essential to doctors' thinking and reasoning about their patients. Much of the clinical categorization learned in medical school serves useful purposes, but an extensive literature exists on students' reliance on broad systems of social categorization. In this article, the authors challenge some of the orthodoxies of categorization by combining narrative approaches to medical practice with the theoretical term "intersectionality" to draw students' attention to the important intersecting, but often overlooked, identities of their patients. Although intersectionality applies for all patients, the focus here is on its importance in understanding and caring for marginalized or disadvantaged persons.Intersectionality posits that understanding individual lives requires looking beyond categories of identity in isolation and instead considering them at their intersection, where interrelated systems of power and oppression, advantage and discrimination are at play and determine access to social and material necessities of life. Combined with narrative approaches that emphasize the singularity of a person's story, narrative intersectionality can enable a more robust understanding of how injustice and inequality interrelate multidimensionally to produce social disadvantage.The authors apply this framework to two films that present characters whose lives are made up of numerous and often-contradictory identities to highlight what physicians may be overlooking in the care of patients. If the education of physicians encourages synthesis and categorization aimed at the critically useful process of making clinical "assessments" and "plans," then there must also be emphasis in their education on what might be missing from that process.

Slow medical education borrows from other “slow” movements by offering a complementary orientation to medical education that emphasizes the value of slow and thoughtful reflection and interaction in medical education and clinical care. Such slow experiences, when systematically structured throughout

Since the emergence of the field in the 1970s, several trends have begun to challenge the original assumptions, claims, and practices of what became known as the medical humanities. In this article, the authors make the case for the health humanities as a more encompassing label because it captures recent theoretical and pedagogical developments in higher education such as the shift from rigid disciplinary boundaries to multi- and interdisciplinary inquiry, which has transformed humanities curricula in health professions. Calling the area of study health humanities also underscores the crucial distinction between medicine and health. Following a brief history of the field and the rationales that brought humanities disciplines to medical education in the first place-the "why" of the medical humanities-the authors turn to the "why" of the health humanities, using disability studies to illuminate those methodologies and materials that represent the distinction between the two. In addition, the authors make note of how humanities inquiry has now expanded across the landscape of other health professions curricula; how there is both awareness and evidence that medicine is only a minor determinant of health in human populations alongside social and cultural factors; and finally, how the current movement in health professions education is towards interdisciplinary and interprofessional learning experiences for students.

It would be unusual to find a current medical school administrator or faculty member who has not heard the phrase "literature and medicine" or who does not know that literature is taught in various forms-short stories, novels, poems, essays-at many points in the curriculum at U.S. medical schools. Yet the phrase is used in slippery if not elusive ways, with no clear referent common to all who use it. This article focuses on three theoretical and pedagogical uses for literature in medical, health professions, and interprofessional education: close reading, ethical or moral inquiry, and drawing illustrations. Summaries of these approaches are provided, followed by demonstrations of how they might work in the classroom by using the story "Blankets," by Native American writer Sherman Alexie.Close reading requires reading slowly and carefully to enrich an initial encounter with a text. Ethical or moral inquiry turns to literary representations to challenge readers' assumptions and prejudices. Literature offers rich, provoking, and unusual depictions of common phenomena, so it can be used to draw illustrations. Although each approach can be used on its own, the authors argue that reading closely makes the other two approaches possible and meaningful because it shares with the diagnostic process many practices critical to skilled interprofessional caregiving: paying attention to details, gathering and reevaluating evidence, weighing competing interpretations. By modeling a close reading of a text, faculty can demonstrate how this skill, which courts rather than resists ambiguity, can assist students in making ethical and compassionate judgments.

From the poetry of William Carlos Williams, the novels of Walker Percy, and the short stories of Anton Chekov to the contemporary essays of Atul Gawande, physicians' contributions to literary genres have been significant. This article explores the specific form of confessional writing offered by physicians during the past half century, writing that often exposes medical error or negative feelings towards patients. A history of confessional practices as a legal tool, as religious practice, and as literary genre is offered, followed by analyses of selected confessional writings by physicians, many of them found in clinical journals such as Journal of the American Medical Association, Annals of Internal Medicine, and the Lancet. The authors of the narratives described here are engaged in several or all elements of the confessional sequence, which may offer them some resolution through the exposure and acknowledgment of their shared humanity with their patients and their expression of regret for any harm done.

