A (Un)Natural Alliance: Medical Education and the Humanities The Rise and Fall of the Institute on Human Values in Medicine 1971-1981 Public

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…………………………..107

Part 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

About this Dissertation

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School	Laney Graduate School
Department	Graduate Institute of the Liberal Arts
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	History of Science Education, Sociology of Sociology, Organization Theory
Mot-clé	Medical Education Medical Humanities
Committee Chair / Thesis Advisor	Howard I. Kushner, Emory University Mark W. Risjord, Emory University
Committee Members	Richard B. Rubinson, Emory University

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