Hannah Hendrix
February 10, 2014
ENG 2100-43
Jane Blakelock
The Benefits of a Liberal Arts Foundation for Medical Education
Harry Potter would not be expected to be a subject for serious reflection for medical
school, but at Vanderbilt School of Medicine in Nashville, one might reconsider. After
being sorted into four colleges named for former deans—reminiscent of the four houses of
Hogwarts from the Potter novels—Vanderbilt’s medical students compete each year in the
College Cup (Chen, 2011). While the Cup is not won by defeating a dark wizard, students do
participate in cooking competitions, races, and quiz games.
The Harry Potter-themed competitions are only one facet of the Vanderbilt program.
Students are also required to attend humanities classes to foster empathy and intellectual
skepticism—it is viewed as a critical part of their medical education. Some people might ask
why medical students are wasting their time with elaborate Harry Potter metaphors and
humanities courses when they should be learning about pharmacology and disease. The
answer? They have to learn how to keep themselves alive and well, too.
It’s no secret that medical school is not for the faint of heart—or of intellect—but that
simple truth gains new meaning when faced with some chilling statistics about medical
students. Currently, more than half of all medical students experience burnout and
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professional or personal distress, with around 11 percent a year contemplating suicide
(Bornstein; Chen). Students enter medical school with mental health profiles that are very
similar to their peers, but by the time they finish their medical education, something has
changed: they experience much higher rates of depression and mental illness than people in
other professions. When these students graduate from medical school as physicians, they
enter a group which has the highest rates of suicide in the general population. These numbers
may be due in part to access to and knowledge of lethal substances, but some research traces
the shift to medical school. Interestingly, male and female physicians commit suicide at the
same rate: male physicians are 40 percent more likely to commit suicide than non-physician
males and female physicians are 130 percent more likely to commit suicide than nonphysician females. This suggests that, in particular, female physicians are subject to greater
pressures than their non-physician counterparts (Chen).
Medical education is, ironically, a vicious animal—the competition is fierce from the
get-go, with more than 48,000 applicants vying for only about 25,000 spots in medical
schools across the country (Iglehart 297). To be admitted, students need stellar overall and
science GPAs and high scores on the Medical College Admissions Test (MCAT). Once
there, students experience enormous pressure to avoid mistakes and to avoid owning up to
them, a problem they will grapple with for the rest of their careers.
As a participant in this race for perfection, I can attest that the pressure is intense.
Waiting for a score on a regular course test is like waiting for a diagnosis when you have
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already convinced yourself that it is terminal, while 300 others watch and wait, hoping the
numbers will turn up in their favor. Science courses generally include more credit hours than
general education classes, so a “B” in a chemistry course means frantically calculating a
secondary GPA for science courses. To have more than a 50 percent chance at medical
school admission a student needs a score of at least 30 out of 45 on the MCAT, and only
about 22 percent of test-takers score that well (Percentile Ranks for MCAT…). In addition,
medical schools look for volunteer work, relevant work experience, physician shadowing,
and sometimes undergraduate research. It all adds up to an incredibly tense—and testy—
troop slogging through a miasma of molecular structures and hospital scrubs.
The perfection obsession may seem like an overreaction, but it is not without cause:
from 2006 to 2013, medical school admissions skyrocketed, creating nearly 15,000 new
medical school enrollments per year, and opening up slots for students who may not have
scored as well on their MCAT exams. This may sound like good news for aspiring doctors,
but there are not enough residency training positions to go around (Iglehart 298). General
practitioners are not required to participate in a residency program but any physician aiming
to specialize, be it dermatology or podiatry, has to complete a three- to six-year residency in
order to become board-certified in their chosen field. The constant need medical students feel
to achieve may stem in part from this competition, but it has more far-reaching detrimental
effects than benefits, including a tendency to blot out the “softer” side of healthcare.
Officially, medical training encourages empathy, altruism, and compassion, but some
researchers say medical education instead teaches students to become cynical and remain
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detached (Bornstein). In pre-health and medical education, students are required to make
decisions and give answers only according to proof and fact, leaving little room for the
nuance and subtlety needed to interact with patients in health settings who may be
experiencing a range of emotions and perceptions.