In this essay, I explore medical humanities practice in the United States with descriptions offered by fifteen faculty members who participated in an electronic survey. The questions posed focused on the desirability of a core humanities curriculum in medical education; on the knowledge, skills, and values that are found in such a curriculum; and on who should teach medical humanities and make curriculum decisions regarding content and placement. I conclude with a call for a renewed interdisciplinarity in the medical humanities and a move away from the territorial aspects of disciplinary knowledge and methods sometimes found in medical humanities practice.

To examine perceptions of the formal, informal, and hidden curricula in psychiatry as they are observed and experienced by (1) attending physicians who have teaching responsibilities for residents and medical students, (2) residents who are taught by those same physicians and who have teaching responsibilities for medical students, and (3) medical students who are taught by attendings and residents during their psychiatry rotation.From June to November 2007, the authors conducted focus groups with attendings, residents, and students in one midwestern academic setting. The sessions were audiotaped, transcribed, and analyzed for themes surrounding the formal, informal, and hidden curricula.All three groups offered a similar belief that the knowledge, skills, and values of the formal curriculum focused on building relationships. Similarly, all three suggested that elements of the informal and hidden curricula were expressed primarily as the values arising from attendings' role modeling, as the nature and amount of time attendings spend with patients, and as attendings' advice arising from experience and intuition versus "textbook learning." Whereas students and residents offered negative values arising from the informal and hidden curricula, attendings did not, offering instead the more positive values they intended to encourage through the informal and hidden curricula.The process described here has great potential in local settings across all disciplines. Asking teachers and learners in any setting to think about how they experience the educational environment and what sense they make of all curricular efforts can provide a reality check for educators and a values check for learners as they critically reflect on the meanings of what they are learning.

The humanities offer great potential for enhancing professional and humanistic development in medical education. Yet, although many students report benefit from exposure to the humanities in their medical education, they also offer consistent complaints and skepticism. The authors offer a pedagogical definition of the medical humanities, linking it to medicine as a practice profession. They then explore three student critiques of medical humanities curricula: (1) the content critique, examining issues of perceived relevance and intellectual bait-and-switch, (2) the teaching critique, which examines instructor trustworthiness and perceived personal intrusiveness, and (3) the structural/placement critique, or how and when medical humanities appear in the curriculum. Next, ways are suggested to tailor medical humanities to better acknowledge and reframe the needs of medical students. These include ongoing cross-disciplinary reflective practices in which intellectual tools of the humanities are incorporated into educational activities to help students examine and, at times, contest the process, values, and goals of medical practice. This systematic, pervasive reflection will organically lead to meaningful contributions from the medical humanities in three specific areas of great interest to medical educators: professionalism, "narrativity," and educational competencies. Regarding pedagogy, the implications of this approach are an integrated required curriculum and innovative concepts such as "applied humanities scholars." In turn, systematic integration of humanities perspectives and ways of thinking into clinical training will usefully expand the range of metaphors and narratives available to reflect on medical practice and offer possibilities for deepening and strengthening professional education.

Context A study of medical students’ perspectives on derogatory and cynical humour was published in 2006. The current study examines residents’ and attending doctors’ perspectives on the same phenomenon in three clinical departments of psychiatry, internal medicine and surgery. Methods Two focus groups were conducted in each of the three clinical departments, one with residents and one with attending doctors, during the 2006–07 academic year. Seventy doctors participated, including 49 residents and 21 attendings. The same semi-structured format was used in each group. Questions focused on characterisations of derogatory and cynical humour along with motives and rules for its use. All focus groups were audiotaped and the tapes transcribed. Each transcript was read independently by each researcher as part of an inductive process to discover the categories that describe and explain the uses, motives and effects of such humour. Results Three categories that appeared in the first study with medical students – locations for humour, the humour game, and not-funny humour – emerged as virtually identical, whereas two others – objects of humour and motives for humour – were more fully elaborated. Discussion Discussions of derogatory and cynical humour should occur in any department where teaching and role modelling are priorities. In addition, the tenets of appreciative inquiry and the complex responsive process, particularly as they are used at the Indiana University School of Medicine, offer medical educators valuable tools for addressing this phenomenon.

