THE STUDY OF LITERATURE IN MEDICAL-EDUCATION

The study of literature encourages the development of otherwise hard-to-teach clinical competencies. It provides access to the values and experiences of physicians, patients, and families; it calls for the exercise of skill in observation and interpretation, develops clinical imagination, and, especially through writing, preserves fluency in ordinary language and promotes clarity of observation, expression, and self-knowledge. Faculty in one-third of U.S. medical schools teach literature in courses that, although concentrated in the preclinical years, range from the first day of school through residency programs. Once focused on the work of physician - authors and realist fiction about illness that encouraged moral reflection about the practice of medicine, literary study in medicine now encompasses a wide range of literature and narrative types, including the patient history and the clinical case. Literary study is intended not only to enrich students' moral education but also to increase their narrative competence, to foster a tolerance for the uncertainties of clinical practice, and to provide a grounding for empathic attention to patients. Literature may be included in medical humanities courses, and it may provide rich cases for ethics courses or introductions to the patients - physician relationship; it also may be the focus of small, elective, or selective courses, frequently on particular social issues or on the experience of illness. Reading, discussion, writing, and role-play rather than lectures are the methods employed; faculty include those the PhDs in literature and MDs who have strong interests in the contributions of literature to practice. Pedagogical and scholarly resources include Literature and Medicine, the Center for Literature and the Health Care Professions, and an online database and discussion group.