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Section 7. Pedagogy
Simonova Zhanna Gennadievna, Ph D. in Pedagogy, Associate Professor of the Department of Philosophy, federal state-financed educational institution of higher education "Kursk State Medical University" of Ministry of Health of the Russian Federation, Kursk, Russian Federation E-mail: zhanna-simonova@yandex.ru
ROLE OF THE HUMANITIES IN PROFESSIONAL MEDICAL EDUCATION
Abstract. Reforms of the system of higher education in Russia do not always entirely meet the goals of teaching future specialists. The target of training a sympathetic, compassionate doctor with the necessary amount of general cultural and general professional competencies can hardly be achieved in the conditions of constant reduction of the number of humanitarian disciplines and classroom hours allocated to their acquisition in the curriculum of medical students. As a result of the analysis of foreign experience of training future doctors the author of the article confirms the necessity and importance of studying the Humanities by students of medical schools in Russia.
Keywords: medical students, medical humanities, medical ethics, deontology, empathy, communicative competence, professional activity.
The medical school curriculum undergoes significant modifications as a result of constant reforms of the system of higher education in Russia. Nowadays there is a trend towards the reduction of the humanities in the syllabus of future doctors. The Ministry of Higher Education of the Russian Federation treats these changes as the "enforced measures," justifying all the transformations by the process of globalization, hence, the Russian system of higher education following the foreign models of training doctors should not lag behind the Western and European medical school. That is why the reforms will continue going.
Do we really deal with the devaluation of the Humanities? Is it possible today to train a humane doctor teaching only sciences? In order to answer these questions we will analyze the works of foreign authors and compare their viewpoints on the problem in focus.
50 years ago an English scientists and writer, Charles Percy Snow, initiated a debate on whether medicine could be treated as a science or an art, or an inseverable alliance. He did not see any progress of the society without the unity of science and the humanities [1].
Another outstanding American educationist, Abraham Flexner, the person who carried out the reform of the medical education in the United States of America one hundred years ago, wrote: "a professional physician is not the one who treats
the illness, but who heals the human being." It was Abraham Flexner who insisted on the necessity to train future doctors both as scientists and humanists [3].
Modern medicine has achieved tremendous results in its development. It goes without saying that the scientific evolution goes along with the evolution of the society. The system of health care is getting more and more complicated due to a wide range of factors influencing its changes. Firstly, it is the process of commercialization of the modern medicine, secondly,- consumerism of modern patients. The increasing number of court trials, and the constant growth of demands which modern patients place on doctors impose additional responsibilities on medical workers. For a modern physician is not enough to be merely a highly-qualified specialist, he must know the laws, possess cognitive, communicative and behavioral skills, and the last but not least, he should also have managerial qualities. Needless to say that it is impossible to be a good doctor without the accurate knowledge of anatomy, physiology, histology, and a wide range of other major disciplines but the Humanities integrated into the medical curriculum will help to bring up empathetic and compassionate medical practitioners with the necessary complex of general cultural and professional competencies.
At one of the meetings of the General Medical Council of Great Britain, dedicated to the problem of training
Section 7. Pedagogy
of future doctors, the necessity of a fundamental change in the medical school curriculum was recognized. As soon as the requirements of the society to the modern doctors have changed the following resolution was taken: "the modern doctor must be able to build relationships with patients at a high professional level, possess the skills of critical thinking, be unbiased, show compassion and care for patients, show respect for lives, rights, dignities of patients and their families" [2]. The solution to this problem becomes possible due to the inclusion of various humanities into the curriculum of medical students.
The term "medical humanities" coined by European scientists, should be interpreted as an interdisciplinary cluster that includes the Humanities (literature, philosophy, ethics, history, religion), social sciences (anthropology, culture studies, psychology, sociology, medical geography) and art (theater, cinema, visual arts), which form the basis of medical education and practice.
K. Wachtler differentiated between two functions of the medical humanities in the medical school curriculum: instrumental and non-instrumental ones. The instrumental function of the Humanities can be directly applied to the daily routine of doctors. Thus, for example, the study of visual arts can be used to develop the skills of the future doctors to recognize the clinical signs of diseases in their patients [4].
The legacy of the arts left by the outstanding artists of the past who skillfully portrayed crippled bodies, defects and deformities of the sick can be used nowadays with the educational purposes. For example, the canvases of famous painters represented in the Louvre allow carrying out "physical examinations" of the bodies of people and get the glimpses of the specific features of the state of medicine during a particular era when those works of art were created. The Louvre Collection is full of the portraits of naked women. The work "Naked Bath-sheba" created by Rembrandt in the XVII century presents a special attention from the point of view of medicine. The pits and bulges on the left breast of the woman demonstrate the clinical signs of breast cancer. The archival data indicate that the model has lived 9 years after the creation of the picture, and her health noticeably deteriorated year by year. She died of a severe cachexia and this proves that the breast cancer was the cause of it. Based on this example, we can conclude: the picture created by Rembrandt illustrates the natural history of breast cancer, proves that this disease is not new and confirms the fact that patients can live for about 10 years even without getting any treatment [1]. This example proves that the visual arts as one of the powerful teaching tools should be included into the medical school curriculum.
