Cooper Medical School of Rowan Univerisity
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The Selectives

Mandatory for all students in the M1 and M2 Classes

Objective: The Selectives in the Medical Humanities are intended to create a well-rounded physician with a background in the arts as well as the sciences and to foster the development of creative, empathic, and intellectually adaptable physicians who are capable of using their right hemisphere as well as their left. The compilation of courses is meant to provide students with various perspectives and thereby facilitate problem-solving and creativity in multiple arenas.

Employing the arts and the humanities serves multiple purposes. The first is to create physicians who can develop a tolerance for ambiguity, a trait so needed in clinical practice. Second, encountering the experiences of others via the surrogate means of literature, fine art, film, philosophy, etc. allows students to empathize with their patients and colleagues. Third, wisdom is a key feature in decision-making and there are few aspects of a physician more important than possessing the ability to make truly wise decisions. Over the course of our short lives, we may not acquire all the experiences necessary to become wise in and of ourselves but the knowledge accrued in 40,000 years of recorded history provides us a window to the experiences of all those who have gone before us. Fourth, being able to access and develop a different aspect of cognition facilitates problem-solving and creativity in multiple arenas. Those physicians with a humanities background have been noted to surpass their colleagues with science backgrounds even if they do struggle more in the beginning of their training. Musicians (and Albert Einstein) have been noted to have a larger corpus callosum and right/left brain communication is a hallmark of flexible, “out-of-the-box” thinkers. Developing our interests outside of pure information acquisition expands our horizons, providing a buffer to the burnout that many in the medical field face and affording us personal fulfillment.

Selectives are offered on a rotating basis. The selectives will consist of 6 sessions over a semester which will run the fall and spring of each year although different courses may be available during the fall and spring to minimize the burden on our course directors. While most will meet on Friday afternoons from ~1:30-3:30pm), the expansion of the humanities curriculum has allowed the opening of additional time slots. All selective require approximately the same time commitment.

Selectives:

Applied Medical Ethics
Art of Observation
Dance and Medicine
Death, Dying, and Bereavement
Emotional Intelligence
Exploring Medicine through Composition
Medical Cineforum
Medical Improvisation
Mindfulness
Observational Drawing for Future Physicians
Opera and Medicine
Physician Personality
Script-Writing
Social Determinants of Health
Social Mission of Medical Schools
Theater and the Role of Role-playing
World Cultures and Dance
Writing to Persuade and Convince


Elizabeth Cerceo, MD

Applied Medical Ethics

Reconciling the needs of patients, families and communities with the practical considerations of medical decision making is a nuanced and increasingly complex process. This course provides an overview of current approaches to resolving ethical issues facing clinicians in private office and hospital practices and academic medical settings. The entire span of medical ethics including death and dying issues and research ethics will be covered in case based and current issue formats. Student team debates and a variety of interactive formats will be utilized in the course.

Art of Observation

This course offers medical students a chance to add a humanities element to their course of study, focused particularly on widening their understanding of the historical relationship of collaborative discovery between medicine and art. Students will be introduced to research showing that observational skills for clinical application are proven to be enhanced by learning to look at art, and will be asked to participate in a series of exercises to improve their own acuity of vision and diagnosis.

Dance and Medicine

This curriculum will incorporate ideals from Transformational Learning Theories. John Dirkz describes learning as a “…democratic vision of society and self-actualization of individuals.” He further explains that learning requires an awareness of feelings and emotions within the learning setting. Learning must be meaningful and reflect the relationship of self and society. In the case of this course, students should reflect on their relationship with patients. It is the aim of the Dance and Medicine Course to help students understand the feelings and emotions of self and to further understand the feelings and emotions of others. The committee wants students to find common ground with others and develop relationships that will lead to exceptional patient care. N.B.: Students should wear yoga attire because each session will include movement and dance to help the students understand their own body.

Death, Dying, and Bereavement

This course focuses on death education, thereby bringing attention to an often hidden, but significant dimension of human development. The course is designed to provide medical students who deal directly with dying, death and bereavement an overview of the topics, trends, research and issues that are current in the field of thanatology today. Through a series of assigned readings, students will have the opportunity to explore and evaluate medical, ethical, emotional, spiritual and cultural topics that constitute ongoing issues in the field. Topics are centered on new definitions of death; dying and death across the life cycle; the dying process; ongoing ethical questions connected with dying and death; and current concepts in the grieving process. Students who are specializing in emergency services, hospice care, and gerontology are among those who will especially benefit from the subjects covered in this course. Regardless of the specialty area chosen by medical students enrolled in the program, however, each student who takes this course is certain to learn information that will serve to enhance the doctor-patient relationship and improve their overall performance as medical care professionals.

