An interdisciplinary curriculum in the medical humanities that incorporates community-based learning is proposed. Such a course would link health care students with graduate literature students. It would promote dialogue between professions and enhance awareness of illness experiences. Students would read shared literary works and collaborate on a community project, learning different perspectives. Benefits include developing empathy, discerning values, and identifying opportunities in applied humanities fields like medical writing. Challenges involve scheduling and engaging students from diverse backgrounds, but can be addressed through support and selection of engaging materials.
A research-based narrative assignment for global health education.pdfMonique Carr
This document describes a research-based narrative assignment implemented in an undergraduate global health course. The assignment required students (n=20) to research a global health issue and write a narrative based on their findings. Students then wrote a two-page reflection on their experience. Analysis of the reflections identified four themes: (1) the challenge of representing real people, (2) developing an engaged understanding of the issue, (3) integrating various determinants into a coherent story, and (4) struggling to create an accurate and compelling narrative. The strengths and limitations of using this assignment approach for global health education are discussed.
This report contains the preliminary findings from a research project that aimed to explore:
• What is the current practice around teaching social science research methods to undergraduate medical students in the UK: what is being taught, how are teaching and learning organised within the curriculum, how is content is delivered, to and by whom and how is student learning assessed?
• And, what are the challenges and opportunities around developing this teaching and learning practice and the curriculum and policy contexts that frame it?
Crafting an essay on health care presents many challenges. The topic is complex due to the interplay of medical, social, economic, and ethical issues. To understand it fully requires knowledge of both medical principles and the socio-political landscape shaping healthcare globally. The essay must also synthesize diverse sources, from research to policies to studies, and present statistical data, examples, and opinions in a cohesive narrative. Moreover, health care evolves rapidly, requiring the essay to address the latest developments accurately. It must also navigate sensitive ethical issues around disparities, resources, and practices by exploring diverse stakeholder viewpoints carefully. Finally, the essay should communicate complex medical concepts clearly to a wide audience while maintaining analytical depth, requiring linguistic skill
Crafting an essay on health and social care poses unique challenges that require synthesizing information from diverse sources like medical literature, social sciences, and policy documents. This interdisciplinary topic demands integrating medical knowledge with social and ethical considerations. Staying up to date is also vital as the landscape constantly evolves. The essay must demonstrate a deep understanding of the ethical dilemmas, patient rights issues, and societal implications within healthcare. Effective communication is key to conveying complex concepts accessibly to audiences without medical backgrounds.
AbstrActOne of the biggest challenges in nursing educati.docxransayo
AbstrAct
One of the biggest challenges in
nursing education is to develop cul-
turally sensitive graduates. Although
theory and lecture are appropriate to
introduce cultural issues, the applica-
tion of those skills is limited by the
kinds of clinical experiences and pa-
tient populations students may treat.
Literary works are a rich source of
information for nursing. This assign-
ment was created to sensitize the
students to the influence of cultural
diversity. Students were assigned to
read one novel from an approved list
and answer the questions posed on
the Cultural Discovery worksheet.
The only direction that was given re-
garding novel selection was that the
novel had to represent a culture other
than the student’s own. The focus
was to expose students to a different
culture. Classroom discussion, based
on worksheet answers, followed. The
assignment’s good, bad, and ugly out-
comes are discussed. Suggestions for
adaptation of this assignment to an
online format are also provided.
T
he United States is home to
one of the most ethnically and
culturally heterogeneous popu-
lations in the world. There are more
than 150 ethnic groups (U.S. Census
Bureau, 2006) and 430 recognized
tribes of Native Americans in the
United States (Redish & Lewis, 2007),
all with their own diverse practices
and beliefs. Culture and ethnicity of-
ten determine the clients’ perception
of health and illness. This includes
kinds of acceptable treatment, type
of follow up permitted, and who will
make health care decisions. As a cul-
ture defines health and illness, it also
defines health care and treatment
practices. Cultural values determine,
in part, how patients will behave.
The provision of culturally compe-
tent care is a dynamic process that
requires individuals to be aware of
their own values and beliefs, as well
as understand how these affect their
responses to those from cultures dif-
ferent from their own. Leininger
(1991) defined culture as the learned,
shared, and transmitted values, be-
liefs, norms, and life practices of a
particular group that guide their
thinking, decisions, and actions in
patterned ways. Cultural competence
includes the attributes of caring, re-
spect, adaptation, honesty, appropri-
ate body language, and interest and
the ability to develop working rela-
tionships across lines of difference
(Galanti, 2004). This encompasses
self-awareness, cultural knowledge
about illness and health practices, in-
tercultural communication skills, and
behavioral flexibility (Strivastava,
2006). Even the concept of transcul-
tural nursing is relatively new in the
nursing literature. In fact, only in the
past 3 decades have nurses begun to
develop an appreciation for the need
to incorporate culturally appropriate
clinical approaches into the daily rou-
tine of client care (Giger & Davidhi-
zar, 1999). Educators strive to develop
students into sensitive practitioners,
and they are challenged .
This document summarizes an article about community-engaged scholarship in health professions schools. It discusses how, since Ernest Boyer's 1990 report advocating for broader definitions of faculty work, there has been a push for faculty to engage with communities through teaching, research, clinical care and service. However, there remains a gap between rhetoric and reality in how these community-engaged activities are evaluated for promotion and tenure. The document proposes frameworks for defining community-engaged scholarship and assessing it, with a focus on process measures like collaboration, in addition to traditional products and outcomes. It concludes by recommending changes to better recognize and reward community-engaged scholarship.
This document discusses how career development policy and practice can better support community wellness in remote communities in the Northwest Territories (NWT). It takes an interdisciplinary approach, drawing on disciplines like economics, sociology, psychology, education, political science and history. It provides context on the NWT, where communities face high unemployment, loss of culture, and poverty. While career programs aim to address unemployment, the remote labor market is very limited. The document examines ideas from career development, community development, and wellness models to identify new approaches that value local input and priorities to foster livelihood opportunities and a healthy future for remote NWT communities.
Promoting knowledge and understanding in societyIme Hilmy
The document discusses the importance of training students in communication skills, particularly the ability to communicate with non-specialist audiences. It notes that while the 1997 Dearing Report highlighted communication skills as essential, many higher education programs have not adequately developed training in this area. The paper examines drivers for improving communication skills training in fields like medicine, healthcare, and science. It provides examples of approaches used to integrate both written and oral communication skills development and assessment into curricula. The value of training students to engage with and explain their work to the public is discussed.
A research-based narrative assignment for global health education.pdfMonique Carr
This document describes a research-based narrative assignment implemented in an undergraduate global health course. The assignment required students (n=20) to research a global health issue and write a narrative based on their findings. Students then wrote a two-page reflection on their experience. Analysis of the reflections identified four themes: (1) the challenge of representing real people, (2) developing an engaged understanding of the issue, (3) integrating various determinants into a coherent story, and (4) struggling to create an accurate and compelling narrative. The strengths and limitations of using this assignment approach for global health education are discussed.
This report contains the preliminary findings from a research project that aimed to explore:
• What is the current practice around teaching social science research methods to undergraduate medical students in the UK: what is being taught, how are teaching and learning organised within the curriculum, how is content is delivered, to and by whom and how is student learning assessed?
• And, what are the challenges and opportunities around developing this teaching and learning practice and the curriculum and policy contexts that frame it?
Crafting an essay on health care presents many challenges. The topic is complex due to the interplay of medical, social, economic, and ethical issues. To understand it fully requires knowledge of both medical principles and the socio-political landscape shaping healthcare globally. The essay must also synthesize diverse sources, from research to policies to studies, and present statistical data, examples, and opinions in a cohesive narrative. Moreover, health care evolves rapidly, requiring the essay to address the latest developments accurately. It must also navigate sensitive ethical issues around disparities, resources, and practices by exploring diverse stakeholder viewpoints carefully. Finally, the essay should communicate complex medical concepts clearly to a wide audience while maintaining analytical depth, requiring linguistic skill
Crafting an essay on health and social care poses unique challenges that require synthesizing information from diverse sources like medical literature, social sciences, and policy documents. This interdisciplinary topic demands integrating medical knowledge with social and ethical considerations. Staying up to date is also vital as the landscape constantly evolves. The essay must demonstrate a deep understanding of the ethical dilemmas, patient rights issues, and societal implications within healthcare. Effective communication is key to conveying complex concepts accessibly to audiences without medical backgrounds.
AbstrActOne of the biggest challenges in nursing educati.docxransayo
AbstrAct
One of the biggest challenges in
nursing education is to develop cul-
turally sensitive graduates. Although
theory and lecture are appropriate to
introduce cultural issues, the applica-
tion of those skills is limited by the
kinds of clinical experiences and pa-
tient populations students may treat.
Literary works are a rich source of
information for nursing. This assign-
ment was created to sensitize the
students to the influence of cultural
diversity. Students were assigned to
read one novel from an approved list
and answer the questions posed on
the Cultural Discovery worksheet.
The only direction that was given re-
garding novel selection was that the
novel had to represent a culture other
than the student’s own. The focus
was to expose students to a different
culture. Classroom discussion, based
on worksheet answers, followed. The
assignment’s good, bad, and ugly out-
comes are discussed. Suggestions for
adaptation of this assignment to an
online format are also provided.