However, medical schools are starting to take action against the toxicity of medical
education by changing their interview styles and by offering humanities courses. More and
more medical schools are moving to Multiple Mini-Interviews (MMIs) rather than traditional
interviews. MMIs are composed of six to ten interviews, each less than ten minutes long,
with a series of interviewers. Nearly all MMIs include a staged scenario with an actor; some
schools include a traditional, longer interview; some an essay-writing segment; and still
others incorporate group problem-solving tasks (“What’s It Like to…”). These multiple
scenarios eliminate some assessor bias, since each candidate is rated by multiple people. In
addition, each scenario is removed from the others, so a less-than-stellar performance at
Station Two will not affect the candidate’s rating at Station Five (school.med.nyu.edu/).
According to NYU’s Langone Medical Center, MMIs help schools select students by
measuring abilities like professionalism, critical thinking, ethical decision-making, and
communication skills. The MMI does not, however, test candidates on medical or scientific
knowledge. While the MMI approach is relatively new in the United States, it has been used
for over a decade in Australia and Canada, and is currently being implemented in some
institutions in the United Kingdom (Young-Powell).
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Another route medical schools are using is the implementation of medical humanities
courses. One of the first, taught at the University of California-San Francisco School of
Medicine by Dr. Rachel Remen, was called The Healer’s Art. The course taught aspiring
doctors to connect with “compassion, service, reverence for life and harmlessness”
(Bornstein). The Healer’s Art is directly in line with research which suggests that “emotional
attunement can improve critical thinking, decision-making” and the ability to take action
during crises. When Remen designed the course 22 years ago, she feared for her job if the
dean of the School of Medicine found out she was teaching it. Now it is taught yearly in
more than 70 United States medical schools.
The increase in classes like Dr. Remen’s does more than open the minds of current
medical students to the value of humanities. It also paves the way for students with diverse
academic interests to participate in medicine.
The recent push for Science, Technology, Engineering, and Mathematics (STEM)
majors has created an illusion for undergraduate students: that one must have a STEM major
to apply to medical school. In 2013, 53.5 percent of medical school applicants in 2013 had
pursued majors in the biological sciences and another 25 percent had pursued mathematics
and other sciences. Only four percent—2,001 total applicants—had majored in humanities
(“Applicants and Matriculants”). However, medical schools have no requirement for the
undergraduate major, generally requiring a specific collection of classes instead of a narrow
course of study.
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Institutions of higher learning have long valued a diverse student population. It is no
surprise that schools of medicine are beginning to push for diversity as well. Since 2003, a
growing number of medical schools have been actively supporting holistic review processes
for applicants, which consider all the ways a particular student could contribute to a class
through “unusual intellectual achievement…or personal background” (Witzberg and
Sondheimer 1565), along with aptitude in the sciences. Besides introducing different
perspectives and ways of thinking into the pool of medical students through inclusion of nonSTEM majors, faculty members report that students are “more collegial, more supportive of
one another, more engaged in the curriculum, and more open to new ideas and to
perspectives different than their own” (Witzberg and Sondheimer 1567).
Detractors point out that holistic review means that knowledge and ability in
biomedical sciences is, by definition, less important. Scientific aptitude has been one of the
largest determining factors in application decisions for more than a century: medical schools
have used MCAT scores and performance in the physical and biological sciences to select the
members of their medical classes (Witzberg and Sondheimer 1566). Yet test scores and
GPAs cannot predict some of the key traits in character and behavior—the human aspects—
that are necessary in practicing medicine.
The attitude that empirical evidence is the only valuable information begins early. As a
humanities major who is pursuing medicine, my course of study has been heavily criticized
by other pre-health students, who claim that the social sciences are not sciences at all—and
by the narrow margins of what determines an empirical science, they are not. They rely on
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subjectivity rather than objectivity, feeling rather than fact, and invisible power dynamics
rather than quantitative information. The social sciences and humanities use more fluid data,
but if anything it is due to an acceptance of the fact that there is no way to study human
interaction and experience without subjectivity, rather than acceptance of sub-par research
and methodology.
Medical students are often critical of medical humanities, referring to humanities
teaching as “boring, worthless, or just plain stupid,” (Shapiro et al., 192) and questioning its
relevance and practicality. Students may feel that taking a humanities course takes away
from their time in other, more conventional medical courses.
“The humanities” is a broad term including the fields of study relating to human life
and culture: literature, sociology, history, anthropology, ethics, and philosophy are only a
few. Creative arts foster the imagination and make it possible to try to see the world from
another’s eyes. Literature demands that its reader take on new points of view and tries to
derive meaning from the stories of life, rather than its measurements (Kidd and Connor).
Shapiro, et al., also defined medical humanities as teaching students how to “critically reflect
on their professions with the intention of becoming more self-aware and humane
practicioners” (192).