There is currently little knowledge or understanding of medical students' knowledge and attitudes toward the poor. Teaching hospitals bring students face-to-face with poor and uninsured patients on a regular basis. However, an overview of the research available suggests that this contact does not result in students' greater understanding and empathy for the plight of the poor and may, in fact, lead to an erosion of positive attitudes toward the poor. A basic understanding of justice suggests that as the poor are disproportionately the subjects of medical training, this population should enjoy a proportionate benefit for this service. Furthermore, medicine's social contract with the public is often thought to include an ideal of service to the underserved and a duty to help educate the general public regarding the health needs of our nation. In their discussion, the authors situate medical students' attitudes toward the poor within larger cultural perspectives, including attitudes toward the poor and attributions for poverty. They provide three suggestions for improving trainees' knowledge of and attitudes toward the poor-namely, increasing the socioeconomic diversity of students, promoting empathy through curricular efforts, and focusing more directly on role modeling. The authors argue that service learning, especially efforts that include gaining detailed knowledge of a particular person or persons, coupled with critical reflection, presents a very promising direction toward achieving these goals. Finally, they posit an agenda for future educational research that might contribute to the increased efficacy of medical education in this important formative domain.

The use of simulation and standardized patients in medical education is firmly established. In this "point-counterpoint" format we debate not their important function but the extent to which they are used to establish "evidence" for trainees' empathic communication skills beyond their surface manifestations. We also question such issues as the power dynamics implicit in simulation when patients are not really worried or dependent but rather students who are under the evaluative surveillance gaze, often relying on formulaic and superficial behaviors associated with good communication. We offer educative experiences in narrative domains as opportunities to develop the habits of thinking and authentic feeling often absent in evaluative-based simulations.

The literature consistently reports that sexual harassment occurs with regularity in medical education, mostly in clinical settings, and most of it goes unreported. Reasons for nonreporting include the fear of retaliation, a reluctance to be viewed as a victim, a fear that one is being "too sensitive," and the belief that nothing will be done.We wanted to examine with greater concentration the stories women students tell about sexual harassment, including what they count as sexual harassment, for more or different clues to their persistent nonreporting.We used focus groups to interview 30 women students at 5 U.S. medical schools. We used systematic inductive guidelines to analyze the transcribed data, linking to and building new theoretical frameworks to provide an interpretive understanding of the lived experiences of the women in our study.Consistent with previous literature, most of the students interviewed had either witnessed or observed sexual harassment. We selected 2 theoretical lenses heretofore not used to explain responses to sexual harassment: 3rd-wave feminist theory to think about how current women students conceive sexual harassment and personality theory to explain beliefs about nonreporting.Medical educators need new ways to understand how contemporary women students define and respond to sexual harassment.

In this essay we link the rationale for the medical humanities with radical hermeneutics, a move that infuses the medical humanities with incredulity and suspicion. This orientation is particularly important at this historical moment, when the evidence-based and competency blanket is threatening to overpower all aspects of medical education, including the medical humanities discourse itself. Radical hermeneutics works relentlessly against the final word on anything, and as such, it provides a critically provocative way of thinking about doctors, patients, illness, health, families, death--in short, the experience of being human. We use three literary examples to illustrate the complex, contradictory, perplexing, and disturbing questions related to a life in medicine: Rafael Campo's "Like a Prayer," Irvin Yalom's "Fat Lady," and Richard Selzer's "Brute."

Introduction Upon designing and implementing a literature course on family values for Year 4 medical students, we found that while the supposed benefits of literary inquiry were to lead students to a deeper understanding of difficult issues such as illness and violence in the family, many of our students were unable to engage critically with the course material. This, we believe, was a result of their resistance to confronting issues such as inequality and oppression. This paper is an attempt to theorise student resistance to difficult, unruly subjects they encounter in a literature class, particularly those surrounding race, gender, social class and sexual identity. Methods We modify some of the expansive claims made by narrative medicine and put forth a new pedagogical and curricular approach to the uses of literature in medical education. Results We found that many students resisted course material and corresponding discussions, especially those related to sexual identity and non-traditional family values, male−female relationships and white racism. Discussion To reduce student resistance, we pose a more critical approach to narrative inquiry in medical settings that may deepen students' willingness to imagine what it is like to be someone who is suffering, and to work against oppressive social structures that sustain such suffering. Thus, we recommend moving narrative inquiry beyond a focus on the self and the patient in that individualised, circumscribed relationship and into a collective process involving the social, political, cultural and economic conditions that affect health and well-being.