T
he United States is home to
one of the most ethnically and
culturally heterogeneous popu-
lations in the world. There are more
than 150 ethnic groups (U.S. Census
Bureau, 2006) and 430 recognized
tribes of Native Americans in the
United States (Redish & Lewis, 2007),
all with their own diverse practices
and beliefs. Culture and ethnicity of-
ten determine the clients’ perception
of health and illness. This includes
kinds of acceptable treatment, type
of follow up permitted, and who will
make health care decisions. As a cul-
ture defines health and illness, it also
defines health care and treatment
practices. Cultural values determine,
in part, how patients will behave.
The provision of culturally compe-
tent care is a dynamic process that
requires individuals to be aware of
their own values and beliefs, as well
as understand how these affect their
responses to those from cultures dif-
ferent from their own. Leininger
(1991) defined culture as the learned,
shared, and transmitted values, be-
liefs, norms, and life practices of a
particular group that guide their
thinking, decisions, and actions in
patterned ways. Cultural competence
includes the attributes of caring, re-
spect, adaptation, honesty, appropri-
ate body language, and interest and
the ability to develop working rela-
tionships across lines of difference
(Galanti, 2004). This encompasses
self-awareness, cultural knowledge
about illness and health practices, in-
tercultural communication skills, and
behavioral flexibility (Strivastava,
2006). Even the concept of transcul-
tural nursing is relatively new in the
nursing literature. In fact, only in the
past 3 decades have nurses begun to
develop an appreciation for the need
to incorporate culturally appropriate
clinical approaches into the daily rou-
tine of client care (Giger & Davidhi-
zar, 1999). Educators strive to develop
students into sensitive practitioners,
and they are challenged .
This document summarizes an article about community-engaged scholarship in health professions schools. It discusses how, since Ernest Boyer's 1990 report advocating for broader definitions of faculty work, there has been a push for faculty to engage with communities through teaching, research, clinical care and service. However, there remains a gap between rhetoric and reality in how these community-engaged activities are evaluated for promotion and tenure. The document proposes frameworks for defining community-engaged scholarship and assessing it, with a focus on process measures like collaboration, in addition to traditional products and outcomes. It concludes by recommending changes to better recognize and reward community-engaged scholarship.
This document discusses how career development policy and practice can better support community wellness in remote communities in the Northwest Territories (NWT). It takes an interdisciplinary approach, drawing on disciplines like economics, sociology, psychology, education, political science and history. It provides context on the NWT, where communities face high unemployment, loss of culture, and poverty. While career programs aim to address unemployment, the remote labor market is very limited. The document examines ideas from career development, community development, and wellness models to identify new approaches that value local input and priorities to foster livelihood opportunities and a healthy future for remote NWT communities.
Promoting knowledge and understanding in societyIme Hilmy
The document discusses the importance of training students in communication skills, particularly the ability to communicate with non-specialist audiences. It notes that while the 1997 Dearing Report highlighted communication skills as essential, many higher education programs have not adequately developed training in this area. The paper examines drivers for improving communication skills training in fields like medicine, healthcare, and science. It provides examples of approaches used to integrate both written and oral communication skills development and assessment into curricula. The value of training students to engage with and explain their work to the public is discussed.
Application Access to Quality Health Care for Vulnerable Population.docxhirstcruz
Application: Access to Quality Health Care for Vulnerable Populations
Access to quality health care for disparate populations is a critical challenge for today's health care organizations and for the health care system as a whole. In this Application Assignment, you will describe the advantages and challenges facing the health care system in providing equal access to quality health care.
To prepare
for this Application Assignment, consider how health care is delivered to populations who are sometimes affected by the
Healthy People assigned focus area
you were previously assigned.
To complete
this Application Assignment,
write a
2- to 3-page paper
(essay style) that addresses the following:
What two obstacles confront vulnerable/underserved populations when they attempt to obtain quality health care
Healthy People assigned focus area
(e.g., a prevention program, screening program, diagnosis, treatment, and rehabilitation)? Be specific.
Name and describe
two
intervention programs that have addressed these obstacles (e.g., prevention, screening, diagnosis, treatment, and rehabilitation). You can find examples of these on the internet or by searching the library databases (CINAHL). Try searching with your Healthy People area (i.e. obestiy; heart disease) as a key term as well as the word "intervention" or "program"). You may also try looking at professional organizations that address that health issue. For example, the American Diabetes Association sponsors a program called "Project Power" which addresses diabetes type 2 among African Americans—specifically for church settings.
In your paper, summarize the programs by including the following:
The name of the program
The type of program (hospital based; for churches; online program, etc.)
Who has implemented the program (researchers, professional group, university, state, etc.) and where was it implemented:
For example, training programs are sometimes offered by commercial businesses and programs or activities are sometimes sponsored by federal government or professional organizations.
The types of services the program provides
How the program has addressed disparities
The achievements of the program
Does it address the issue of culture? How so?
Is there any evidence that it has been successful?
Your written assignments must follow APA guidelines (6th edition). Be sure to support your work with specific citations from this week's Learning Resources and additional scholarly sources as appropriate. Refer to the
Essential Guide to APA Style for Walden Students
to ensure that your in-text citations and reference list are correct. Also, since this is one of your only applications, you may want to submit this to a Walden Writing Center tutor first as well as run it through Turnitin.com prior to submission.
Learning Resources
Required Resources
Media
Video:
Laureate Education, Inc. (Executive Producer). (2009).
Behavioral and cultural issues in health care:
Health care disparities.
Baltimo.
An Exploration Of Nurses Health Beliefs Ways Of Knowing And Implications Fo...Melinda Watson
This document summarizes a study that explored nurses' health beliefs in five countries. It revealed three main themes:
1) Nurses drew their health beliefs from various sources, including professional education and cultural traditions, creating tensions between personal beliefs and evidence-based practices.
2) Some nurses held beliefs they had not examined critically and may not have been supported by evidence.
3) Nurses believed experience was an important source of knowledge, though personal experiences need to be evaluated critically rather than assumed to represent reality.
The study highlighted tensions between nurses' personal beliefs and critical health literacy expected in contemporary nursing practice. It also illuminated the need for nurse education to help nurses examine their own beliefs.
Public Health Essays. California Trinity School of BusinessNatalie Taylor
Writing public health essays is challenging for several reasons. It requires narrowing a vast field down to a specific focus, understanding complex research and data, integrating insights from different disciplines like sociology and economics, critically analyzing evidence to identify issues and solutions, and clearly communicating technical concepts to varied audiences. However, addressing pressing public health problems through well-researched essays is important for progressing knowledge and enacting change.
How many articles do i need to have for phd in public health pubricaPubrica
PhD pupils have to submit at least one research paper in a refereed journal and make two paper displays in conferences/seminars previously than the submission of the dissertation/thesis for adjudication and produce a proof for the same in the structure of presentation certificates and/or reprints.
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Discussion 1In today’s society, certain types of cultural barrie.docxcharlieppalmer35273
Discussion 1
In today’s society, certain types of cultural barriers in healthcare have the power to negatively impact outcomes and can lead to expensive consequences for health systems. Cultural competency refers to the ability to interact with people across cultures. When used in healthcare, it focuses on being able to care for patients with diverse values, beliefs, and behaviors. Today, the delivery of healthcare needs to be tailored to patients’ social, cultural and linguistic needs. According to the health care service company Cigna, cultural competency in healthcare can overcome health disparities. Some of these disparities include language barriers, cultural beliefs and practices, medical bias, variations in care access and quality, and low health literacy (Husson University, 2019).
The Purnell Model of Clinical Competence is a mid-range theory that is used for the research examining culture and within the context of culture and values. This theory was created by Larry Purnell and it was developed based on his observations of undergraduate nursing students and how they would interact with patients that are from different cultural backgrounds. In the United States, culturally competency is a key area for nurses and advanced practitioners (Marzilli, 2017).
Having the ability to communicate effectively with patients and their families is key for good patient care. The importance of communicating effectively in cross-cultural encounters is necessary. Cultural competence includes providing effective health care across diverse cultures by working collaboratively and communicating effectively. Advanced practice nurses and physicians who are aware of their own and their patients’ cultural backgrounds, along with the values that are often implicit in current medical models, are better able to achieve mutual understanding within the patient encounter and to focus on culturally appropriate health care interventions (Ladha et al., 2018)
With the Purnell Model, all aspects and domains of this model work by affecting one another, rather than standing alone. With this model there are specific cultural domains that include, heritage, communication, family roles and organization, workforce issues, bicultural ecology, high risk behaviors, nutrition, childbearing, death rituals, spirituality, health care practices and the healthcare practitioner (National Association for School Nurses, 2019).
As nurse practitioners, understanding the impact that cultural competence and interaction with your patients are key in quality patient care and trust. Cultural competency is relevant to healthcare education due to the fact that minorities will constitute 54% of the total United States population by 2050. The Purnell Model helps by evaluating the impact of interventions such as service learning and the change on cultural competence following the specific intervention. Research involving the Purnell Model is used as the theoretical framework for determining the h.
The document provides an overview of the key elements that should be included in a research proposal. It discusses the purpose of a research proposal is to convince others that the proposed research project is worthwhile and that the investigator has the competence and work plan to complete it. The main elements that should be included in a research proposal are an introduction section outlining the background, problem statement, objectives, literature review, methodology, ethical considerations, time schedule and references.
Disability Studies takes a multidisciplinary approach to analyze the complex interactions between social, cultural, political, economic, and physiological factors that shape disability experiences and policies. It seeks to locate differences within the broader context of cultural influences, rather than solely through a medical lens. Disability Studies also aims to conduct rigorous research and analysis to inform efforts toward social change.
