Humanities Education at Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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S P E C I A L T H E M E A R T I C L E : U N I T E D S T A T E S
Humanities Education at Pennsylvania State
University College of Medicine, Hershey,
Pennsylvania
Anne Hunsaker Hawkins, PhD, James O. Ballard, MD, and David J. Hufford, PhD
ABSTRACT
The Department of Humanities at Pennsylvania State ter for Humanistic Medicine. The Humanities Depart-
University’s (Penn State) College of Medicine, created at ment is closely allied with the Doctors Kienle Center,
the founding of the College in 1967, was the first of its which integrates the College and the Medical Center by
kind at any medical school. This article begins by describ- supporting a variety of projects, research, and awards that
ing how the department has developed over the years, and further the teaching and practice of humanistic medicine.
then discusses its present configuration, including kinds of Faculty in the department are encouraged to demonstrate
faculty appointments, information about how it is funded, excellence in scholarship and in teaching, but are also
specific courses that comprise the department’s four-year expected to become engaged in the life of the Medical
curriculum, and activities it sponsors. Center, especially in furthering humanistic patient care.
That a College of Medicine would make the teaching As such, the Humanities Department plays a major role in
and practice of humanistic medicine a major and explicit furthering the mission of the Pennsylvania State Univer-
commitment attracted the notice of Drs. Lawrence and sity’s College of Medicine.
Jane Kienle, who made possible the Doctors Kienle Cen- Acad Med. 2003;78:1001–1005.
I
n 1964, George T. Harrell, MD, dean of the University University Park. Harrell envisioned a new sort of medical
of Florida School of Medicine, accepted an invitation to school, unlike the five existing Pennsylvania medical
become the founding dean of a medical school that had schools, which were located in the major urban areas of the
not yet been built. Under the terms of the Milton state. Its innovative curriculum would emphasize under-
Hershey School Trust that funded its creation, the new standing the family and its resources in the community,
College of Medicine was to be built in Hershey, a small town investigating the impact of lifestyle and behavior on the
in central Pennsylvania about 90 miles from the college’s incidence of chronic disease, and understanding the philo-
parent, the Pennsylvania State University (Penn State) in sophic, spiritual, and ethical aspects of illness and medical
care. Accordingly, the first three department chairs ap-
pointed were in Family and Community Medicine, Behav-
Dr. Hawkins is professor, Department of Humanities; Dr. Ballard is ioral Science, and Humanities, preceding the appointments
professor, Departments of Medicine, Pathology, and Humanities, and holds of chairs of Medicine and of Surgery.1
the Doctors Kienle Chair for Humanistic Medicine; Dr. Hufford is professor
and interim chair, Department of Humanities, professor of Family and
Community Medicine, and director of the Doctors Kienle Center for Human-
istic Medicine; all at Pennsylvania State University College of Medicine, HISTORY OF THE HUMANITIES DEPARTMENT
Hershey, Pennsylvania.
Correspondence and requests for reprints should be addressed to Dr. Hawkins, The purpose of instituting a Humanities Department was to
Department of Humanities, H134, Penn State College of Medicine, 500 recruit scholars trained in the methodology and subjects of
University Drive, Hershey, PA 17033; telephone, (717) 531-8778; fax
(717) 531-3894; e-mail: 具ahh1@psu.edu典. traditional humanities disciplines to bring their unique per-
For more information, visit the program’s Web site at 具www.hmc.psu.edu/ spectives to bear on medical education and practice. The
humanities典. initial faculty consisted of three members, representing reli-
ACADEMIC MEDICINE, VOL. 78, NO. 10 / OCTOBER 2003 1001HUMANITIES EDUCATION AT PENN STATE, CONTINUED
gion, history, and philosophy of science (literature was added ous commitment of support. The endowment provided by
two years later). Humanities faculty, like faculty in under- the Kienles has made possible a variety of programs in
graduate programs, were expected to excel in teaching, schol- humanistic medicine including a lectureship that began in
arship, and collegial activities at both local and national 1986 with Dr. Edmund Pellegrino as well as sponsorship of
levels, and promotion and tenure were a function of excel- Wild Onions, the Medical Center’s annual literary and artistic
lence in these three areas. journal.
