Section Name Description
Module 1: Lesson 1: The Emergence of Modern Medicine URL The Physicians' Profession through the Ages
Edmund Pellegrino (1979), defined humanism as a "set of deep-seated personal convictions about one’s obligations to others, especially those in need, encompassing a spirit of sincere concern for the centrality of human values in every aspect of professional activity." Throughout this course, we will explore various aspects of humanism as it relates to health and health care. Gaufberg and Hodges (2016) elaborate this point writing, that humanism “more than learning how to display empathy and appreciate another's perspective," but involves “recognizing and navigating tensions between values such as empathy and objectivity, efficiency and quality, standardized and individualized care” as well the “influence of systems and culture on relationships.”

We will begin this endeavor by situating the notion of humanism in the larger history of medicine and health care. Read the classic article by medical historian Henry Sigerist, which gives an account of various premodern medical traditions and then the emergence of modern medicine. As you read, think about how the orientation of premodern medical practitioners captured particular notions of humanism--of what the body was, of what disease was, of the relationship of different aspects of a person's life to their health. As modern medicine emerges, what forces shaped it and how did these affect the humanistic sensibilities of medicine (both for better and worse).

Continue by reading the article at the link below. 
Module 2: Lesson 1: The Epidemiological Transition URL The Epidemiological Transition (or What We Died, Die and Will Die From)

Please read the linked article. The video clips embedded in the article are interesting but not required. As you explore the epidemiological transition, think about what it means for how we think about and deliver health care in different systems and how these changes have influenced how health care has evolved over the last 40 years (e.g. does the epidemiological transition have any relationship with the push toward preventive medicine).

Module 2: Lesson 2: The Impact of the Epidemiological Transition on Humanism in Health and Healthcare URL The End of Modern Medicine: The Evolution of Disease and Transformations in Medical Practice

Please read the linked article. As you explore the epidemiological transition, think about what it means for the humanistic aspects of medicine. In other words, reflect on whether, in light of the epidemiological shift toward chronic diseases, health is becoming increasingly social and humanistic.

Module 3: Lesson 1: Medicalization and Social Control URL Medicalization: A Historical Perspective

Please read the linked article on medicalization. While you read, pay particular attention to understanding what medicalization is, and the different forces that promote medicalization. Think about what other sorts of conditions have become increasingly medicalized over the last century. Are there any conditions that have become less medicalized over time?

Module 3: Lesson 2: Medicalization and Overdiagnosis URL Medicalisation and Over-diagnosis: What Society Does to Medicine

Please read the article on medicalization and over-diagnosis. As you read, think about how the expectations of patients, combined with the profit driven nature of many clinical practices and practitioners fear of lawsuits might combine to create a situation in which patients are over-diagnosed and over-treated. How might this be bad for patients, and for health care as a whole?

Module 4: Lesson 1: An Overview of the Biopsychosocial Model URL The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry

Please read the article which not only gives a good account of George Engel's original specification of the biopsychosocial but also updates to those ideas. As you read it, think about how the psychological and social aspects of health and illness intersect with its biomedical features, as well as what other sorts of things might still be missing from this 3-part formulation (e.g. in hospice/palliative care, practitioners often think in terms of a four-part, bio-psycho-social-existential model).

URL The Role of Spirituality in Healthcare

Many talk not only of the biopsychosocial model, but of a bio-psycho-social-spiritual model or a bio-psycho-social-existential model of care. This article by Christina Puchalski describes the role of spirituality in health and health care. As you read it, think about how you might integrate notions of spirituality into what you've already read about the biopsychosocial model.

URL The Biopsychosocial Model 40 Years On

This chapter is a useful supplement for exploring the strengths and weaknesses of the biopsychosocial model. It expands on the issues mentioned in the required reading in ways you might find helpful. It is quite lengthy, so it is provided here only as an optional supplement for those who want to investigate these issues further than is necessary for the course.

URL Bringing a humanistic approach to cancer clinical trials

While we have largely focused on humanism in the therapeutic context, it is also important in the research context. This article articulates various considerations of humanism within the setting of clinical research.

Module 5: Lesson 1: The Historical Evolution of Bioethics URL What is Bioethics: A History

Please read the book chapter provided. Think about how bioethics as a discipline emerged in response to growing humanistic concerns in medicine. How has the expansion and development of bioethics brought in additional notions of social and human experience of health and illness?

