Understanding the Medical Humanities (MH) and their role in medical education is in its infancy in India. Students are initiated into professional (medical) education too early in life, usually at the expense of a basic grounding in the humanities, resulting in warped intellectual growth. The author, arguing against the wholesale import of foreign systems, advocates free inquiry by medical educators to evolve a humanities programme for medical students derived from our own cultural context. This essay describes the early experiences of efforts to make a beginning at the University College of Medical Sciences, Delhi. The author reviews the various strategies used and the challenges of introducing the subject to the current generation of medical students.
Don’t you ask yourself why you are being educated? Do you know why you are being educated and what that education means? As we know, education is going to school to learn how to read and write, to pass examinations, and to play a few games; and after you leave school, you go to college, there again to study very, very hard for a few months or a few years, pass an examination and then get a job; and then you forget all about what you have learned. Do you understand what I am talking about? Isn’t that what we all do?
— J Krishnamurti (1)
Why do we need to educate medical students in the humanities? Let me begin with an outline of the path to higher education in India. Consider a child’s trajectory from early school to higher professional education. The school-going child is encouraged to learn by rote. The ability to recite or reproduce memorised text is rewarded at each step. Little effort goes into developing the higher cognitive abilities of comprehension, analysis, synthesis, and evaluation of knowledge.
At barely 15 years of age, the need to make a career choice is thrust upon the hapless child. Our educational system assumes precocity beyond the ability of most 15 year olds to decide career paths for themselves. Perforce, ambitious parents make the surrogate decision to prepare the child for a professional career of their choice. Parents may know what is best for their child in matters relating to food and friends, but they may make the wrong choice considering the long-term consequences that a professional career entails. On the other hand, few adolescents are equipped for such a choice either.
Often, a child’s preparation for a professional career begins with enrolment in a coaching institution whose aim is to equip aspiring young minds with a solitary skill: how to crack the entrance examination of their choosing by honing their ability to memorise. Then follows a hectic round of classes tailored to the nuances of each separate entrance examination. For the next four years, from the age of 15 to 18, when these children should have been discovering themselves and their world, their likes and dislikes, inclinations and attitudes, they lead a blinkered existence with the solitary goal of entering an engineering or a medical college regardless of the aptitude required for these careers. We, the parents, teachers, and policy makers, never inquire about our children’s true vocation or interests. At 18, the rigours and demands of professional education deny our adolescents the chance to grow, to understand themselves, to come to terms with the world around them, and to decide on their own course.
Far from bringing relief, the joy of those who succeed in entering a professional course is destined to be short-lived. Soon the realisation comes that the years of self-denial are going to last a lifetime. The struggle worsens when parental pressure to perform mounts. Many are told, “Now that you are here, at least continue and finish the undergraduate course.” There is no way out for the unfortunate trapped soul but to continue. The heavy investments in intense coaching cannot simply be discarded for a new career choice.
The misery does not end there. Three years into the MBBS course, the spectre looms again post-graduate admissions are on the horizon. Then follow another two-and-a-half years of intense coaching, beginning in a critical phase of the MBBS course, to crack the postgraduate entrance exam. Success does not necessarily earn the right to pursue a postgraduate career in a subject of one’s choice. Depending on performance, a person wanting to become a gynaecologist may well have to settle for being a pathologist. There is a hierarchy to the choice of subject, which is often determined by considerations of monetary returns from the workplace.
It is not uncommon in our medical institutions for postgraduate trainees, untutored and unskilled in the nuances of teaching, to shoulder all teaching responsibilities in small groups, where teaching is said to be most effective: tutorials, demonstrations, practicals, and at the bedside. The faculty recruited to “teach'” confines itself to the least effective form of teaching – taking lectures, often speaking to large crowds of 150 or more bored, listless students. Small wonder then that the commonest graffiti etched indelibly into the wooden desks, and in the minds of the students, reads “In memory of those poor souls who died waiting for this lecture to finish.” Taking teaching beyond the classroom is viewed as an esoteric pursuit best confined to philosophers and the unbalanced. To ensure full classes, institutions resort to compulsory attendance, resulting in vicious cycles of frustrated teachers and increasingly uninterested students. Oppression is the name of the game.
