YEAR 1
Kindness Curriculum: required component of Clinical Foundations 1
Ralph Clayman MD; Aaron Kheriaty MD; Johanna Shapiro, Ph.D.
Course Description: The purpose of the kindness curriculum is to give students a space to think about the role of kindness in clinical interactions; and to show them different facets of kindness by examining the construct from a variety of disciplinary perspectives.
The kindness curriculum consists of 8 required hours in the 1st year and 8 required hours in the 2nd year.
Course Objectives:
Students will be able to demonstrate the following:
- Active knowledge of the history of kindness in medicine
- Active knowledge of the construct of kindness as situated within various ethical traditions
- Active knowledge of the neurobiology of empathy and kindness
- Specific performative and narrative techniques that communicate kindness to others
Anatomy Creative Projects: Human Gross Anatomy and Embryology (optional)
Johanna Shapiro, PhD; Jamie Wikenheiser, Ph.D.
Course Description: An optional creative project has been incorporated into the Human Gross Anatomy and Embryology Course. It provides an opportunity for students to express their experiences in anatomy creatively through media such as poetry, prose and art. Projects can be exhibited or performed as part of the Anatomy Donor Family session.
Course Objectives: Participation in this project is designed to accomplish the following:
- Provide an opportunity for students to engage in retrospective reflection and personal assessment regarding their thoughts and feelings about gross anatomy through the use of creative media such as poetry, prose and art.
- Improve faculty understanding of the anatomy experience from the perspective of students so that course adjustments can be made that enhance student learning as well as professional and personal growth.
Patient Stories, Doctor Stories: The Doctor-patient Relationship and the Experience of Illness in Literature (elective)
Johanna Shapiro, PhD, Tan Nguyen, M.D., Monisha Vasa, MD
Course Description: This course uses short selections from literature, including poetry, short stories, and role-plays written mostly by doctors, patients, or medical students, to help participants deepen their understanding of patients’ experiences of illness, and patients’ and doctors’ experiences of each other. Most readings will be done in class, followed by comments and discussion. Each student will complete a creative project reflecting on some aspect of their experience as medical students at the end of the class.
Course Objectives: At the end of this rotation, the student will be able to:
- Stimulate empathy for and understanding of the condition of patients confronted with serious illness
- Develop insights into the doctor-patient relationship
- Understand how narrative is useful in addressing ethical issues
- Be more comfortable with ambiguity, uncertainty, and multiple perspectives
- Deepen understanding of and respect for colleagues and teachers
- Use literature as a method for reflecting on and coping with stresses and strains of professional training
Examine the Painting/Examine the Patient (elective)
Joel Shallit, MD
Course Description: The objective of this course is to improve the visual skills needed in clinical diagnosis and the emotional sensitivity needed in compassionate care through techniques learned in examining works of art
Course Objectives:
* The student will be able to develop visual analysis skills related to interviewing, physical diagnosis, communication, and clinical reasoning through the study of art
*The student will be better able to deal with complexity and diagnosis through the examination of paintings.
* The student will be better able to interpret patient emotions, and thereby to feel empathy and compassion for patients, through the study of art.
* The student will be better able to understand patients of different backgrounds through the study of art.
History of Medicine (elective)
Douglas Merrill MD
Course Description: This elective will survey significant themes in the study of the history of medicine and health care through the prism of the humanities. Each session will be devoted to the discussion of one of the themes. Each student will be asked to lead a session of his or her choice, which will entail prior review of articles and other resources, as well as development of a class plan for discussion. Preparation and leading one session and completing one written assignment on one of the other topics will provide the student an opportunity to explore these topics personally and to develop their critical assessment, discussion and writing skills.
Course Objectives:
*Students will discern and discuss major themes present in the study of the history of medicine and health care and their relative interactions with one another.
*Students will be able to develop and articulate – verbally and in writing – their understanding of these themes and their relation to current medical care and healthcare delivery issues.
YEAR 2
Kindness Curriculum – required component of Clinical Foundations 2
Ralph Clayman, MD, Aaron Kheriaty MD, Johanna Shapiro, PhD (various faculty)
Course Description: This year emphasizes the development of empathy through a series of professional videos that focus on the definition and neurobiology of empathy; breaking bad news; and dealing with difficult clinical encounters. In addition, each session will incorporate a physician and patient to speak from a personal perspective about how these topics have intersected with their clinical care. The final session will focus on end of life from both clinician and patient perspectives.
