There has been little discussion of how and why to teach the broader field of critical medical and health humanities outside of postgraduate and undergraduate medical education. Tanya Sheehan draws on her experience of teaching “Medicine and Society” to adolescents in a US summer school in 2021 to explore the value and implications of introducing the field into secondary schools.
As the humanities are increasingly integrated into medical education, particularly in North America, Britain, and parts of South America and Asia, we must ask: What is the right moment in a student’s career to introduce critical humanistic approaches to the study of medicine and human health? Widely reported at the postgraduate level are the instrumental benefits of such approaches, including stronger clinical observation skills, interpretative abilities, empathy, and cultural understanding. These have helped fuel the expansion of medical and health humanities curricula to institutions devoted to undergraduate education, like the small liberal arts college in the United States where I have taught since 2013. But what would it mean to introduce critical humanistic perspectives on medicine to students before they enter university? What might such perspectives offer adolescents who have not formalized an intention to enter the health professions?
Beginning in the 1970s, these questions have been explored chiefly through the introduction of bioethics to secondary school education. Prominent efforts in the US, such as the National Institutes of Health’s wide distribution of the science curriculum supplement “Exploring Bioethics,” aimed to “promote problem-solving and communication skills, critical thinking, and teamwork.”[i] Educators have since elaborated on these benefits, observing that teaching bioethics generates “conversations about issues for which there usually is no right answer.” It addresses “big questions about the value of life, the significance and purpose of human endeavor, one’s responsibilities and obligations toward other people and animals, and one’s place in the world”—all of which require deep “reflection and consideration” and thus promote emotional and social maturity.[ii] The persistent emphasis on teaching moral decision making in science classrooms, however, fails to address the significance of exposing students in secondary school to the broader range of inquiry encompassed by the critical medical and health humanities. How and why might we teach adolescents to approach medicine as a socially embedded and culturally specific practice, analyze a variety of texts and images in relation to medical histories and cultures, interrogate medical knowledge, power, and access, and better understand where our ideas about health and the body come from?
In the summer of 2021 I had an unique opportunity to explore these questions when I taught “Medicine and Society” at Phillips Academy Andover, an independent boarding school in the US. Andover runs summer programs that enroll American and international students ages 12 to 17 in courses that emphasize experiential learning and innovative pedagogy. On the first day of class, a short written response to the question “What is medicine?” revealed that almost all of my students aspired to become medical doctors, and everyone had previously approached medicine as science. Although I asked the students to respond based on personal experience alone, a few of them imagined there was a right answer to my prompt and shied away from reflecting on their own health experiences or posing questions about medical authority. Others, however, demonstrated a remarkable openness to seeing medicine as a culture whose values have not always served their families well.
As we quarantined together in our first week at Andover—masked, distanced, podded, and regularly tested for COVID-19—I felt compelled to address head-on the social dimensions of the ongoing health crisis. As I would do in an undergraduate medical humanities classroom, I facilitated critical analyses of COVID news stories and pandemic visual culture centered on the concepts of moral panic, xenophobia, and the (un)representable. We also considered the kinds of “truth” expressed in first-person narratives as different as Daniel Defoe’s Journal of a Plague Year (1772) and Audre Lorde’s Cancer Journals (1980). Alongside their reading, students documented their social and emotional experiences of quarantine by keeping a daily journal in which they expressed their feelings of isolation, anxiety, budding kinship, and solidarity. On the day our confinement to campus ended, the class contributed stories based on their journal writing to the online digital project, A Journal of the Plague Year. By adopting a nontraditional assessment format with a public-facing outcome, I could measure students’ willingness to take risks in their thinking and learning. The assignment also modeled the importance of representing the whole person within a medical context. Overwhelmingly, the experiment paid off. “I was super proud of myself for publishing my own story,” one student shared with me. “Being able to show thousands of people who may choose to read about how I was feeling was different because I usually never show much emotion when writing.” Some members of the class continued journaling even after the assignment ended, demonstrating that it positively contributed to their mental health, which had been deeply impacted by the pandemic.
Over the next three weeks our attention turned to interrogating the doctor-patient relationship. Anne Fadiman’s The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (1997) and Damon Tweedy’s Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine (2015), supplemented by essays in the medical humanities, stimulated lively discussions of cross-cultural medicine, narrative medicine, and the impact of social bias on doctors and patients. I had anticipated their eagerness to debate who or what was to blame for the devastating brain damage suffered by a Hmong child named Lia Lee in a California hospital. I was less prepared for the deftness with which they critiqued the cultural competence model promoted by Fadiman and embraced cultural humility, which emphasizes lifelong reflection on one’s own cultural biases over mastering the cultures of others. Although role-playing scenarios are widely used in American medical education to teach these models, I also wondered whether the students could engage in such exercises without slipping into harmful stereotyping. After openly discussing my concerns with the class, however, they modeled patience and empathy in their performance of a medical team, proposing a treatment plan that bridged the gap between the culture of biomedicine and the imagined culture of their reluctant patient, played by one of the rising seniors in the class. Similarly, I was struck by the interest and thoughtfulness with which my students consumed Tweedy’s narrative about race-based health disparities in the US and the antiblack racism he encountered in his medical training. While several students of color shared stories about their own lives that resonated with the author’s experiences, the book provided everyone an opportunity to meaningfully connect its message about medicine to the nationwide protests for racial justice they had witnessed in 2020.