Module 5: Lesson 2: Clinical Ethics Analysis URL Clinical Ethical Decision Making: The Four Topics Approach

Please read the article provided. Think about how the four topic approach brings together key normative considerations (ideas about what we morally are obligated to do), with the social and human experiences of patients (how they live and how they think about health and illness), and with the landscape of health and medicine (the availability of treatments and technology and the costs of those).

Module 6: Lesson 1: The Science of Empathy URL The Role of Empathy in Medicine: A Medical Student's Perspective

Read the article by Elliot Hirsch as he describes not only the important difference between sympathy and empathy, but also his own process of coming to appreciate the role of empathy in healthcare. As you read, think about your own goals as a health care provider be it in the realm of medicine, nursing, or another allied health profession. How might empathy be critical to your own practice? Do you encounter skepticism about empathy in patient care (either your own or that of your peers)? How might you respond to such critics?

URL The Science of Empathy

Read the article by Helen Riess that articulates a neurocognitive basis for empathy and describes how it plays out in interpersonal relationships between clinicians and patients. As you read, think about how the demands for empathic interactions have amplified after the epidemiological transition (using concepts from the first section of this course).

Module 6: Lesson 2: Empathy in Patient Care URL Effectiveness of Empathy in General Practice: A Systematic Review

Read the systematic review by Frans Derksen and colleagues. This article reviews empirical research on the outcomes associated with empathy in clinical relationships. As you read it think about your own interactions with health care providers (physicians, nurses, and other allied health professionals), either in a professional or personal context. How has empathy mattered to you as a health care provider, as a patient, or as a family member of a patient?

Module 7: Lesson 1: Working with Literature URL Three Things to Do With Stories Using Literature in Medical, Health Professions, and Interprofessional Education

Please read the article by Michael Blackie and Delese Wear in which they describe three ways to leverage the power of stories for deepening our insights into the humanistic aspects of illness and healthcare. As you read, pay particular attention to the three objectives: 1) Reading closely; 2) Modeling ethical or moral inquiry; and 3) Drawing out their illustrations. Examine how the authors do each of these using the example in their article.

URL Choose a Story and Practice Reflection and Response

Please choose a story of illness from the Health Story Collaborative and apply the three exercises described in the previous reading by Blackie and Wear. That is, in reading each story, 1) read deeply, 2) engage in moral inquiry, and 3) draw out their illustrations, particularly of illness and the experiences of healthcare that are represented.

Module 7: Lesson 2: Working with Visual Art URL Last Scene

Health care workers learn to probe the intimate depths of an individual often through a dispassionate, scientific lens and language: measuring and interpreting blood serum chemistries, taking a history of illicit drug use, episodes of heart disease within the family. These questions are important for understanding the biomedical aspects of disease, but humanistic healthcare requires understanding the social, psychological, affective, and existential aspects of illness as well. Art can help us expands the boundaries of our exploration beyond the body further, to the individual beyond the pathology. The artist Hrair Sarkissian describe their piece ’Last Scene’ (2016) as “a series of 47 photographs of places in The Netherlands that there chosen by terminally ill patients to go and see as their last wish. The project centers on the power of a well-loved place to compress an outlook on life into a telling scene that is at once melancholic and joyful. The simplicity of each landscape or scene heightens attention to an inner journey of remembering the past and envisioning a future that no longer includes you.In contemporary culture the notion of death and dying is often consciously ignored. This project gives the viewer a way in to grapple with the question of where we come from, and where we are going. The images turn into mirrors: on the one hand you try imagine the person who looked at the scene for the last time, while at the same time it encourages introspection: what would my wish be?. These scenes were photographed at the date and time of the actual last visit.” 

Please view at least 5 of these photographs. Spend time staring at them, and even when you think you've taken in everything one has to offer you, look a while longer and see if additional thoughts or insights don't emerge. Jot down your thoughts and reflections. In particular, what sort of image of the each patient associated with each photograph comes to your mind. How might those insights help you provide more humanistic care to those patients?

Module 7: Lesson 3: Working with Poetry and Prose URL Kindness

Reading and writing poetry is as much a tool for self-expression as a tool for self-exploration. While reading these works connect with the memories, associations, and emotions that the poems bring forward for you personally. Use the “Questions to Consider” as jumping off points to explore your own feelings regarding the themes discussed in each poem. As you read, thinking about how your own relationship with loss/death/suffering changed because of your experiences in healthcare (either as a patient, a student, or a practitioner). Do you feel your capacity for empathy has deepened or dulled? How do these experiences impact the way you view yourself and your patients? 