The Humanities Department was in operation when the The Humanities Department continued to develop, add-
first students matriculated in 1967. At its creation, no aca- ing new positions until by 1988, the faculty had grown to
demic department of humanities existed in a medical school include six full-time professors. In 1992, these positions
anywhere in the world; indeed, the fields of medical human- represented religion, anthropology, literature, history, philos-
ities and bioethics had not yet been formalized. And thus the ophy and ethics, and philosophy of science. A major curric-
first task of the new faculty was to develop a curriculum for ular change was instituted in 1995, shortly after the imple-
its students. They pioneered the concept of integrating mentation of problem-based learning. Wanting to extend
humanities teaching into the structure of medical education. humanities instruction to students in their clinical years as
Initially, course offerings consisted of small-group seminars well as provide all students with the fundamentals of medical
on a variety of topics for first- and second-year medical humanities education, we displaced special topic seminars to
students. Humanities faculty members also played significant the fourth year and instituted a core course for first-year
leadership roles in the development of their individual pro- students that combined plenary and small group discussion
fessional disciplines at the national level by helping to sections. Within a few years, the department developed a
inaugurate national societies and professional journals. core course in clinical ethics and professionalism for second-
In the mid-1970s the Humanities Department further year students.
collaborated with clinical colleagues through an extramural
grant, “Humanistic Medicine: A Clinical Teaching Pro-
THE DEPARTMENT NOW
gram.” When that grant ended in 1978, all those involved
felt the need to sustain the formal dialogue between clini-
The rationale for our program 35 years ago was to respond to
cians and faculty in the humanities and in behavioral sci-
problems brought about by rapidly increasing knowledge and
ence. To this end the Center for Humanistic Medicine was
technology in medical science. There was a concern that
founded in 1979, with two major purposes: to provide a
despite the benefits of such advances, medical technology
central resource facility at the College for projects in human-
was tending to preempt medicine’s long-standing concern for
istic medicine; and to stimulate new projects from individu-
human values. Today, the rationale behind a humanities
als or groups related to the Medical Center. Activities of the
component in medical education is even stronger, with the
Center involved lectures by both visitors and Medical Center
need to reassert the values of the profession in the wake of
personnel, a lunchtime discussion series, support for a play
managed care and its business ethic, the fact that physicians
written by a third-year student about dying, and a Grand
must be able to serve an increasingly culturally diverse
Rounds on religion and medicine. The Center for Human-
population, and the problems posed by technological ad-
istic Medicine not only served as an important ally in the
vances in fields like genetics. The mission of the Department
Department of Humanities’ mission, but also helped inte-
is a function of this rationale: to engender a critical aware-
grate the College with the Medical Center.
ness of the values, presuppositions, and methods that under-
An important event in the history of the Center for
gird medical education and practice; an appreciation for
Humanistic Medicine took place in 1985, when retired
ethical issues in medicine; empathy for the patient’s experi-
physicians Lawrence F. and Jane Witmer Kienle, from Med-
ence of illness; awareness of social values and beliefs that
ford, New Jersey, entered into an agreement with the College
shape the behaviors and expectations of patients, physicians,
of Medicine to provide material support for the Center. The
and research; a critical understanding of one’s own capabil-
Kienles also generously began to work as full members of the
ities and limitations; and a self-perpetuating intellectual
Center, devoting a great deal of energy and thought to its
curiosity.
projects. In 1988 the Doctors Kienle Chair for Humane
Medicine was established, to be filled by a clinician with
special interest in humanistic aspects of medicine. In 1991, Faculty
when Dr. Jane Witmer Kienle died suddenly at her home, the
Center lost a staunch friend and ally. The following year, it The Humanities Department now has six faculty: three PhDs
was officially renamed The Doctors Kienle Center for Hu- representing the disciplines of history, literature, and anthro-
manistic Medicine in recognition of the Drs. Kienle’s gener- pology; two MD/ethicists with joint appointments in (and
1002 ACADEMIC MEDICINE, VOL. 78, NO. 10 / OCTOBER 2003HUMANITIES EDUCATION AT PENN STATE, CONTINUED
responsibilities to) the departments of Medicine and Pediat- literary magazine), GLAMA (gay and lesbian student alli-
rics; and an RN with a PhD in health education. The ance), “Silver Lions” (nontraditional students), the “Hershey
addition of physicians and nurses has enabled our department Medical Theatre Group,” and the “Global Health Initiative.”
