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Abstract

The ﬁeld of medical humanities has attracted serious and growing interest among medical educators around the globe in recent decades. This entry examines how the concept of medical humanities was born, how the ground for its integration into medical education was prepared, and how it gained institutional standing. It then deals with the nature of its impact on the world of professional medicine, the problems of deﬁning the term, its current status in medical education, and the challenges that it needs to overcome if it is to consolidate and enhance that status.

Introduction

Medical and other healthcare educators around the globe have devoted increasing attention to “medical humanities” as a ﬁeld of study and teaching in medical and allied healthcare curricula in recent decades. They seem today to have reached something of a consensus on the need to emphasize the study of disciplines belonging to the humanities (including ethics, philosophy, history, religious studies, literature, the arts, and others) at various levels in both medical and related healthcare education.

Educational and research institutions focusing on medical humanities have been founded in various countries, many conferences on the subject have been held at both national and international level, and books, periodicals, and webpages on it have proliferated. This entry examines how the concept of medical humanities was born, how the ground for its integration into medical education was prepared, and how it gained institutional standing. It then deals with the nature of its impact on the world of professional medicine, the problems of deﬁning the term, its current status in medical education, and the challenges that it needs to overcome if it is to consolidate and enhance that status. At the outset, however, something needs to be said about the elements that the concept of medical humanities attempts to harmonize.

The term “humanities” has a broad and somewhat blurred meaning. Scholars usually deﬁne the word in two ways: the ﬁrst deals with content, categorizing the disciplines considered to comprise the humanities by listing a set of topics generally felt to be relevant, and the second focuses on the methodology common to these speciﬁc areas of study and the type of inquiry traditionally associated with them (Newell 1987).

This second deﬁnition highlights the characteristic ways in which the humanities are pursued (including reﬂection, speculation, inspiration, and evaluation) that involve engaging individuals in reﬂective, creative expression, and in conceptualizing the human spirit. Using this methodology, the humanities focus on the dimensions of our lives not susceptible to empirical investigation, though they neither ignore nor deny the results of such investigations (Newell 1987).

Combining these two ways of deﬁning the term, the humanities can be said to be the disciplines that help us to know ourselves, including our values and what it means to be a human being, through reﬂection, speculation, inspiration, and evaluation rather than by empirical or scientiﬁc methods. Historically, then, the humanities have dealt with fundamental questions of human values (Pellegrino 1979).

The fact that science cannot claim to be “valuefree” certainly does not mean that questions of human values should be considered freely or holistically, without reference to science. But in making clinical decisions on questions like as prolonging life, abortion, or dangerous diagnostic and surgical procedures, physicians do need to take account of the religious or other personal values of the patient and society and to interweave all such elements in the eventual decision on every individual case. Science cannot address these problems nor arrive at answers to them in isolation. Rather, greater consideration of the humanities can provide us with ideas about how to deal conﬁdently and sensitively with the qualitative phenomena of human value-related issues. Therefore, the humanities need to be incorporated into the curricula of medical education.

Formulating The Concept Of Medical Humanities: Peabody, Pellegrino, And Clouser

The concept of medical humanities emerged in the USA in the twentieth century in response to a fundamental philosophical question; what is medicine or medical practice? The most distinctive feature of medicine in the twentieth century was its close identiﬁcation with science. This so-called scientiﬁc medicine or medical science spread throughout the West and into the wider world, including Asia, the Middle East, South America, and the countries of Oceania. Even though indigenous or traditional medicines still exist in most of regions or countries, scientiﬁc medicine or Western medicine has been widely accepted. Its pervasive inﬂuence means that when we examine the curricula of medical science instruction in medical schools, medicine as a discipline seems in essence to be equivalent to science, to be a solely science-oriented discipline.

But the need to understand medicine not simply as a science but as something more complex has long been recognized. The respected US clinician, Francis W. Peabody, believed that the practice of medicine should also involve a holistic relationship between physicians and their patients in the broadest sense, on the grounds that medical practice “is an art, based to an increasing extent on the medical sciences, but comprising much that still remains outside the realm of any science” (Peabody 1927).