Essay On Malnutrition. Florida Vocational InstituteLeah Roberts
Writing an essay on malnutrition requires extensive research into the biological, medical, socio-economic and environmental factors that contribute to its prevalence globally. It also demands the ability to synthesize information effectively and communicate complex ideas in a clear, concise manner so that all readers can understand the severity and implications of malnutrition. Producing a well-structured essay on this challenging topic involves a blend of skills including research, critical thinking and effective communication to create a compelling narrative that educates and raises awareness about malnutrition and its interconnectedness with other global issues like poverty and food insecurity.
The Social Dimensions of Health Institute (SDHI) conducts interdisciplinary research focused on the social aspects of health, well-being, and healthcare delivery. It has two main research strands: 1) exploring the social and environmental contexts of health and healthcare services, and 2) examining human resilience and capabilities, especially for those with disabilities. SDHI is a partnership between the Universities of Dundee and St Andrews, with the goal of conducting collaborative research, knowledge sharing, and capacity building through networking across disciplines and institutions.
This article analyzes students' epistemological reasoning patterns on socio-scientific issues across different cultures. The study found that students from different countries exhibited consistent trends in their epistemological beliefs and framed their justifications for socio-scientific issues similarly. While some cultural differences existed, there was an underlying commonality in how students across cultures approached these issues. The findings suggest epistemological beliefs may transcend cultural boundaries on certain scientific matters.
The purpose of the present study is to analyze the differences between the lifestyle and the scholar culture from the university student’s perspective of five different schools. The results were obtained by a quantitative study, with a traversal design, open and observational, and they were derivate from a descriptive and comparative analysis with the ANOVA one factor test. The sample was took on a random way; the total of participants was of 890. The results showed that the principal characteristics from the university students´ lifestyle is exercise, sports practice, physical activity, health and unhealthy food ingest, alcohol consume, smoking and sedentary lifestyle. It was conclude that the university students have a Lifestyle that could be classify in three aspects, the first one, their free time (leisure), that is usually employ on social network and frequent alcohol consume. The second lifestyle aspect is related with the scholar culture, in this sense, is associated with dedication and compromise with the academic activities of their school (doing homework, projects, expositions and extracurricular activities) and the last one, their alimentation, which is characterized by consuming two kinds of food, healthy and unhealthy (high caloric content food). The schools in the Autonomous University of Coahuila are systemically working on the development of new strategies of cultural promotion for the integral development of their students.
Cultural Competence in the Health Care Workforce.docxstudywriters
Cultural competence in healthcare can help reduce health disparities. This document discusses the importance of cultural competence among healthcare professionals in delivering equitable care to vulnerable populations. It provides definitions of cultural competence and describes how understanding a patient's culture, language and health beliefs can improve care quality and outcomes. The document also presents strategies for healthcare providers to practice cultural competence, such as learning about a population's health traditions and tailoring care to be respectful of their cultural needs and values.
INSTRUCTIONS2. For your replies (two minimum) you will need tTatianaMajor22
INSTRUCTIONS:
2. For your replies (two minimum) you will need to:
a. Respond to at least two other student who solved a problem different than you and comment on:
i. Do you agree or disagree with their thoughts on the types of distributions needed to solve each problem? Why or why not?
ii. Solve their problem and see if you got the same answer. Discuss why or why not you have the same or different answers.
iii. Would you add anything to their interpretation of the probability in their problem? Why or why not?
STUDENT 1:
STUDENT 2:
STUDENT 3:
STUDENT 4:
REVIEW Open Access
Medical professionalism: what the study of
literature can contribute to the conversation
Johanna Shapiro1*, Lois L. Nixon2, Stephen E. Wear3 and David J. Doukas4
Abstract
Medical school curricula, although traditionally and historically dominated by science, have generally accepted,
appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical
professional formation have led to discussions about the specific role and contribution of literature and stories. In this
article, we demonstrate how professionalism and the study of literature can be brought into relationship through
critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the
meaning of “professionalism” itself (as well as its virtues), thereby resisting standardization in favor of diversity method
and of outcome. Literature can also actively engage learners with questions about the human condition, providing a
larger context within which to consider professional identity formation. Our fundamental contention is that, within a
medical education framework, literature is highly suited to assist learners in questioning conventional thinking and
assumptions about various dimensions of professionalism.
Keywords: Medical professionalism, Professional identity formation, Literature, Health humanities, Medical humanities
Introduction
Over the past fifty years the study of literature has be-
come a generally accepted aspect of medical education.
As thoughtful scholars have recently considered how to
teach professionalism effectively and meaningfully, ques-
tions have arisen about the role of stories, essays, first-
person narratives, and poetry in facilitating the professional
identity formation of medical students. Those who argue
affirmatively imply that exposing students to literature will
inculcate professionalism virtues and attributes [1]. Those
who disagree assert that the study of literature has goals
and purposes unrelated to professionalism [2]. In this art-
icle, we investigate definitions of medical professionalism,
and frame its inclusion in the competency framework as an
effort to anchor its abstract virtues in behavioral specificity.
Next we consider how literature can advance our under-
standing of medical professionalism through a different
kind of sin ...
Dr. David Marcinko outlines new skills needed for healthcare and education professionals in the modern era. These include negotiation, teamwork, respecting different cultures, supporting evidence-based practices, fostering open communication, and exercising flexible decision making. He also emphasizes the importance of listening to patient and student narratives to provide compassionate care and effective teaching.
Discussion 1 (Lindsay)
Module 1 Discussion
Cultural competence is having the capability to effectively interact with individuals belonging to different cultures. Being culturally competent is essential in the nursing profession. Specifically, because advanced practice nurses (APN) care for many different cultural groups in the community. Cultural competence plays a significant role in eliminating and decreasing health care disparities. Therefore, APNs must have the ability to communicate appropriately with different cultural backgrounds to effectively treat patient’s health concerns in a manner that is acceptable to the patient.
The Purnell model defines culture as behavioral patterns, beliefs, values, lifestyles, and all other factors that influence the human work and thought characteristics of a group of people that guide their worldview and decision making (Purnell, 2005). The Purnell model was a framework designed to use across all disciples and practice settings to assess different cultures. Every healthcare discipline values communication and must know their patients ethnocultural beliefs. Healthcare providers are more effective in caring for patients when they understand ethnocultural diversity. The model is a circle with three rims, the outlying rim represents global society, a second rim representing community, a third rim representing family, and the inner rim representing the person (Purnell, 2005). The interior of the circle is split into 12 parts representing cultural domains and their concepts. The 12 cultural domains construct the framework of the model. The Purnell model was developed for multiple purposes. These include providing a framework to learn concepts and characteristics of culture; define instances that affect an individual’s worldview; provide a tool that links the most significant relationships of culture; interrelate characteristics of culture that promote congruence to deliver sensitive and competent care; provide a structure for analyzing cultural data; and view individuals, families, and communities within their unique ethnocultural environment (Purnell, 2005). Communicating in a culturally sensitive way can minimize prejudices and biases.
Culturally competent communication means communicating with mindfulness and knowledge of health disparities and understanding that sociocultural influences have important effects on beliefs, behaviors, and the skills used to manage these factors appropriately (Taylor & Lurie, 2004). It is also important to recognize and understand different communication needs and styles. For example, identifying patient language preferences, literacy levels, and level of English proficiency. Promoting culturally competent communication in the health care setting reflects high quality care and a holistic approach. Good patient-provider communication is associated with increased adherence to treatment plans, higher patient satisfaction, and improved health outcomes (Taylor & Lurie, 2004). ...
What is the value of studying humanities in a business or technical .pdfinfo785431
What is the value of studying humanities in a business or technical curriculum?
Solution
Having learned more about the myths and stories of Western civilization, I am understanding
more how study of the humanities (art, history, and literature) can be used to help people better
understand and communicate with one another. It is obvious that the study of humanities is not
just a college course, but it is an ongoing process and practice in life.
The humanities can first be used to understand the past which has created the present. The
culture which we have was shaped by the past. Facts, findings, and literature of even thousands
of years ago have influenced our world today. Knowing this past can allow people to understand
our present; knowing how we came to this present helps us to communicate about it and the
future.
The study of the humanities can also be used to realize differing interpretations of life and
history. Studying facts of the past helps to understand literature of the past. Art reflects the
cultures of the past, and shows how we achieved what we have today. For example, the Song of
Roland was very biased about the Saracens (Muslims). If one only studied literature, they would
have a totally skewed interpretation of who the Muslims were. By studying history though, we
know that the battle in this literature wasn\'t even against Muslims. Also by studying history and
religion we can see how Islam developed and what it really is. This is just one example of how
the comprehensive study of the humanities can be used to understand the world, and to
communicate fairly and intelligently with others in the world.
The humanities are not just part of the college\'s curriculum. The study of the humanities teaches
one how to study and look at how the past developed and how it has impacted today\'s world.
The humanities allows people of different cultures to communicate and understand their
sometimes common pasts but present differences. The humanities shows how different
disciplines affect and complement one another. Finally, the study of the humanities shows that
this study is ongoing and continual, constantly evolving and shaping.
Highly successful executives, entrepreneurs and policy makers offer words of wisdom about the
practical value of studying the humanities. “I think if you have a good background in what it is to
be human, an understanding of life, culture and society, it gives you a good perspective on
starting a business, instead of an education purely in business...You can always pick up how to
read a balance sheet and how to figure out profit and loss, but it\'s harder to pick up the other
stuff on the fly. ”
1. The humanities prepare you to fulfill your civic and cultural responsibilities.
The
reason that John Harvard left his library to the college in Cambridge,
Massachusetts, that Jane and Leland Stanford founded Stanford University, and
that states established land-grant colleges was to educate cultured and
useful citizens. T.