In addition, medical professionalism includes many criteria that align better with
humanities than empirical science. For example, tolerance of anxiety and ambiguity,
recognition of biases and responses to them, forming judgments based on different sources—
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clinical, scientific, and humanistic—and the recognition of multiple truths, priorities, and
perspectives (Shapiro et al., 195).
Despite the benefits of a humanities education, courses of study in those fields are
being cut nationwide to make way for the influx of STEM majors. Even illustrious
humanities programs are not immune. For instance, at Stanford University, where 45 percent
of faculty are involved in teaching humanities, only 17 percent of students pursue humanities
(Lewin). The national average—seven percent—has been relatively stable since it dropped in
the late 1970s to the mid-1980s.
Humanities are an important part of human connection in healthcare, something that
some doctors feel is a disappearing in a sea of paperwork and quick diagnoses (Bornstein).
The intimate relationship between patient and healer is one that requires compassion,
empathy, respect, and discretion. It is important for healthcare providers to learn how to see
their patients both diagnostically and narratively, a skill that studies in humanities can
provide. In addition, humanities studies promote healthy skepticism of established systems,
which can be applied to systems of diagnosis, treatment, or accessibility of care.
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Works Cited
“Applicants and Matriculants to U.S. Medical Schools by Primary Undergraduate Major,
2013.” Aamc.org. Association of American Medical Colleges, Dec 2013. Web. 12
Feb 2014. https://www.aamc.org/download/321496/data/2013factstable18.pdf
Bornstein, David. “Medicine’s Search for Meaning.” The New York Times 18 Sept 2013.
Web. 30 Jan 2014. http://opinionator.blogs.nytimes.com/2013/09/18/medicinessearch-for-meaning/
Chen, Pauline W., M.D. “A Medical School More Like Hogwarts.” The New York Times 22
Dec 2011. Web. 3 Feb. 2013. http://well.blogs.nytimes.com/2011/12/22/a-medicalschool-more-like-hogwarts/
Chen, Pauline W. “Medical Student Distress and the Risk of Doctor Suicide.” The New York
Times 7 Oct 2010. Web. 22 Feb 2014. http://www.nytimes.com/2010/10/07/health/
views/07chen.html?pagewanted=all
Inglehart, John K. “The Residency Mismatch.” New England Journal of Medicine 369
(2013): 297-299. Web. 23 Feb 2014. http://www.nejm.org/doi/full/10.1056/
NEJMp1306445?viewType=Print&viewClass=Print
Kidd, M.G. and Connor, J. T. H. “Striving to Do Good Things: Teaching Humanities in
Canadian Medical Schools.” Journal of Medical Humanities (2007): n. pag. Web. 23
Feb 2014. http://link.springer.com/article/10.1007/s10912-007-9049-6/fulltext.html
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Lewin, Tamar. “As Interest Fades in the Humanities, Colleges Worry.” The New York Times
30 October 2013. Web. 3 Feb. 2013.
http://www.nytimes.com/2013/10/31/education/as-interest-fades-in-the-humanitiescolleges-worry.html
“Multiple Mini-Interview (MMI) FAQ.” NYU School of Medicine. New York University, 8
Oct 2009. Web. 15 March 2014. http://school.med.nyu.edu/md-admissions/mmifaqs#
“Percentile Ranks for MCAT Total and Section Scores for Tests Administered in 2013.”
Aamc.org. American Association of Medical Colleges, 14 Nov 2013. Web. 18 March
2014. https://www.aamc.org/students/download/85332/data/combined08.pdf
Shapiro, Johanna, et al. “Medical Humanities and Their Discontents: Definitions, Critiques,
and Implications.” Academic Medicine 84.2 (2009): 192-198. Web. 22 Feb 2014.
http://www.meded.uci.edu/medhum/presentations_mh/MH.DISCONTENTS.pdf
“What’s It Like to… Participate in Multiple Mini Interviews (MMIs)?” Aamc.org. American
Association of Medical Colleges, n.d. Web. 8 March, 2014.
https://www.aamc.org/students/download/369358/data/multipleminiinterviews.pdf
Witzburg, Robert A., M.D. & Sondheimer, Henry M., M.D. “Holistic Review – Shaping the
Medical Profession One Applicant at a Time.” The New England Journal of Medicine
368 (2013): 1565-1567. Web. 3 Feb. 2014. http://www.nejm.org/doi/full/10.1056/
NEJMp1300411
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Young-Powell, Abby. “Applying for medicine? Get ready for the new-style interview.” The
Guardian 7 October 2013. Web. 8 March 2014.