In a similar manner, literature study will help in teaching the students to avoid impersonalization of the patients - the
typical feature of physician-patient relationship according to the engineering model proposed by R. Veatch.
The pieces of literature have a drastic teaching potential. The stories and novels created by the writers who had medical education and solid experience such as A. P. Chekhov, V. V. Ve-resaev, M. A. Bulgakov, A.J. Cronin, W. S. Maugham, etc. affect the readers even nowadays due to the acute relevance of the problems raised in their works. In their books various mental states of the characters are depicted, general medical problems are analyzed; the "diseases of the societies" are highlighted, and from some of them our society still continues suffering. In their works without the excessive shyness, falsification, and exaggeration the authors share their experience, give pieces of advice, and warn against repeating the same mistakes. The books written by doctors do not only capture readers with scientific knowledge, they also contribute significantly to the development of medical thinking. Moreover, they can help teachers to develop the students' skills of making responsible decisions in non-standard situations, develop social and ethical responsibility for the decisions made, and therefore, they will lead to success in the process of developing the students' general cultural competencies. From the viewpoint of psychology literary works contribute to the development of empathy as one of the main principles of deontology.
The science and the Humanities are the pillars of "good medicine". The development of communication skills occupies the central place in the medical school curriculum, the success of which depends on the depth of empathy of the future doctors. Through the prism of medicine empathy implies the faculty of a physician to "penetrate" into the patient's mind, his thoughts, feelings, fears, and sufferings, in short, empathy is an ability that even the most sensitive doctors find extremely difficult.
Another question arises: can a person's culture and his empathy be considered as identically equal? The answer is in the following example.
Among the doctors of the Third Reich accused of the atrocities against the humanity in 1946 there were honorable professors, clinical directors, A. Hitler and G. Him-mler's personal doctors, the president of the German Red Cross K. F. Gebhardt, and a lot of other medical professionals who were interested in conducting biomedical experiments on human beings. Most of them were known as the representatives of the refined culture. Historical documents prove the fact that the music composed by Richard Wagner and Ludwig van Beethoven used to be broadcast over the loudspeakers of the fascist concentration camps. However, the classical music did not stop either the "Angel of Death" or his colleagues, and this fact lets us make such a conclusion that the doctor's humanism is not based only on his culture.
The main task of teaching the humanities to medical students is to strive to bring up more humane doctors who are ready to do their best and even sacrifice themselves trying to save the patients' lives. The role of deontology, bioethics, and medical ethics can hardly be underestimated in achieving the curricular goals.
Medical ethics is a kind of code of conduct for doctors. The laws of medical ethics are flexible, open to changes and reforms, and unfortunately not always it can be treated as an advantage. Historical events, cultural characteristics of various ethnic groups have had a significant impact on the content of medical ethics. In connection with the outstanding achievements in the field of biomedicine and the introduction of innovative medical technologies the modern doctor is forced to make decisions which may contradict the norms of classical medical ethics. The law is a tool by means of which the authorities can respond with a significant delay to the most severe violations of medical rules, or it can be passed a posteriori as a response to an event that has received the public resonance. All ethical codes of conduct for medical practitioners originate in philosophy and theology. For instance, the Hippocratic Oath was written as a response to the respect for human rights and dignities during the heyday of democracy in Athens in the 5th century BC.
It is known that the mental activity of a doctor differs from the similar activity of other specialists due to the specific peculiarities of the profession which involves close communication with people. In this regard, the formation of students' communication skills is of a particular relevance. It is impossible to overestimate the role of teaching philosophy to future doctors in order to achieve the curricular goal. Studying philosophy students acquire the skills of listening to patients; they get ready to respect the different beliefs and values, to make tolerant decisions and to justify their viewpoints giving reasonable arguments; they acquire the skills of critical analysis, contributing to the development of clinical judgments - the basis of the process physician-patient relationship.
The humanities, having a non-instrumental function, contribute to the acquisition of common knowledge, promote students' self-development, and form new ways of thinking that go beyond biomedicine. Sharing K. Wachtler's viewpoint we note that it is the study of the Humanities that stimulates the development of self-reflection and self-analysis, and also contributes to the awareness of professional functions and duties in society [4]. In a word, the humanities have enormous potential, which makes it possible to bring up the future doctors with the stable system of values, the necessary set of general cultural and professional competencies which will allow them to fulfill the professional duties.
References:
1. Baum M. Teaching the humanities to medical students. URL: https://ru.scribd.com/document/81256327/teaching-the-humanities-to-medical-students-Micheal-Baum-^ (accessed: 23.03.2019).
2. General Medical Council. Tomorrow's doctors, 2009. URL: http://www.gmc-uk.org. (accessed: 23.03.2019).
3. Jakusovaité I., Luneckaité Z., Riklikiené O. The place of medical humanities in medical education in Lithuania // TRAMES, 2014. 18(68/63), 1,- P. 77-87.
4. Wachtler C., Lundin S., Troein M. Humanities for medical students? A qualitative study of a medical humanities curriculum in a medical school program // BMC Medical Education 2006. 16:6. URL: https://doi.org/10.1186/1472-6920-6-16 (accessed: 18.03.2019).
