A (Un)Natural Alliance: Medical Education and the Humanities The Rise and Fall of the Institute on Human Values in Medicine 1971-1981 Open Access
Horton, Mary E. Kollmer (Fall 2020)
Abstract
The medical humanities have long been considered a valuable part of physician education. Yet, its standard inclusion in undergraduate medical education has been elusive. In the 1960's leaders in medical education began formal meetings with humanists to discuss concerns that medical students were increasingly cynical, and that the content of their curriculum had become highly scientific and technical to the exclusion of humanism. The Society for Health and Human Values, incorporated in 1969, formed from these concerns. The Institute on Human Values in Medicine, a project of the Society, was formed to consider the integration of human values content into medical curricula. With funding from the National Endowment for the Humanities leaders of the Institute worked tirelessly from 1971 to 1981 through a variety of well planned and executed activities to promote the teaching of human values content. Ultimately, the Institute lost its funding, which ended its active work. Lacking direction from its parent Society or professional associations, it closed. The Institute’s efforts drew attention to the medical humanities in medical education and laid some of the groundwork for the inclusion of ethics into the accredited undergraduate medical curriculum. Nonetheless, it fell short of its goal to integrate a spectrum of humanities content into the standard medical curriculum.
This dissertation uses historical methods to examine the activities of the Institute to identify barriers in the standard inclusion of humanities in medical education. Barriers identified validate sociological theories of schools as complex open organizations with strongly institutionalized cultures. Sociological studies of mass global curricula also show the devaluation of humanities as an essential curricular element. The institutional scientific and corporate culture of academic medical centers makes the integration humanities difficult and ‘unnatural’. This study emphasizes the strength of social and professional belief systems, legitimizing agencies, and forces in constant interaction with the institution and supports a predictive model based on the sociological definition of professions and organizational theories. Calls for humanism in medicine and medical education have escalated in the current century. Recent efforts to integrate humanities cast in language acceptable to corporate and scientific culture predicts greater integrative success.
Table of Contents
Chapter One: An Introduction to Humanities in American Medical Education ..1
The Growth of Academic Medicine and Loss of Humanism ………………6
Humanism in Modern Medical Education ……………………………………...18
Project and Study Questions …………………………………………………………28
References ………………………………………………………….…………………….….35
Chapter Two: Study Methods ……………………………………………………………………….. 40
Archival Research ………………………………………………………………………..41
Interviews …………………………………..………………………………………………48
IHVM Reports Analysis ………..…………………………………………………...….56
Survey of Schools ………………………………………………………………………...59
References …………………………………………………………………………………..62
Appendix A ………………………………………………………………………...………..64
Appendix B ………………………………………………………………………………….66
Appendix C ……………………………………………………………………………….…67
Chapter Three: An Answer to the Call……………………………………….……………………68
Modern Medicine Finds and Looses Religion ………………………………...69
Formation of the Society for Health and Human Values …………………74
The Institute on Health and Human Values …………………………………...83
“Action Research” Conferences ………………………………………………..…...86
The Institute in “Action” ……………………………………………………………….93
The End of a Decade and the Legacy of an Institute ………………………..98
References …………………………………………………………………………………105
Chapter Four: Broad Strokes Can’t Change the Landscape…………………………..107Part I: Activities of the IHVM: Seeding the Medical Humanities across American Medical Schools ……………………………………………………………………………………………………111
Part II: Activities of the IHVM: Creating Medical Humanities Knowledge and Intersections………………………………………………..……………………………...164
End of a Decade ………………………………………………………………………..…187
References ………………………………………………………………………………….193
Appendix to Chapter Four Part One ………………………………………....…..196
Chapter Five: Broad Work - Narrow Change, A Sociological Analysis………… 206
Organizational Structure and Function of the IHVM …………………..….209
Organizational Structure and Function of Schools and Professional
Societies …………………………………………………………………………………….215
Theories and Realities of Curriculum Development ……………….……..230
Ethics Engaged ……………………………………………………………………………240
The Medical Profession – A Theoretical Construct ………………………...246
Concluding Thoughts …………………………………………………………………..250
References….…………………………………………………………………………… …257
Chapter Six: The Future of Humanities in Medical Education ……………………..261
Humanism in Medical Education …………………………………………..…….…264
Twenty-first Century Movements ………………………………………..…...…....270
Professionalism in Medical Education …………………………………………....287
Curricular Reforms since IHVM ……………………………………………..……….290
What has the IHVM taught us about humanities in medical education? …………………………………………………………………………………………..…………302
Lessons from Affiliated Schools ………………………………..……………………305
Concluding Thoughts ………………………………………………………………...…..318
References ………………………………………………………………………………..…..324
Tables and Figures
Table 1. School Contact and Outcomes Chart ……………………………………………………61
Table 2. Advisory Committee of the Institute on Human Values in Medicine…....92
Table 3. Activities of the IHVM 1971-1981………………………………………………………..96
Figure 1. Model for Curricular Change in a Complex Organizational System ……..33
Figure 2. Number of Articles Published By Decade since 1960……….………………..267
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