THE STUDY OF LITERATURE IN MEDICAL-EDUCATION

The study of literature encourages the development of otherwise hard-t o-teach clinical competencies. It provides access to the values and ex periences of physicians, patients, and families; it calls for the exer cise of skill in observation and interpretation, develops clinical ima gination, and, especially through writing, preserves fluency in ordina ry language and promotes clarity of observation, expression, and self- knowledge. Faculty in one-third of U.S. medical schools teach literatu re in courses that, although concentrated in the preclinical years, ra nge from the first day of school through residency programs. Once focu sed on the work of physician - authors and realist fiction about illne ss that encouraged moral reflection about the practice of medicine, li terary study in medicine now encompasses a wide range of literature an d narrative types, including the patient history and the clinical case . Literary study is intended not only to enrich students' moral educat ion but also to increase their narrative competence, to foster a toler ance for the uncertainties of clinical practice, and to provide a grou nding for empathic attention to patients. Literature may be included i n 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, frequ ently on particular social issues or on the experience of illness. Rea ding, 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 pract ice. Pedagogical and scholarly resources include Literature and Medici ne, the Center for Literature and the Health Care Professions, and an online database and discussion group.