Background: A well-known phenomenon among U.S. medical students known as pimping, or the pedagogical device of questioning students in the clinical setting, receives virtually no attention in medical literature. Purpose: Identifying 4th-year medical students' relevant knowledge and attitudes about pimping may help educators understand the range of beliefs about pimping and the role it plays in the socialization process into the medical community. Methods: Over a 2-month period, 11 fourth-year medical students at a Midwest medical school were asked 6 open-ended questions focusing on pimping as understood and experienced in the clinical setting. Investigators individually analyzed the interview data using qualitative methods to characterize students' experiences and recurring ideas and concepts. Results: All students noted the hierarchical nature of pimping, viewing it as a tool for attendings or residents to assess students' levels of knowledge. Although some students experienced malignant pimping, humilia...

The topic of developing professionalism dominated the content of many academic medicine publications and conference agendas during the past decade. Calls to address the development of professionalism among medical students and residents have come from professional societies, accrediting agencies, and a host of educators in the biomedical sciences. The language of the professionalism movement is now a given among those in academic medicine. We raise serious concerns about the professionalism discourse and how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label of "professionalism." In particular, we argue that the professionalism discourse needs to pay more attention to the academic environment in which students are educated, that it should articulate specific positive behaviors, that the theory of professionalism must be constructed from a dialogue with those we are educating, and that this theoretical and practical discourse must aim at a deeper understanding of social justice and the role of medicine within a just society.

Literary inquiry has been a part of the curriculum at many North American medical schools for more than 30 years. Ostensibly its original purpose was to “humanize” the overstuffed, science-based curriculum. Since then, other rationales for its place in the curriculum have appeared, including, among others, translating critical reading skills to “reading” the patient, obtaining moral knowledge, and acquiring patients’ perspectives on illness. In this article, I use my experiences in a literature and medicine class for fourth-year medical students to examine how they construct “family”—the medium in which most medical care is delivered—through their readings of Pat Conroy's novel, The Prince of Tides. Throughout the article I return to assumptions of how literature is supposed to “work” on medical students as they read this novel, showing how the culture of medical education, particularly its curriculum practices, has installed ways of reading and methods of analysis that oppose literature's potential offerings. Beyond the selection of texts, I address issues surrounding the epistemological, pedagogical, and ideological undertaking of literary inquiry in the medical curriculum.

The Human Values in Medicine Program (HVM) at the Northeastern Ohio Universities College of Medicine is composed of 120 required hours in medical humanities, social sciences, and behavioral sciences. In addition to a required HVM month in the fourth year when the bulk of the course work is completed, students can also choose from lectures, seminars, and short courses during the first, second, and third years. The broad goal of the HVM program as originally conceived was for students to use the content and skills of the humanities disciplines to reflect on their own and others' values, and to appraise their role in the patient-physician relationship, both in the community and in the larger culture. During the past several years, a cultural studies orientation has also been included, particularly the practice of critical analysis aimed at identifying the inequities and injustices within the doctor-patient relationship, in medical training, and in health care access and delivery in the U.S. and beyond. Current program development includes standardizing a bioethics curriculum for all students and developing a required fourth-year course that all students take during their HVM elective month.

The author proposes a theoretical orientation for cultural competency that reorganizes common curricular responses to the study of culture in medical education. What has come to be known in medical education as cultural competency is theoretically truncated and may actually work against what educators hope to achieve. Using Giroux's concept of insurgent multiculturalism, she suggests that the critical study of culture might be a bridge to certain aspects of professional development. Insurgent multiculturalism moves inquiry away from a focus on nondominant groups to a study of how unequal distributions of power allow some groups but not others to acquire and keep resources, including the rituals, policies, attitudes, and protocols of medical institutions. This approach includes not only the doctor-patient relationship but also the social causes of inequalities and dominance. Linked to professional development efforts, insurgent multiculturalism can provide students with more opportunities to look at their biases, challenge their assumptions, know people beyond labels, confront the effects of power and privilege, and develop a far greater capacity for compassion and respect.

