University of Bristol at Gloucestershire Academy
Number 113
Monthly News
1st April 2013
Dr Phil Davies, Deputy Dean, Gloucestershire Academy
writes:“Aujourd’hui, maman est morte. Ou peut- être hier, je ne sais
pas.” J’ai recu un télégramme de l’assile: MERE DECEDEE.
ENTERREMENT DEMAIN. SENTIMENTS DISTINGUES. Cela
ne veut rien dire. C’etait peut- être hier.
This must have been the strangest introduction to any lecture
that I experienced as a medical student. I can still remember the
quizzical looks on other students’ faces as we listened to the
lecturer. Some checked their timetable to make sure that they
were in the correct lecture theatre. Slowly it dawned on us all
that the lecturer had meant to start this lecture talking in French.
The lecture theatre became unusually quiet as we all sat waiting
to see what would happen next. The lecturer slowly eyed his
audience and, once he had confirmed that he had captured all
the students’ attention, he started to translate into English.
“Mother died today. Or maybe yesterday; I can't be sure.” The
telegram from the Home says: YOUR MOTHER PASSED
AWAY. FUNERAL TOMORROW. DEEP SYMPATHY. Which
leaves the matter doubtful; it could have been yesterday.
Most of us were still none the wiser. We were scientists. We
were studying anatomy, physiology and biochemistry.
Pharmacology, microbiology and cardiology. We were learning
about the human body in all its forms so that we could
understand it and naïvely follow the promise that we had made
in our medical school entry interviews “to help people”. We had
no need to learn French.
By introducing us to ‘’The Stranger’’ by Albert Camus, the
psychiatry lecturer was trying (consciously or subconsciously) to
subtly change our focus on how we could learn and what we
could learn from. Over the course of his one hour lecture and by
using quotes from the book (spoilers coming) he introduced to
the central character of Meursault. We were told that Meursault
was a man who had strange views and behaved differently from
what we thought of as normal. He was an emotionally detached,
amoral young man. He did not cry at his mother’s funeral and
did not believe in God. He killed a man he barely knew without
any discernible motive.
The lecturer also introduced us to the mental state examination
(the timetabled topic) and asked us to construct an assessment
DATES FOR YOUR
DIARY:EXAMINERS
REQUIRED:Year 3 Student OSLERs;
7th – 10th May 2013 &
13th – 17th May 2013 @
CGH & GRH – If you are
interested in examining please
email
Emily.L.Matthews@glos.nhs.uk
COMP2 OSCE Exams
Tues 11th June 2013
Sandford Education
Centre, CGH
GOAM & GP Examiners
required – if you’re interested
in examining please email
Emily.l.matthews@glos.nhs.uk
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for Meursault. Why he chose “The Stranger” I
have no idea. It could have easily been “The
Silence of the Lambs”, “The Heart of Darkness”
or “Oranges are not the only Fruit”. Dickens
and Shakespeare would have offered many
interesting characters to study. Some people
may have even enjoyed “The House at Pooh
Corner” with its many ‘mentally interesting’
characters (Piglet suffering from generalized
anxiety
disorder,
Eyeore
the
chronic
depressive, the hyperactive Tigger with
possible ADHD and Pooh with a suggestion of
cognitive impairment, possibly induced by
being dragged down the stairs bump, bump,
bump, bump on the back of his head). What he
did do that afternoon was to try to open up our
field of vision and make us realise that we did
not need to focus purely on scientific principles
as we studied medicine. It was certainly a
fascinating introduction to the mental state
examination. He could have used a real
patient’s history but I am sure that it would not
have been half as memorable.
Retrospectively I now realise that afternoon
was my introduction to the use of humanities to
teach medical education. Medical humanities is
now
firmly
established
within
the
undergraduate and postgraduate curriculum.
The term is thought to have been coined in
1976 by Anthony Moore, an Australian
surgeon, as he described his approach of
using literature to teach students in Melbourne
a way of understanding the human experience
of health and illness as well as exploring
ethical issues in clinical practice. Medical
humanities is defined as “an interdisciplinary
field of medicine which includes the humanities
(literature, philosophy, ethics, history and
religion), social science (anthropology, cultural
studies, psychology, sociology), and the arts
(literature, theatre, film, and visual arts) and
their application to medical education and
practice”. Its place within medical education is
strongly supported by the General Medical
Council.
A rich source of material is available and the
British Medical Journal has led the way in
making this more accessible with its series of
Medical Classics which started in January
2007 with the then president of the Royal
College of General Practitioner David Haslam’s
review of M*A*S*H. Other articles have
covered such diverse areas such as ‘’The
Huangdi Neijing’’, an ancient treatise on health
and disease said to have been written by the
famous Chinese emperor Huangdi around
2600 BC and Van Morrison iconic blues track
“TB Sheets”, describing the death of a close
friend or possibly lover (‘Van the Man’ leaves
the detail characteristically opaque).
As with all subjects, medical humanities
struggles to find its own space within the
increasingly packed curriculum and at present
is largely only taught in Bristol within student
selected components (SSC). Perhaps as
recommended by the Association for the Study
of Medical Education (ASME) we should be
aiming to blend medical humanities into the
medical curriculum rather than offering it as
direct competition.
Blending can be quite difficult, however. during
a recent revision session I showed a
radiograph of an osteosarcoma. After
describing the characteristic radiographic
findings I was reminded of Helen Dunmore’s
book “The Betrayal”. Set in Stalinist Russia the
plot involves the treatment of a Party official’s
son who presents with a swollen knee – later
diagnosed as an osteosarcoma. Whilst I
enthused about the book, I noted that most of
the students had only noted down the words
‘spiculated’ and ‘Codman’s triangle’, rather
than ‘betrayal’. Three days before an exam is
perhaps not the time to ‘blend’ but I hope that
they find some time to read the book. They will
not only learn about the ‘Doctor’s Plot,’ where
due to Stalin’s fanatical belief many doctors
were arrested and accused of murdering Party
officials, but find excellent descriptions of how
to gain the confidence of an anxious ill child in
a clinical setting, how an osteosarcoma may
present and an astute observation on the
origins of the auditing process. Perhaps I
should have chosen something in French?