Incorporating Humanities into the Surgical Curriculum

Karen J. Brasel MD, Amy J. Leisten BA, Robert Treat PhD, Brian Lewis MD, Cynthianne Morgenweck MD, Bruce Campbell MD, Nancy Havas MD, Julia Uihlein MA, Arthur R. Derse MD, JD

Medical College of WisconsinMilwaukee, WI

Background• Loss of empathy during medical school• Reflective experiences concentrated in nonprocedural

clerkships or electives

Background• July 2009, students on

the surgical clerkship were creative option in lieu of 25% of required histories and physicals.

• Requirement: relate to

something the student experienced during the clerkship.

• Students shared their

projects at the end of the rotation and completed evaluations of the creative session.

Objective• To analyze the impact of the creative option on student

performance.

Methods• Project themes were categorized using a grounded theory

approach. • Residency specialty choice was categorized as

procedural/nonprocedural. • ANOVA was used to determine effect on clerkship grades. • specialty choice• participation in project

Results• 388 students during 3 year period• 143 students participated in creative project

• No participation difference by rotation or year

• 300 non-procedural

Results--Format• poems • additional writing forms • mixed media • baked goods • performances • painting/drawing

Results--Themes• anatomy and physiology • specific procedures • patient as person • student role • death • physician responsibilities • reflection on career choice• surgery as a specialty

Results

Soap and WaterThe first scrub is best,peeling open the sponge whilea high-pitched rush of watersplashes into the stainless sink.

My mind empties, meditative,counting rapid brush strokesunder every nail, over every plane.

The bristles are soft and harsh, simultaneously.This is the cleanest I feel all day.

Results--SpecialtyOutcome Specialty Mean Score (SD) P*

Final grade Non-procedure 70.5 (5.6) 0.001

Procedure 73.9 (5.0)

Clinical grade Non-procedure 69.1 (7.7) 0.001

Procedure 73.7 (6.6)

NBME subject exam

Non-procedure 72.6 (8.5) 0.028

Procedure 75.3 (7.9)

*Mean score differences determined by two-factor (specialty x project) ANOVA*No statistically significant interaction between specialty and project

Results--ProjectOutcome Project Mean Score (SD) p

Final grade No 71.8 (5.7) 0.051

Yes 70.4 (5.5)

Clinical grade No 71.0 (7.5) 0.024

Yes 68.8 (8.0)

NBME subject exam

No 73.3 (8.7) 0.681

Yes 73.0 (8.1)

After accounting for specialty choice, NO differences in any outcome by project participation

Results—Survey evaluation• Offered learning not included in the standard curriculum:• to better see their patients as whole persons—79% strongly

agree • to learn something new or important about themselves--72%

strongly agree • to learn something new or important about their patients--63%

strongly agree

• Overwhelming agreement that the creative option should be continued (94%).

Summary• Clerkship experience for a wide variety of students• First experience with death

• Creative option provides a valuable learning experience• Positively reviewed by students• No impact on overall grade