Emotional Intelligence

This course will introduce the humanities in medicine through the exploration of emotional intelligence. Students will be presented with an overview of the origins of the theory of emotional intelligence, learn about the two leading models of emotional intelligence and explore the role of emotional intelligence in leadership, teamwork and empathy. The course will involve independent student activities and group activites during the course sessions. The course directors are available to consult with students during the regular school day by appointment or via email.

In 1983, Howard Gardner introduced the idea that traditional types of intelligence, such as IQ, fail to fully explain cognitive ability. He posited that multiple intelligences included both interpersonal intelligence (the capacity to understand the intentions, motivations and desires of other people) and intrapersonal intelligence (the capacity to understand oneself, to appreciate one's feelings, fears and motivations).

In 1990, Mayer & Salovey described emotional intelligence as, "the subset of social intelligence that involves the ability to monitor one's own and others' feelings and emotions, to discriminate among them and to use this information to guide one's thinking and actions." This model, which expanded with the addition of Davied Caruso, to an EI blueprint of perceiving emotion, using emotion, understanding emotion and managing emotion.

In 1995 Daniel Goleman adapted the model to leadership in the business environment in a groundbreaking article in the Harvard Business Review. Goleman organized the model into the the categories of personal and social competencies.

Literature on EI in medical students theorizes that self-aware students are able to assess both their emotions and their skills, and that students who successfully self-manage are able to recognize and use their emotions, both positive and negative, to control their environments and outcomes. Empathy, understanding and responding to the emotional needs of others, is a subscale of emotional intelligence that is highly relevant in the work of all healthcare professionals.

Exploring Medicine through Composition

This course will introduce the humanities in medicine through the dynamic medium of musical composition. Students will be presented with an overview of concepts in music but no musical training is required. The course will involve independent students’ activities during the day (mostly work on compositional projects from the prior class session) plus discussions and composers workshop with the course director during the course sessions. The course director is available to consult on student work through email, and by prior appointment, through Skype (rdammers). Music, through the intentional organization of its elements, can express and evoke emotion and feeling through time (just as we experience feelings through time). Through making expressive musical decisions, a composer can explore and refine their understanding experience of being human. In this instance, composition can provide a platform for physicians to explore the affective side of their patients and their own experiences of illness, medical procedures, and recovery. No prior musical experience is required for this course. Music software such as Soundation, provides an environment in which anyone, regardless of musical background or ability, can make expressive musical decisions at some level. While Soundation is geared toward vernacular styles of music, students will be free to create in the musical styles of their choice, as their ability and software allows.

Medical Cineforum

Movies have a powerful influence on popular culture. Doctors are among the professionals most frequently portrayed in movies. Hence, cinematic depictions of physicians have the potential to affect public expectations of physicians, and the doctor-patient relationship. The portrayals of doctors in movies at times may be inspiring, at other times disturbing, but are always thought provoking. Empathic physicians will want to know how their patients perceive them and what expectations they bring to the encounter. Through this course, students will explore key themes underlying the portrayal of doctors in the movies, and by doing so, show students aspects of the physician’s persona with which they may otherwise be unfamiliar, and which affect the public perception of our profession. This course will focus on nine movies. Using a written guide, students will independently view the movies, and participate in subsequent discussions led by the course directors.

Medical Improvisation

“Medical Improvisation” is a theatre improvisation course in which students will actively engage in a sequence of exercises designed to build their listening, responding, and observation skills. Students will improve their cognition by working creatively in groups as they explore storytelling, character development, role- playing, status, reading emotions, and multi-tasking in the six sessions. Through assigned readings and discussion, students will analyze the relevance of theatre improvisation and its usefulness in the medical workplace. The goal is to prepare future doctors for the profession by actively engaging them in improvisational exercises that allow them to build skills that are essential to their work while providing them with an experience that is fun, imaginative, and creative as an alternative learning experience in their clinical and basic science education.

Mindfulness

Mindfulness meditation (MM) is a skill that has been successfully taught both with a teacher present as well as via guided meditation tapes (Ditto, Eclache, & Goldman, 2006, Evans-Chase, 2014). Successful integration of MM into individual practice has been found with programs ranging from 45-minute sessions once per week for 4 weeks (Jain et al., 2007) to 2-hour sessions once per week for 8 weeks (Ramel, Goldin, Carmona, & McQuaid, 2004). The three components common to most definitions of MM practice include present awareness, or having one’s awareness in the present moment; nonjudgmental awareness, or being aware of but not judging the emotions, thoughts, or events of the present moment as good or bad; and acceptance, or accepting the emotions, thoughts, or events of the present moment as they are (Biegel, Brown, Shapiro, & Schubert, 2009; Burke, 2010). Effects associated with MM include lowered anxiety, depression, anger and worry; a greater sense of well-being; increased emotional control; lowered levels of cortisol; an increased ability to reduce harmful behaviors such as binge eating, smoking, and substance use (Greeson, 2009); pain relief (Zeidans, Emerson, Farris, Ray, Jung, McHaffie, & Coghill, 2015); and reduced insomnia (Martires & Zeidler, 2015).