In the late 1960s and early 1970s, the scholar who most clearly grasped the essence of the central problem about medicine and medical practice that Peabody had raised was another prominent US physician and philosopher, Edmund D. Pellegrino. He emphasized that the complex nature of medicine is not the province of medical science and biotechnology but can only be understood with the aid of the humanities that stand outside of the realm of science.

Rapidly increasing knowledge and the ever widening use of technology in medical science have extended the range and effectiveness of medicine, but have also created new problems in the process. Since technological development will certainly continue, greater attempts need to be made to encourage a focus on the humanities, because in both medical education and practice, there is a concern that medical technology can crowd out medicine’s traditional concern for human values by overemphasizing its scientiﬁc aspects. So while it will inevitably remain technical in many aspects, medicine and medical practice need to address questions about values, including moral ones.

Pellegrino certainly recognized the importance of doing this, warning us that the gulf between technology and human values is at its most dangerous in the case of medicine, where the focus is on human beings and the human condition and consequently where the emphasis on science and the consequent neglect of human values and the humane dimension can dehumanize patient care itself (Pellegrino 1979). He argued that medicine cannot and should not try to separate the scientiﬁc dimension from the humanistic one, either practically or philosophically. Clinical decisions need to be considered in both the scientiﬁc and the humane dimensions; medicine must be both objective and compassionate. Pellegrino captured its multidimensional essence in a maxim of acute perception; “Medicine is the most humane of sciences, the most empiric of arts, and the most scientiﬁc of humanities” (Pellegrino 1979, p. 17).

This insight into the close relationship between the disciplines of medicine and the humanities was built on by the US philosopher and medical educator K. Danner Clouser, who advocated that the humanities should play an integral, although subordinate, part in medical education. This reﬂected his underlying conviction that medicine exists primarily and fundamentally as a body of science. The humanistic disciplines were to be added to this, but only secondarily and peripherally; their role was to enhance the ability of medical science to heal patients by facilitating a more effective patient-physician relationship through an understanding of its humanistic aspects. On this view, medicine could use the humanities to improve the outcomes of treatments that were in essence scientiﬁc (Clouser 1997).

Clouser suggested the relationship of the humanities to medicine could be clariﬁed by determining and deﬁning the core of medicine and medical practice. A philosophical examination of “purely scientiﬁc medicine” was crucial to deciding whether or not the humanities could relate to it, and Clouser’s method was to start with as broad a conception of medicine as possible and then move gradually to a smaller and smaller core until something that was “purely scientiﬁc medicine” came into focus. So he began with a survey of the entire practice of medicine, in which he included diagnosis, therapy, prevention, education, distribution, research, and technology; the disciplines of the humanities were relevant in some of these areas, he argued, including questions of “allocation, rationing, costs versus quality, ranking, pedagogy, and historical parallels and insights” (Clouser 1997, p. 27).

Further analysis of the relationship between medicine and humanities suggested to Clouser that patient-physician interactions are integral to medical care, since “diagnosis” and “therapy” focus primarily on such interactions. He argued that diagnosis and choice of treatment should not exist independently of any consideration of the concerns found in the humanities, since they can genuinely beneﬁt from a deeper understanding of a patient’s goals, values, beliefs, lifestyle, and view of suffering. He went on to question whether “disease” and “lab tests” should be viewed as “purely scientiﬁc medicine,” noting that the deﬁnition of something as a disease is not just grounded on scientiﬁc-based observations, but takes the form of a value judgment. What constitutes a disease was, for him, not a matter for scientiﬁc determination alone; the central concept of medicine itself is thus value-laden (Clouser 1997).