Course Objectives:
Students will be able to demonstrate the following:
- Specific communicative skills relevant to breaking bad news
- Specific interactional approaches in difficult student-patient encounters
- Deepening of knowledge about neurobiology of empathy including ability to reference specific research
- Active knowledge of how breaking bad news and challenging clinical situations are addressed and resolved in actual clinical encounters with patients.
- Active knowledge of how end of life issues affect patients, families, and physicians
Reflective Reading and Writing for Medical Students (elective)
Johanna Shapiro, PhD.
Course Description: This course provides an introduction to reflective reading and writing that links these skills with professional development and patient care. In Week 1, an introductory presentation orients student to the theoretical and empirical work on therapeutic and health-promoting aspects of reflective reading and writing. Each subsequent week (2-9) consists of in-class readings by medical student and physician-authors focusing on the socialization experience of medical students; professionalism; and the doctor-patient relationship. These readings will also provide models for different writing approaches. In addition, most sessions will include an in-class writing assignment examining such features as voice and point of view, parallel charting, free writing, and write-it-thrice techniques. Students will come prepared to discuss readings and participate in writing exercises and class discussion that link writing to their ongoing patient care experiences. A final session (Week 10) will summarize the course and present student writing projects.
Course Objectives: After participation in this elective, the student will:
- Understand and be able to explain theoretical and empirical evidence for the therapeutic value of reflective reading and writing
- Become familiar with and practice various reflective writing techniques
- Understand and be able to explain how to use reflective reading and writing such as: a) methods of observing and paying attention to patients b) tools to reduce frustration, anger, helplessness, and burn out c) ways of developing increased empathy for the patient’s perspective d) means of developing additional insights into patients.
YEAR 3
Humanism through Humanities: Pediatric Clerkship (required clerkship component)
Penny Murata, MD; Johanna Shapiro, PhD.
Session Description: As part of the Pediatrics Clerkship students are required to complete a “humanities” reflection project for a student conference held near the end of their six-week Pediatrics Clerkship.
The project may be based on child advocacy, ethics, physician-patient-family relationship, or any other aspect of the clinical experience. Students may choose the format. They may work individually or in groups, as long as each student participates.
Instructions for the project are provided during the Pediatrics orientation and are included in the clerkship manual. The humanities conference is the final conference and usually lasts for two hours. After each presentation, other students are free to comment. Comments and discussion points are made or facilitated by the Director of Medical Humanities and the Pediatrics Clerkship Director.
Projects can be presented in a variety of formats — poetry, skits, song, point of view narrative, patient education pamphlets, scrapbook or artistic collage of pediatric patient experiences, narrative, drawings, readings. Students discuss their feelings about taking care of patients (including patients with chronic medical conditions and victims of abuse), interacting with parents and caregivers, being students, interacting with residents, and ethical issues.
Session Objectives:
- Students will understand how medical humanities can promote empathy for pediatric patients and their families
- Students will understand how medical humanities can promote child advocacy
- Students will be able to describe ethical issues in pediatrics
- Students will be able to reflect on their clinical experiences in a creative manner that facilitates their understanding of the patient-caregiver-physician interaction
Reflective Practice: Difficult Student-Patient Encounters and Cross-Cultural Issues: Family Medicine Clerkship (required clerkship component)
Johanna Shapiro, PhD
Session Description: A required Reflective Practice writing assignment and discussion session that focuses on difficult student-patient encounters and practicing medicine across cultures is incorporated as part of the four-week Family Medicine clerkship.
The 9-10 students rotating through the clerkship each month first complete a written assignment reflecting on various issues, including language and culture,that can complicate the patient encounter.
Students subsequently participate in a facilitated 2 hour session, to exchange and examine different points of view, and interrogate their own assumptions and biases.
Session Objectives: The goals of this session are to…
- Help students understand that medicine is its own culture
- Examine and challenge students’ unconscious assumptions about patients from diverse backgrounds
- Explore different ways of addressing encounters that students perceive to be frustrating and that can result in barriers to optimal healthcare
- Identify positive and negative physician role-models and what students can learn from each in terms of managing challenging clinical interactions
Medical Readers Theater: Family Medicine Clerkship (required clerkship component)
Johanna Shapiro, PhD.