We will explore

  1. Mindfulness Meditation as one specific type of meditation and one way to increase Mindfulness
  2. Outcomes associated with MM
  3. Key elements of MM practice
  4. Neural activity and structural changes associated with MM practice
  5. Implications of key elements and neural activity/structural changes with special populations
  6. Implications of key elements and neural activity/structural changes to the use of other popular techniques to increase Mindfulness

Observational Drawing for Future Physicians

Like a master detective, the astute physician is a precise observer. There is no better way to hone one’s observational skills than to learn to accurately record what one sees. Observational drawing teaches students how to pay attention to detail and translate their perceptions into a picture of their own. This course will utilize a “life drawing” environment for a focus on core drawing skills, methods, and materials. Compositional elements, visual perception, proportion, value, line, shape and form relationships will be emphasized in this course. Students will be introduced to various mark making and blocking techniques and a small compliment of drawing materials.

Opera and Medicine

Opera is musical drama and provides a heightened sense of emotion through the nonverbal (both in acting, in staging, and of course in the music itself) and verbal (the libretto and the music). Music and socio-cultural analysis are possible because of a dynamic relationship which Lawrence Kramer calls a "network of social, intellectual, and material conditions that strongly, though often implicitly, affect meaning." While it is embedded in the cultural context of their time, Western operas have explored much of what is essential to the human condition, desires, needs, anxieties, fears, disease, and death. Understanding the depths of the human condition and all of its complexity cannot be reached through a unilateral approach. However, adopting a multimodal approach, such as that offered by opera with its visual and aural sides, brings us closer to this understanding. This is not a simple assertion of music's ineffable power to move the emotions or, on the other hand, a technically advanced theory available only to musicologists. Rather, the course seeks to combine medical and cultural history with literary and dramatic analysis. Just as the barriers separating the different arms of the sciences have begun to dissolve, so to should the divide between science and humanities, the one used to compliment the other. We will explore the portrayal and use of disease and death in five operas as well as the various portrayals of the physician in opera. This course requires student attendance at one live opera.

Physician Personality

This course will introduce social science and humanities through an exploration of the physician-patient clinical encounter. In this course, we examine the clinical encounter in which participants bring their own, and often differing definitions of the situation.

Medical educators have struggled to maintain and improve the empathy and compassion of their students. Research suggests they diminishes with each year of training, but especially with the start of clinical training. Both the physician and the patient seek the essential competence and caring in the encounter, i.e. treatment and healing. How¬ever, how the physician and patient each understand and interact on the expectations of competence and empathy is a product of differing definitions of the situation, specifically emanating from their respective defini¬tions of embodiment. The physician’s sense of embodiment, a product of medical training, is often labeled the “biomedical model’ or “medicalized body.” At the same time, the patient brings a sense of embodiment best understood as “the lived-body.” The lived-body, as the name suggests, is an interpretative product of the interaction between biology, psychosocial and sociocultural experiences of daily living of each person. These two views of embodiment generate differing understandings of what constitutes disease and illness that the physician and patient bring to the clinical encounter. This dilemma is exacerbated by the relational asymmetry of power, knowledge and privilege between the physician and patient which serves to impede the development of trustworthiness in clinical encounters.

We discuss the notion of the “working personality” of the physician. The working personality of the physician is a socially constructed understanding of the nature of the work; its dictates, required skills and knowledge, clinical experience and ethics focused on the physician’s worksite, i.e., the human body as contextualized by the profession’s application of the biomedical model. We examine the nature of the worksite to understand the components of the physician’s working personality. The patient’s sense of embodiment is conceptualized as the existential self, the lived-body which is theorized as a non-Cartesian holistic notion. These two views of embodiment generate differing expectations during the physician-patient encounter. We delineate these differing expectations, i.e., treating and healing, in an attempt to better understand the relational deficits such as empathy and compassion in clinical encounters. The course draws on the psycho-social, cultural and philosophical aspects of embodiment and professionalism. Additionally it draws on the instructor’s training in relational therapy.