After reading and the poem Kindness by Naomi Shihab Nye, and thinking about these questions, return here for some additional thoughts (STOP HERE and read the poem "Kindness" first). 

Naomi Shihab Nye wrote this poem shortly after a horrific experience during her honeymoon. She and her husband planned to spend a few weeks in South America but shortly after arriving the entire bus they were traveling with was robbed. One man on the bus was killed during the incident. Later, a local man approached them, sensing their distress, and asked what happened. He listened and was kind. While her husband hitchhiked to a nearby town, with night approaching quickly, penniless, without a passport, sitting alone in an empting small town plaza Naomi Shihab Nye wrote this poem. Here kindness is connected with experiences of sorrow and as one deepens, often so does the other. This connection is later reiterated as kindness being both a friend, and a shadow. It is not sorrow alone that deepens our appreciation of kindness but rather we must “speak to it until your voice catches the thread of all sorrows and you see the size of the cloth”; it is when we allow our sorrow to connect us to the universal experience of suffering, with others, and with what we love. How does the sorrow you experience connect you with others and what does it bring you to more deeply appreciate?

URL The Journey

Similar to the activity above, please read the poem, "The Journey" by Mary Oliver. As you read, think about whether unrealistic expectations from patients or their family members undermined the confidence you have in your capacity as a practitioner? If you have ever, cared for a patient that could not be “saved”, did you blame yourself or feel it was a reflection of your capacity (if you have not yet had this experience, think about how you might feel)? 

After reading the poem "The Journey" by Mary Oliver, and reflecting on the questions above, return here for some additional thoughts (STOP HERE and read the poem "The Journey" first): 

Mary Oliver’s poem focuses on the journey we take to become an individual. Realizing what we know we need to do to thrive and accepting responsibility for the path we take is the first step that propels us toward growth. Initially, the traveler is met with voices that try to sway them from the path they know they must take. These voices may be society’s expectations, family expectations, obligations we feel toward others that come at the cost of our wellbeing. She writes “You knew what you had to do… through their melancholy was terrible” which emphasizes how our sympathy can sometimes lead us to betray ourselves. It is a confusing and uncomfortable journey. The house is a metaphor for the self; when we venture on this journey the very foundation of how we understand our self is shaken. The road is “full of branches and stones” but “little by little” our own voice becomes clearer. The further along on our journey we go, the easier it becomes to know our true self and go where our individual conscious, our own internal voice, leads us. What bad advice/voices/pleas/expectations do you know you must ignore as a health care practitioner in order to thrive?

Module 7: Lesson 4: Working with Music URL Jazz and the 'Art' of Medicine: Improvisation in the Medical Encounter

While art can be used to promote self-reflection and deepen our understanding of our own practices, it also can inform how we practice more directly. Think about the old adage, "medicine is an art and a science." The artistic side of health care practice requires sensitivity to the humanistic dimensions of patient care, which inherently involves a set of complex and often seemingly chaotic factors. Please read the article by Paul Haidet. As you read, think about how the intricacies and complexities of music, in this case improvisational jazz, offer a model for how to approach the complex human aspects of patient care.

URL Supplemental: More on medicine and the arts

For more resources on the relationship between art and healing, including works of narrative, poetry, and visual art, please explore this journal.

Module 8: Lesson 1: Narrative Medicine: Connecting with Patients URL Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust

Please read the article by Rita Charon with a focus on understanding what narrative medicine is, and how it inherently incorporates empathy and relationship building. As you read it, think about how the practices above of reading poetry or examining art, help strengthen our capacity to engage patient narrative.

URL What is Narrative Based Medicine

Please read the article by George Zaharias, which briefly reviews the notion of narrative medicine, but then elaborates key concepts needed to put it into practice. In particular, pay close attention to the 7 Cs and the open-ended questions that can help elicit narratives from patients, as well as helping them elaborate their stories.

URL Professional identity (trans)formation in medical education: reflection, relationship, resilience

The articles above mainly focus on how narrative can add to the picture of the patient and their illness, particularly in ways that foster a humanistic view. This supplemental article turns that lens back toward the professional identity development of the practitioner, exploring how narrative, in the form of reflective writing, can foster humanism and empathy among professionals.

URL Making it “More Real”: Using Personal Narrative in Faculty Feedback to a Medical Student’s Reflective Writing – An Illustrative Exemplar

This supplemental article will be particularly useful for those of you engaged in this course as a mentored experience with a faculty member or peer. This article explores interactive reflection in the process of giving feedback on narrative. If you've written narrative above, think about employing the type of interactive reflective model described by Wald and Weiss in the process of giving feedback. Then, think about the types of connections this has fostered that may not have been present with a more traditional form of feedback.

