Goal

To provide selected medical students with a coherent, substantial, educational experience in ethics and the humanities as they relate to the medical profession.

Vision

An integrated curriculum that enhances the study of clinical medicine by providing educational experiences in a variety of ethics and humanities-related interests, including art, economics, philosophy, film and theater, history, law, literature, policy, and sociology, as they relate to the medical profession.

Mission

To offer medical students a pathway of emphasis in ethics and the humanities that includes core coursework, elective experiences, regular faculty mentoring and supervision, and a final project in the student’s area of interest.

Learning Objectives

By completing this pathway of emphasis, students will:

1. Increase competence or develop expertise in at least one area of the humanities, as demonstrated by completion of a substantial product in their chosen field.

2. Appreciate the range of disciplines and experiences in the humanities that inform the profession of medicine.

3. Recognize the value of group interaction in the development of a professional identity.

4. Articulate how the selected area of humanities or ethics relates to the practice of medicine.

Introduction

For centuries, medicine has been known as a learned profession.  Physicians have been celebrated not just for their clinical prowess or scientific expertise, but also for their work as writers, artists, musicians, theologians, philosophers, historians, and political advocates.  While relatively few physicians have gained fame in such areas, historically all physicians have been expected to participate in appreciating these activities—a well-respected physician appreciates the humanities and might attend the opera, appreciate poetry, discuss ethical questions thoughtfully, and participate in community leadership.  Such engagement has long been considered critical to professional development of every physician; it demonstrates that a practitioner truly appreciates the privilege of participating in the most intimate matters of life and death.

Although such expectations dwindled by the middle of the 20th century, lately there has been a reemergence of interest in professionalism.  Medical organizations have promulgated charters of professionalism, and both undergraduate and graduate medical educators have incorporated educational outcomes in ethics and professionalism.  Indeed, as medicine has become increasingly a matter of cost containment and consumer satisfaction, there has been a yearning among physicians and patients for a return to a golden age of medicine, when physicians practiced the art of medicine and patients were neighbors and friends rather than consumers of health care.

For this pathway, we define ethics/humanities (E/H) broadly to include any discipline or experience in the humanities that has been historically linked to the practice of medicine by practitioners or scholars: music, art, history, anthropology, literature, religious studies, and philosophy are examples.  By agreement with the Pathway in Social Medicine, students particularly interested in health policy, epidemiology, sociology, public health, and international health experiences should pursue that pathway.  We do see overlap (and occasional co-programming) with the Social Medicine Pathway, and we would not discourage E/H Pathway students whose work led them to focus on policy issues.  Indeed, all student projects in the E/H Pathway should be relevant to current issues in medicine, but the methods used will fit in the category traditionally defined as the humanities.  “Ethics” is part of the title of the E/H Pathway because ethics is the most readily identifiable aspect of the overlap between the humanities and medicine, and at this point is the most developed field of the humanities associated with the medical school.  For more information about the Miller School of Medicine’s Pathways of Emphasis program, click here

The content of the E/H Pathway takes advantage of the many current opportunities for students at the University in E/H, and the requirements of the pathway have been designed to complement the core curriculum in professionalism and ethics offered through the Doctoring courses.

Admission

Students will be admitted to the E/H Pathway during their first year following a similar application process to other pathways such as Social Medicine.  The process will include an application form and short essay describing the student’s background/interest in E/H and thoughts about a project in E/H (the more details, the better: what the student would like to do, why it’s important to the practice of medicine, how it will be completed, when it will be completed, what support the faculty can provide).  Students can discuss potential E/H projects with faculty anytime, but formal admission to the pathway is for first-year students following the deadlines set by the Medical Curriculum Office.

Students may apply to more than one pathway, as we recognize the overlap with Social Medicine in particular.  If applying to more than one pathway, students should note this on their application.  They should understand that ultimately they can only pursue only one pathway, and the specific pathway will be determined by the faculty co-directors.

A student must be in good academic standing to be admitted to the pathway (no D’s or F’s in any medical school course, and any Incompletes made up within 1 month).  A maximum of 5 students will be admitted each year, and final decisions about entry to E/H Pathway lie with the the E/H Pathway Advisory Committee (EHPAC – Appendix A).  (In exceptional cases, a 2nd year student may be allowed to apply if he or she demonstrates the potential to complete the E/H Pathway requirements.  Such a student might already be far along in an appropriate E/H project.) A student must remain in good academic standing to continue in the pathway.