Harnessing the Potential of Important Social Topics in Academic Writing | Fut...Future Education Magazine
Here are 5 points on harnessing the potential of important social topics in academic writing: 1. Understanding the Significance 2. The Power of Academic Writing 3. Challenges and Considerations
The document examines literature on interdisciplinary education and teamwork in healthcare. It finds that as patient care becomes more complex, there is both an increase in medical specialization but also a need for collaboration between specialists. Healthcare teams with members from different professions can address this need by working closely together. However, the medical education system provides limited opportunities for interdisciplinary training to teach professionals how to function effectively on these teams. While team-based models of care show promise, many questions remain about how to best educate healthcare professionals for this approach.
19The Purnell Model forCultural CompetenceChapter 2.docxherminaprocter
19
The Purnell Model for
Cultural Competence
Chapter 2
LARRY D. PURNELL
This chapter presents the Purnell Model for Cultural
Competence, its organizing framework, and the assump-
tions upon which the model is based. In addition, American
cultural values, practices, and beliefs are presented to assist
non–native American health-care providers to understand
American ways. The American references are meant to
describe, not prescribe or predict, behaviors and practices.
Although the authors recognize that Canada and Mexico are
part of North America, American, as used in this chapter,
refers to the dominant middle-class values of citizens of the
mainland United States. Owing to space limitations, this
chapter deals not with the objective culture—arts, literature,
humanities, and so on—but rather with the subjective cul-
ture. Many Americans are not aware of the subjective culture
because they identify differences as individual personality
traits and disregard political and social origins of culture.
Many view culture as something that belongs only to for-
eigners or disadvantaged groups. However, when Americans
travel abroad, their host country inhabitants many times
stereotypically identify them as Americans because of their
values, beliefs, attitudes, behaviors, speech patterns, and
mannerisms. Some feel that Americans are “fun lovers” and
that, for some Americans, violence is a way of life. However,
“the right to bear arms” is guaranteed by the Constitution.
Most likely, the United States is not any more violent than,
or even as violent as, many other societies, but American
media coverage may be better than other countries, thereby
giving the impression that the United States is more violent
than it actually is. Accordingly, these stereotypes are not
always accurate or desirable.
Western academic and health-care organizations
stress structure, systematization, and formalization when
studying complex phenomena such as culture and eth-
nicity. Given the complexity of individuals, the Purnell
Model for Cultural Competence provides a comprehen-
sive, systematic, and concise framework for learning and
understanding culture. The empirical framework of the
model can assist health-care providers, managers, and
administrators in all health disciplines to provide holis-
tic, culturally competent therapeutic interventions;
health promotion and wellness; illness, disease, and
injury prevention; health maintenance and restoration;
and health teaching across educational and practice
settings.
The purposes of this model are to
1. Provide a framework for all health-care providers
to learn concepts and characteristics of culture.
2. Define circumstances that affect a person’s cul-
tural worldview in the context of historical per-
spectives.
3. Provide a model that links the most central rela-
tionships of culture.
4. Interrelate characteristics of culture to promote
congruence and to facilitate the delivery of con-
sciously sensitive and competent h.
are necessary for social program credibility. Similarorgan.docxjewisonantone
are necessary for social program credibility. Similar
organizations have evolved in other countries. With these
exemplars, the wonder is why schools of social work have not
developed comparable research capacity at the state and metro-
politan level.
In sum, Gray, Plath, and Webb have presented an important
book for critiquing the generation and application of data in
social work. The book addresses major epistemological issues,
and the overview of the globalization of EBP is impressively
detailed. The shortcoming of Evidence-Based Social Work is
that it fails to seize the opportunities implicit in the empirical
project. Thus, the authors conclude that EBP ‘‘may well be
replicating some of the most pernicious effect of ‘technological
reasoning’ in advanced capitalist societies’’ (p. 189). Doubt-
less, there is a downside to all institutional configurations: tech-
nology, economy, polity, education, and the like; at the same
time empiricism has been an important source of social reform.
In the midst of the worst recession since the Great Depression,
skepticism about empiricism may be current among university-
based intellectuals, but among those attempting to ameliorate
the rapidly deteriorating circumstances of people worldwide,
it remains the common denominator for addressing social and
economic injustice. Social work could play a larger role, in that
effort if it were more engaged in generating useful evidence. In
that respect, less rhetoric and more data, please.
References
Anastas, J., & Congress, E. (1999). Philosophical issues in doctoral
education in social work. Journal of Social Work Education, 35,
143-153.
Karger, H. J., & Stoesz, D. (2003). The growth of social work educa-
tion programs, 1985–1999. Journal of Social Work Education, 39,
279-295.
Kuhn, T. S. (1970). The structure of scientific revolutions. IL: Univer-
sity of Chicago Press.
Stoesz, D. (2005). Quixote’s ghost: the right, the liberati, and the
future of social policy. New York, NY: Oxford University Press.
Stoesz, D., Karger, H. J., & Carrilio, T. (2010). A dream deferred:
How social work education lost its way and what can be done
about it. New Brunswick, NJ: Transaction Books.
Wulczyn, F., Barth, R., Yuan, Y., Harden, B., & Landverk, J.
(2005). Beyond common sense. New Brunswick, NJ: Transac-
tion Books.
National Association of Social Workers. (2006). Assuring the suffi-
ciency of a frontline workforce: A national study of licensed social
workers. Washington, DC: Author.
LeCroy, C. W. (2008). Handbook of Evidence-Based Treatment Manuals
for Children and Adolescents (2nd ed.). New York: Oxford University
Press (624 pp, $65 hb, ISBN 019517741X)
Reviewed by: Elizabeth K. Anthony, Arizona State University
DOI: 10.1177/1049731509331878
The Handbook of Evidence-Based Treatment Manuals for
Children and Adolescents (2nd edition) is an important contri-
bution to the ongoing quest to intervene effectively with young
people. B.
The key elements of the Christian worldview are faith, love, forgiveness, and living in Christ. These elements are fundamental to Christ's teachings and reflect the author's own worldview. Living in Christ incorporates aspects like praise, prayer, and witnessing. However, the Christian worldview should focus more on redemption than reconciling the Bible with science. The overarching themes of the Bible can be summarized as creation, humanity, sin/fall, and redemption.
The document provides instructions for requesting writing assistance from HelpWriting.net. It outlines a 5-step process: 1) Create an account with a password and email. 2) Complete a 10-minute order form providing instructions, sources, and deadline. 3) Review bids from writers and choose one based on qualifications. 4) Review the completed paper and authorize payment if satisfied. 5) Request revisions until needs are fully met, with a refund option for plagiarized content.
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Application: Access to Quality Health Care for Vulnerable Populations
Access to quality health care for disparate populations is a critical challenge for today's health care organizations and for the health care system as a whole. In this Application Assignment, you will describe the advantages and challenges facing the health care system in providing equal access to quality health care.
To prepare
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intervention programs that have addressed these obstacles (e.g., prevention, screening, diagnosis, treatment, and rehabilitation). You can find examples of these on the internet or by searching the library databases (CINAHL). Try searching with your Healthy People area (i.e. obestiy; heart disease) as a key term as well as the word "intervention" or "program"). You may also try looking at professional organizations that address that health issue. For example, the American Diabetes Association sponsors a program called "Project Power" which addresses diabetes type 2 among African Americans—specifically for church settings.
In your paper, summarize the programs by including the following:
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In today’s society, certain types of cultural barriers in healthcare have the power to negatively impact outcomes and can lead to expensive consequences for health systems. Cultural competency refers to the ability to interact with people across cultures. When used in healthcare, it focuses on being able to care for patients with diverse values, beliefs, and behaviors. Today, the delivery of healthcare needs to be tailored to patients’ social, cultural and linguistic needs. According to the health care service company Cigna, cultural competency in healthcare can overcome health disparities. Some of these disparities include language barriers, cultural beliefs and practices, medical bias, variations in care access and quality, and low health literacy (Husson University, 2019).
The Purnell Model of Clinical Competence is a mid-range theory that is used for the research examining culture and within the context of culture and values. This theory was created by Larry Purnell and it was developed based on his observations of undergraduate nursing students and how they would interact with patients that are from different cultural backgrounds. In the United States, culturally competency is a key area for nurses and advanced practitioners (Marzilli, 2017).
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REVIEW Open Access
Medical professionalism: what the study of
literature can contribute to the conversation
Johanna Shapiro1*, Lois L. Nixon2, Stephen E. Wear3 and David J. Doukas4
Abstract
Medical school curricula, although traditionally and historically dominated by science, have generally accepted,
appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical
professional formation have led to discussions about the specific role and contribution of literature and stories. In this
article, we demonstrate how professionalism and the study of literature can be brought into relationship through
critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the
meaning of “professionalism” itself (as well as its virtues), thereby resisting standardization in favor of diversity method
and of outcome. Literature can also actively engage learners with questions about the human condition, providing a
larger context within which to consider professional identity formation. Our fundamental contention is that, within a
medical education framework, literature is highly suited to assist learners in questioning conventional thinking and
assumptions about various dimensions of professionalism.
Keywords: Medical professionalism, Professional identity formation, Literature, Health humanities, Medical humanities
Introduction
Over the past fifty years the study of literature has be-
come a generally accepted aspect of medical education.