Script-Writing

This course will introduce the art of story-telling to medicine. Educational activities focus on the practical process of script writing with special attention to the following elements: Dramatic tension, character development, dialogue construction, artistic exploration, creative imagination, and action/spectacle. Students will write monologues and short scenes based on actual or imagined medical scenarios as a creative means to explore, express, and build empathy for others. Students will read, write, and ultimately perform dramatic scenarios in order to strengthen communication and collaborative skills and to creatively imagine, create, and express complex, dialogue-driven doctor/patient interactions. Reflective, group discussions will take place and all writing and performing exercises will be based on sound, ensemble based academic practice. We anticipate 10 to 15 students in the class and there will be 2 instructors in the session: one focused on acting/directing and one focused on dramatic writing. Additionally, students from the Rowan Department of Theater and Dance may be invited to attend the class to demonstrate various acting techniques and perform needed roles in student written work.

Social Determinants of Health

The “Social Determinants of Health” (SDH) offers a perspective on health and illness that departs from a commonly-held view that health exists in the absence of disease, while disease is reduced to a deviation from “normal” biological conditions. In contrast, the SDH perspective views health and illness as the product of social conditions that foster or discourage individual or collective well-being. Fundamentally it asks how access to social resources – e.g., jobs, income, education, housing, connections, status – affects health and illness. The SDH perspective alerts us to everyday social realities that shape the health and illness of individuals, communities, and populations. Understanding these realities can enhance the effectiveness of health professionals in their roles as clinicians and as concerned citizens.

This course relies on videos, readings, statistics, powerpoints, and other tools to help inform students about how diverse social conditions shape health and illness, and to stimulate engagement and discussion of the SDH perspective and how it may apply to everyday practice.

Social Mission of Medical Schools

Do medical schools have a mission beyond the successful education of physicians? Should medical schools be accountable to the broader society? Beginning with a review of the landmark 1910 report by Abraham Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching, and the resulting changes in medical schools, this selective will explore the traditional “metrics” by which these institutions have been externally evaluated and rated. The Historically Black Medical Schools (HBMS) will be utilized as examples of institutions with clearly defined goals and social missions. Recent perspectives on the social missions of medical schools will be incorporated into discussions regarding the future importance of these institutions as change agents to improve society beyond health equity. Students will have the opportunity to review and discuss CMSRU’s mission, vision and values and the relevance of these to the direction currently envisioned for our school. Students will develop a CMSRU social mission scale to delineate the measures of success in achieving a social mission for our school and for other schools.

Theater and the Role of Role-playing

Educational activities will focus on topics such as emotion expressed in the dramatic scripts, the embodied physical and vocal reactions of others and the benefits of drama as therapy and as a means to build empathy for others. The goal is to prepare future doctors for the profession by actively engaging them in replicating the standard patient care model, where doctors practice interacting with simulated patients and/or colleagues in constructed, “real life” hospital and office scenarios. Students in the class will construct and perform relevant scenarios with class peers in order to strengthen communication and collaborative skills and to physically practice developing effective strategies to defuse potentially fraught encounters with simulated patients. Reflective, group discussions will take place and all acting exercises will be based on sound, ensemble based academic practice. We anticipate 10 to 20 students in the class and there will be 2 instructors in the session. The Course Director will be present at each class with a member of the theatre faculty. Additionally, 3 or 4 students from the Department of Theater and Dance will attend the class to demonstrate various acting techniques and exercises. Other presenters may be present depending on the session.

World Cultures and Dance

This course will introduce the art of story-telling to medicine. Educational activities focus on the practical process of script writing with special attention to the following elements: Dramatic tension, character development, dialogue construction, artistic exploration, creative imagination, and action/spectacle. Students will write monologues and short scenes based on actual or imagined medical scenarios as a creative means to explore, express, and build empathy for others. Students will read, write, and ultimately perform dramatic scenarios in order to strengthen communication and collaborative skills and to creatively imagine, create, and express complex, dialogue-driven doctor/patient interactions. Reflective, group discussions will take place and all writing and performing exercises will be based on sound, ensemble based academic practice. We anticipate 10 to 15 students in the class and there will be 2 instructors in the session: one focused on acting/directing and one focused on dramatic writing. Additionally, students from the Rowan Department of Theater and Dance may be invited to attend the class to demonstrate various acting techniques and perform needed roles in student written work.

Writing to Persuade and Convince

Successful physicians must be able to write clearly and convincingly. This is true whether the student plans a career in patient care, education, research, administration, advocacy, population health, or some combination. To write persuasively and convincingly requires more than just good vocabulary and grammar. Persuasive writing requires skill in constructing a logical argument from a set of facts, and presenting that argument in a compelling and elegant essay. Logical arguments often use the classical rhetorical devices of logos, pathos, and ethos. This course will review classical rhetoric, as well as some of the latest science about how an audience responds to persuasive writing. This course also will help students practice crucial writing skills by having them critically analyzing good and bad essays, and by writing short pieces of their own.