Module 9: Lesson 1: Understanding Burnout in Healthcare: Causes and Consequences URL Burnout in United States Healthcare Professionals: A Narrative Review

Please read the article by Thomas P. Reith. As you read, pay particular attention not only to the causes of burnout, but also to the kinds of causes (e.g. individual level factors versus system level factors). Think about various strategies that might be employed in response to each kind of factor.

URL The Problems With Burnout Research

This supplemental article interrogates the conceptual issues with the notion of burnout in an enlightening way, including how the construct is misused, and often overlooks the systemic features of burnout, incorrectly locating it solely within the individual practitioner. That is, while burnout is a systemic issue, it often is only examined at a level of individual pathology, which can lead to a sort of blaming the victim.

Module 9: Lesson 2: Self-care and Patient Care URL Developing resilience to combat nurse burnout

The Dalai Lama (2003) said, “For someone to develop genuine compassion towards others, first he or she must have a basis upon which to cultivate compassion, and that basis is the ability to connect to one’s own feelings and to care for one’s own welfare. . . Caring for others requires caring for oneself.” This lesson focuses precisely on this concept.

Please read the following article by the Joint Commission on burnout. While the article focuses on nursing, it mostly is applicable to health professionals more broadly. As you read it, think about the particular strategies for responding to burnout at the systems level (e.g. what you might do within the operational structure of your institution or unit), interpersonal level (e.g. what you might do in response to a colleague who appears to be struggling with burnout), and the intrapersonal level (e.g. how you might respond to your own feelings of burnout).

URL Case Study: Dealing with Burnout

Read the case study provided by Elllis and Lasic. Reflect on the discussion questions and apply your insights from the Joint Commission reading to how you might respond to the situation described in each case. After reflecting on these questions, read the case discussion section for each case and compare your insights to the ideas and strategies articulated there.

URL Compassion Fatigue and Substance Use Among Nurses

Read the entire article except for the Methods section. (24 minutes)

URL Addressing Alcohol and Substance Use Disorders among Refugees: A Desk Review of Intervention Approaches

Read the section under the section "Introduction" on the pages 9-12. (18 minutes)

URL Cultivating Moral Resilience

Resilience is an important aspect of burnout and attempting to mitigate it. This supplemental article focuses specifically on the intersection of two important concept that are highly related in the context of burnout: Resilience and moral distress.

Module 9: Lesson 3: Empathy and Self-care at Odds?: Thinking Realistically and Critically URL Empathy and Burnout in Medicine: Acknowledging Risks and Opportunities

Please read the short commentary by Rajvinder Samra in which she raises critical questions about the potential conflict between providing engaged and empathic patient-centered care, and combating burnout, particularly in the form of emotional fatigue. As you read, think about how it might be challenging to be empathically engaged and at the same time resilient against the emotional burdents that this might open up. Is it possible to be both empathic and resilient in this way? Do the concepts from previously modules (e.g. the difference between empathy and sympathy) offer a starting place for how to think about this dilemma?

URL Compassion and self-compassion in medicine: Self-care for the caregiver

This supplementary article both articulates the specific concept of self-compassion as a construct of self care, and has a nice section on distinguishing empathy and compassion in the context of self-care.

URL The dangerous practice of empathy

This supplementary article problematizes the construct of empathy (though really a particular definition of empathy that not all share). It makes important points about the prospects for intersubjectivity and the limits of the clinical encounter.

Module 10: Lesson 1: Problematics of Otherness URL Ethics Explainer: The Other

Read the short introductory essay from the Bioethics Centre, which describes the ethics of otherness and potential dilemmas that result from even well-intentioned efforts to help marginalized groups. 

URL The Face of James

Read the essay "The Face of James," by Jason Adam Wasserman, which describes a man who was a participant in Wasserman and Clair's (2010) ethnographic research on homelessness. Think about how not only those who were openly judgmental of homeless persons in the city, but also those attempting to help them, and even the researchers themselves, all saw James through particular, othering lenses. As you read the end, which describes an "ethics of difference" think about what that might mean for how we engage patients in clinical practice.

URL Othering in the Nursing Context: A Concept Analysis

Read the conceptual review article on othering by Roberts and Schiavenato, which elucidates how practices of othering occur within patient care.

