`Arts and humanities': a new section in Medical Education

This year Medical Education is launch-

ing a new section entitled `Arts and

Humanities'. The journal has carried

individual articles on this theme in the

past but the arrival of this section

re¯ects a growing interest in the rela-

tionship between the humanities and

medical education. This interest is such

that we now need a forum to host

sustained debate about the nature,

purposes and outcomes of that rela-

tionship. As happens during the devel-

opment of any new ®eld of interest, the

wellspring of enthusiasm from indi-

viduals working in isolation from each

other can lead to similar ideas and

arguments being re-rehearsed in the

journals. We now need to move beyond

the statement that `arts and humanities

in medical education is a good idea' to

developing the evidence base that

proves effectiveness.

Of course the humanities and medi-

cine are not new bedfellows. As Roy

Porter has observed in his superb his-

tory of medicine, The Greatest Bene®t to

Mankind, `Greek thinking¼emphas-

ised the common ground between what

would later become separate disciplines

of philosophy, medicine and ethics'.1

The dominance of science in medical

education is a relatively recent

phenomenon,2 and it is partly the

emphasis placed on this dominance by

the rise of evidence-based medicine

that has led to a need to re-establish

balance: to emphasise what it is about

medical practice that might derive from

artistic or creative insights and the

exercise of the imagination rather than

from scienti®c certainties.3 In the UK

the General Medical Council helped to

open the door for the arts and human-

ities to be included as assessable sub-

jects in undergraduate curricula in the

form of special study modules.4 Some

graduate entry programmes are now

willing to consider graduates with arts

backgrounds. A study carried out at

the University of Newcastle in New

South Wales showed that the graduates

from their non-traditional programme,

which took in undergraduates from

arts and well as science backgrounds,

were likely to experience better quality

of life in their future careers than those

who had been to more traditional

schools.5

There is, therefore, increasing will-

ingness amongst medical educators to

accept that there may be value in

allowing students to study the arts. A

new discipline is beginning to emerge:

that of the `medical humanities'. While

`medical humanities' has been recog-

nised for some years in the USA, in the

UK this is a relatively new ®eld and

has been described as `a sustained

interdisciplinary enquiry into aspects

of medical practice, education and

research expressly concerned with the

human side of medicine'.6

A new organisation, the Association

for Medical Humanities (AMH), is

about to be established in the UK to

foster research and educational initia-

tives in this ®eld and it will ally itself

with the thriving new journal, Medical

Humanities. Some associated with the

embryonic AMH see the humanities as

having a fundamental role in grounding

both the scienti®c and artistic aspects of

medical practice within a unifying

conception.7

This view would mean that the arts

and humanities would no longer remain

optional extras in medical courses but

might form the base from which per-

sonal and professional development is

taught. Some medical schools, notably

UCL, are interested the value of getting

students to engage in creative activity,

such as writing and painting. I would

regard these courses as part of the

growing `arts and health' movement,

rather than as part of medical human-

ities. The arts and health movement is

concerned with the ways in which the

creative arts can be used therapeutically

and this is to be contrasted with medi-

cal humanities which is an academic

discipline concerned with research and

education.

There is, however, a strong relation-

ship between these two developments.

The arts and health movement is cur-

rently ¯ourishing as it has been recog-

nised that the arts can have a role in

combating social exclusion.8 The cur-

rent New Labour government in the

UK has explicitly acknowledged the

fact that `the social, economic and

environmental factors tending towards

poor health are potent' and that

inequality in health between richer and

poorer is a widespread problem.9 This

acceptance has committed the govern-

ment and the health services to examine

ways of tackling the determinants of

health inequalities.