Since its publication in 1978, Samuel Shem's The House of God has sold over two million copies in over 50 countries. While it has remained popular among medical students, its value as a literary text to promote critical reflection on self and profession continues to be unrecognized in professional spheres. In spite of the ongoing conditions in medical training that prompted Shem's satirical novel, The House of God continues to evoke negative responses from academic medicine and has even been dismissed as "dated." This article examines the novel, its reception by academic medicine, and the relevance of its satire through an analyses of articles, reviews, and letters, along with Shem's observations on the novel and its controversies. Finally, the future of The House of God is proposed.

The professional development discourse currently circulating in academic medicine owes much to the work of the American Board of Internal Medicine (ABIM) and their Project Professionalism. They identify the elements of altruism, duty, excellence, honor and integrity, accountability, and respect for others as forming the basis of professional development. While an admirable effort, Project Professionalism remains primarily an abstract set of attitudes and behaviors with a number of vignettes that are of limited use to medical educators attempting to foster the development of professionalism in medical students. This paper outlines an approach to professional development grounded in medical narratives written by physicians, including memoirs, essays, and poetry, that may help students grapple with the challenges of medicine that involve those very elements put forth by ABIM. An argument is made that literature may be a superior medium for engagement with these elements because of its ability to evoke discomfort and vulnerability in ways the case report does not.

Stories, film, drama, and art have been used in medical education to enhance empathy, perspective-taking, and openness to "otherness," and to stimulate reflection on self, others, and the world. Yet another, equally important function of the humanities and arts in the education of physicians is that of "making strange"-that is, portraying daily events, habits, practices, and people through literature and the arts in a way that disturbs and disrupts one's assumptions, perspectives, and ways of acting so that one sees the self, others, and the world anew. Tracing the development of this concept from Viktor Shklovsky's "enstrangement" (ostranenie) through Bertolt Brecht's "alienation effect," this essay describes the use of this technique to disrupt the "automaticity of thinking" in order to discover new ways of perceiving and being in the world.Enstrangement may be used in medical education in order to stimulate critical reflection and dialogue on assumptions, biases, and taken-for-granted societal conditions that may hinder the realization of a truly humanistic clinical practice. In addition to its ability to enhance one's critical understanding of medicine, the technique of "making strange" does something else: By disrupting fixed beliefs, this approach may allow a reexamination of patient-physician relationships in terms of human interactions and provide health care professionals an opportunity-an "open space"-to bear witness and engage with other individuals during challenging times.

Using René Magritte's well-known painting The Treachery of Images (This is not a pipe), we argue that the current focus on competencies throughout medical education can sometimes lead educators to rely too heavily on scores, checkmarks, or other forms of assessment that come to be viewed as equivalents for the actual existence of what is being measured. Magritte insisted that the image he created on the canvas was not a pipe but rather a representation of a pipe, an important distinction for educators to remember as we seek ways to evaluate trainees' attainment of the fundamental knowledge and skills of the profession. We also urge that the focus on broader skills, values, flexibility, reflection, and insight development should fall outside the net of a competency orientation in a supportive environment spared from traditional assessment methods, using a classroom in undergraduate medical education as an example of working toward this end.

Arnold Relman argues that medical education does not prepare students and residents to practice their profession in today’s corporate health care system. Corporate health care administrators agree: Physicians enter the workforce unskilled in contract negotiation, evidence-based medicine, navigating bureaucratic systems, and so forth. What about practicing physicians? Do they agree as well? According to this study, they do. Feeling like decentered double agents and unprepared, physicians find themselves professionally lost, struggling to balance issues of cost and care and expressing lots of negativity toward the cultures of medicine and managed care. However, physicians are resilient. A group of physicians, who may be called proactive , are meeting the professional demands of corporate health care by becoming sophisticated about its bureaucratic organization and the ways in which their professional and personal commitments fit within the system. Following the lead of proactive physicians, the authors support Relman’s thesis that education for both students and physicians requires a major overhaul.