Concluding that “purely scientiﬁc medicine” could not exist, Clouser described the relationship of the humanities to medicine using the “Baby Swiss Cheese Model,” in which the cheese represents medicine and the holes are the humanities. While the holes are both smaller and more numerous than the body of the cheese, they permeate it so diffusely that they must be said to be part of it. Any attempt to exclude them is impossible; in exactly the same way, medicine cannot exist without the humanities, since “[h]umanistic issues are in, under, and through medicine. Medicine is shot through with value issues (although they are not all necessarily ethical values)” (Clouser 1997, p. 29).

Preparing The Ground For The Integration Of The Humanities Into Medical Education

Two organizations, the Society for Health and Human Values (SHHV) and the Institute of Society, Ethics and the Life Sciences (later known as the Hastings Center), played important roles in the process by the time humanities began to make a contribution to medical education.

The SHHV was the ﬁrst formal gathering of medical school faculty from across the USA to commit its members to promote the understanding of human values and humanities as an essential and explicit dimension of professional medical education and to reﬂect this in medical education curricula for which they were responsible. The Society endeavored to encourage and promote informed concern for humanities education in medicine in a variety of theoretical and practical ways. These included working “to facilitate communication and cooperation among the professionals from diverse disciplines who share such an objective… [and] to support critical and scholarly efforts to develop knowledge, concepts, and programs dealing with the relation of human values to education for the health professional” (Barker 1987, p. 40).

To promote these aims, ﬁve binary areas considered signiﬁcant to the development of interdisciplinary human values teaching were selected for attention. They were literature and medicine, history and medicine, religion and medicine, the visual arts and medicine, and the social sciences and medicine. Each group dealing with one of these pairs (except history and medicine) published the fruits of its discussions as Healing Arts in Dialogue: Medicine and Literature (Joanne Trautmann, ed., 1982), Medicine and Religion: Strategies of Care (Donald W. Shriver, Jr. ed., 1980), The Visual Arts and Medical Education (Geri Berg, ed., 1983), and Nourishing the Humanistic in Medicine: Interactions with the Social Sciences (William R. Rogers and David Barnard, eds., 1979).

These reports outlined areas of joint interest that might provide the basis for future interdisciplinary teaching and research. Their authors believed that there was much to be gained from the interaction between medicine and other disciplines, notably in exploring the ways in which the new sciences were impacting our understanding of the human condition. They argued that the various disciplines belonging to the humanities could not only contribute to medicine and medical education in general but also provide rich sources of insight into the problems faced by providers of healthcare, especially when dealing with difﬁcult situations involving patients and their families.

A second organization, the Institute of Society, Ethics and the Life Sciences, also did valuable work in making it possible for the humanities to contribute to medicine. ISELS (now known as the Hastings Center) is one of the world’s most prestigious bioethics-related educational and research institutions. It initiated projects of its own to treat not only bioethical issues but also the broader ones of the humanities, based on a ﬁrm belief in the enduring importance of the humanities to civic life and a desire to bring about a more satisfactory relationship between the sciences and the humanities (Callahan et al. 1984).

The Hastings Center set up its “Project on Applied Humanities and Public Policy (1981–1983)” to explore the contributions that the humanities could make to medicine and the relevance of “applied humanities” to certain speciﬁc medical ﬁelds. One such scholar involved in the project, Eric J. Cassell, produced a monograph entitled The Place of the Humanities in Medicine in which he promoted Pellegrino’s belief in the signiﬁcance of the humanities for medicine, encouraging medical humanities educators to incorporate the humanities into medical education on the grounds that they “have always had a place in medicine, and that they will play an increasingly important, necessary, and speciﬁc role as medicine evolves beyond its present romance with technology toward a more balanced view of the origin and treatment of illness” (Cassell 1984, p. 6).

Cassell emphasized the problems created by science-oriented curricula in medical schools. He recognized that superb training in the relevant sciences is the hallmark of contemporary medical education, but was concerned that those who taught medical students these sciences had found it necessary and acceptable to depersonalize the human body; the development of experimental and statistical methods had persuaded the body to yield up its secrets so consistently that scientiﬁc generalizations could be reached that were utterly divorced from the individuality of patients. The pressures of a science-oriented curriculum meant that for decades the need to re-personalize physicians’ learning and teach them how to apply the generalities of science to individual patients had been relegated to the periphery in medical schools.

