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Cultural Context in Medical Humanities: Lessons from Turkey
LETTER
Cultural Context in Medical Humanities: Lessons from Turkey To the Editor: In the past few decades, there has been increasing interest in establishing medical humanities as the core integrated provision in medical curricula, especially in the US, Canada, the UK, and Europe.1 Several papers, including a brief observation in The American Journal of Medicine,2 have tried to set out a vision for medical humanities’ role in teaching empathy in medical education. However, little attention has been paid to local experiences about the implementation of this concept in different countries.3 During my 3-year experience in teaching medical humanities at a Turkish university that enrolled both Turkish and international students from Africa, Europe, and the Middle East, I have observed that higher rates of cultural diversity among students have had significant influence on the efficiencies of medical humanities courses, and the expected outcomes from the course and students’ interest in course materials have had a large amount of variance. This is presumably because of the non-culture-specific educational materials used for the course. Hooker and Noonan4 have argued that the current concept of medical humanities is culturally limited by “a distinctive emphasis on Western cultural artefacts” and “a tendency to enact an uncritical reliance upon foundational concepts within Western medicine”.4 Agreeing with this, Funding: None. Conflict of Interest: The author has no conflicts of interest to disclose. Authorship: The author is solely responsible for writing this manuscript.
0002-9343/$ -see front matter Ó 2016 Elsevier Inc. All rights reserved.
people coming from different cultures have different values toward patients, illness, and care. For instance, the precepts of Western bioethics such as autonomy and truth telling may clash with non-Western cultural mores; and attitudes toward end-of-life care, abortion, and genetic engineering may differ across cultures.5 Therefore, it is suggested that the lecturers of medical humanities courses carefully select the course materials because cultural conflict can lead to emotional disturbance, self-defeating behavior, and hence, decline in empathy among students from diverse social and cultural backgrounds. Incorporating local experiences in medical humanities courses will also help students to recognize and appropriately address some culture-specific bias that occurs in health care delivery in their own countries. Halil Tekiner, PhD Department of the History of Pharmacy and Ethics Erciyes University School of Pharmacy Kayseri, Turkey
http://dx.doi.org/10.1016/j.amjmed.2016.10.034
References 1. Bleakley A. Medical Humanities and Medical Education: How the Medical Humanities Can Shape Better Doctors. New York: Routledge; 2015. 2. Graham J, Benson LM, Swanson J, Potyk D, Daratha K, Roberts K. Medical humanities coursework is associated with greater measured empathy in medical students. Am J Med. 2016;129(12):1334-1337. 3. Viney W, Callard F, Woods A. Critical medical humanities: embracing entanglement, taking risks. Med Humanit. 2015;41(1):2-7. 4. Hooker C, Noonan E. Medical humanities as expressive of Western culture. Med Humanit. 2011;37(2):79-84. 5. Alora AT, Lumitao JM. Beyond a Western Bioethics: Voices from the Developing World. Washington, DC: Georgetown University Press; 2001.
Cultural Context in Medical Humanities: Lessons from Turkey To the Editor: In the past few decades, there has been increasing interest in establishing medical humanities as the core integrated provision in medical curricula, especially in the US, Canada, the UK, and Europe.1 Several papers, including a brief observation in The American Journal of Medicine,2 have tried to set out a vision for medical humanities’ role in teaching empathy in medical education. However, little attention has been paid to local experiences about the implementation of this concept in different countries.3 During my 3-year experience in teaching medical humanities at a Turkish university that enrolled both Turkish and international students from Africa, Europe, and the Middle East, I have observed that higher rates of cultural diversity among students have had significant influence on the efficiencies of medical humanities courses, and the expected outcomes from the course and students’ interest in course materials have had a large amount of variance. This is presumably because of the non-culture-specific educational materials used for the course. Hooker and Noonan4 have argued that the current concept of medical humanities is culturally limited by “a distinctive emphasis on Western cultural artefacts” and “a tendency to enact an uncritical reliance upon foundational concepts within Western medicine”.4 Agreeing with this, Funding: None. Conflict of Interest: The author has no conflicts of interest to disclose. Authorship: The author is solely responsible for writing this manuscript.
0002-9343/$ -see front matter Ó 2016 Elsevier Inc. All rights reserved.
people coming from different cultures have different values toward patients, illness, and care. For instance, the precepts of Western bioethics such as autonomy and truth telling may clash with non-Western cultural mores; and attitudes toward end-of-life care, abortion, and genetic engineering may differ across cultures.5 Therefore, it is suggested that the lecturers of medical humanities courses carefully select the course materials because cultural conflict can lead to emotional disturbance, self-defeating behavior, and hence, decline in empathy among students from diverse social and cultural backgrounds. Incorporating local experiences in medical humanities courses will also help students to recognize and appropriately address some culture-specific bias that occurs in health care delivery in their own countries. Halil Tekiner, PhD Department of the History of Pharmacy and Ethics Erciyes University School of Pharmacy Kayseri, Turkey
http://dx.doi.org/10.1016/j.amjmed.2016.10.034
References 1. Bleakley A. Medical Humanities and Medical Education: How the Medical Humanities Can Shape Better Doctors. New York: Routledge; 2015. 2. Graham J, Benson LM, Swanson J, Potyk D, Daratha K, Roberts K. Medical humanities coursework is associated with greater measured empathy in medical students. Am J Med. 2016;129(12):1334-1337. 3. Viney W, Callard F, Woods A. Critical medical humanities: embracing entanglement, taking risks. Med Humanit. 2015;41(1):2-7. 4. Hooker C, Noonan E. Medical humanities as expressive of Western culture. Med Humanit. 2011;37(2):79-84. 5. Alora AT, Lumitao JM. Beyond a Western Bioethics: Voices from the Developing World. Washington, DC: Georgetown University Press; 2001.