This is the story of one medical educator’s attempt to combine literary and epistemological inquiry in a 4th-year elective called Women’s Health: Views from Literature, Communities, and Clinical Medicine. The assumption fueling this attempt was that medical students’ thinking rarely moves outside rationalist constructs, and because of this, they often confuse the nature or distinguishing features of something or someone—its quality—with what the numbers tell them. Thus, the class content and experiences were purposely developed to engage the students with knowledge from a variety of qualitative domains and would be, as such, an epistemological experience. This article details how the class worked and how it did not.

Observers and critics of the medical profession, both within and without, urge that more attention be paid to the moral sensibilities, the characters, of medical students. Passing on particular moral values and actions to physicians has always been an essential core of medical training, and this call for renewal is not new in modern medicine. Some of the structures and characteristics of modern medical education, however, often work directly against the professionalism that the education espouses. For example, medical students are socialized into a hierarchy that has broad implications for relations among health care professionals, other health care workers, and patients, and academic medicine has not promoted and taught critical reflection about the values and consequences of this hierarchy. Further, behind the formal curriculum lies the "hidden curriculum" of values that are unconsciously or half-consciously passed on from the faculty and older trainees. Two resources for thinking anew about professional development for medical students are feminist standpoint theory and critical multicultural theory, each of which raises important and fundamental questions about defining the role of medicine in society and the role of the physician in medicine. The author discusses these two theories and their implications for medical education, showing how they can be used to move discussions of professional development into analysis of the widespread social consequences of how a society organizes its health care and into critical reflection on the nature of medical knowledge.

Our purpose has been to illuminate questions surrounding the use of literature in medical education, and to propose criteria for selecting literature which is more likely to evoke readers to reflect on their personal and professional selves. We have suggested that literature promoting vicariousness and vulnerability may validate readers' questions, insecurities, and beliefs insofar as readers are willing to engage with the text cognitively and phenomenologically. This we call reader responsibility. Crucial to nurturing this responsibility are medical educators 2- ducators in any context, for that matter - who are vulnerable themselves, who puzzle outloud, who admit their own incompleteness. Together as learners, teachers and students may come to realize that it is, in the end, the artist whopresses upon our minds the deepest mysteries, so we may feel again their majesty and power ... (which) seizes our lives, and which reveals us startlingly to ourselves as creatures set down here bewildered. (Dillard 1989 72-73).

During these times of the situated, contingent text, it is not unusual for an author to disclose her biases and other sources of potential partiality as a researcher or theorist. That is, an author often discloses her race, class origins, or sexual orientation at the onset, announcing particularities that enable readers to adjust their reading to the subjectivities inherent to knowledge production. One glaring omission to these announcements, especially in medicine, has to do with the spiritual domain. This essay, written as a personal narrative, provides one example of how one's spirituality is connected to what and how one chooses to teach, even in the medical academy. Acknowledging those beliefs and considering how our spirituality (along with our other subjectivities that are known to us) may influence our work is an important process in developing a more reflective practice.

During the past decade, "reflection" and "reflective writing" have become familiar terms and practices in medical education. The authors of this article argue that the use of the terms requires more thoughtfulness and precision, particularly because medical educators ask students to do so much reflection and reflective writing. First, the authors discuss John Dewey's thoughts on the elements of reflection. Then the authors turn the discussion to composition studies in an effort to form a more robust conception of reflective writing. In particular, they examine what the discipline of composition studies refers to as the writing process. Next, they offer two approaches to teaching composition: the expressivist orientation and the critical/cultural studies orientation. The authors examine the vigorous debate over how to respond to reflective writing, and, finally, they offer a set of recommendations for incorporating reflection and reflective writing into the medical curriculum.