This new socioeconomic view of the

origins of health problems is a challenge

to the pervasive biomedical approach to

medicine in the UK and most Western

societies. It is a challenge to doctors to

promote a new way of working and, in

consequence, to encourage a change in

the way in which future doctors are

educated. The arts and health move-

ment is responding to this changing

view by using the arts to promote

greater social cohesion and involve-

ment. There is evidence that commu-

nity arts and health projects are having

this effect. A recent report published by

the independent research organisation,

Comedia, found that participation in the

arts can increase people's con®dence

and sense of self-worth, extend

involvement in social activity and

encourage adults to take up education

and training experiences.10

What is now required from doctors

and from doctors in training is a wider

perception of what in¯uences health

and a broader conceptual under-

standing of the basis of health

Editorial

Correspondence: J Macnaughton, Centre for

Arts and Humanities in Health Medicine,

University of Durham Business School, Mill

Hill Lane, Durham DH1 3LB, UK

106 Ó Blackwell Science Ltd MEDICAL EDUCATION 2002;36:106±107

inequalities and how these cause ill

health. In turn this should encourage

doctors to develop a bigger toolkit for

tackling health problems.

The arts and health and medical

humanities are, however, connected in

a deeper sense than that of providing

doctors with another range of thera-

peutic opportunities. It seems that part

of what is therapeutic about the

involvement of the artist in a health care

context is the way in which that artist

regards the patient. The artist sees in

the patient an opportunity for creativ-

ity: either the artist's own or the

patient's. The communication between

the artist and patient, in consequence,

is positive, life-af®rming and often

creatively productive. The character-

istic gaze of the artist is that of the

creative imagination. What is offered in

the medical humanities is the education

of the creative imagination of doctors.

The hope is that via this education they

may better begin to exercise the gaze of

the artist and see the potential in their

individual patients rather than the

negativity of illness and disease.

What I have said in this ®rst editorial

for the new section is by no means

uncontroversial amongst those of us

working in the ®elds of medical

humanities and arts and health. This is

quite intentional! I hope I have opened

up a number of areas for debate within

the new section and I eagerly await

articles on the following subjects:

· What can the arts and humanities

bring to medical education?

· What kinds of course are being run?

· How can we measure the effective-

ness of such courses, and what does

success mean?

· Should the medical humanities be a

core part of the curriculum?

· What is the relationship between arts

and health and medical humanities?

· Of what value is engagement in the

creative arts as an educational activity

for medical students?

Potential authors may have other

ideas and I hope very much that this

new section will progress the debate in

this ®eld and begin to help develop the

evidence base for its applications to

medical education.

Jane Macnaughton

Centre for Arts and Humanities in

Health and Medicine,

University of Durhan,

Durham,

UK

References1 Porter R. The Greatest Bene®t to Man-

kind. London: Harper Collins; 1997:

pp. 64.

2 Downie RS, Charlton B. The Making

of a Doctor. Oxford: Oxford University

Press; 1992.

3 Downie RS, Macnaughton J. Clinical

Judgement: Evidence in Practice. Oxford:

Oxford University Press; 2000.

4 General Medical Council. Tomorrow's

Doctors. London: GMC; 1993.

5 Hazell P, Pearson S-A, Rolfe I. In¯u-

ences on the quality of life of general

practitioners in New South Wales,

Australia. Educ Health 1996;9:229±37.

6 Evans M, Arnott R, Bolton G, Finlay

I, Macnaughton J, Meakin R, Reid W.

The medical humanities as a ®eld of

enquiry. Statement from the Associ-

ation for Medical Humanities. Med

Humanities. In press, 2001.

7 Greaves D. The nature and role of the

medical humanities. In: Evans M,

Finlay I, eds. Medical Humanities.

London: BMJ Books; 2001.

8 Social Exclusion Unit. National Strat-

egy for Neighbourhood Renewal: a

Framework for Consultation. London:

Cabinet Of®ce; 2000.

9 Department of Health. Saving Lives:

Our Healthier Nation. London:

HMSO; 1999: pp. 2.

10 Matarasso F. Use or Ornament? The

Social Impact of Participation in the

Arts. Stroud: Comedia; 1997: pp. 14.

Editorial · J Macnaughton 107

Ó Blackwell Science Ltd MEDICAL EDUCATION 2002;36:106±107