Requirements

The requirements of the E/H Pathway are designed to ensure that each pathway student has the opportunity to pursue a project in depth (Req. 1), yet has exposure to a variety of experiences in E/H (Req. 2), and participates in an ongoing group exploration of the value in E/H in medicine (Req. 3).  Each student will be assigned a faculty mentor, who will be responsible for meeting regularly (at least monthly) with the student regarding the project, as well as the student’s progress toward meeting the other requirements.  Requirements 2 and 3 will be monitored through the use of a “student portfolio,” through which a student documents his/her experiences and their contribution to student’s education.  A student will be deemed to have successfully completed the E/H Pathway after the student’s project and portfolio have been reviewed and approved by both the student’s mentor,  the EHPAC, and the E/H Pathway co-directors.

1. Completion of a faculty-mentored project with a tangible outcome

2. Participation in at least 15 ongoing experiences in E/H throughout the four years of medical school

3. Participation in at least 15 monthly E/H Pathway meetings throughout the four years of medical school

Requirement 1: Project

This is a student-directed project that contributes to a greater understanding of an important issue in medicine.  Students have broad discretion in choosing a topic and methods, and we anticipate a wide variety of projects.  Examples might include writing a short story or series of poems, completing a scholarly work in history or ethics, designing a new curriculum, helping to write an ethics policy for Jackson Health System, or producing a work of art or music.  In all cases, the student must explicitly indicate how their work contributes to the understanding of an important medical issue, work with a faculty advisor to submit a proposal (presumably a refined version of their “admission” proposal), and the proposal must be approved by the student’s faculty mentor, the EHPAC, and the Pathway co-directors.  The student will meet regularly with the faculty advisor to ensure appropriate progress on their project, document the time spent on their project, and demonstrate successful completion of a tangible product prior to graduation.  We expect that a typical project will take a total of at least 50 hours of student time over the course of their enrollment in the E/H pathway.

Project Timeline

—Year 1
- Meet monthly with faculty advisor to craft project proposal
- Meet with faculty advisor and Pathway co-directors to discuss proposal before April
- April: Submit proposal to EHPAC for approval
- Consider applying for project funding (e.g. Arsht grant)

—Year 2
- Meet monthly with faculty advisor to discuss work on project
- Meet with Pathway co-directors if necessary
- April: Present progress report to EHPAC: project should be more than 50% complete

—Year 3
- Meet every other month with faculty advisor to discuss work on project
- Meet with Pathway co-directors if necessary
- April: Present progress report to EHPAC: project should be more than 66% complete

—Year 4
- Meet monthly with faculty advisor to discuss work on project
- Meet with faculty advisor and Pathway co-directors before January
- Present project to E/H Pathway faculty and students at a monthly meeting
- April: Present final report to EHPAC

Requirement 2: Ongoing Experiences

There are currently many opportunities to explore the role of the humanities in medicine both within and outside of the School of Medicine.  Indeed, the Coral Gables campus offers both academic expertise and informal opportunities in ethics and the humanities.  Examples on the medical campus include Dialogues in Research Ethics, meetings of clinical ethics committees, special grand rounds in nearly every department, and guest speakers or discussion groups sponsored by medical student groups.  Off campus events include plays, concerts, lectures, museums—many of which are available on the Coral Gables campus.  Participation as a leader in the core PELM curriculum, such as directing a small group discussion, would also constitute an appropriate experience.  (See Appendix B for a list of additional E/H experiences.) 

E/H Pathway students will be expected to participate in at least 15 of these ongoing experiences before graduation.  There should be a variety of experiences (10 ethics committee meetings would not do), and the student would be responsible for recording the experiences in a portfolio.  This portfolio would include a brief description of the experience and how it impacted the student’s development as a physician.  For example, students might relate the E/H experience to a particular clinical encounter.  The portfolio will be reviewed in depth at least annually by the faculty mentor, and a plan for future experiences jointly written each year. 

At the annual EHPAC meeting, the student and faculty mentor will describe to the EHPAC how the student’s chosen experiences constitute a coherent educational experience.

Requirement 3: E/H Pathway Meetings

Monthly meetings for the pathway will be established to provide an ongoing forum for group exploration of themes and issues in the practice of medicine.  These meetings will include a number of required experiences that reflect the core knowledge/skill sets to be acquired by all of the E/H pathways students.  For example, discussion of a core set of readings will occur in these meetings, as well as sharing of how a particular field in the humanities helps a student/physician understand certain clinical experiences.  These meetings will be informal at a faculty home in the early evening, and will vary in their specific content. 