Cassell went on to identify the dearth of reﬂective opportunities for medical students and qualiﬁed professionals as the central problem of medical education and practice. Exceptionally busy schedules left both groups with almost no time to reﬂect on their behavior as learners and practitioners, even though they felt dissatisﬁed with this situation. Like Pellegrino, Cassell attempted to solve this and other problems of medicine by incorporating the humanities into medical education under the aegis of liberal arts education, arguing that “Science cannot solve many of the problems that loom on medicine’s horizon. Thus, like it or not, interested or not, in the decades ahead medicine will pursue scholars in the humanities until they and the humanities produce what medicine needs” (Cassell 1984, p. 54).

Cassell believed that if the sick, rather than their diseases, were to become the new focus of medicine, physicians needed the valuable perspectives offered by the humanities that constituted the core of a liberal arts education. They could bring to the fore the humanistic aspects of medicine, what Cassell called the art of medicine. He identiﬁed four different but interrelated skills that a liberal arts education could develop in aspiring physicians: the ability to acquire and integrate subjective and objective information so as to make decisions in the best interests of the patient, the craft of strengthening and utilizing the relationship between doctor and patient for therapeutic ends, an appreciation of how sick persons (and doctors) behave, and effective communication skills (Cassell 1984).

The Institutionalization Of Medical Humanities Education

Today the medical humanities are taught in a variety of ways across the globe, but these all have a common parent in the USA. In 1967, the Pennsylvania State University was the ﬁrst to establish an academic department of the humanities in its College of Medicine at Hershey, teaching three disciplines: history, literature, and philosophy. The College created an innovative curriculum focused on engendering a better understanding of families and their resources within communities, the inﬂuence of lifestyle and behavior on the prevalence and impact of disease, and the philosophical, spiritual, and ethical aspects of healthcare.

The institutionalizing of medical humanities advanced further in 1973 with the establishment of the Institute for the Medical Humanities of University of Texas Medical Branch at Galveston to promote the “apperceptive and appreciative apparatus” and “varied and enlarging cultural experience” that can act as a complement to scientiﬁc knowledge in its application to the practice of medicine. The Institute pursued this goal by encouraging multidisciplinary faculty members to offer humanities programs including art, drama, history, law, literature, philosophy, and religious studies across the 4-year curriculum of the school of medicine, as well as in its residency programs. This appeared the second medical humanities program in the USA, and a graduate program offering interdisciplinary MA and Ph.D. degrees in medical humanities made its appearance in 1988. This was the ﬁrst Ph.D. in medical humanities anywhere in the world.

Academic journals dealing with the humanities and medicine began to be published in the early 1970s. The Hastings Center Report, the ﬁrst of these, appeared in 1971 and focused in particular on ethical issues in medicine and healthcare and on public policy. In the UK, the Journal of Medical Ethics, which began life in 1975, likewise concentrated on ethical issues in ﬁelds. In addition to speciﬁc ethics journals such as these, cross disciplinary ones started to appear in the late 1970s and early 1980s that would become pivotal to the ﬁeld of medical humanities, notably The Journal of Medicine and Philosophy (1976), the Journal of Medical Humanities and Bioethics (1979), and Literature and Medicine (1982). The Journal of Medical Humanities and Bioethics subsequently dropped the second part of its title to become simply the Journal of Medical Humanities, and the Journal of Medical Ethics began to issue a special edition of Medical Humanities in 2000; this was an acknowledgement that while there are close ties between the ﬁelds of ethics and the humanities, the perspective of the latter on issues does differ from that ethics and bioethics. Nonetheless, these journals helped to internationalize the ﬁeld of medical humanities and amplify its impact.