Session Description: Readers’ theater (RT) is a minimal form of theatrical performance in which there are no or negligible sets or costumes, and scripts are used in staging. It has been used in a variety of educational settings. More recently, medically-themed readers’ theater (MRT) has generated interest in medical education circles as a method of engaging students and other learners with the human side of medicine. MRT is an effective way of bringing together individuals with different backgrounds and life experiences and getting them to share their perspectives on various topics.
In collaboration with the UC Irvine Program in Geriatrics and residents from a local CCRC we have incorporated a required MRT session as part of the Family Medicine clerkship.
Nine to 10 students participate in each session. Students meet for 1 ½ hours with facility residents to participate in a brief skit highlighting issues of importance to older patients, including ageism, multiple, chronic health problems, disability, dementia and Alzheimers disease, and end-of-life issues. The role-plays are followed by facilitated discussion.
Session Objectives:
- To assist future physicians and geriatricians in gaining insight into and understanding of older patients, particularly the health issues and life transition issues they face
- To have older persons with health issues see the human side of physicians and to appreciate their concerns and quandaries
- To encourage students and seniors to get to know each other better as people, while sharing in the joy of doing something creative
Relationship, Ethics, and Communication as Components of Clinical Practice: Internal Medicine Clerkship (required clerkship component)
Ron Koons, MD, Elena Bezzubova, MD, Johanna Shapiro, PhD.
Session Description: This required one-hour session employs an intimate, small group setting with a 2:1 student/faculty ratio to engage in narrative medicine, i.e., telling stories about memorable patient encounters. Students present patient care situations that troubled, angered, confused, or inspired them. Subsequent discussion explores in a nonjudgmental way various relational, ethical, and communication issues raised. Emphasis is on self-awareness, reflective practice, and translation of values into language and behavior.
Session Objectives:
- Help students to better understand the clinical situation they present during the class
- Improve students’ ability to constructively reflect on difficult patient-doctor encounters and ethical dilemmas
- Help students learn how to more effectively problem-solve difficult clinical and professional encounters
- Improve students’ ability to understand patients and families and how to develop relationships with them
- Facilitate student adaption to the challenges of the third year environment
- Help students to clarify their professional identity as a student-physician
- Address important aspects of patient care ethics which have not been addressed previously
YEAR 4
699E Research Elective in Medical Humanities and Social Sciences
Johanna Shapiro, PhD
Course Description: Medical Humanities encompass a broad range of subjects and activities, including history, ethics, literature, visual and performing arts. This elective provides an opportunity for students to explore and engage in analysis of various clinical issues in medicine through the development of a specific medical humanities-based project related to the art of medicine.
Course Objectives: At the end of this rotation the student will:
- Participate in a meaningful way in the implementation and completion of a humanities creative project/research project related to the art of medicine
- Understand and be able to state the intellectual basis for developing this humanities project as an aspect of medical education
- Complete a written document describing the goals and outcomes of the project
- Identify an appropriate mentor, and expert on the topic of choice, who can evaluate and guide the student’s work
647 The Art of Doctoring
Johanna Shapiro, PhD; Matt Butteri, MD
Course Description: Art of Doctoring is a longitudinal experience to enhance the physician-patient relationship, expand students’ communication skills, teach team-building skills, and provide strategies to promote compassion and empathy as core physician values. The class uses reflective practices, role-modeling, readings, and case-based problem solving discussion.
Course Objectives: At the end of this elective students will:
- Understand the usefulness of reflection and imaginative perspectives in a) cultivating compassion and empathy for patients, patients’ family members, peers, self, and others b) developing insight into how best to convey compassion and caring in the doctor-patient relationship.
- Be able to identify and assimilate compassionate attitudes and behaviors modeled by others.
- Know how to use mindfulness and other re-centering techniques to maintain an attitude of compassion in difficult and stressful situations.
- Know how to use reflective writing and other humanities-based techniques to develop and maintain compassion and empathy.
- Implement these strategies to enhance physician-patient communication and improve patient care.
- Implement strategies to promote self-awareness and to enhance their own career satisfaction.