There is some discourse regarding how and whether to integrate humanities into medical curricula at present (13)(17)(18). Imperial College provides an epidemiology & sociology of medicine course in earlier years, an ethics course in 3rd year and a ‘dermatology and art’ teaching day in later years. There is also a Medical Humanities, Philosophy & Law intercalated BSc option in year 4.
The majority of students believe that additional humanities subjects would be better incorporated in earlier years. Qualitative comments suggested an integrated approach was preferred by some students, with some specifically requesting vertical learning throughout education. Participants highlighted the need to keep a broad-minded perspective of medicine in the pre-clinical years, when students may feel there is a lack of insight towards the broader aspects of a physician’s training outside scientific knowledge, a viewpoint shared by some critics of the standalone approach (13). Furthermore, many older years state that there is greater time-flexibility during younger years, allowing for greater stimulation with humanities, which provides a break from the science-focus. In contrast, other participants view the humanities as a separate entity to medical education, which would take away from the scientific focus.
This disparity in students’ understanding of how the humanities relate to medical education was most starkly demonstrated in Table 2 where participants were split 55–45% in favor of humanities being a compulsory component of the course. The main reasons against compulsory integration was it was either unnecessary to medical education or that students would be disinterested in the topics, which may be due to the lack of discussion around the utility of humanities in medicine (19). Disinterest as a reason to avoid compulsory teaching could strengthen the idea that many students perceive the medical humanities as a separate entity from medicine. Conversely, those in favor of integration, cited its importance to a well-rounded education, and proposed that students in “need” of the skills obtained by the study of the humanities are those who would opt out from elective courses (18).
There were varying conceptions of what the humanities are, and how they relate to medical education, some conceptualising the humanities as the arts and some with more complex conceptions that might include philosophy, sociology or history. This varied view of medical humanities role within the medical profession is shared in the literature with some emphasising its ability to help the physician at work, while others stress its role is outside the realm of academia (20)(21).
An area that many participants agreed upon is that engagement in humanities should be considered more important than assessment, citing that the large number of exams already present in the medical school as a source of stress and concern (22). Whilst outside the scope of this study, the role of exams in medical school was the largest detractor for assessing the humanities, those in favor of examination argue that students will only fully engage with a subject if it will be assessed. This evidently creates a challenge when trying to design a more holistic course which fosters learning through curiosity.
Quantitative analysis found that there was no difference between genders in regards to interest in the humanities. This contradicts previous research and beliefs dictating that males tend to favour the more traditional STEM subjects, with females preferring humanities. Despite evidence to the contrary in this study, overall UCAS data still displays a major discrepancy between genders in regard to engagement in the humanities (Supplementary information, Fig. 1). This has largely been put down to societal pressures and a lack of role models in the field. However, this study shows that for those students who choose to study medicine, a science that combines humanistic care with science-based clinical practice, there is no significant difference in engagement or interest in the humanities. Whilst difficult to interpret, this may indicate that when exposed to similar societal pressures, which pushed these individuals to pursue a medical vocation, there is no inherit difference between genders.
The comparison between senior and junior students indicated a disparity wherein senior students were less likely to engage with the humanities (23). This is indicative of the culture of medical school where students approaching final exams often struggle to continue extracurricular pursuits they developed in their younger years. A focus on academia and in particular the management of a patient is especially important to senior medical students as the focus of their written and practical examinations. These may have influenced the results of senior students rating management significantly higher in contrast to their junior counterparts, who overall deemed empathy more important. This may be an indication of a change in priority as students move towards a more goal-oriented outlook on medicine during finals, as opposed to the holistic route that can be afforded in younger years. It also resonates with the work of Hojat M et al, which suggests that the empathy of students decreases in later clinical years (24).
Unsurprisingly, there is correlation between doing the humanities and thinking positively about the humanities, however it is difficult to see whether engagement in the humanities drives satisfaction or vice versa. There are elective opportunities for students more inclined towards the humanities within the medical curricula for example the extra-curricular courses and the Humanities BSc. However, this doesn’t lean towards a more integrated nature afforded by the humanities, or elective modules more directly related to medicine. It also demarcates that the humanities are only related to medicine in a purely accessory capacity, something which was highlighted as problematic by the students surveyed in this study.