Such publications helped spread educational medical humanities programs from the USA to other countries; in 2003 a journal, Academic Medicine, published a special issue noting the existence of such programs in Canada, Croatia, Germany, Norway, Sweden, Switzerland, the UK, Argentina, Australia, New Zealand, Israel, and Taiwan. In the UK, for example, the ﬁrst unit devoted to the ﬁeld of medical humanities was established by the Center for Philosophy and Health Care at the University of Swansea, which launched an M.A. in medical humanities in 1997 whose core was philosophical inquiry but which also utilized the methodologies of history, anthropology, and sociology, literature, the visual arts, and others. Medical humanities programs have continued to expand in the UK since then, with three professorial chairs in the ﬁeld being established: one at the University of Swansea in “Healthcare and Medical Humanities,” another at the University of Durham in “Humanities in Medicine,” and a third at King’s College, London, in “Medicine and the Arts.” Specialized degrees are now offered at Leicester (M.A. in Medical Humanities), Swansea (M.A. and Ph.D. programs in Medical Humanities), Bristol (B.A. in Medical Humanities), and King’s College, London (M.A. in Literature and Medicine).

Asian countries, too, including China, Japan, Indonesia, India, South Korea, Singapore, Qatar, and Saudi Arabia, have established courses or programs in medical humanities that focus on different disciplines depending on local needs and circumstances. The Peking University in China, for example, set up its Institute for Medical Humanities (IMH) in 2008, charged with providing humanities education for medical students. At the IMH, various humanities and social sciences disciplines promote the study of medicine from different perspectives, such as the History of Medicine, Bioethics/Medical Ethics, Medical Psychology, Health Law, the Philosophy of Medicine, and Medical Sociology. The IMH is a pioneer of medical humanities and social sciences education in China: it established its Section for the History of Medicine of IMH as early as 1946; it has the only Ph.D. program in the History of (Western) Medicine in China; it offers Ph.D. programs in Medical Ethics and Medical Psychology; and it has created several training courses for teachers in the medical humanities in medical schools across China.

In 2008, it inaugurated its Medical Humanities Week, an annual campus event held each October. The 2009 event included a workshop for scholars, a Ph.D. students’ forum on bioethics, public lectures, and student activities. More than 20 scholars from Japan, South Korea, Hong Kong, Taiwan, the UK, and the USA took part in a workshop entitled “Dialogue in Medical Humanities between the East and West.” Such discussions between scholars from Western and Eastern countries are vital if the central issues in this ﬁeld are to receive proper attention.

Medical Humanities In The Professional World

The spread of medical humanities education made an increasing impact on professional medical societies from the 1980s on. In the USA, the Association of American Medical Colleges (AAMC) issued a Report of the Panel on the General Professional Education of the Physician and College Preparation for Medicine. Physicians for the Twenty-First Century – The GPEP Report – that dealt with the education of medical residents and emphasized the signiﬁcance of continuity of medical ethics education from medical school to medical residency training. It advocated beginning ethics education in medical schools and bringing it to maturity in residency training.

With regard to internal medicine residency, in 1985 the American Board of Internal Medicine published A Guide to Awareness and Evaluation of Humanistic Qualities in the Internist urging program directors to prepare medical residents to demonstrate high standards of humanistic behavior. Since that time, it has been the explicit responsibility of internal medicine residency programs to develop humanistic qualities in residents in a variety of ways. Requiring such an emphasis on the human dimension of medical practice in educational programs is a very promising development in the provision of training by medical educators in the USA.

These trends have inﬂuenced the activities and thinking of professional medical organizations in the USA and elsewhere. In 1999, the American College of Physicians, the American Board of Internal Medicine, and the European Federation of Internal Medicine launched the Medical Professionalism Project. This placed the discipline of medical ethics at the center of a charter of behavior and attitudes for physicians; it underlined the role of personal qualities in the building up of medical professionalism and emphasized that knowledge and skills alone do not constitute professionalism. Attitude and behavior certainly need attention in any educational program for doctors (Project Professionalism 2002).