As thoughtful scholars have recently considered how to
teach professionalism effectively and meaningfully, ques-
tions have arisen about the role of stories, essays, first-
person narratives, and poetry in facilitating the professional
identity formation of medical students. Those who argue
affirmatively imply that exposing students to literature will
inculcate professionalism virtues and attributes [1]. Those
who disagree assert that the study of literature has goals
and purposes unrelated to professionalism [2]. In this art-
icle, we investigate definitions of medical professionalism,
and frame its inclusion in the competency framework as an
effort to anchor its abstract virtues in behavioral specificity.
Next we consider how literature can advance our under-
standing of medical professionalism through a different
kind of sin ...
Dr. David Marcinko outlines new skills needed for healthcare and education professionals in the modern era. These include negotiation, teamwork, respecting different cultures, supporting evidence-based practices, fostering open communication, and exercising flexible decision making. He also emphasizes the importance of listening to patient and student narratives to provide compassionate care and effective teaching.
Discussion 1 (Lindsay)
Module 1 Discussion
Cultural competence is having the capability to effectively interact with individuals belonging to different cultures. Being culturally competent is essential in the nursing profession. Specifically, because advanced practice nurses (APN) care for many different cultural groups in the community. Cultural competence plays a significant role in eliminating and decreasing health care disparities. Therefore, APNs must have the ability to communicate appropriately with different cultural backgrounds to effectively treat patient’s health concerns in a manner that is acceptable to the patient.
The Purnell model defines culture as behavioral patterns, beliefs, values, lifestyles, and all other factors that influence the human work and thought characteristics of a group of people that guide their worldview and decision making (Purnell, 2005). The Purnell model was a framework designed to use across all disciples and practice settings to assess different cultures. Every healthcare discipline values communication and must know their patients ethnocultural beliefs. Healthcare providers are more effective in caring for patients when they understand ethnocultural diversity. The model is a circle with three rims, the outlying rim represents global society, a second rim representing community, a third rim representing family, and the inner rim representing the person (Purnell, 2005). The interior of the circle is split into 12 parts representing cultural domains and their concepts. The 12 cultural domains construct the framework of the model. The Purnell model was developed for multiple purposes. These include providing a framework to learn concepts and characteristics of culture; define instances that affect an individual’s worldview; provide a tool that links the most significant relationships of culture; interrelate characteristics of culture that promote congruence to deliver sensitive and competent care; provide a structure for analyzing cultural data; and view individuals, families, and communities within their unique ethnocultural environment (Purnell, 2005). Communicating in a culturally sensitive way can minimize prejudices and biases.
Culturally competent communication means communicating with mindfulness and knowledge of health disparities and understanding that sociocultural influences have important effects on beliefs, behaviors, and the skills used to manage these factors appropriately (Taylor & Lurie, 2004). It is also important to recognize and understand different communication needs and styles. For example, identifying patient language preferences, literacy levels, and level of English proficiency. Promoting culturally competent communication in the health care setting reflects high quality care and a holistic approach. Good patient-provider communication is associated with increased adherence to treatment plans, higher patient satisfaction, and improved health outcomes (Taylor & Lurie, 2004). ...
What is the value of studying humanities in a business or technical .pdfinfo785431
What is the value of studying humanities in a business or technical curriculum?
Solution
Having learned more about the myths and stories of Western civilization, I am understanding
more how study of the humanities (art, history, and literature) can be used to help people better
understand and communicate with one another. It is obvious that the study of humanities is not
just a college course, but it is an ongoing process and practice in life.
The humanities can first be used to understand the past which has created the present. The
culture which we have was shaped by the past. Facts, findings, and literature of even thousands
of years ago have influenced our world today. Knowing this past can allow people to understand
our present; knowing how we came to this present helps us to communicate about it and the
future.
The study of the humanities can also be used to realize differing interpretations of life and
history. Studying facts of the past helps to understand literature of the past. Art reflects the
cultures of the past, and shows how we achieved what we have today. For example, the Song of
Roland was very biased about the Saracens (Muslims). If one only studied literature, they would
have a totally skewed interpretation of who the Muslims were. By studying history though, we
know that the battle in this literature wasn\'t even against Muslims. Also by studying history and
religion we can see how Islam developed and what it really is. This is just one example of how
the comprehensive study of the humanities can be used to understand the world, and to
communicate fairly and intelligently with others in the world.
The humanities are not just part of the college\'s curriculum. The study of the humanities teaches
one how to study and look at how the past developed and how it has impacted today\'s world.
The humanities allows people of different cultures to communicate and understand their
sometimes common pasts but present differences. The humanities shows how different
disciplines affect and complement one another. Finally, the study of the humanities shows that
this study is ongoing and continual, constantly evolving and shaping.
Highly successful executives, entrepreneurs and policy makers offer words of wisdom about the
practical value of studying the humanities. “I think if you have a good background in what it is to
be human, an understanding of life, culture and society, it gives you a good perspective on
starting a business, instead of an education purely in business...You can always pick up how to
read a balance sheet and how to figure out profit and loss, but it\'s harder to pick up the other
stuff on the fly. ”
1. The humanities prepare you to fulfill your civic and cultural responsibilities.
The
reason that John Harvard left his library to the college in Cambridge,
Massachusetts, that Jane and Leland Stanford founded Stanford University, and
that states established land-grant colleges was to educate cultured and
useful citizens. T.
Harnessing the Potential of Important Social Topics in Academic Writing | Fut...Future Education Magazine
Here are 5 points on harnessing the potential of important social topics in academic writing: 1. Understanding the Significance 2. The Power of Academic Writing 3. Challenges and Considerations
The document examines literature on interdisciplinary education and teamwork in healthcare. It finds that as patient care becomes more complex, there is both an increase in medical specialization but also a need for collaboration between specialists. Healthcare teams with members from different professions can address this need by working closely together. However, the medical education system provides limited opportunities for interdisciplinary training to teach professionals how to function effectively on these teams. While team-based models of care show promise, many questions remain about how to best educate healthcare professionals for this approach.
19The Purnell Model forCultural CompetenceChapter 2.docxherminaprocter
19
The Purnell Model for
Cultural Competence
Chapter 2
LARRY D. PURNELL
This chapter presents the Purnell Model for Cultural
Competence, its organizing framework, and the assump-
tions upon which the model is based. In addition, American
cultural values, practices, and beliefs are presented to assist
non–native American health-care providers to understand
American ways. The American references are meant to
describe, not prescribe or predict, behaviors and practices.
Although the authors recognize that Canada and Mexico are
part of North America, American, as used in this chapter,
refers to the dominant middle-class values of citizens of the
mainland United States. Owing to space limitations, this
chapter deals not with the objective culture—arts, literature,
humanities, and so on—but rather with the subjective cul-
ture. Many Americans are not aware of the subjective culture
because they identify differences as individual personality
traits and disregard political and social origins of culture.
Many view culture as something that belongs only to for-
eigners or disadvantaged groups. However, when Americans
travel abroad, their host country inhabitants many times
stereotypically identify them as Americans because of their
values, beliefs, attitudes, behaviors, speech patterns, and
mannerisms. Some feel that Americans are “fun lovers” and
that, for some Americans, violence is a way of life. However,
“the right to bear arms” is guaranteed by the Constitution.
Most likely, the United States is not any more violent than,
or even as violent as, many other societies, but American
media coverage may be better than other countries, thereby
giving the impression that the United States is more violent
than it actually is. Accordingly, these stereotypes are not
always accurate or desirable.
Western academic and health-care organizations
stress structure, systematization, and formalization when
studying complex phenomena such as culture and eth-
nicity. Given the complexity of individuals, the Purnell
Model for Cultural Competence provides a comprehen-
sive, systematic, and concise framework for learning and
understanding culture. The empirical framework of the
model can assist health-care providers, managers, and
administrators in all health disciplines to provide holis-
tic, culturally competent therapeutic interventions;
health promotion and wellness; illness, disease, and
injury prevention; health maintenance and restoration;
and health teaching across educational and practice
settings.
The purposes of this model are to
1. Provide a framework for all health-care providers
to learn concepts and characteristics of culture.
2. Define circumstances that affect a person’s cul-
tural worldview in the context of historical per-
spectives.
3. Provide a model that links the most central rela-
tionships of culture.
4. Interrelate characteristics of culture to promote
congruence and to facilitate the delivery of con-
sciously sensitive and competent h.
are necessary for social program credibility. Similarorgan.docxjewisonantone
are necessary for social program credibility. Similar
organizations have evolved in other countries. With these
exemplars, the wonder is why schools of social work have not
developed comparable research capacity at the state and metro-
politan level.
In sum, Gray, Plath, and Webb have presented an important
book for critiquing the generation and application of data in
social work. The book addresses major epistemological issues,
and the overview of the globalization of EBP is impressively
detailed. The shortcoming of Evidence-Based Social Work is
that it fails to seize the opportunities implicit in the empirical
project. Thus, the authors conclude that EBP ‘‘may well be
replicating some of the most pernicious effect of ‘technological
reasoning’ in advanced capitalist societies’’ (p. 189). Doubt-
less, there is a downside to all institutional configurations: tech-
nology, economy, polity, education, and the like; at the same
time empiricism has been an important source of social reform.
In the midst of the worst recession since the Great Depression,
skepticism about empiricism may be current among university-
based intellectuals, but among those attempting to ameliorate
the rapidly deteriorating circumstances of people worldwide,
it remains the common denominator for addressing social and
economic injustice. Social work could play a larger role, in that
effort if it were more engaged in generating useful evidence. In
that respect, less rhetoric and more data, please.