to be much better integrated with clinical departments and However, most of our work with students is devoted to
generally informed about clinical medicine. Because the teaching.
student body has increased by a third since the inception of
the medical school, we also rely on medical faculty outside
our department to help meet our teaching responsibilities. Courses and Seminars
Recently, to make such teaching desirable (and to show our
gratitude), we instituted a policy whereby clinicians who Since the inception of medical humanities at Penn State
teach in Humanities courses on a regular basis are awarded College of Medicine nearly 40 years ago, the humanities
joint appointments in our department. We now have four program has grown substantially, alongside our research fa-
such appointments. Inclusion of clinicians as course faculty is cilities and our student body. We now offer required courses
a part of our mission to the institution, and we are proud that and seminars in all four years. In the first and second years we
the dean of the medical school chooses, despite his many offer “core” courses, both of which are integrated into a larger
responsibilities, to teach a section of the first-year course. course component in the curriculum (see List 1).
The College of Medicine has since its inception made an The first year course, Humanities and Medicine, consists of
explicit and major commitment to the teaching and practice 12 two-hour, weekly sessions that in some way relate to three
of humanistic aspects of medicine. Housing for the Human- key themes: the patient’s perspective on illness, cultural
ities Department consists of a handsome suite of rooms on issues in medical practice, and medical professionalism. The
the ground floor of the medical school complex, making the course format consists of small groups of approximately 16
department readily accessible to medical students and col- students each, with occasional plenary sessions. These ses-
leagues. All current faculty positions and basic departmental sions include a disability rights activist who is disabled, a
operations in the Humanities are fully supported by univer- physician who is personally involved in providing medical
sity funds. Our MD/ethicists have been successful in bringing care for the poor, and a former patient who used alternative
in National Institutes of Health grants, and the rest of us medical modalities in recovering from breast cancer. For the
have been awarded funds for curriculum development and session on aging, we draw on the College of Medicine’s
teaching from the National Endowment for the Humanities, standardized patient program to bring eight “seniors” to each
the Templeton Foundation, the American Council of discussion group to be interviewed by our students about a
Learned Societies, the Arthur Vining Davis Foundation, and specific problem. Students are asked to find out about their
the Fund for the Improvement of Postsecondary Education, patient’s goals and needs and then work toward a solution
as well as occasional extramural funding for humanities with the patient that incorporates those goals and needs.
research. Though we are expected to seek foundation sup- This exercise enables students to bring together their newly
port, administrators recognize that Humanities faculty do not acquired skills in clinical interviewing and issues relevant to
have the same opportunities for salary support through grants certain patient groups.
as do their colleagues in the sciences. A dimension of our emphasis in this course on patient
Humanities faculty are full members of the college in every experience is “The Patient Project,” a year-long exercise
sense: we sit on (and sometimes chair) major committees wherein first-year students are assigned in pairs to follow a
that include the Medical School Selection Committee, Eth- specific patient through monthly visits at the patient’s
ics Committee, Institutional Review Board, Curriculum home.2 The purpose of this exercise is for students to learn
Committee, Health Affairs Legislative Committee, and Pro- from patients about the experience of illness and treatment.
fessional Advisory Committee for Pastoral Services, and we At the end of the year, students write a “rich” patient history
serve as Directors for Clinical Clerkships. We hold annual, that includes a variety of social and psychological issues
two-day “retreats” for residents (an activity funded by the relevant to illness and treatment. Though originating in the
Doctors Kienle Center for Humanistic Medicine), offer sem- Humanities Department, the Patient Project is now drawn
inars in our disciplines for medical faculty, and give formal on by other courses in our first-year integrated curriculum. It
presentations at Grand Rounds and various clinical confer- has proved to be an excellent (and popular) learning expe-
ences. Despite these activities, our primary involvement is rience for the students, who have little contact with patients
with medical students. Humanities faculty serve as student in their first year, and it has also proved to be an experience
advisors, direct independent study projects and MSRs (med- that our patients value and enjoy.