A successor to the Project Professionalism, the Project to Rebalance and Integrate Medical Education (PRIME), examined how medical humanities can contribute to medical education and medical professionalism. The aim of PRIME was to improve education in the humanities by benchmarking standards for medical schools and residency training programs, with a focus on the speciﬁc disciplines of ethics, history, literature, and the visual arts (Doukas et al. 2012). Those leading this project proposed that medical humanities programs should integrate humanities-based reasoning and scientiﬁc reasoning in standardized medical curricula in the following ways (Doukas et al. 2010).

Argument-Based Reasoning In Medical Ethics

Students learn to assess how ethical analysis and argument – the tools of argument-based ethics – apply to clinical care, research, and leadership by conforming their reasoning to the criteria for argument-based ethics, including clarity, consistency, coherence, clinical applicability, and clinical adequacy.

Narrative-Based Reasoning In Literature

Narrative reﬂections about patients and providers in the healthcare setting promote students’ insights into perspectives on illness and medical care other than their own, leading them to challenge the adequacy of their own views. Narrative reﬂection can also promote introspection and empathy, while providing an enhanced context for the suffering of the healer and healed.

Creative Reasoning In The Fine Arts

The study of art history can train students in “slow looking,” turning one’s full visual attention to a work of art. The skills of slow looking are used when the physician turns his or her full visual attention to the patient’s body during a physical examination, to the interpretation of images, and to anatomy exposed in a surgical ﬁeld. The study of art history also emphasizes the social context in which images are created and interpreted, providing an opportunity to think critically about the roles of medical imaging in the clinical setting and in the broader visual culture.

Historical Reasoning In Learning

The study of the histories of medicine and science provides students with a critical perspective on contemporary medicine by requiring them to gain an understanding of how physicians thought and acted in the past. As a result, contemporary ways of thinking become open to critical appraisal. Students can thereby challenge the naïve view that with change comes progress in all cases.

These reasoning-based elements derived from four humanities disciplines presuppose that the learners are training to be clinicians. They illustrate the importance for those teaching medical humanities of being fully aware of how such disciplines can enhance speciﬁc clinical competencies tomorrow’s medical professionals.

Defining Medical Humanities In Its Contemporary Setting

The information provided above about the growing role of humanities education in medical settings showed that its signiﬁcance for medical students and medical professionals was generally acknowledged. It has found a role of its own in medical schools and other medical institutions such as teaching hospitals, which is to cultivate humanistic moral behavior or humanism generally in medical students and medical professionals. Various terms have been coined for it, including “humanism in medicine,” “medical humanism,” and “humanities studies in medicine,” but “medical humanities” has come to be the preferred usage (Evans and Finlay 2001).

The most important problem regarding “medical humanities” today is to deﬁne this term precisely, since its broad nature has prevented it acquiring a ﬁxed identity; there is currently no consensus among scholars about how it should be understood (Evans and Finlay 2001). The ﬁrst issue of Medical Humanities, published as a special number of the Journal of Medical Ethics in 2000, illustrates this perfectly; the editors of the journal refrained from offering any deﬁnition of the term at all (Greaves and Evans 2000).

From a practical and educational point of view, medical humanities is a ﬁeld of study in which disciplines belonging to the humanities and social sciences are taught in educational programs provided by medical institutions and are therefore humanities or social sciences courses that focus on the concerns and interests of medicine or healthcare or on issues relevant to the life and work of medical professionals. Most nonmedical science disciplines provided in medical curricula can therefore be classiﬁed as “medical humanities disciplines” in general. Seen in such a context, medical humanities can be considered as either “additive” or “integrated” in nature (Greaves and Evans 2000).