Module 11: Lesson 1: Global Health and Cross-Cultural Practice URL Global Health Training: Ethics and Best Practice Guidelines for Training Experiences in Global Health

Read the article by the Working Group on Ethics Guidelines for Global Health Training (WEIGHT) in which they articulate a number of best practices for both organizations engaging in global health training opportunities and for those trainees who go on such experiences. As you read, think about how ethical and humanistic challenges emerge both for those organizations and those individuals.

URL More harm than good? The questionable ethics of medical volunteering and international student placements

Read the article by Imgard Bauer which highlights some of the common issues that arise with medical volunteering, particularly with short term experiences and in under-resourced countries. How do the WEIGHT best practices address some of these concerns? What can you do as a potential global health volunteer and/or trainee to avoid problematic situations?

Module 11: Lesson 2: Issues of Class and Poverty URL Socioeconomic Disparities in Health Behaviors

Please read the article by Pampel, Krueger, and Denney. As you read it, pay attention to the complex interplay of socioeconomic status and health, where lack of resources not only limits one's access to health care, healthy foods, healthy neighbourhoods, and the like, but also conditions one's expectations of health and health behavior. In other words, think about the multiple ways that social class constrains and enables health.

URL Structural Violence and Clinical Medicine

Please read the article by Paul Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. While the first article in this module reviews numerous ways in which social class can impact health (positively or negatively), this piece by Farmer and colleagues turns to the critical question about the relationship of poverty and disease, by framing the ways that poverty causes disease and illness as a form of violence. Furthermore, they explore the role of clinical practitioners with respect to mitigating the health consequences of poverty.

Module 11: Lesson 3: Race/Ethnicity and Health URL Race: A Starting Place

Please read the article by Brooke Cunningham, in which she articulates the deep historical roots of race/ethnic disparities in both US society at large and within medicine in particular. While she focuses largely on the US context, it is important to recognize that these same sorts of race/ethnic disparities, with their roots in race essentialism, are pervasive around the world. As you read, think about how our underlying epistemic orientation toward race/ethnicity might exacerbate inequalities in health.

URL Race, Ethnicity, and the Health of Americans

Please read the report authored by Roberta Spalter-Roth, Terri Ann Lowenthal, and Mercedes Rubio and sponsored by the American Sociological Association, which explores persistent race/ethnic disparities in health. While the report is from 2005, these disparities have persisted to the present day. Moreover, similar disparities can be seen across race/ethnic strata in countries around the world, with marginalized race/ethnic groups consistently experiencing worse health. Many of these issues have structural roots. That is, they are rooted in macro-level social structures in ways that might seem relatively immutable from the standpoint of the individual practitioner. As you read, however, think about how knowledge of these disparities might inform your clinical practice, the questions you raise, the ways you set up your office/unit and train your staff, etc.

URL Avoiding Racial Essentialism in Medical Science Curricula

Please read the article by Lundy Braun and Barry Saunders on the dangers of essentializing race in medicine. This article raises important questions and cautions about the ways we use race (or any other group-level characteristic) to speak about health risks. As you read, think about ways that we might use race/ethnicity in health and medicine that support efforts to attend to and reduce disparities. Alternatively, think about ways that race/ethnicity might be invoked such that, even unintentionally, the concepts are employed in ways that exacerbate disparity and/or stigma.

Module 11: Lesson 4: The Health of Immigrants, Refugees, and Displaced Persons URL Illegal Immigrants, Health Care, and Social Responsibility

Please read the article by James Dwyer, which discusses common arguments involving the provision of health care to undocumented immigrants. 

***NOTE: Make sure to select the PDF version, as the regular "full text" version requires you create a free account (the PDF version should launch without doing so). As you read, think about arguments that you hear today about this very issue and Dwyer's way of reframing the debate around different conceptions of scarcity and social membership.

URL Immigration as a Social Determinant of Health

Please read the article by Heide Castaneda and colleagues. As you read, think about how individual level factors are often focused on to the exclusion of social structural factors in understanding and addressing the health challenges faced by patients who are immigrants or refugees. How might some of the social factors nonetheless be useful in the clinical care of patients (i.e. in understanding their diseases, how well they might be able to manage them, etc.)?

