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Introducing Humanities Into the Oncology Curriculum

David N. Korones, MD; Michelle Shayne, MD; and Alok A. Khorana, MD*
Published: Friday, Sep 09, 2011

It seems that every year, the list of Accreditation Council for Graduate Medical Education (ACGME) requirements grows longer and more bewildering. That’s no surprise in oncology. Our patients are increasingly complex, our therapies are more numerous and more sophisticated, and the ACGME’s reach extends beyond medicine into patient safety, quality improvements, and understanding medical systems. In addition, there is the burgeoning list of required conferences, institutional demands, and the dawning of the electronic age, complete with electronic medical records, electronic admission, electronic discharge, electronic sign-in and sign-out, and electronic communication, all of which conspire to keep us at our laptops far longer than at the bedsides of our patients.

Add to this the stress of our clinical work. We try to satisfy the needs of our patients and their families, many of whom are facing life’s biggest crisis. They deserve more attention than our crowded and fragmented schedules will allow; this only heightens our stress. For the fellow, this stress can be still greater. There are the additional burdens of being less experienced, being less appreciated by families, struggling with difficult decision-making and poor outcomes, and managing the competing demands of patients, faculty, the fellowship program, and the fellow’s own family life.

Given the stresses and demands of our field, it is not surprising that the prevalence of burnout is high. Burnout is defined as emotional exhaustion, depersonalization (ie, treating patients as objects), and a low sense of accomplishment. However, there are many ways to maintain the deep satisfaction that comes with working with patients with cancer and their families and with our colleagues. Incorporating medical humanities into one’s medical practice and the fellowship curriculum is one such way. Medical humanities is simply application of history, literature, art, music, and other fine arts to the practice of medicine and the care of the patient.1

There is not much literature on this approach, particularly in oncology. Gilewski describes a forum for fellows at Memorial Sloan-Kettering Cancer Center that focuses on end-of-life care and the stresses of such care on fellows and other caregivers.2 Sands et al reported on a narrative training course, in which members of a pediatric oncology team wrote about their own personal experiences with their patients.3 The 19 participants in this course displayed improved perspective on their patients’ problems, higher empathy scores, and better teamwork.

‘Narratives in Oncology’ Seminar



In 2009, we introduced a seminar at the James P. Wilmot Cancer Center in Rochester, New York, titled “Narratives in Oncology,” which was designed for medical and pediatric oncology fellows and radiation oncology residents. Our goal was to introduce our trainees to literature, poetry, and essays in the lay press as well as in the medical literature that focus on the human side of patient care. We hoped that such literature would open the eyes of our fellows to a rich source of thought-provoking material on patient and physician perspectives on life, death, and medical care. We also hoped that discussion of these essays would stimulate dialogue among us about subjects we seldom discuss: what to tell (or not to tell) our patients, the challenges of communicating bad news, how to deal with difficult families, coping with loss, and our own personal stresses caring for so many medically and emotionally needy patients.

The seminar was designed so that we would meet in a 1-hour session once a month for 6 months. The faculty preceptors and the fellowship director chose articles to review, and 1 week prior to each session 1 or 2 essays/articles were distributed to the fellows. We chose articles that provided the patient’s perspective and that highlighted common clinical dilemmas. For example, for our first session we read an essay by Stephen Jay Gould called “The Median Isn’t the Message,” which discusses how a patient might look at odds of survival very differently than would a physician.4 In another session, we read a Glamour magazine excerpt, “I Want My Life Back,” by Andrea Coller, a young patient with multiply recurrent Hodgkin lymphoma, and learned what it feels like to be 27 years old and go through intensive chemotherapy and how we physicians look from the perspective of a young adult. (It wasn’t pretty!)5 We read a painful essay called “Facing Our Mistakes” by David Hilfiker6 and watched Casey’s Legacy, a video of a physician who tearfully describes a mistake he made in caring for a child.7 For the last session, fellows were asked to write an essay about a moving interaction with a patient, and selected essays were read at that session.


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