09/10/2020 Physiotherapy students have much to learn from the humanities

Academic rigour, journalistic flair

Physiotherapy students have much to learn from

the humanities
March 17, 2016 4.02am GMT

Author

Michael Rowe
Senior Lecturer in Physiotherapy,
University of the Western Cape

A little girl in Sudan gets treated by physiotherapist Fatima Mohamed. Reuters/UNAMID/Albert

Gonzalez Farran/Handout

Undergraduate physiotherapy students spend most of their time learning about the basic and clinical
sciences. This has a certain pragmatic appeal, but a person is more than an assemblage of body parts.
Our students learn anatomy and biomechanics – the idea of bodies as machines – and then explore
what can be done to those bodies in order to “fix” them. Universities pay lip service to the idea that
patients require holistic management. But not much in the curriculum signals to students that it
really matters.

Research has confirmed what seems intuitively true to many: empathy is critical in developing
medical students’ professionalism. The humanities, and particularly literature, are considered
effective tools for increasing students’ empathy. There is also some evidence that health professionals
who are trained in the humanities and liberal arts are better at caring for themselves and their
patients.

In addition, a relationship between emotion and learning has been well established, with findings
from multiple domains supporting the idea that emotion is intimately intertwined with cognition,
serving to guide learning, behaviour and decision making. This suggests that introducing concepts

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09/10/2020 Physiotherapy students have much to learn from the humanities

from the humanities when educating health professionals can do two important things: develop
students’ emotional responses and their empathy; and simultaneously improve their overall learning.

Examples from other disciplines

The medical disciplines have started to embrace the role that the humanities and the arts can play in
developing empathy in their graduates. In the US, Johns Hopkins Medical School has a department of
art as applied to medicine and Stanford School of Medicine has a programme for medical humanities
and the arts. These are two of the world’s top medical schools. Elsewhere in the world, South Africa’s
University of Cape Town’s medical school chose the theme “Medicine and the Arts” for its first ever
Massive Open Online Course.

In an editorial explaining Stanford’s stance, the medical school’s dean, Lloyd B Minor, wrote:

The specificity of scientific interventions does not account for the messiness of human life …
We as physicians heal best when we listen to and communicate with our patients and seek to
understand the challenges they face in their lives. The perspectives on illness, emotions and
the human condition we gain from literature, religion and philosophy provide us with
important contexts for fulfilling these roles and responsibilities.

Physiotherapy lags behind

There is little evidence that physiotherapy and other health professions are following these medical
schools’ innovative approaches in undergraduate education. Some physiotherapy researchers have
explored how concepts from the humanities could be integrated into clinical practice. But this has
tended to focus on the impact on professional practice among qualified therapists, rather than on
students and their learning.

The reasons for this are unclear, though several factors may be at play. Physiotherapy is conservative
by its nature and tends to privilege positivist methods in general. It favours quantitative
measurements of progress as the standard against which impact is measured. Our students are taught
how to address physical impairments in a patient’s anatomy and biomechanics, using joint range of
motion, strength and fitness as indicators. This is important but also tends to sideline approaches that
are more interpretive in nature. For example, it’s good to know how to treat back pain from a purely
physiological point of view – but it’s also important to know how to respond to a patient who believes
his or her pain is the result of witchcraft.

These differences in perspective may be what limits the potential for the humanities to have much
impact on curriculum change from the point of view of the clinical therapist. My own teaching
experience, though, suggests that physiotherapy students benefit hugely from practices and ideas that
are influenced by the humanities.

Putting theory to the test

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About three years ago, as an experiment, I started applying some of these ideas in the professional
ethics module I teach at a South African university. Initially the module’s emphasis was on human
rights, but I started foregrounding empathy and the development of empathy instead.

Over the past few years my students have explored the humanities – art, literature, theatre, music and
dance – in their assignments for this module. This has helped them to develop a sense of awareness of
empathy in the context of clinical education.

Students can interpret the assignment in any way they want as long as they integrate concepts from
the ethics module with their own experiences in clinical practice. They must also express their work
through “creative” means: they write poems, draw pictures or cartoons, film video diaries or re-
interpret popular songs. Two of my students have even filmed themselves using interpretive dance to
try and embody what it might be like to live with a disability. Others have completed PhotoVoice
assignments (such as the image below). Here, they photograph people in community or clinical
contexts, and then reflect on how those experiences and interactions informed their personal and
professional development as ethical practitioners.

An example of a photograph taken by a fourth-year student in the author’s professional ethics module. Sarah Manig

Students’ response

Many students were initially worried about the assignments, telling me they were “not creative” and
would prefer to write an essay. I suspect that they were simply feeding off my own hesitation in the
early days. Now that I provide literature to support the assignment design, give examples from
previous students and am fully committed to the process, far fewer students express these concerns.

They are also starting to open up in much more interesting ways. They draw from their own very deep
emotions and personal experiences, and are more willing to share and discuss their work in class.
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Building empathy

Creativity does not naturally decrease over time. Instead, higher education systems place less and less
emphasis on creative expression as students move through the system. If universities want to
graduate physiotherapists who have an increased awareness of patient suffering, and an associated
empathic response, maybe the key is to provide them with learning tasks that encourage their creative
expression through humanities and the arts.

This article was adapted from a post that first appeared on the author’s own blog.

Physiotherapy Empathy medical schools Medical humanities Arts and humanities Medical Students
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