The Liberal Arts
J. William Eley
Carolyn K. Clevenger
The artful caregiver must be an astute student of science and humanity. Whether they are recommending increased exercise, administering a vaccination, or performing an organ transplant, those providing help to the sick or attempting to prevent illness are interventionists. The goal of medical intervention should be to alleviate suffering, so that individuals may experience lives of quality, meaning, and enjoyment. In practice, the cure or amelioration of disease allows an individual to pursue activities and engage with others—through words, visual arts, or music, for example—in ways that define quality of life.
Each individual defines quality of life according to her or his culture, family, and experience. The best medical practitioners assess each individual life situation to be of the greatest help, especially given the increasing gravity of medical intervention—miraculous benefits as well as serious side effects.
To make optimal, patient-centered decisions, the caregiver must partner with the patient. For the practitioner to achieve such a partnership, also referred to as a “therapeutic” relationship, he or she must seek to understand both the personal and the broader contexts of the patient’s life. The physician or nurse with a deep knowledge of a patient, family, and community, born of a long-term caring relationship, is the greatest ally in times of health and illness. The appropriate medical interventions should ultimately support individuals and communities as they seek to live moral lives that are appreciative of beauty.
From the above, it should be clear that the liberal arts (including the natural sciences, social sciences, and humanities) are foundational to the effective practice of medicine. By basing modern medicine firmly upon the natural sciences, extraordinary progress has been made. Yet the other disciplines of the ancient and modern liberal arts are equally important. The liberal arts help define the very meaning of the lives we hope to prolong or improve by describing beauty, interpreting suffering, and explaining the biology and chemistry of life. The art of communication, study of ethics, and understanding of probability (logic and math) are rooted in the classic liberal arts; each of these disciplines is critical to the generation, understanding, and application of medical science. Sociology, anthropology, psychology, history, and political science are essential to our understanding of humans and society. This is the rationale for the place of the liberal arts as historically required for admission to formal programs of health professions education.
Currently, an undergraduate nursing degree at Emory includes requirements in the liberal arts, both in the natural sciences and the humanities, to be achieved during the first two years of nursing education, prior to clinical nursing training. Likewise, the prerequisites for admission to the graduate programs in nursing and medicine include coursework in the natural sciences and humanities. As in the undergraduate program in nursing, there are no clear requirements for the explicit study of the humanities, arts, or social sciences in the graduate programs. Thankfully, the accrediting bodies and the curricular objectives of nursing and medical programs are full of references to the importance of the understanding of the human condition broadly and in context of community and culture. In fact, the education of both nurses and physicians has seen a resurgence of interest in including the humanities in the education of the caregiver.
Recognition of the biologic underpinnings of medical care has been and should remain strong; this is an inextricable link between the liberal arts and medicine. The importance of the humanities in the training of caregivers is increasing. The American Academy of Colleges of Nursing (AACN), the accrediting body for nursing education, clearly states that nursing education is based in a liberal arts education. Unfortunately, this has been traditionally achieved through pre- or co-requisite courses, so that learners understand the liberal arts and nursing education to be separate entities. The inclusion of both the arts (literature, music, sculpture, dance, and theology) and sciences (physical, life, mathematical, and social) places these subjects as the cornerstones for cultural competence and clinical reasoning. Finally, the analytic skills developed in the liberal arts education build the intellectual and innovative capacities needed for the much-needed reform of healthcare delivery.
Recent reports on the education of the professions have recommended significant overhaul of medical and nursing education. In Educating Physicians (2010) and Educating Nurses (2009), the Carnegie Foundation for the Advancement of Teaching specifically calls for a deeper integration of the liberal arts in the professional education. These reports have ignited change and strong policy statements from licensure, accreditation, credentialing, and educational bodies. Many of the AACN statements are derived from these reports. They also advocate for a move to a more conceptual learning styles, and away from an information learning style. The medical college admission test of 2015 will broaden its scope to include social sciences. New models of patient care are being introduced to once again emphasize the importance of a long-term relationship with a practitioner who appreciates the complexity of the human condition in improving care and medical decision-making.
Curricular reforms at Emory in both medicine and nursing have emphasized the value of the mentoring relationship and the understanding of health, medicine and the individual in the broadest sense: family, community, and culture. While courses in the medical humanities are attractive for their simplicity, we do not feel that new courses are the best approach. Rather, we believe that the integration of the liberal arts throughout the training of caregivers is the logical, and most effective, way to truly emphasize the importance of what we have described as disciplines critical to the effective practice of nursing and medicine. In nursing and medicine we have begun this integration, but we look to our fellow faculty writ large to continue our efforts. We have chosen to include the liberal arts in our classrooms amidst the science.
We have also made deliberate efforts to include the beauty inherent in the arts within our schools. The new School of Medicine building has hosted numerous art and photography exhibits, and performances by the Vega String Quartet, cellist Matt Haimovitz, and many student musicians. The School of Nursing houses an exhibit of artistic photography from nursing care around the world. These moving displays and performances have included artist talks inside the classroom and beside their art. None of these would have been possible without the kind gifts of our college and graduate school faculties. At the university level, the clear links between the liberal arts and health professions were highlighted during a recent Fox Center for Humanistic Inquiry evening dedicated to the future of the liberal arts. The foundational links between the liberal arts and the health professions were clearly elucidated; the potential to advance professional medical education and care was limited only by our time together and our imaginations.
Finally, there is an additional role for the liberal arts and the fine arts in healing work that should be emphasized. The liberal arts do play a critical part in our understanding of what it is to be human and to live a “good” life. It thereby serves as the bedrock of why we give care. However, the arts also represent the greatest expression of the human spirit. Literature, music, art, architecture, and dance lead all of us, patients and caregivers alike, to greater understanding and joy. The arts are often the best treatment, an elixir for the soul and spirit as we grapple with the challenges of life and caregiving.
We have described four fundamental roles for the liberal arts in the education of the medicine and nursing professional: 1) The natural sciences as pre-requisite to the medical sciences; 2) the humanities, social sciences, and fine arts as essential to being an artful practitioner; 3) the practitioner’s understanding of the human condition, through which he or she is able to share interests with a broad range of people and strengthening the therapeutic relationship; and 4) the humanities and arts as they provide all of us with greater understanding of the human condition.
While it is clear that the current university structure of centers, schools, and departments can be a barrier to collaborative efforts, it is also heartening to have participated in the successful collaborations to date and the ongoing efforts by the faculty to better define the role of the liberal arts at Emory and beyond. May our collaborations continue to move our uni-versity forward for the benefit of all.