Stephanie Brown Clark, MD, PhD
I have always lived a double life.
By double life, I mean that I am a twin. An effect of always being both myself and also a self intertwined with my brother is a blurring of boundaries of identity and perspective. It is both a liability and a gift. I think in terms of pairs and connections; inter-relatedness is fundamental to my experience of the world and my intellectual work. I like both sciences and humanities. For me, it has always been hard to choose.
I chose to do an undergraduate degree in English Literature, and then a Master’s degree at the University of Western Ontario in Canada. My papers were almost all comparative analyses between two different texts, between two subjects. What interested me most was 18th/19th c. literature and diseases.
It was through humanities that I became interested in medicine.
When I applied to McMaster’s medical school in 1986, I appreciated the alternative “non-traditional” ethos of the place. Founded in 1972, the curriculum was not lecture-based; from the beginning, faculty were committed to a “constructivist” approach—students worked in small collaborative groups around clinical cases as “problems” with a tutor who facilitated discussion through inquiry rather in answers. Barrows and Tamblyn at McMaster are credited with developing and refining this Problem-Based Learning (PBL) approach.1 Additionally, the school endorsed a wholistic approach of patient care based on a model proposed by physician George Engel in the late 1970’s. Engel insisted that students and practicing clinicians attend not only to the biomedical aspect of a patient’s disease, but also more broadly to the patient as a person in a family, a community, a culture(s), a society and a global environment. The “biopsychosocial” (BPS) model2 was reflected in the institutional culture and embedded in the curriculum.
I immersed myself in the sciences, integrated in a framework of broader social and cultural and relational aspects of patients, healers and disease. At the end of this program, I found myself more drawn to the human context, more strongly interested in teaching than in practicing medicine. I felt unsure. I had made no space for humanities during medical school and I missed it profoundly. Circumstances required me to make a choice. My husband was offered a job in the Netherlands.
For my last elective before graduation, I went to University of Leiden in the Netherlands to try to connect medicine and humanities. My proposal to examine 18th–19th C. medical theories on madness and the literary writings by the “mad” poet William Blake became a paper. The paper became a PhD dissertation, supervised jointly by faculty in the departments of medical history and English literature, which I finished in Leiden in 1998. Job opportunities for my husband and me brought us to Rochester, New York. I looked for it on a map of the United States.
Before I visited the University of Rochester in 1998 I had never heard of Medical Humanities. I had not realized that George Engel was a faculty member in the school of medicine there, and that the BPS model was foundational to the institutional culture. I did not know that a significant curricular re-design based on small group problem-based learning (PBL) was about to begin.
As I settled into the Division, I read about the field and its history. I tried to understand its purpose, its role and its relevance in education of medical students. Over the next year or two, I reflected with some uncertainty about my own role and wondered how to teach learners about these human contexts using humanities and the arts that would be meaningful and applicable to clinical work with patients.
My medical training at McMaster University in Canada, with its focus on collaborative small group learning with a facilitator who asked questions instead of giving answers was a remarkable experience. The BPS model integrated the biomedical science components of medicine with a humanistic patient-centred model of care that attended to the human contexts of the “patient as person.” I valued these two foundational frameworks; I wanted to integrate it in my teaching of medical humanities.
Over my first few years in Rochester, I applied my historical, literary and medical sensibilities and training to understand the history of the field of medical humanities that includes the sister arts and social sciences, and its evolving connections with the practice of medicine. I had a sense of what the field was, but I wondered how to do medical humanities as an educator, how to connect the knowledge and how to make my teaching relevant to the human work of medical practice with patients.
The visit of medical residents to an art museum that Dolev3 described was compelling to me; it offered an educational activity that was arts-based, in facilitated small groups like problem-based learning and taught by professional partners with different content expertise – a museum educator and a physician. Their educational goals were to develop visual diagnostic skills. Their work at Yale and the subsequent conversations with a museum educator at the University of Rochester’s art museum, prompted some clarity and direction in my own thinking about how to effectively and creatively teach humanities and the arts that had clinical applicability for the students.
University of Western Ontario, Canada, BA 1981
University of Western Ontario Graduate Program in English Literature, MA, 1982
Trinity College, Dublin, Ireland, Anglo Irish Literature, Higher Diploma, 1984
McMaster University School of Medicine, MD, 1990
Rijksuniversiteit Leiden, Netherlands, Medical History and English Literature, PhD, 1997
Division of Medical Humanities & Bioethics, University of Rochester School of Medicine & Dentistry, 1998 – to date
1. Barrows, H. S. (1996). “Problem-based learning in medicine and beyond: A brief overview”. New Directions for Teaching and Learning, 68, 3–12. doi:10.1002/tl.37219966804.
3. Dolev, J., Friedlaender, L., & Braverman, I. (2001). Use of fine art to enhance visual diagnostic skills. JAMA, 286(9), 1020–1021. doi:10.1001/jama.286.9.1019.