That many of our students survive the ordeal that we call a medical education, and actually go on to become outstanding physicians and compassionate human beings, is a tribute to their resilience, strength of will, and indomitable spirit.
Nowhere in the scheme outlined above is there a place for the growing adolescent to be exposed to the humanities. Even a passing acquaintance with subjects like languages, history, philosophy, and the arts is simply not possible for those who are herded into professional education by this route which, unfortunately, is the rule rather than the exception. Language skills suffer the most. One has only to struggle through identical written answers, mistakes and all, in hundreds of answer sheets at any examination to comprehend the extent of the problem. The phenomenon is neither new, nor unrecognised. In an interview (2) with a prominent newspaper, Venkataraman Ramakrishnan, winner of the Nobel Prize in Chemistry in 2009, said it all: “I grew up in the Indian system and I, unfortunately, had to choose between humanities and science in high school. I’m making up for it. I’m learning Spanish. I’ve to take an exam in January. ”
Is introduction of humanities during the MBBS course a way to correct the imbalance created by several years of mindless pursuit of a single, mindless goal: to obtain a professional degree in as few years, and as early in life, as possible? How do we take our students beyond the defined curriculum, into pursuits which at first appear to have no tangible benefits to their immediate, short-term goals? Force, as in structuring a humanities curriculum into the medical, creating yet another examination to pass, yet another hurdle to clear, marks, evaluations, the fear of failure, cannot be an option. In the words of the eminent thinker, philosopher and educationist J Krishnamurti, “we should create a school where the student is not pressed, is not enclosed, is not squeezed by our ideas, by our stupidity, by our fears, so that as he grows, he will understand his own affairs, he will be able to meet life intelligently.” (1) We are at a stage where we have the unparalleled opportunity to do the right thing. Transplanting other’s ideas of the medical humanities into the Indian cultural context may appear to be the easy way out, but is likely to be counter-productive in the long run. The onus is on us to think this one out for ourselves.
How is it possible to awaken the over-burdened mind to new thinking, to new horizons? At the University College of Medical Sciences (UCMS) we have been asking these questions and seeking answers. Clearly, it is not easy to decide what to do. To change established thinking and behaviours is a time consuming, uphill task calling for the patience of Job. We need committed people, a conducive environment, and the understanding that we may not see the result of our labour in our lifetimes.
My hope and wish is that one day, formal education will pay attention to what I call “education of the heart”. Just as we take for granted the need to acquire proficiency in the basic academic subjects, I am hopeful that a time will come when we can take it for granted that children will learn, as part of the curriculum, the indispensability of inner values: love, compassion, justice, and forgiveness (3).
What is meant by medical humanities (MH)? MH is an unfortunate term that suggests that medical humanities are different from the humanities taught in general arts colleges. Use of this phrase propels us to find a medical angle to everything that the medical student may have to do with the humanities. In that sense, it is restrictive, and only serves to perpetuate the myth that study of the humanities is not essential to the student of medicine. That the medical student’s interest in the performing arts, music, literature, history, culture, and other similar subjects can only flourish when given a medical twist is rather irrational thinking. Arguably, if the learner has a basic foundation in the study of humanities, the experience can be directed to unravelling the mysteries of medical relationships. Currently there is a void in the students’ minds created by the missing humanities education in their school and college years. We need to fill this void. To grow, the learner must be provided with a steady stream of knowledge, the luxury of choice, and a non-threatening environment.
At our institution, we took our first baby steps three years ago. Using subliminal advertising and guerrilla tactics, we began by setting up a small group of interested students and faculty. In deference to the prevailing wisdom of the time we called it our Medical Humanities Group (MHG). We have experienced much scepticism, even derision, in the community, but it seems to be gradually giving way to hesitant curiosity. Strangely, members of the group seemed to have no misgivings.