References
Anastas, J., & Congress, E. (1999). Philosophical issues in doctoral
education in social work. Journal of Social Work Education, 35,
143-153.
Karger, H. J., & Stoesz, D. (2003). The growth of social work educa-
tion programs, 1985–1999. Journal of Social Work Education, 39,
279-295.
Kuhn, T. S. (1970). The structure of scientific revolutions. IL: Univer-
sity of Chicago Press.
Stoesz, D. (2005). Quixote’s ghost: the right, the liberati, and the
future of social policy. New York, NY: Oxford University Press.
Stoesz, D., Karger, H. J., & Carrilio, T. (2010). A dream deferred:
How social work education lost its way and what can be done
about it. New Brunswick, NJ: Transaction Books.
Wulczyn, F., Barth, R., Yuan, Y., Harden, B., & Landverk, J.
(2005). Beyond common sense. New Brunswick, NJ: Transac-
tion Books.
National Association of Social Workers. (2006). Assuring the suffi-
ciency of a frontline workforce: A national study of licensed social
workers. Washington, DC: Author.
LeCroy, C. W. (2008). Handbook of Evidence-Based Treatment Manuals
for Children and Adolescents (2nd ed.). New York: Oxford University
Press (624 pp, $65 hb, ISBN 019517741X)
Reviewed by: Elizabeth K. Anthony, Arizona State University
DOI: 10.1177/1049731509331878
The Handbook of Evidence-Based Treatment Manuals for
Children and Adolescents (2nd edition) is an important contri-
bution to the ongoing quest to intervene effectively with young
people. B.
Similar to A Community Based Approach To The Medical Humanities (20)
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A Community Based Approach To The Medical Humanities
1. See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/8779726
A community‐based approach to the medical
humanities
Article in Medical Education · March 2004
DOI: 10.1111/j.1365-2923.2004.01756.x · Source: PubMed
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Portland State University
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2. A community-based approach to the medical
humanities
Martin Donohoe & Susan Danielson
BACKGROUND This paper discusses the rationale
behind, and an approach to, the development of a
graduate level interdisciplinary curriculum in litera-
ture and health care that incorporates community-
based learning. Such an innovative approach emer-
ges from the recognition that professional training in
both health care and humanities programmes often
does not model the kinds of collaborative relation-
ships and professional values desired by con-
temporary health care students, providers and
patients.
METHOD Recent trends in literary study and the
medical humanities are described, along with the
function (and benefits to students) of interdisciplin-
ary classrooms and the role of community-based
learning in higher education. The authors discuss
their experiences teaching, and offer students’ re-
sponses to medical humanities courses from which
the concept for such a curriculum evolved. The paper
offers advice on developing, evaluating and dissem-
inating such a model curriculum for medical, nursing
and graduate literature students.
Proposal By linking health care with graduate English
literature students, such a course would promote
dialogue and understanding among health profes-
sionals, enhance student awareness of the effects of
illness on patients, their caregivers and families, and
encourage student activism and community service. A
common set of literary works would provide a shared
vocabulary and opportunities for ethical, critical and
personal response. Working together in a commu-
nity-based project, students from diifferent pro-
grammes would learn to appreciate alternative
professional and lay perspectives on common
experiences.
KEYWORDS curriculum; education, medical, under-
graduate, *methods; humanities, *education; inter-
professional relations.
Medical Education 2004; 38: 204–217
doi:10.1046/j.1365-2923.2004.01756.x
INTRODUCTION
This paper discusses the rationale behind and an
approach to the development of a graduate level
interdisciplinary curriculum in literature and health
care that incorporates a community-based learning
component. Such an innovative approach emerges
from the recognition that professional training in
both health care and humanities programmes often
does not model the kinds of collaborative rela-
tionships and professional values desired by con-
temporary health care students, providers and
patients.
The authors have each taught versions of the course
envisioned below. Dr Donohoe has designed courses
entitled ÔLiterature, Medicine and Public HealthÕ and
ÔThe Humanities and Social Sciences in MedicineÕ, in
which medical (and sometimes nursing) students
reflect upon and discuss literary selections that allow
them to experience vicariously the social, economic
and cultural contributors to health and illness, in the
hope that the students may be motivated to under-
take community service work on behalf of the
disenfranchised. Dr Danielson regularly teaches an
undergraduate ÔLiterature and Medicine in the
CommunityÕ course that has attracted premedical
and prenursing students, as well as humanities majors
who have an interest in health care issues. Recently,
she introduced a new interdisciplinary graduate
course entitled ÔIllness and CultureÕ that attracted
arts and humanities
Portland State University, Oregon, USA
Correspondence: Susan Danielson, PhD, English Department, Portland
State University, P.O.Box 751, English Department, 415 Neuberger
Hall, Portland, OR 97207-0751, USA. Tel: + 1 503 725 3569, Fax: + 1 503
725 3561. e-mail: daniel@pdx.edu
Blackwell Publishing Ltd MEDICAL EDUCATION 2004; 38: 204–217
204
3. students in Fine Arts, Gerontology, Literature, and
Social Work.
This call for a new course moves us outside our
separate spheres to try to imagine the basis on which
diverse communities seeking to address the common
goal of humanistic health care could be brought
together. By linking students from health profes-
sional programmes with those from the humanities,
such a course would promote dialogue and under-
standing among health professionals, enhance stu-
dent awareness of the effects of illness on patients,
their caregivers and families, and encourage student
activism and community service. Medical and nursing
students would have a structured opportunity to
discern their own values on diverse cultural and
professional issues in health care delivery. Simulta-
neously, humanities graduate students would learn
the role of literary and cultural analysis in health
professions education, and perhaps identify scholarly
and vocational opportunities in the applied human-
ities. As nonhealth care providers, these students
would enrich the conversation as all students work
together to interpret the relationships between cre-
ative literature and community service.
Two activities would establish the basis for this
dialogue. Firstly, reading a common set of literary
works would provide a shared vocabulary and
opportunities for ethical, critical and personal
response. Secondly, working together in a commu-
nity-based service project, students from different
programmes would learn to appreciate alternative
professional and lay perspectives on common
experiences. Technological resources would enable
conversations begun in class among students from
different programmes to continue, as learners share
their ideas and concerns about the literature and
their community service projects.
LITERARY STUDY
The 1997 Modern Language Association (MLA)
Committee on Professional Employment explored
Ôthe disparity between the expectations and assump-
tions about college teaching that most graduate
programmes inculcateÕ, as well as students’ job
placements when they left graduate school. The
report urged graduate programmes to introduce
students Ôto strategies through which abilities devel-
oped by higher education in the humanities can be
translated into proficiencies useful in nonacademic
careersÕ.1
For at least the last 10 years, traditional
literary study has evolved from a historically based
model to a theoretically based model, emphasizing
social and cultural contexts as well as aesthetic and
stylistic features. Literature is recognized as a repos-
itory and reflection of images and themes and as part
of a dynamic cultural process in which meaning is
created and contested. Courses coupling community-
based service projects with literary analysis could help
students identify the underlying skills in reading,
writing and critical, ethical thinking that accrue to
English majors and the resources that literature can
provide the health care community. For example, in
her article, ÔPassports for PhysiciansÕ, anaesthesiolo-
gist-poet Audrey Shafer identifies some of the ways
that language study can encompass and move beyond
bioethics case studies:
Language is one of the fundamental means of
linkage between two human beings; understanding
the nuances of language, its cultural and ethnic
variations, and its symbolic content are essential as
any skills the clinician may possess. The study of
stories can enhance Ôethical reflection.Õ and in fact
the more complex the situation, the more lan-
guage skills may help us ascertain differing value
systems and multiple perspectives. Certainly the
patient should not be reified into a text; rather
narrative skills should be viewed as a tool for
dialogic communication.2
Furthermore, coupling literary analysis with ques-
tions related to health care delivery would lead to
discussions concerning issues such as the historical
Key learning points
Interdiscuplinary curricula in the medical
humanites will promote dialogue, under-
standing and co-operation.
Audiences for interdisciplinary curricula
include health professionals, graduate litera-
ture students and other relevant communities.
Literature would build a shared language for
analysis of ethical and cultural health-related
issues.
Community service projects incorporated into
interdisciplinary medical humanities courses
would promote public service and social
activism.
205
Blackwell Publishing Ltd MEDICAL EDUCATION 2004; 38: 204–217
4. development of medical professionalism and chan-
ging definitions of health and illness as well as the
limits of professional medical care in the creation of
healthy communities.
THE MEDICAL HUMANITIES
In the early 1980s, the National Endowment for the
Humanities, the Association of American Medical
Colleges, the Accreditation Council on Graduate
Medical Education and the Society for Health and
Human Values called for increased emphasis on the
humanities in both undergraduate and graduate
medical education.3
By 1994, approximately one-
third of US medical schools offered formal elective
courses in literature, and more than 80% offered
some form of humanities instruction.4
Until recently,
literature and medicine courses were typically aimed
at medical students; today, most are still discipline
specific and reflect traditional approaches to litera-
ture and pedagogy.5
Literature and health care share a fundamental
concern: the human condition. Through literature,
readers would experience new situations, meet a
variety of people, explore diverse philosophies,
commute between particular examples and universal
truths6
and develop empathy with and respect for
others.1–10
Literature’s power lies in its ability to call
up and articulate feelings and to evoke vicarious
experience.11
Reading stories encourages imagina-
tion, appreciation of subtleties and ambiguities, and
the consideration of alternative viewpoints.12,13
It
increases the analytical skills of health professionals,
in that the subtleties and ambiguities of literature are
not unlike those of their patients.14
Furthermore,
reading literature encourages us all to examine the
ethical dilemmas created by medical science and the
economics of health care delivery.4,10–12, 15–17
Imaginative literature both inscribes and challenges
attitudes towards the body and towards various
therapeutic models, thus helping to demystify the rise
and success of particular forms of clinical medicine.
