Can Literature Enhance Oncology Training? A Pilot Humanities Curriculum

DOI: 10.1200/JCO.2010.33.3617 The use of humanities curricula, specifically narrative-based instruction, is increasingly common in medical education. The overarching goal for introducing humanities into medical training is to allow physicians to empathize with the patient’s perspective, and thus to train physicians to adopt patient-centered approaches in the delivery of medical care. As physician and writer Verghese points out, “To hear the voice of the patient preserves our capacity to imagine the suffering of the patient.” Furthermore, using humanities in medical education allows for self-reflection and introspection and can lead to alliance building with colleagues. A conceptual framework for the use of illness narratives in medical education has recently been proposed. In this framework, illness narratives and patient encounters lead to an understanding of chronic illness that is personal and immediate, rather than abstract or statistical, and this fosters identification with patients. Humanities-based education can be a transformative experience. Oncology is a stressful occupation, and oncologists commonly deal with burnout and grief. In one survey, 56% of oncologists reported being burned out. Oncology trainees may be particularly susceptible to these feelings. In a recent French survey of oncology residents, 44% of trainees experienced burnout, and 18% had abnormally elevated levels of emotional exhaustion and depersonalization. In this study, burnout was significantly associated with the desire to either leave health care altogether or to change specialties. It is also notable that medical training has been shown to be associated with a progressive decline in empathy that can be measured using a quantitative scale. The use of medical humanities in its various forms may help oncology trainees and other physicians to rekindle empathy and cope with burnout. Indeed, Krasner et al demonstrated that an education program in mindful communication that included narratives and discussion of meaningful clinical experiences significantly increased empathy and reduced symptoms of burnout (including depersonalization and emotional exhaustion) among participants. Despite the increasing use of humanities-based medical education, a majority of these efforts to date have focused on medical students and, to a lesser extent, on residents, and only rarely on specialty fellows. Informal discussion forums and lecture series focusing on various aspects of oncology, particularly end-of-life care, have been created at various institutions. However, to our knowledge, there is no oncology-specific humanities curriculum. Furthermore, humanities are not a required part of oncology fellowship training, although humanities training may help trainees meet several required Accreditation Council for Graduate Medical Education competencies, particularly in the areas of patient care, interpersonal and communication skills, and professionalism. Since 2003, we have held occasional lecture series related to medical humanities and narratives as part of oncology fellowship training at our institution. In 2009, we decided to create a more formal humanities curriculum and integrate it into the oncology fellowship curriculum. We describe here the development and implementation of this pilot program, discuss qualitative feedback, and offer suggestions that may help other oncology training programs to incorporate humanitiesbased curricula.