One of the earliest activities that we indulged in was to try and bring about awareness and respect for the environment. An undergraduate student took the initiative. Being a singer, he wrote and sang a song bemoaning the plight of the polluted river Yamuna in Delhi, likening the river to a life-giving mother. He followed this up by organising a tree plantation exercise in the campus. Three people planted saplings, while two others looked on! It was the wrong time of year to be planting, and the saplings were in the shade of a large tree, in the path of pedestrians taking a shortcut from the college canteen to the car park. The plants did not survive the week. It was our first lesson in learning the odds that faced us.
The Society for Promotion of Indian Classical Music and Culture among Youth (SPIC-MACAY), a well-known volunteer organisation that facilitates performances in educational institutions worldwide by eminent artists, began small. A role model for the success that volunteerism can achieve, it graciously provided us with our first real opportunity. We are inspired by the selfless quality and quantity of its members contributions to their cause, which is very similar to promoting humanities in medical education. Awareness and appreciation of the performing arts by Indian classical artistes is gradually increasing at UCMS. In the first year, the main hurdle that we faced was finding an audience for the performances. Our students and faculty were indifferent, simply not interested. With time that is changing too, as successive batches of students volunteer in and contribute to organising these events, the numbers are beginning to add up.
During this period we explored other avenues. Our students wrote and performed a street play, under a banyan tree in the college compound, for the MHG. Titled “We all have AIDS”, the acronym standing for “academics-induced degeneration syndrome”, the play took a clever dig at the difficulties faced by students trapped in the rat race of gaining a medical education. A small number of students attended a reading session, where everyone was required to read a literary passage or poem. The participants had never realised that reading could be an art form. Listening to an audio recording by Zia Mohiuddin, famed Pakistani performer and exponent of the art, quickly dispelled that notion.
There is always hidden talent within the community. We stumbled upon a painter and a photographer of uncommon ability in one of our residents. He obliged the MHG by exhibiting a collection of his work at the institution. In our effort to spread awareness of the humanities we have invited speakers from diverse fields, including a linguist, a rationalist, a prominent journalist proponent of the Tibetan people’s struggle for freedom, and a leading role model for persons with disability. Infinite Ability, a support group for disabled students, conceived and established by a prominent member of the MHG, is currently engaged in this area.
Early in 2011, we had Dr Radha Ramaswamy facilitate a two-day workshop in “Theatre of the oppressed”. A form of people’s theatre devised by the Brazilian visionary Augusto Boal, it had a profound and lasting impact on our group, for whom it was a cathartic experience. In contrast to most other activities where the participants are passive onlookers, this demands active involvement. The workshop encouraged participants to look inward and examine many of the troubling questions raised in the earlier part of this article, and helped them find their own solutions, come to terms with themselves and their environment, and see themselves as people of high intrinsic worth. Many communication and interpersonal skills learned in the workshop have the potential to be profitably used in the classroom.
The dedication, time and effort of committed individuals is very encouraging. However, how our experiences will translate for use in large classes and in imparting actual, hardcore, “medical” training is still unclear. We have made a small beginning; where do we go from here? Chalta hoon thodi door har ik raah-roh ke saath; Pehchanta nahin hoon abhi raahbar ko main (4). (I look to every fellow traveller to show me the way; I do not yet recognise the messiah.) When we cease to seek, we shall no longer progress.
Students entering professional medical education in India are disadvantaged by the lack of basic education in the humanities. In this essay I attempt to examine the reasons for this void as also to share my personal experiences and efforts to restore a balance. To keep the avenues of inquiry open, I refrain from offering solutions or recommendations. Instead, fresh thinking in the Indian cultural context is advocated.
Medical Humanities at UCMS: http://medicaleducationunit.yolasite.com/medical-humanities.php
Radha Ramaswamy and TO: http://www.ccdc.in/
SPIC MACAY: http://www.spicmacay.com/
Zia Mohiuddin: http://www.youtube.com/watch?v=cpEqMqDwlgA