Cultural theory and reader-response criticism
encourage students to articulate their particular
relationship to a literary work: In what ways is a
student’s response to a work of literature contingent
on his⁄her particular location (professional and⁄
or personal) vis-à-vis the events or characters repre-
sented?
Various approaches to teaching literature and medi-
cine have been described, such as the ethical,
aesthetic, and empathic approaches of Jones18
and
Coulehan19
and the cognitive developmental, affect-
ive developmental, and cultural transmission
approaches of Self.5
Today, literature is employed
throughout health care for both instructional and
therapeutic purposes. Courses for medical and nur-
sing students have been well-received,4,10–12,20,21
although publication bias may limit information
regarding unsuccessful offerings. Physical diagno-
sis22
, psychoanalysis23 and
medical ethics15
are taught
through poetry and prose. Poetry, creative writing,
haiku, drama, essays, short stories and novels have
been utilized successfully in the treatment of patients
with chronic and terminal illnesses, intractable pain,
and cancer, as well as depression and schizophre-
nia.23–26
These media have been employed to foster
greater communication among hospital staff mem-
bers and between physicians and patients and their
loved ones.25–28
They are also used to teach healers
about the experiences of illness, suffering and death,
and thereby promote humanism in the practice of
medicine.2–28
Anthologies, scholarly journals, student
literary magazines and compendia of articles on the
rationale for teaching literature in medical schools
and on the practical applications of literature in
medicine have been published29,30
(see also Appen-
dix A) and an on-line database of literature, medicine
and the arts can be accessed via the World Wide
Web.31
INTERDISCIPLINARY CLASSROOMS
While literary study encourages broader professional
and cultural understanding, the interdisciplinary
classroom directly promotes communication across
disciplines and the integration of knowledge.32
It is in
professional education that most practitioners learn
their disciplines’ special languages and adopt their
disciplines’ stereotypes of those in other fields and of
the public they will serve. Although physicians and
nurses work together daily and the quality of the
relationship between physicians and nurses may be
linked to career satisfaction and longevity and key
indicators as patient mortality,33,34
medical and
nursing students often lack understanding of each
other’s training and responsibilities. They face
numerous barriers to communication in general and
with respect to the care of particular patients.35
As a
result, they may encounter difficulties providing well-
co-ordinated therapeutic support for patients recov-
ering from acute illnesses, those living with chronic
conditions, and these patients’ caregivers.34–36
Inter-
disciplinary classrooms in the medical humanities, in
combination with community-based learning, would
arts and humanities
206
Blackwell Publishing Ltd MEDICAL EDUCATION 2004; 38: 204–217
5. provide unique opportunities for students from
various health professions disciplines and from
graduate programmes in literature to learn from
each other as they negotiate the meaning of their
service placement and of the literary texts.
Benefits to graduate humanities students are theor-
etical and practical. Over the past decade, scholars
such as Arthur Frank, Arthur Kleinman, and David
Morris have appropriated postmodern theory to
enhance the reading of fiction in its relationship to
questions of personal and cultural health and illness.
Their work invites us to ask new questions of fiction
such as: In what ways is health defined in this text?
Are health and illness stable or mutable categories?
What are the relationships between bodily and
societal illness? What are the aspects of care giving
and who are their best practitioners? As a final
project in the ÔIllness and CultureÕ course, a Fine Arts
graduate student adapted Arthur Frank’s definition
of the communicating body to discuss the work of
Frida Kahlo and Katherine Sherwood. A nurse
practitioner returning for a Master’s degree in
Literature explored the representation of personality
disorder in contemporary film and developed a
brochure for clinicians in her rural community to
help them in diagnosing patients. Community-based
learning in health care enables literature students to
creatively explore the relationship between literary
studies and the community outside the academy.
Here they can explore the ways an engaged reading
can illuminate previously neglected aspects of a text
as well as potential careers and volunteer opportun-
ities in health care (e.g. poetry therapist, medical
writer), and the opportunity to hone their teaching
skills.
Obstacles to interdisciplinary classrooms include
scheduling difficulties, competing curricular de-
mands on health professions and humanities gradu-
ate students, a lack of interest in the humanities
among some medical students, resistance among
humanities graduate students to specialize so early in
their career, and different levels of ability in reading
and interpreting texts. These obstacles, while for-
midable, can be overcome through publicity, creative
scheduling of electives (e.g. evening sessions), selec-
tion of challenging but not obtuse texts, and the
support of deans and departmental leaders.
COMMUNITY-BASED LEARNING
Over the past decade, community-based learning has
emerged as a strategy to engage students in their
communities as part of their academic curricu-
lum.37,38
Community-based learning emphasizes the
direct connection between the academic content of a
course and the community service undertaken. Stu-
dents participate in organized activities that meet
identified course objectives and community needs.
For example, in a recent interdisciplinary medical
humanities course ÔLiterature and Medicine in the
CommunityÕ, undergraduates who were required to
participate in a 20-hour community-based learning
project provided emotional and logistical support for
Alzheimer’s disease patients and their families, cler-
ked at a homeless health clinic, assisted victims of
domestic violence at a shelter, and provided health
education at local public schools. By reflecting on
their experiences in light of the readings covered in
class and their own personal development, students
became conscious of the connections between aca-
demic and experiential ways of knowing38
and become
more critical thinkers and empathetic healers.
An older, returning student in this course, whose
community service was at a group home for five
developmentally disabled men ages 35–50, found
unusual connections between the play ÔWitÕ39
and his
role as a caregiver:
This class has opened my eyes to a problem with
the group home system…The state of Oregon
requires agencies like the one for which I work to
keep detailed records on the lives of residents.
After I had read the play, ÔWitÕ, it occurred to me
how invasive this data-collecting really is…Is
it…normal to have a person in your home who is
watching you constantly in order to record your
every move?
Although the student noticed this connection
immediately, events in his personal life, coupled with
the literature read for class, triggered his deepest
insights:
The unexpected benefit of taking this course came
in dealing with my personal life. The last three
months for my family have been absolutely crazy.
First my grandmother died…A couple of weeks
later my mother suffered a small heart attack. Then
three days later, someone else close to my family
died…my best friend Glen’s mother…a few days
after that, another one of my high school friends
drowned at Winchester Bay. After my mother had
been released from the hospital, the doctors found
a lump under her right arm…This is where I got
the most out of this class. I was writing journals
about my work at the group home when I realized
207
Blackwell Publishing Ltd MEDICAL EDUCATION 2004; 38: 204–217
6. that up to this point I had been more worried
about caring for the patients medically than I was
about caring for them emotionally…Since I real-
ized this, I have made an effort to pay careful
attention how the guys are feeling. Wouldn’t you
know it, in a short time it is already paying off. The
guys are more compliant and more enthusiastic…
Another student challenged herself by choosing to
do her service project at a local nursing home,
feeding elderly stroke patients and examining her
Ôown fears of disabling illness, again, and loss of
independence. The project put me face to face with
health issues I had never experienced. Dysphasia,
dementia, depression, the effects of a stroke, and the
world of the seriously ill patient and their caregivers
were all concepts that I became familiar with over the
quarter.Õ Her final reflective essay explored various
readings that illuminated her experience:
The most surprising literature that applied to my
service project was [Cortney Davis’ poem] ÔWhat
the Nurse Likes.Õ40
I was initially shocked by this
poem because of its detachment and almost
mocking tone towards patients. I learned through
this poem, through the narrator in [Rebecca
Brown’s] ÔThe Gifts of the BodyÕ,41
and through my
own observations that caregivers must find a place
within themselves to store the experiences of their
jobs. I first saw this attitude in the poem as
nonchalant and disconnected, but after closely
observing nurses and aides and being a caregiver
myself, I see this as a form of self-preservation. The
nurse in ÔWhat the Nurse LikesÕ defines the things
that keep her interested in her patients and
competent in her job. The narrator in ÔThe Gifts of
the BodyÕ eventually takes a break from her job.
These two seemingly contrasting medical charac-
ters both have a place of detachment that allows
them to lead a life of their own and care on an
emotional and physical level for their patients.
Thanks to my service project and the literature of
this course, I have been able to travel through the
process of caring and care giving. This process has
evolved from fear, revulsion, and lack of confid-
ence to sympathy and empathy, competence and
caring.
REINVIGORATING THE PATIENT–
PROVIDER RELATIONSHIP
Many patients are becoming increasingly dissatisfied
with the quality of the physician–patient relation-
ship.42–46
Some of the factors involved in producing
patient dissatisfaction are a product of the medical
school and residency environments, which can foster
depression, anger, fatigue and loss of empathy47
and
promote ageism48
and unfavourable attitudes toward
providing care for the underserved.49
Tending to
physical symptoms often overshadows health profes-
sionals’ attention to the psychological, economic,
social and cultural factors that prompt many outpa-
tient visits50
and cause as much functional impair-
ment as physical complaints.51
Patients often seek
help for hidden reasons, such as life stress, emotional
distress, psychiatric disorders, social isolation, and
simply for information.52
While literary study can help students learn to
recognize these underlying issues and the contribu-
tions of diverse cultural factors to health and illness,
community-based projects can provide an equally
potent ÔtextÕ for students to read. In tandem, the two
experiences would heighten students’ awareness of
subtle factors in their own and others’ responses to
clinical and ethical issues.
