의료인문학을 의학교육에 통합하기: 국제적 상황(Curr Opin Psychiatry, 2016)

Progress integrating medical humanities into medical education: a global overview

Stefani Pfeiffer a,b, Yuchia Chenb,c, and Duujian Tsai b,d




도입

INTRODUCTION


의료인문학운동은 1990년대 북미, 영국, 뉴질랜드, 캐나다에서 발전하기 시작했고 그 이후 유럽, 아시아, 중동 대학들의 상당한 기여를 받아 세계적인 운동이 되었다.

The medical humanities movement began developing in North America, the United Kingdom, New Zealand and Canada in the 1990s and has since become a global movement, with significant contributions from European, Asian and Middle Eastern universities.


교육과정에서의 FLAWS에 대한 고찰

REFLECTIONS ON FLAWS IN TEACHING PROFESSIONALISM


프로페셔널리즘 교육은 의대생들이 윤리적 또는 인본주의적인 열망을 가진 학습자가 되도록 만들어야 한다[10]. 그러나 그러한 가르침은 종종 지나치게 단순화되어[11] 의대생들로 하여금 윤리적 책임으로부터 감정적으로 그리고 지적으로 격리시키는 '하지 말아야 할 것'의 체크리스트가 되곤 한다. 프로페셔널리즘을 '신뢰 창출을 위한 약속'이자, 환자의 이익에 대한 전문적 헌신으로 이해하는 것은 단순한 행동을 넘어서 태도에 근거해야 한다[12].

Professionalism teaching ought to push medical students to be learners with ethical or humanistic aspirations [10]. However, such teaching is very often oversimplified into a checklist of ‘Do Nots’ that detaches medical students emotionally and intellectually from their ethical responsibilities [11]. Understanding professionalism as a trust-generating promise, professional commitment to patients’ interests should be based on attitudes & deeper rather than mere behavior [12 ].


지배 엘리트들에 의한 무비판적인 '도움'은 불평등 권력 역학을 지속시키는 역할을 할 수 있기 때문에, 프로페셔널리즘을 가르치는 데 있어 가장 최근의 발전은 critically & reflexive social accountability를 향한 움직임이다[13 ,15].

As uncritical ‘helping’ by dominant elites may function to sustain inequitable power dynamics, the most recent development in teaching professionalism is a movement toward critically && reflexive social accountability [13 ,15].


전국적인 조사에서 한국의 의사들은 환자들에 대한 이타주의와 정직성 같은 도덕적 미덕moral virtue보다 책임감과 진실성과 같은 도덕적 의무moral duty를 더 중시하는 것으로 나타났다[19].

a nationwide survey revealed that Korean physicians value moral duties, such as responsibility and veracity, more than they do moral virtues, such & as altruism and honesty with patients [19 ].


의학교육에서 창의적 아트와 인문학

CREATIVE ARTS AND HUMANITIES IN MEDICAL EDUCATION


창조적인 작업은 스트레스를 줄이거나(또는 긍정적인 감정을 증가시키고) 전문적인 성찰을 증진시키거나, 의사들과의 상호작용을 강화하기 위한 목적으로 사용되어 왔다[20].

Creative work has been used in training health professionals for the purposes of reducing stress (or increasing positive emotions) [20], promoting professional reflexivity [21] and enhancing physicians’ interaction with peers [22].


의학교육에서 성찰의 실천으로서 네러티브 의학

NARRATIVE MEDICINE AS REFLECTIVE PRACTICE IN MEDICAL EDUCATION


의료 프로페셔널리즘을 육성하는 효과적인 방법에 대한 최근의 관심은 문학과 서사가 갖는 특정 역할을 강조합니다 [26,27,28 ].

Recent concern about effective ways to foster medical professionalism points to a specific role for contributions from literature and stories [26,27 ,28 ].


프로페셔널리즘을 가르치는 것에 대한 성찰과 비판적 인문학에 대한 요구는 세계적으로 중요하다.

These reflections on teaching professionalism and calls for critical humanities have global significance.


따라서 의료인문교육의 성과평가의 발전도 국제적 중요성을 갖는다[40].

Accordingly, advances in assessing outcomes of medical humanities education are also of international significance [40].


CONCLUSION


의료인문학을 활용한 교육적 개입이 프로페셔널리즘 학습을 향상시키는데 필수적이라는 세계적인 합의가 나타나고 있다. 이 고찰에 따르면 모든 훈련 단계에서 의료인문학을 적용하는 것이 중요하다는 것을 뒷받침하며, 의사소통능력 강화에 도움이 된다[7]. 우리는 의학 교육 자체에 대한 연구가 translational science에 유용하며, 의료인문학적 개입의 궁극적 목적은 환자와 공동체를 위한 치료개선이라는 맥가지의 생각에 동의한다. [46,47]


A global consensus is emerging that educational interventions of the medical humanities are essential to improve the learning of professionalism. This review article endorses the promise of applied medical humanities at any stage of training, with flexibility as the essential added value enhancing communication competence [7]. We concur with McGaghie’s idea that research on medical education itself is useful for translational science and serves the ultimate goal of using medical humanities interventions to improve care for patients and communities & [46 ,47].



Brody H, Doukas D. Professionalism: a framework to guide medical education. Med Educ 2014; 48:980–987. &


Martimianakis MA, Michalec B, LamJ, et al. Humanism, the hidden curriculum, and educational reform: a scoping review and thematic analysis. Acad Med && 2015; 90 (11 Suppl):S5–S13.


42. Goodwin D, Machin L. How we tackled the problem of assessing humanities, social and behavioural sciences in medical education. Med Teach 2016; && 38:137–140. XXX


30. Hurst SA, Baroffio A, Ummel M, Burn CL. Helping medical students to acquire a deeper understanding of truth-telling. Med Educ (Online) 2015; 20:28133. && XXX




 2016 Sep;29(5):298-301. doi: 10.1097/YCO.0000000000000265.

Progress integrating medical humanities into medical education: a global overview.

Author information

1
aDepartment of History, Rutgers University, New Brunswick, New Jersey, USA bCenter for Bioethics and Social Medicine, Pingtung Christian Hospital, Pingtung cInstitute of Philosophy, National Central University, Taoyuan dDepartment of Medical Humanities, Taipei MedicalUniversity, Taipei, Taiwan.

Abstract

PURPOSE OF REVIEW:

The article reviews the most recent developments in integrating humanities into medical educationGlobalimplications and future trends are illustrated.

RECENT FINDINGS:

The main concern of medical humanities education is teaching professionalism; one important aspect that has emerged is the goal of nurturing emotion through reflexivity. Relating effectively to all stakeholders and being sensitive to inequitable power dynamics are essential for professional social accountability in modern medical contexts. Mediating doctors' understanding of the clinical encounter through creative arts and narrative is part of most recent pedagogic innovations aimed at motivating learners to become empowered, engaged and caring clinicians. Scenario-based and discursive-oriented evaluations of such activities should be aligned with the medicalhumanities' problem-based learning curriculum. Medical humanities education fosters professional reflexivity that is important for achieving patient-centered care.

SUMMARY:

Countering insufficient empathy with reflective professionalism is an urgent challenge in medical education; to answer this need, creative arts and narrative understanding have emerged as crucial tools of medical humanities education. To ensure competent professional identity formation in the era of translational medicine, medical humanities programs have adopted scenario-based assessments through inclusion of different voices and emphasizing personal reflection and social critique.

PMID:
 
27429215
 
DOI:
 
10.1097/YCO.0000000000000265


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