Students and faculty in the pathway will rotate responsibility for the content, which may include discussion of a reading, a case presentation, or a work of art or music.  (A number of “founding students” in the E/H Pathway will continue to participate until formal E/H Pathway students become upperclassman; see Appendix C.)  The meetings will be open to students and faculty who are not formally part of the E/H Pathway, but it is expected that pathway students and faculty will form the core group.  E/H Pathway students must document their attendance in at least 15 of these meetings in their portfolio, along with a brief description of how the meeting contributed to the student’s development as a physician.  Eventually, these monthly meetings will also provide a showcase for each E/H Pathway student to present his or her project.

Faculty

Jeff Brosco and Ken Goodman are the co-directors for this pathway.  Both have extensive experience mentoring medical students and others in projects in E/H, and they are responsible for the medical school’s formal curriculum in ethics and professionalism (PELM).  They will be aided by a group of students who have been the impetus for this pathway (Appendix C), who will provide senior student leadership in the implementation of the pathway.

More than 20 associated faculty from nearly every department in the Miller School of Medicine have expressed interest in participating as mentors or group facilitators for the pathway (Appendix D).  In addition, faculty in the humanities in other schools at the University are also participating in seminars, small groups, and mentors for student projects.

E/H Pathway Advisory Committee (EHPAC)

The EHPAC will consist of at least 7 people, including the 2 E/H Pathway co-directors, E/H Pathway faculty from a variety of disciplines, at least one student, and at least one liaison member from the Executive Faculty Curriculum Steering Committee.  (See Appendix A for a list of current members.) The EHPAC will meet bi-annually (November and April) to review students’ initial proposals, to monitor a students’ interim progress in both the project and other pathway requirements, and to determine whether the student has successfully completed all three of the E/H Pathway requirements.


APPENDIX A
Ethics/Humanities Pathway Advisory Committee

Forthcoming


APPENDIX B
Selected List of Optional Ongoing Experiences

This list represents examples of the sorts of experiences that may fulfill E/H Pathway Requirement 2.  It is critical that the experiences both allow students to pursue particular interests and also provide a range of experiences.  Together they must fit into a coherent individualized curriculum. 

Attendance at E/H events. Examples include Dialogues in Research Ethics, meetings of clinical ethics committees, special grand rounds, and guest speakers or discussion groups sponsored by medical student groups.  Cultural events include plays, concerts, lectures, museums—many of which are available on the Coral Gables campus. 

Participation as a leader in the medical school curriculum.  Examples include arranging lectures or panel discussions, serving as a small group leader in the core PELM curriculum, or participating in other educational experiences as teacher. In particular, E/H students can be helpful in introducing new students to the Doctoring course: during orientation/beginning of the first year, E/H students can discuss the benefits of the Doctoring curriculum and the issues it brings up.

Audited courses at University of Miami Coral Gables Campus.  Students may make arrangements to audit select courses offered through the College of Arts and Sciences.  Such course might include ethics, medical sociology, history of medicine, art history, or music performance.

Electives for 4th Year Medical Students. There is currently a 4th year elective course in the History of Medicine, and electives offered at other medical schools may be appropriate as well.

Community Service Events.   Pathway students are encouraged to seek out meaningful volunteer experiences that enhance the interconnection between the healing arts of medicine and the humanistic principles of the liberal arts.  Such community service events should be related to the student’s area of interest in the E/H Pathway.  For example, students interested in art may become involved in the Department of Pediatrics various art programs for children.  Musically oriented students might find a grateful audience at a local nursing home.  Students who write well may volunteer to tutor high school students. 

Professional Organization Membership.  Professional organizations offer forums to share information and serve as venues for networking and career building.  The E/H Pathway encourages students seek involvement in professional organizations.  Of note are the American Medical Student Association (AMSA), which has special events for medical writers; the American Medical Association and Florida Medical Association’s Legislative Visit (especially for students interested in politics, philosophy, and economics); and the Florida Bioethics Network.  There are also a variety of discipline-specific national organizations that encourage student membership, such as the American Association of the History of Medicine and the American Society of Bioethics and Humanities.

Social Events. Social events include special E/H Pathway student meetings with guest professors who visit UM for E/H events.  Other events might bring together students and faculty from several different academic backgrounds, including nursing students, law students, and faculty from varied fields.

APPENDIX C
List of “Founding Students”

Michael Kritzer: Ethics
Ghislaine Guez:  General Humanities, Ethics
Joshua Lennon:  Ethics
Toral Parikh: Humanities
Aliye Runyan: Literature, General Humanities, Ethics
Matt Wideroff:  Ethics
Daniel Cushman: Ethics

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