URL PD 24 - Migrant and Refugee Health - World Health Summit 2020

In this session, after an update from the European Commissioner for Home Affairs about the recent regulations of the European Union related to immigration, well known experts in the field will present and discuss migrant and refugee health issues in Europe and beyond. (84 minutes)

Module 11: Lesson 5: Gender and Health URL Gender Disparities in Health: Strategic Selection, Careers, and Cycles of Control

Please read the article by Phyllis Moen and Kelly Chermack. This article provides an overview of the pathways between gender and health, across the spectrum of femininity and masculinity. As you read it, think about how the various factors described (caregiving, gender roles and expectations, coping, locus of control, etc.) create advantages or disadvantages. Bear in mind also that the health disadvantages of gender do not always flow in the same direction. In particular, think about the various social and humanistic factors related to our gendered experiences within society help explain the public health adage, "Women get sicker, but men die quicker."

URL The promises and limitations of gender-transformative health programming with men: critical reflections from the field

Read the article by Shari L. Dworkin, Paul J. Fleming & Christopher J. Colvin. As you read, think about how gender sensitive health interventions might be useful in clinical practice. While the article mainly focuses on public health intervention programs, can you think of ways in which these insights might also inform clinical practices with individual patients?

URL How gender affects the relationship between physician and patient

Read the short article by Fulvia Signani. As you read, think about your own experience in clinical practice--as a practitioner, a student, and/or a patient. How did notions of gender affect the relationships between practitioners and patients? Do the author's observations ring true to your experience? Why or why not? Are there other ways in gender can complicate clinical relationships (including interprofessional relationships on the health care team)?

Module 11: Lesson 6: LGBTQ + Persons and Health URL Understanding the Health Needs of LGBT People

Read the report by the National LGBT Health Education Center. As you read it, think about how the social experiences of LGBTQ+ patients impact their health through complex and interacting pathways. The report concludes with suggestions for ways that clinical practitioners can create inclusive environments. Can you think of practices you've encountered (as a practitioner, a student, or a patient) that were more or less inclusive? In what ways?

URL Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide

Read Chapters 1 and 2 (pages 7-17) from the LGBT Field Guide, published by the Joint Commission. Chapter one describes how health system leadership must articulate an inclusive vision and create inclusive systems. But leadership in a health system occurs at multiple levels and takes different forms in everyday practice. Chapter 2 follows with suggestions for inclusive practice. As you read these chapters, think about how you might be a leader who promotes inclusive environments and practices within not only your health system, but your unit or on your care team.

Module 11: Lesson 7: Incarcerated and Formerly Incarcerated Persons URL Linkages Between Health and Incarceration

Please read this essential resource that further elaborates the connection between incarceration and health.

URL Caring for ex-prisoners presents management challenges

Please read the article by Janet Colwell. As you read, pay particular attention to the health disadvantages faced by individuals who are currently incarcerated, and how incarceration disrupts health and health care for patients once they are released from the carceral system. How might this complicate the clinical care of patients who are or have been incarcerated? What strategies can you utilize at a clinical level to mitigate these difficulties and best care for these patients?

URL What Does Health Justice Look Like for People Returning from Incarceration?

Please read the case by Lisa Puglisi, Joseph P. Calderon, and Emily A. Wang. Before reading the authors' commentary on the case, think about it for yourself. In particular, identify the various ethical issues inherent in the case, and analyze how you would navigate each of them. Then read the author's commentary and compare their insights to your own.

URL Correctional Health: Recommendations and Guidance

If you choose, please review the CDC guidelines for correctional health, which contain specific recommendations for disease screening and treatment that are sensitive to the particular health vulnerabilities of those involved with the carceral system.

URL Federal Bureau of Prisons: Health Management Resources

If you choose, please review the Federal Bureau of Prison guidelines for correctional health, which contain specific recommendations for disease screening and treatment, beyond those covered by the CDC (which emphasizes infectious disease screening and treatment), that are sensitive to the particular health vulnerabilities of those involved with the carceral system.

Module 11: Lesson 8: Disability, Health, and Healthcare URL Prevalence of Disability and Disability Type Among Adults — United States, 2013

Please read the article by Elizabeth Courtney-Long and colleagues. Pay particular attention to the way that disability prevalence intersects with other social factors like socioeconomic status, race/ethnicity, and age. Think about how the intersection of these social factors and disability might compound the disadvantages that these patient populations face.

URL Disability: Definitions, Models, Experience

Please read the encyclopedia entry by David Wasserman and colleagues. As you read it, think about how we define disability in both everyday social life, but also in the realm of health and medicine. Do these definitions imply a particular set of values, norms, or priorities, that may be problematic for patients who live with disabilities? How might the assumptions inherent in our models of disability influence our interactions with patients in the healthcare context?

