Med School promotes humanistic medicine

At the end of a year dissecting and studying cadavers, first-year students at the Alpert Medical School host an annual Ceremony of Gratitude. Each May, they meet and thank the families of those who donated their bodies to help students understand human anatomy. During the ceremony, students express their gratitude through poetry and speeches, dances and hand-written cards. Despite working with these bodies for the past year, students do not learn the first names of the donors until the flower ceremony during the Ceremony of Gratitude.

This ceremony serves as one of the many ways that students at the Med School strive to remember and reflect on individuals as people instead of  just as bodies they interact with. Humanistic practices are incorporated into classes and scholarly concentrations, electives, extracurriculars and reflection sessions.

Brown has taken a lead in thoughtfully incorporating critical topics that have previously been neglected into curricula, such as LGBTQ+ patient care, racism and transgender medicine, said Steven Rougas, assistant professor of medical science and emergency medicine.

Medical students first learn and practice patient-centered communication through Doctoring, a clinical skills training program for first- and second-year students. Based on a collection of poems and essays entitled “On Doctoring,” the program teaches topics such as medical interviewing, administering a physical exam and presenting an oral case, as well as “thinking about the patient as a whole,” said Rougas, who directs the program.

Each class is typically made up of eight or nine students and is taught by both a physician and a social behavioral sciences faculty member who comes from a background such as nursing, pastoral care, education or social work. The combination of a physician and a non-physician perspective “allows for a more interprofessional approach,” Rougas said.

“We help students navigate how to respond empathetically, how to use reflective listening (and) how to utilize what the patient’s telling you and their story to respond appropriately based on their needs,” Rougas explained.

The program “helps students start thinking about the transformation that takes place in a person when they decide to become a physician,” said Elizabeth Toll, clinical associate professor of medicine and pediatrics, who teaches one of the courses. This transformation includes coping with emotions that may arise during “really basic things like cutting into a cadaver (and) realizing that people will start telling you the most private stuff.”

The majority of the course is hands-on. Students practice communication not only with their peers and faculty members, but also with patients through the Med School’s standardized patient program. After these practice sessions, students are given weekly feedback about whether the patient felt that they were heard and acknowledged compassionately.

The program attempts to “instill structural awareness and competency, which is a way of thinking about individuals from many different facets” including their family life, home life and medical experience, as well as race, age, gender identity and sexual orientation, Rougas added.

“One of the mantras we have is that these things are important because they help us take the best care of patients,” Rougas said. The Med School teaches these topics within the first two years so that third- and fourth-year students, who spend most of their time working with patients, are ready to provide compassionate care, he added.

Up to 15 percent of fourth-year students can be nominated by their peers and faculty for the Gold Humanism Honor Society, a national organization whose “mission is to support and promote the values of humanism and professionalism in medicine,” said Fred Schiffman, faculty advisor to the society and professor of humanistic medicine. The society promotes projects at the Med School that explore the intersection of medicine with museums and art, narratives and poetry, spirituality, food insecurity and other topics.

For instance, Schiffman aims to use meditation and mindfulness to discuss patients “as people, not only as their physical” diagnoses by co-teaching a human physical diagnosis course, he said.

“It’s truly an honor to see patients who uniformly love the attention they get from these students who are not just looking at a physical finding, such as an abnormal wrist or a heart murmur,” Schiffman said. “We challenge students to get to know patients as people in a very short period of time.”

Schiffman has also taught courses that address “cultural approaches to death and dying,” as well as a joint Rhode Island School of Design-Brown course on communicating medical risk.

In addition to the LGBTQ Healthcareand Advocacy concentration, the Med School also offers several scholarly concentrations that touch on humanistic medicine, including Medical Humanities and Ethics, Caring for Underserved Communities and Physician as Communicator. Course electives such as medical illustration and narrative medicine further help students think about patients’ stories, Toll explained.

Toll cited several aspects of humanistic medicine as most meaningful to her: a deep interest in patient narratives, a desire to take time for patients, an incorporation of creativity and community involvement. At the Med School, these opportunities manifest in elective courses and extracurriculars, such as volunteering at Clinica Esperanza, a free clinic in Providence for people who are uninsured.

However, Toll also emphasizes the importance of self-reflection during this process. Toll hopes that having students write reflections, take their first two years of medical school pass/fail and learn from faculty members who practice humanistic medicine will teach them to take time for themselves and their patients.

Reflection sessions also serve as a critical part of the required anatomy course for first-years. Though initially given only the cadaver donor’s occupation, age when they passed away and cause of death, students often learn about the donor as they perform the dissection and uncover implants or tattoos, said Naaman Mehta MD’21 and Alicia Hersey MD’20.

The dissections are “an intense experience, so it’s nice to have sessions where people can talk about how they feel,” Mehta said.

Dale Ritter, senior lecturer in biology who teaches the anatomy course, said that he eases students into working with cadavers by first talking about how the cadaver donors all chose to give their bodies for study. After conversations about where the bodies come from and how they will be dissected, students are shown an undissected cadaver and then a dissected cadaver before they are finally are taught to perform the procedure in groups of five.

Both Mehta and Hersey sat on their first-year student committees, which organize the annual Ceremony of Gratitude. As members of the reflections sub-committee, they also facilitated sessions throughout the year that allowed students to think deeply about how it felt to work with human bodies. The session prior to the Ceremony of Gratitude entailed letter-writing to the families.

Hersey said that the opportunity for students to meet the families helped them humanize and reflect on their anatomy experience after the course was over.

This past year, around 70 families attended the ceremony, Mehta added.

“It’s more than just working with cadavers,” Mehta said. “It’s about understanding why we’re in the lab and what bodies may suffer from while they’re living.”

Toll views humanistic medicine as taking a step back from the technicalities and “being human beings as we encounter human beings in our care,” she said. “I’ve always thought that my personal reason for wanting to be a doctor was to answer the question: What does it mean to be a human being?”