With the “additive” approach, medical humanities complements medical science and technology by providing the contrasting perspective of the humanities, without either viewpoint impinging on the other, and its main effect is to “soften” medicine and/or medical practice by exposing its practitioners to humanities education. The “integrated” approach, on the other hand, is designed to refocus the study of medicine in light of an understanding of what it is to be fully human, meaning that the reuniting scientiﬁc or/and technical knowledge with humanistic knowledge and practice is central. Here, the aim of medical humanities education is to understand the nature, goals, and knowledge base of medicine itself.

It can be argued that the “integrated” use of medical humanities is intrinsically more appropriate than the “additive” in light of the early development of the medical humanities movement in the USA. As previously noted, Clouser’s “Baby Swiss Cheese Model” illuminates the fact that the humanistic aspects of medicine are ubiquitous and cannot be separated out from it. Hence, disciplines belonging to the humanities cannot be excluded from any consideration of what medical education must be. Since the “integrated” approach to the use of medical humanities accords with the intrinsic nature of medicine, medical humanities must be placed at the core of medical education.

Shapiro and others argue that in spite of ongoing lack of clarity on what exactly the medical humanities comprise, and how they should be integrated into medical education, several common characteristics in terms of teaching activities are apparent. These include their use of the methods and concepts of one or more of the humanities disciplines, their capacity to teach health professionals and students critical reﬂection aimed at engendering a better understanding of their profession and a more humane practice, and their interdisciplinary and collaborative nature (Shapiro et al. 2009).

Contemporary Issues And Future Challenges

Medical humanities can certainly improve the quality of medical education in a variety of ways, but the route to this is not without its obstacles. The ﬁrst is the need for it, as a new approach to medical education, to demonstrate to medical educators that it can make a measurable positive impact on their students, and here there is still lack of empirical evidence and proof, not least because it is far from easy to measure improvements in humanistic skills. Nonetheless, to defend, maintain, and even strengthen the status of medical humanities in medical education, its advocates need to provide more empirical evidence that it produces positive outcomes (Kuper 2006).

Regarding the effect of medical humanities education, there have been many discussions on whether studying humanities leads to develop their professional behaviors and/or attitudes toward patients. According to a literature review on humanities in medical education, there are some research studies showing that studying humanities improve attitudes and/or behaviors of medical students and personnel. However, very few systematically investigations ﬁnd empirical evidence of long-term impact of humanities education for professional attitudes or behaviors. The present trend of evidence-based learning in medical education requires that the study of the humanities should be able to justify its existence with empirical evidence of its effectiveness (Ousager and Johannessen 2010).

A second and more serious issue has already been noted; medical humanities still lacks a clear and universally accepted deﬁnition due to its multifaceted and broad nature. But a more precise deﬁnition is needed for practical as well as theoretical reasons and is critical if medical humanities is to take its rightful place in the realm of medical professional education and practice. A critical and reﬂective attitude toward the subject is needed if it is to be reﬁned and improved. This is just as necessary as proof of its effectiveness (Brody 2011).

Conclusion

As an educational concept and ﬁeld of activity, the signiﬁcance of medical humanities around the world today is widely recognized. Faced with science-oriented medical curricula, educators from different educational backgrounds, clinicians and nonclinicians with humanities or social sciences expertise alike, have deliberated together and collaborated to incorporate the beneﬁts that disciplines belonging to the humanities or social sciences can offer to members and aspiring members of the medical profession. While there may still be no clear deﬁnition of what the umbrella term, “medical humanities,” actually means, scholars and educators have reached some kind of consensus about the pedagogical importance of humanities disciplines in enhancing professional values, attitudes, behavior, competences and professionalism in clinical settings, and about the characteristic ways in which this can be achieved.

However, the lack of empirical evidence for long-term impact of medical humanities education might undermine this educational concept and ﬁeld of activity. To defend, maintain, or strengthen the status of humanities education for medical or healthcare professionals, it is necessary to provide more empirical evidence that medical humanities education does deliver positive or at least perceptible outcomes. Clearly, educators of medical humanities are urgently required to overcome the difﬁcult issues of clarity of its deﬁnition and provide more evidence of beneﬁt for support and development of medical humanities education.

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