URL Three Things Clinicians Should Know About Disability

Please read the article by Joel M. Reynolds. As you read it, pay particular attention to how the author's recommendations address some of the problematic assumptions that are described in the previous reading by David Wasserman. How might you adopt these recommendations into your own clinical practice?

Module 11: Lesson 9: Health, Humanism, and Aging URL Inequalities Later in Life

Please read the report on inequalities later in life by the Centre for Aging Better. As you read, think about how not only the physical declines of aging confer health disadvantages, but also the social stigmas associated with it. Additionally, think about how aging intersects with socioeconomic position (and you might even want to pair this lesson with the one on social class above). Can you think of other social factors that might also intersect with aging in ways that confer either health advantages or disadvantages? How might you use these insights in the care of patients in the clinical setting?

URL Ageism in the Health Care System: Providers, Patients, and Systems

Please read the book chapter by Mary F. Wyman and colleagues, which explores how the social inequalities and stigmas associated with aging manifest in the health care system specifically. As you read, think about times you've seen this play out in clinical care (in your roles as a patient, a student, or a practitioner). Think about how you might both lead systemic change within your institution or unit, but also how you might alter your clinical practice in light of these insights?

URL “Tho’ much is taken, much abides”: A Good Life within Dementia

Please read the essay by Tia Powell on aging, dementia, and concepts of the "good life." As you read, think about how stigmas of aging, including focus on declines and the way that it is often inherently medicalized, might be reframed, even in the face of illness. Are there insights in this for clinical practitioners dealing with aging patients and their illnesses?

URL Realizing and Maintaining Capabilities: Late Life as a Social Project

Please read the essay by Michael Dunn. As you read, think about the implications of Dunn's attempt to shift the discourse on aging and later life from a medical to a social paradigm. What are the implications of seeing "later life as a social project" for clinical practice? Are there insights in that shift that could inform better, more humanistic care?

Module 11: Lesson 10: Children, Health, and Humanism URL Connecting a sociology of childhood perspective with the study of child health, illness and wellbeing: introduction

Please read the article by Geraldine Brady and colleagues. While this piece introduces an edited collection of articles in a special issue of the journal Sociology of Health and Illness, the authors present an excellent overview of the social, psychological, and humanistic aspects of children's experiences with illness. As you read, pay attention to the different ways in which we might more humanistically engage children who are sick. What insights does the article have for clinical practice?

URL Minimizing pediatric healthcare-induced anxiety and trauma

Read the article by Julie L Lerwick, which explores children's experiences within healthcare setting and the potentially traumatizing nature of illness and treatment. As you read, think about how the complexities of childhood, particularly is ever-changing developmental nature, creates challenges for calibrating how best to engage children in their treatment decisions. How might the communication strategies in the article amplify your ability to engage children in a humanistic way?

URL Levels and Trends in Child Mortality: United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME), Report 2019

If you choose, please explore the data presented by UNICEF on global child mortality trends. Think about how the status of children affects these trends in both positive and negative ways.

Module 11: Lesson 11: Religion/Spirituality and Health URL Religious Involvement, Spirituality, and Medicine: Implications for Clinical Practice

Please read the article by Paul Mueller and colleagues. As you read, think about how your own religious or spiritual beliefs (even if these are not formalized or associated with an organized religious community) have influenced your sense of yourself, generally, and of your health and well being in particular. How have you seen religious or spiritual beliefs among patients affect their experiences of illness and their relationships with their health care providers? How can you leverage the insights in this article to providing better, more humanistic, care to your own patients.

URL How Should Clinicians Respond to Requests from Patients to Participate in Prayer?

Please read the case study and commentary by April Christiansen and colleagues. Just as patients have religious or spiritual beliefs, so do their physicians, nurses, and other healthcare providers. You know from the first article in this lesson that it is important to recognize a patient's religious or spiritual beliefs and that doing so can improve their care. But this also potentially creates very personal ethical dilemmas for clinical practitioners. After reading the case, first think about how you would navigate the situation. Then, read the commentary and compare your insights to those of the authors.

URL Religion, Spirituality, and Health: The Research and Clinical Implications

If you choose, please read the article by Harold Koenig, which gives an in depth review of the relationship of religion/spirituality and health, with a particular focus on how these insights can inform clinical practice.