ical student research projects required for graduation), and The core course for second-year students, Ethics and
act as mentors to such student groups as Wild Onions (our Professionalism, also consists of 12, two-hour, weekly ses-
ACADEMIC MEDICINE, VOL. 78, NO. 10 / OCTOBER 2003 1003HUMANITIES EDUCATION AT PENN STATE, CONTINUED
List 1 course, with other humanities faculty teaching small-group
sections alongside their clinical colleagues. Our clinician-
Topics of Required Courses, Conferences, and Seminars Offered in the ethicists, both of whom serve on the hospital ethics commit-
Humanities at the Pennsylvania State University College of Medicine, tee, are also responsible for ethics-related teaching at various
Hershey, Pennsylvania levels of the institution: weekly ethics case conferences for
medical students participating in their Internal Medicine
Topics of the first-year core course “Humanities and Medicine” clerkship (other Humanities faculty regularly join in this
The culture of medicine
teaching), monthly discussions with students on their Pedi-
The hospital, past and present
Patient perspectives on illness
atrics clerkship, regularly scheduled teaching sessions for
Suffering and the patient residents in Pediatrics and Psychiatry; and staff seminars for
Religion and spirituality the medical intensive care unit (ICU), the surgical ICU, the
Disability pediatric ICU, and Ophthalmology.
Alternative and non-Western medicine In the fourth year, students are required to take any one of
Providing medical care for the poor a number of four-week intensive Humanities seminars on
Aging
particular topics such as palliative care medicine, children
Dying and death
Professional responsibility
and HIV/AIDS, and medical ethics and literature (see List
Topics of the second-year core course “Ethics and Professionalism” 1). The purpose of this requirement is to revisit themes and
Informed consent concerns of the medical humanities that were introduced in
Managed care a general way in the first two years, this time permitting
Legal issues students to bring their clinical knowledge and experience
Ethics and children into direct engagement with humanistic perspectives.
Truth-telling and mistakes
Confidentiality
Research ethics
Ethical issues in genetics Activities
Decisions at the end of life
Advance directives A selected group of students are offered an opportunity to
Physician-assisted suicide complete an independent study project with a humanities
Hospice and palliative care faculty preceptor instead of one of the fourth-year seminar
Third-year conferences
course offerings. In most cases these projects focus on an area
Ethics Case Conferences during Medicine clerkship
Ethics Case Conferences during Pediatrics clerkship
in which the student has a particular interest or skill. For
Fourth-year seminars (one-month-long intensive seminar required) example, Keith Swetz, a student who plans a career in
Palliative Care Medicine academic medicine, designed an elective, intersession course
Children and HIV/AIDS on contemporary issues in medicine for health care careers
Advance Care Planning students at his undergraduate liberal arts college. In 2001–
Medical Ethics and Literature 02, the year before teaching the course, the student met
Folk and Alternative Health Systems
regularly with two Humanities faculty members at the Col-
Contemplative Practice and the Art of Medicine
Religion and Health
lege of Medicine and a professor of Biology at the sponsoring
Controlling Human Heredity: Lessons from History Sufferers and Healers in college to draft lesson plans for each class session, which
History included lecture and discussion topics, a readings list, audio-
Crises and Conflicts around Medical Adversity visual needs and evaluation tools. For most of the didactic
Readings in Literature and Medicine and small group discussion sessions he used concepts and
materials drawn from our first and second year humanities
core curriculum. The course was so popular that the student
was asked to teach the course again the following semester.