Throughout the course I was careful to select, frame, and activate readings to promote students’ understanding and engagement. For denser texts by Defoe and Lorde, short excerpts were discussed in class so I could facilitate and observe their analysis. Sander Gilman’s concept of moral panic in pandemics was applied to Time magazine’s May 2003 cover story, “The Truth About SARS,” and scenes from the 2011 film Contagion. The principles of narrative medicine outlined by Rita Charon were made concrete in a doctor-patient encounter simulated on video by Brown University Medical School and an in-person interview the students conducted with Amy Patel, a physician who serves as Andover’s medical director. When a recent article from the New England Journal of Medicine on social prescribing referenced the National Health Service’s link worker system, we explored related websites and videos together, before the students developed a social prescription for a member of the Andover community that integrated local resources. Further aiding comprehension were frequent critical questions and short responses to assigned texts, and a course glossary. The latter consisted of key terms—from altruism to stigmatize—which students selected from our assigned readings and defined on a shared document before each class.
In the final week, students demonstrated their learning through two assignments: an analysis of an art object at Andover’s Addison Gallery of American Art and a slide-based oral presentation on a current news story. The first began with a class discussion of seven objects I selected from the Addison Gallery’s collection to speak to the major themes of the course—from Lewis W. Hine’s Basement Home of Negro Dying of T.B., Washington, D.C. (1909) to Tim Rollins and K.O.S.’s A Journal of the Plague Year (1988) and examples from Eric Rhein’s Leaves an AIDS Memorial (2013). Equipped only with excerpts from primary sources and artists’ websites I provided, students chose one object to compare with one text or image they had encountered in the course. While some students struggled to cite specific evidence from the artwork to support their claims—a skill that requires extensive cultivation, as any art historian would attest—they all astutely observed similarities and differences in their chosen representations of medicine and society and posed exploratory questions about the contexts from which they emerged. The second assignment asked students to conduct independent research, evaluate and contextualize sources, develop critical perspectives of their own, and communicate them persuasively to others. Scaffolding of the assignment and in-class workshops with peer review and teacher feedback provided structure and support as the students explored the world outside our classroom. The resulting presentations on efforts in Mississippi to restrict or ban abortion, COVID-19 vaccine hesitancy among African Americans, the expansion of telemedicine, and other timely topics showed how far the class had come in their thinking about what medicine is and what it can and should be—to different social groups, in different social contexts. So, too, did the critical questions they drafted for their peers after each presentation. While many probed personal beliefs and ethics, acknowledging matters of health must be approached from multiple perspectives, questions like How can the medical profession begin to mend its relationship to the Black community? expressed an understanding of medicine as defined by social relations that are both constructed and potentially changeable.
Making connections between the classroom, the self, and the world promotes learning at all levels of education, but it is especially crucial for adolescents. In “Medicine and Society” those connections led my students to think differently about healthcare systems, health experiences, and the health professions. In narrative self-assessments they submitted on the last day of class, many described a critical awakening that will impact their future studies and career choices. One student admitted that when she first came to the course she “struggled with seeing the relationship between medicine and society,” but that she learned to “think deeper” about texts and approach “problems within the medical community” from new perspectives. Another described a visit on campus with her sister, who is studying at an American university and following the pre-med track. When her sister asked about her Andover classes, the student “started rambling about how my ideas of medicine had changed entirely. Specifically, the idea of Western medicine being a culture within itself is super interesting to me and something I was able to talk about with my sister for almost an hour.”
To be sure, our experience at Andover was extraordinary in many ways. That independent secondary schools in the US are not bound by the national core curriculum makes it possible for them to offer a stand-alone introduction to the medical and health humanities, even outside a summer enrichment program. As modeled by “Exploring Bioethics,” it should be possible for any secondary school to integrate lessons derived from the field into existing humanities, social science, or science offerings, while still supporting their learning objectives. This might involve closely reading passages from Lorde’s Cancer Journals in an English literature course, where it can stimulate discussion of the intersection of personal health and social crises, or asking biology students to research the social perceptions of HIV or COVID-19 in a unit on viruses and their transmission. When possible, humanities and science instructors can experiment with parallel or collaborative teaching—even for a single class session—so that students are exposed to multidisciplinary perspectives on subjects like disease and disability. Additionally, the methods of the critical medical and health humanities might shape wellness programs, which are on the rise in secondary schools. They could do so by shifting the emphasis of such programs toward exploring the culture of wellness and the social construction of ideas about health and the body. Regardless of where students encounter the field, the benefits of doing so as part of their secondary school education are considerable. Not only will students who wish to enter the medical profession experience the humanities as other than an instrument of science, but all students will have an opportunity to expand their critical perspectives, cultural attentiveness, and self-awareness at a crucial moment in their intellectual and personal development.
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Tanya Sheehan is William R. Kenan Jr. Professor of Art and Principal Investigator of Critical Medical Humanities: Perspectives on the Intersection of Race and Medicine at Colby College in the US.
Acknowledgements: The author wishes to thank her summer 2021 teaching assistant Aleck Silva-Pinto for his contributions to “Medicine and Society”; Beth Friedman, director of Andover Summer Session, for the opportunity to introduce the course to the program; and most importantly the students in the course, who truly made it a joy to teach.
Notes:
[i] “NIH Releases Innovative Approach to Exploring Bioethics in New Curriculum Supplement,” National Institutes of Health (U.S. Department of Health and Human Services, October 22, 2015), https://www.nih.gov/news-events/news-releases/nih-releases-innovative-approach-exploring-bioethics-new-curriculum-supplement.
[ii] Laura J. Bishop and Lola Szobota, “Teaching Bioethics at the Secondary School Level,” Hastings Center Report 45, no. 5 (September-October 2015): 19-20. See also Mildred Z. Solomon et al., “The Pedagogical Challenges of Teaching High School Bioethics: Insights from the Exploring Bioethics Curriculum,” Hastings Center Report 46, no. 1 (January-February 2016): 11-18.