A vast literature exists on teaching reflection and reflective practice to trainees in small groups, yet with few exceptions the literature does not address the benefits of these interactions to faculty. Like multiculturalism or cultural competency, the literature assumes that faculty have themselves “achieved” these propensities and that trainees are the only recipients of the benefits of such inquiry. One of the noticeable exceptions is Arno Kumagai and colleagues’ article, “The Impact of Facilitation of Small Group Discussions on Psychosocial Topics in Medicine on Faculty Growth and Development,” which found that small group teaching stimulated not only students’ personal and professional growth, but also that of the faculty themselves. Our intent is to continue and enlarge the questions posed in this important article. Specifically, this inquiry focuses on the meanings that clinical faculty derive from teaching medical students in discussion- and reflection-driven small group formats. Why do faculty leave the comfort zone of clinical teaching and take time away from income-generating patient care activities? What is it about this teaching experience that calls them back each year? In answering these questions, we conducted a qualitative study consisting of interviews and focus groups with 11 clinical faculty participants who teach in Reflections on Doctoring, a required, longitudinal course for medical students. The data of our study provides insight into the thoughts, attitudes, and motives of our faculty who not only view themselves as teachers and mentors, but also as co-learners who engage personally with the medical humanities content being taught. They confront, reveal and resolve challenges presented by literary perspectives and find enjoyment and sense of purpose in teaching non-jaded medical students. Furthermore, what emerged from our study was a deeper understanding of what inspires our faculty to sacrifice their time and effort to facilitate medical humanities discussions with young medical students and how this experience contributes to the ongoing development of their own professional identities.

Raymond Carver, considered a major US writer of the last half of the 20 century, is credited with revitalizing the short story as a format and is associated with the literary style of minimalism, or one of its derivatives, dirty realism. Despite its innocuous title, Carver’s award-winning “A Small, Good Thing” is one of his most widely read and praised stories. This story is often read during medical education, not merely because of the medical crisis of the story, but because of its nuanced treatment of the emotions surrounding a bedside vigil, the sometimes ambiguous and unpredictable nature of medical care, the waiting for resolution, the bewilderment of grief, and ultimately, the nourishment humans offer one another—the “small, good things”—even in the face of tragedy. The story opens with Ann Weiss ordering a cake for her son Scotty’s 8th birthday. The unnamed baker is “abrupt with her— not rude, just abrupt,” offering “no pleasantries” beyond a perfunctory exchange and the scheduling of a Monday morning pick-up of the cake. Yet on Monday morning, while walking to school, Scotty is struck by a car, dazed but able to return home on wobbly legs. On the sofa, Ann holding his hand, Scotty goes limp and falls asleep. Much of the remaining story unfolds at the hospital where readers feel the slow ticking of the clock as Ann and Howard, Scotty’s father, suffer an anguished bedside vigil waiting for their son to awaken. Expanses of time are broken by interactions with Dr Francis, Scotty’s physician, who swoops in, always reassuring. Scotty has a mild concussion, he tells them, and is in a very deep sleep, but “no coma.” Ann and Howard take turns going home to shower and change clothes, each receiving anonymous phone calls there, the caller referring to a 16-dollar cake, or asking, “Have you forgotten about Scotty?” Back at the hospital, more tests and reassurances are offered by Dr Francis, shaded with progressively more concern, and then on the third day, Scotty dies. From a shaken Dr Francis: “A hidden occlusion . . . a one-in-amillion circumstance.”

This essay explores how breast cancer and mastectomy are portrayed in twentieth-century North American literature. The purpose in doing so is to examine our understandings of how women in contemporary North American culture may experience this potentially fatal disease and disfigurement-understandings that often are narrowly prescribed by the abstract, universalizing language of medicine. The essay is divided into four sections based on the readings of the selected literature: denial and fear; sadness and pain; shame through others' eyes; and transcendence.

This article illustrates the use and value of literature in increasing one's sensitivity and compassion in areas extending beyond the prescribed boundaries of medical training and practice. “Home Burial” by Robert Frost and “Dead Baby” by William Carlos Williams portray in different ways the anguish and despair of parents after a child's death. If anatomy, biochemistry, and micro-biology prepare health care providers for the clinical dimensions of their work, these poems attend to other attributes of good care giving.

The rationales for including the medical humanities in the medical school curriculum are well accepted; in many schools the medical humanities are well established. Yet, pedagogical questions remain, and those who teach in such programs and others like them in health care settings find themselves ill-equipped to conceptualize curricular and instructional issues unique to humanistic inquiry in medical settings. This article identifies one such conceptual framework: using cubism as a metaphor to think about the medical humanities curriculum, in this case, imaginative literature portraying death and dying. The author uses Kafka's The Metamorphosis, Tolstoy's The Death of Ivan Ilych, and Olsen's Tell Me a Riddle to illustrate how literary inquiry might enable medical students and other health care providers to think about the lives of their dying patients from multiple perspectives.