Often, the fourth-year student editor of Wild Onions, our
sions. The course format consists of an introductory plenary school’s literary journal, will undertake a project substantial
lecture, followed by eight discussion groups of about 16 enough to be turned into a course. In 1994, student editor
students each. The sessions on informed consent and confi- Gail Kase, who planned to specialize in Psychiatry, devel-
dentiality employ standardized patients for each of the small oped a poetry therapy program that she brought to patients in
groups, exercises that concretize ethical concepts, which are our adult and pediatric psychiatric wards, medical and surgi-
often abstract, by rendering them as “realistic” patient sce- cal patients, and residents of a retirement community. Many
narios. Our departmental clinician-ethicists direct this of these writings were included (with permission of the
1004 ACADEMIC MEDICINE, VOL. 78, NO. 10 / OCTOBER 2003HUMANITIES EDUCATION AT PENN STATE, CONTINUED
author) as a special section in her issue of Wild Onions. This daunting. But Penn State is well into an extremely rigorous
opportunity for students associated with the journal to en- mission-based management analysis, and the result is strong
gage in clinically related activities continued in subsequent support for the Humanities Department, because of our
years. In 1997, fourth-year student editor Leon Lai expanded contribution to the school’s mission. As medical schools
the poetry therapy program to train medical students in adopt such accountability efforts, the ability of a humanities
organizing and running poetry therapy workshops for people department to engage in the clinically oriented teaching
with HIV/AIDS and their loved ones. He identified estab- mission of the institution is the key to the ability to flourish.
lished AIDS support groups in various central Pennsylvania Humanists have always said that their discipline can con-
communities, and sent students to those groups to run poetry tribute to producing better physicians and a more humane
workshops. Many of these writings were included in that environment within medicine. Solid mission-based manage-
year’s Wild Onions, prefaced by moving, personal comments ment provides an opportunity to prove that point.
from each student poetry-therapy facilitator. In 2002, Jac- The success of our department, in the words of Darrell
queline Dahl focused on women’s health care, sending the Kirch, Dean of the College of Medicine, lies in “the Depart-
students she trained to support groups for breast cancer, ment’s willingness to be both scholarly and engaged . . . en-
infertility, reproductive cancers, infant loss, and teen parents, gaged in the real life of the Medical Center, both in terms of
as well as to a local women’s prison. Jackie worked hard at teaching activities and of contributing ultimately to patient
involving students from the preclinical years. In the essay she care. As we realize the core competencies that students
submitted for Humanities course credit, she wrote: “I thought should acquire during their education, an engaged Humani-
that leading a patient support group would give students ties Department can play a major role in furthering the
insight into the hopes, fears, and struggles of patients—all mission of an academic medical center.” At Penn State, the
topics easily overlooked when a student is struggling to learn Accreditation Council for Graduate Medical Education’s
the many forms of disease the human body can suffer.” professionalism mandate has been wholeheartedly endorsed
The activities sponsored by the Doctors Kienle Center for and extended through the undergraduate medical curricu-
Humanistic Medicine also continue to grow. They include lum, and the Humanities Department is centrally involved.
development of an art collection related to medicine; liter- The future of the medical humanities at the Penn State
ature and art competitions; a medical theatre program which College of Medicine is secured by a commitment to the
led to the publication of a book of plays about end of life clinical and academic missions of the institution, and by a
issues3; sponsorship of student groups devoted to humanistic faculty and administration that recognize that commitment.
topics; an awards program that recognizes students, residents, As Dean Kirch has remarked, “The Humanities Department
faculty, and nurses for outstanding humanistic qualities; cur- is the heart and soul of the institution in that it reminds us
riculum development grants; and most recently the establish- of those dimensions of life that can be obscured by a narrow
ment of the Kienle Chapter of the newly founded Gold focus on the sciences.”
Humanism in Medicine Honor Society (the Arnold P. Gold
Foundation). All of these activities involve clinical col-
leagues at the Medical Center working in collaboration with
members of the Department of Humanities. REFERENCES
1. Harrell GT. Humanities in medical education: a career experience.
THE FUTURE Perspect Biol Med 1985;28:382– 401.
2. Gliem V. Patients: teaching lessons of the heart. Penn State Med.
2002;13:12– 4.
Humanists tend to mistrust quantification. And at a time 3. Hawkins AH, Ballard JO (eds). Time To Go: Three Plays on Death and
when academic medicine in general is experiencing financial Dying, with Commentary on End-of-Life Issues. Philadelphia: University
strain, the “metrics” of mission-based management may seem of Pennsylvania Press, 1995.
ACADEMIC MEDICINE, VOL. 78, NO. 10 / OCTOBER 2003 1005You can also read