Module 11: Lesson 12: Addresing Stigma Surrounding Mental Health and Substance Use Disorders URL Addressing the Stigma that Surrounds Addiction

Read the entire article (5 minutes)


URL Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change

Read the entire chapter, including Figure 2-1 under the heading "Consequences of Stigma" (52 minutes)

National Academies of Sciences, Engineering, and Medicine-2016

Module 12: Lesson 1: From Cultural Competence to Cultural Humility URL The Ethics of Cultural Competence

For several decades, there was a push to increase "cultural competence" among health care providers. This effort importantly was a recognition that cultural values impact patients and their families understandings of their illness, their underlying motivations for health care decisions, and interpersonal relationships with their health care team. Certainly, understanding how groups of people, particularly those who are often marginalized, tend to experiences health and health care can be an excellent starting point and provide important background knowledge (indeed, this is the motivation behind the previous lessons which explore different marginalized groups). However, there are implicity assumptions rooted in the concept of "cultural competence" that may, ironically, undermine its very intentions. Please read the article by Michael Paasche-Orlow in which he discusses some of the potential missteps of the concept of cultural competence. As you read, think about ways in which you've seen beliefs and attitudes of patients that are rooted in culture play out in the clinical setting. Is it problematic to think of culture as a static thing that patients "have"?

URL Addressing culture within healthcare settings: the limits of cultural competence and the power of humility

Please read the article by Lauren MacKenzie and Andrew Hatala. As you read, continue to think about problems associated with the well intentioned efforts to promote "cultural competence." Pay attention to the differences between "cultural competence" and "cultural humility." Do you think that cultural humility "solves" some of the problems of cultural competence?

Module 12: Lesson 2: Practices of Humility in Healthcare URL Cultural humility: The key to patient/family partnerships for making difficult decisions

Please read the article by Beth Fahlberg, Cynthia Foronda, and Diana Baptiste. While the article discusses the role of cultural humility specifically within nursing and in the context of palliative and end of life care, the principles articulated are more broadly applicable across healthcare professions and medical contexts. As you read, think about how the concept of cultural humility might benefit clinical practice, particularly for situations that challenging from a medical, cultural, or psychosocial point of view.

Module 12: Lesson 3: From Cultural Humility to Structural Competency and Social Justice URL Structural competency: Theorizing a new medical engagement with stigma and inequality

Please read the article by Jonathan Metzl and Helena Hansen. As you read, think about the ways in which the notion of "cultural humility" may be insufficient or problematic, despite addressing numerous limitations of the concept of "cultural competence," particularly where it informs a methodology of patient interaction. How does the notion of structural competency add a corrective lens to the ways in which we think about patients and culture in healthcare?

Module 13: Lesson 1: The Future of Humanism in Medicine URL How clinicians integrate humanism in their clinical workplace—‘Just trying to put myself in their human being shoes’

Please read the essay by Amanda Lee Roze des Ordons and colleagues. While in many ways it revisits themes from earlier in this course, it also pulls together a larger conception of what humanism is, and its relationship to healthcare and medical science. As you read it, pay particular attention to how the insights you've gained throughout this course foster a deeper understanding of the role of humanism for health and healthcare.

URL Humanism increasingly important in a changing health care landscape

Health and healthcare are constantly in flux, yet the humanistic aspects of health care practice are timeless. Please read the article by Richard Levin. Pay particular attention to his insights about how humanism is not only enduring with respect to contemporary shifts in health and health care, but in fact, more important than ever.

Module 13: Lesson 2: Humanism and Technology: Threat or Opportunity URL Pursuing Humanistic Medicine in a Technological Age

Read the critical article by Stephen Bertman. You'll note that the author does not appear optimistic as he describes numerous shifts in medicine and health care that impinge on the ability of clinical practitioners to be humanistic. As you read, however, think about the ways that you might not only remain a humanistic practitioner, but even amplify your ability to engage your patients as human beings in the fullest sense of the term. Can you think of ways you might restructure your practice or your workflow to accomplish this? Or within those existing structures and workflows, are there practices or habits you can develop as a healthcare provider that will help you retain a robust humanistic orientation?

URL The digital transformation of medicine can revitalize the patient-clinician relationship

Please read the article by Haider J. Warraich and colleagues. As you read it, think about ways that technology and scientific innovation might not degrade our capacities to exercise humanism in clinical practice, but in fact amplify them. What would it take to leverage technology in this way? How might you make small contributions to doing so within your own institution or practice?

Module 13: Lesson 3: Directions Forward URL Taking Humanism Back to the Bedside

Please read the article by Jennifer Plant and colleagues. While this article revisits many of the themes we have encountered throughout this course, it also specifically focuses on bringing humanism to the bedside. As you read it, think about how you plan to utilize insights from this course in the care of patients.

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