Under the pressures of market- and technology-
driven and technological changes in health care
delivery, the traditional model of the individual
physician–patient relationship is being trans-
formed.53
The 1998 Medical Schools Objective Pro-
ject Report I54
emphasized key themes for the future
of health professions education: understanding of,
and respect for, the roles of different health care
professionals, the need for collaboration in providing
care for individual patients, and promotion of the
health of diverse populations. Furthermore, health
professionals must be able to communicate effect-
ively, both orally and in writing, with patients,
patients’ families and colleagues. Our proposed
educational approach aims to help physicians and
nurses become adaptable, flexible collaborators.55
Physician and nurse scholars already recognize liter-
ary study and writing as a linguistic and cultural
resource for healing:
Literature. . .teaches something of the significance
of symbol and language as the media linking
human minds and personalities. Language is the
instrument of diagnosis and therapy, the vehicle
through which the patient’s needs are expressed
and the doctor’s advice is conveyed. Understanding
the nuances of language, its cultural and ethnic
variations, and its symbolic content are as essential
as any skills the clinician may possess.11
arts and humanities
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7. ÔLiterature, Medicine and Public HealthÕ courses
taught by one of us (M.D.) combine literature with
articles from contemporary medical periodicals to
promote discussion about the social, economic and
cultural determinants of illness.10
The journal articles
augment the literary texts by providing background
on the issues raised in the stories and by suggesting
areas for discussion, debate, research, intervention
and physician activism.
In one session, students read George Orwell’s ÔHow
the Poor DieÕ56
and Anton Chekhov’s letters descri-
bing the destitution he witnessed on his journey to
Sakhalin57
, along with periodical articles on socioe-
conomic inequalities in health58–60
and the health
consequences of economic inequities.61
Students
have commented on the regrettable timelessness of
these writers’ observations. In another session, they
read ÔThe Sky is GrayÕ,62
Ernest J. Gaines’s story of a
poor, single, African-American farm mother trying to
obtain dental care for her ill child, along with articles
on black–white disparities in health care.63
The
discussion of barriers to care faced by the poor and by
African-Americans inevitably turns to opportunities
for medical students and physicians to remedy health
disparities through volunteerism and activism. Stu-
dents also read Doris Lessing’s ÔAn Old Woman and
Her CatÕ,64
a moving fictional entrée into the daily
struggles of two unwanted creatures, an aged gypsy
and her adopted alley cat, trying to cope with life on
the streets of London. In the same session, they
discuss a study on the lifetime prevalence of home-
lessness65
and a clinical review of the health problems
commonly experienced by homeless individuals.66
Students have remarked that these pieces increased
their awareness of the struggles of society’s dispos-
sessed, and encouraged them to volunteer at the
university’s homeless clinic.
DEVELOPING A CURRICULUM
The literary works chosen for a model curriculum
would be drawn from a variety of genres and focus on
a broad definition of illness and on the interrela-
tionships among community and personal caregivers,
health professionals, and the ill or dying (see
Appendices A and C). Sources for material are
plentiful:
• essays by ill patients or their providers gathered
from such columns as ÔMedicine and the ArtsÕ
(Academic Medicine), ÔA Piece of My MindÕ (Journal
of American Medical Association) and ÔOn Being A
PatientÕ and ÔOn Being a DoctorÕ (Annals of
Internal Medicine), or Mandell and Spiro’s book,
When Doctors Get Sick;67
• works of physician-authors such as John Keats,
Anton Chekhov, Somerset Maugham, William
Carlos Williams and others;
• writings of famous artists and authors about their
own experiences with illness, such as Keats
(tuberculosis, depression), Emily Dickinson
(depression), William Styron (bipolar disor-
der⁄depression), and Flannery O’Connor (sys-
temic lupus erythematosis);
• works by caregivers, such as Jewett’s The Country of
Pointed Firs68
or poems and short stories by nurses
as in Davis and Schraefer’s Between the Heartbeats;
• selections suggested in Academic Medicine’s ÔMedi-
cine and the ArtsÕ column; and competing repre-
sentations of illness and community, as in Rudolfo
Anaya’s Bless Me, Ultima69
and Charles Chesnutt’s
Conjure Woman;70
• works focusing on the health consequences of
poverty, sexism, racism, homelessness and isola-
tion, such as Grace Paley’s ÔAn Interest in LifeÕ,71
Michael Lacombe’s ÔPlaying GodÕ,72
Langston
Hughes’ ÔJunior AddictÕ,73
Lars Eighner’s Travels
with Lizbeth74
and John Updike’s ÔFrom the
Journal of a Leper.Õ75
Students would be asked to write narratives from
patients’ perspectives. Topics might include: the
patients’ understanding of his⁄her disease or dis-
ability; the impact of the disease or disability on the
patient’s life, work, and relationships, emphasizing
the physical, mental, and emotional suffering associ-
ated with the illness and its treatment; the patient’s
expectations of medical care; and the patient’s
preferences for end-of-life care and proxy decision
making. Students could discuss the differences and
similarities between the voices of patients and care-
givers as represented in popular culture and in the
medical and nursing literature.
Several approaches to community-based service
learning are possible. One is modelled on ÔThe
Family Stories Workshop.Õ27
In this programme,
students placed in nursing home settings work with
patients’ relatives to develop life stories of residents
suffering from dementia, which they then recount to
staff caregivers. Another model, developed by Rita
Charon,8
has small groups of students observe each
other performing open-ended interviews with a single
209
Blackwell Publishing Ltd MEDICAL EDUCATION 2004; 38: 204–217
8. patient; all students are eventually allowed to interact
with the patient. Each student then writes an account
of the patient’s illness using the narrative voice of the
patient. Students then share their writing with each
other and with the group. Alternatively, as patients’
case histories (including the medical record), oral
case presentations, and published case reports are
formative instruments that shape as well as reflect the
thought, the talk and the actions of trainees and their
teachers, students would analyze these for Ôlanguage
maladiesÕ and suggest remedies for the maladies.76
Another approach, open to both pre- and nonpro-
fessional students, involves placements at local health
clinics, where students work in a variety of capacities,
serving the needs of the organization and its cli-
ents⁄patients and recording their observations in
ÔIncident⁄Reflective Journals.Õ In fact, a key compo-
nent of community-based service learning and one
that unites all these approaches is the Reflective
Journal.77–79
Portions of the curriculum would be devoted to
representations of health and disease in immigrant
literature, cultural differences among patients, care-
givers and providers, and issues of diversity and access
to care. Guest speakers from the community would
share their experiences with the students. Questions
to be considered might include: What are the cultural
barriers affecting health care delivery? What re-
sources can help us identify those barriers? In what
ways can literature and community projects help us to
address such problems? From the reading, commu-
nity project, and self-reflection, can we identify areas
where health care providers ÔmisreadÕ a situation?
Areas where care and healing are at odds with the
goals of professional care givers? Areas where the
patient (or the nurse, or the community) is offered
respite unavailable in bio-medicine? and in what ways
does imaginative literature include and exclude
different community voices?80,81
CURRICULUM EVALUATION
Curriculum evaluation would be both formative and
summative. Formative evaluation would include a
review of syllabus materials and methodological
approaches by a local advisory board. Community
placements supervisors might be invited to evaluate
student participation in their programmes. Faculty
would analyze the discourse utilized by students in
their reflective journals, in terms of the capacity of
students to notice interconnections between com-
munity placement and literature. Students would
evaluate, through numerical ratings and narrative
responses, reading selections, classroom discussions,
community placements, teaching methodologies and
instructors.
Summative forms of evaluation would include
administering the RIPLS (Readiness for Inter-pro-
fessional Learning Scale), designed to assess the
strengths of beliefs in the benefits of interprofes-
sional learning held by health care students, at the
beginning and end of the course.55
Follow up
interviews one or more years after completion of the
curriculum might address the following:
• effect of the course on students’ attitudes toward
and involvement with other health care providers,
their patients, and their patients’ caregivers;
• ways in which graduate literature students chan-
ged their scholarly agendas and⁄or career goals;
• health professionals’ current reading, writing and
community service activities.
FOLLOW-UP AND DISSEMINATION
Students would be encouraged to submit their
creative and nonfiction work to essay contests and to
literary, medical and nursing journals. They would be
encouraged to offer panels or round table discussions
to inform other students of interconnections and
insights. Faculty would publish their curricula and
share their experiences with local colleagues in
health professions and humanities education, and at
national meetings of organizations such as the
American Society for Bioethics and Humanities, the
Modern Language Association, the American Studies
Association, and national medical organizations.
CONCLUSION
Interdisciplinary curricula in literature and health
care that incorporate a community-based learning
component offer potential benefits to health profes-
sion and graduate humanities students, including
greater understanding of the nature of health and
illness, enhanced communication among providers,
improvements in the provider–patient relationship,
and development of skills and attitudes likely to
benefit students in their future endeavours. Ideally,
students will be motivated to read more broadly,
think more critically, and become more involved in
public service and social activism.
arts and humanities
210
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9. ACKNOWLEDGEMENTS
The authors thank Linda Ward for excellent techni-
cal assistance.
No sources of funding are associated with this
manuscript.
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APPENDIX
Other Suggested Readings:
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