Course: Humanism in Health and Healthcare

General

General
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This course has been updated to reflect better the current themes surrounding Community-oriented Primary care. If you are already enrolled in this version of the course, you are allowed to complete it and obtain a certificate or register for the new course version using this link.

This Humanism in Health and Healthcare introductory course provides foundational theoretical and practical knowledge and skills, as well as an opportunity to plan (with locally and globally available peers and mentors) humanistic strategies, and practice humanistic techniques to assist patients in achieving positive health behavior changes. All parts of this training are free, including registration, learning, testing, and a certificate of completion. This course is intended for physicians, nurses, and allied health professionals in training and in practice.

This Humanism in Health and Healthcare course was developed in partnership with the Oakland University -- William Beaumont School of Medicine and The Arnold P. Gold Foundation and sponsored in part by the Annenberg Physician Training Program. Like all NextGenU.org courses, it is competency-based, using competencies from the American Association of Colleges of Nursing, the Association of American Medical Colleges, and the National Board of Osteopathic Medical Examiners.

The course developers are Jason Adam Wasserman, Ph.D., and Stephen Loftus, Ph.D.; additional content creators are Ashley Inez Garzaniti, MSIV; Nathan Loudon, MSIV; Matthew Drogowski, MD; Dorothy Levine, MD; Lesley Miller, MD; and Hedy S. Wald, Ph.D.

There are 13 modules to complete, which provide:
1. An introduction to the foundations and methods of humanism and humanistic engagement;
2. Skills on the science of empathy and cultural competency;
3. An overview of the future of humanism in health and healthcare.
Approximate time for completion of this course is 37 hours at an average reading rate of 144 words/minute.

The course requires completion of all required peer activities. At the end of each lesson, there is a practice quiz. At the end of the course, after you’ve completed each lesson, quiz, and activity, you’ll have access to a final exam, and a chance to assess the training. Once you’ve passed that last test, you will be able to download a certificate of completion from NextGenU.org and our course’s co-sponsoring organizations (listed above). We keep all of your personal information confidential, never sell any of your information, and only use anonymized data for research purposes, and we are also happy to report your testing information and share your work with anyone (your school, employer, etc.) at your request. We hope that you will find this a rewarding learning experience, and we count on your feedback to help us improve this training for future students.

Engaging with this Course:

You may browse this course for free to learn for your personal enrichment; there are no requirements.

To obtain a certificate
- Show in the registration fields that you have the appropriate prerequisites to be certified. This course requires the learner to have already obtained a college-level degree.
- Take the brief pre-test.
- Complete all the reading requirements.
- Complete all quizzes and pass with a 70% with unlimited attempts.
- Complete 2 peer activity and associated certification quizzes.
- Successfully complete the final exam with a minimum of 70% and a maximum of 3 attempts.
- Complete the self and course evaluation forms.
To obtain credit
- Complete all requirements listed above for the certificate.
- Your learning institution or workplace should approve the partner-university-sponsored NextGenU.org course for educational credit, as they would for their learner taking a course anywhere.
- NextGenU.org is happy to provide your institution with:
To obtain a degree co-sponsored with NextGenU.org, registrants must be enrolled in a degree program as a student of a NextGenU.org institutional partner. If you think that your institution might be interested in offering a degree with NextGenU.org contact us.

We hope that you will find this a rewarding learning experience, and we count on your assessment and feedback to help us improve this training for future students.

Next Steps
- Take the short knowledge pre-test below. It allows us to assess various aspects of the course itself.
- Complete the registration form.
- Begin the course with Module 1: History of Medicine, Modernism, and the Emergence of the Biomedical Model. In each lesson, read the description, complete all required readings and any required activity, and take the corresponding quizzes.
This course meets nationally approved standards of education developed for the addiction/substance use disorders counseling profession. This course's participants are assured that the continuing education (CE) credits provided will be accepted toward national credentialing by the NAADAC Certification Commission for Addiction Professionals (NCC AP), as well as by many of the individual state licensing/certification bodies in the addiction and other helping professions.

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*This course is sponsored in part by the Annenberg Physician Training Program: Abstinence-based Recovery from Addictive Disease. Click here to see curricular threading related to mental health disorders.
Module 1: History of Medicine, Modernism, and the Emergence of the Biomedical Model
Before starting this first module, please take a moment to take the short knowledge Pre-test above. It allows us to assess various aspects of the course itself and is mandatory to receive your certificate upon completion of the course.

Competencies covered in this module:

2. Knowledge for Practice (AAMC):
- Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.
- Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations.
6. Systems-Based Practice (AAMC):
- Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
- Advocate for quality patient care and optimal patient care systems.
V.Professionalism (AACOM) :
- 1. KNOWLEDGE - Demonstrate knowledge of the behavioral and social sciences that provide the foundation for the professionalism competency, including medical ethics, social accountability and responsibility, and commitment to professional virtues and responsibilities.
VII. Systems-Based Practice (AACOM)
- Demonstrate an understanding of how patient care and professional practices affect other health care professionals, health care organizations, and society.
- Demonstrate an understanding of how current issues in the world are affecting the delivery of health care to patients and to the community.
AACN:
- VIII.5 : Demonstrate an appreciation of the history of and contemporary issues in nursing and their impact on current nursing practice.
- I.2: Synthesize theories and concepts from liberal education to build an understanding of the human experience.
Module 1: Lesson 1: The Emergence of Modern Medicine
Learning Objective:

Describe the transition from pre-modern to modern medicine and its impact on humanism in health and healthcare.

Approximate time required for the readings for this lesson (at 144 words/minute): 38 mins
Click here to start this lesson
1 URL
- Required Learning Resources and Activities
- The Physicians' Profession through the Ages URL
  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.
- Quiz: Module 1: Lesson 1
  Restricted Not available unless:
  The activity Course Registration is marked complete
  The activity Pre-Test is marked complete
  
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 2: The Epidemiological Transition and the Humanistic (Re)turn
Competencies covered in this module:

Knowledge for Practice (AAMC) :
- Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care
- Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations
Practice-Based Learning and Improvement (AACOM) :
- Describe and apply systematic methods to improve population health.
a. Identify the determinants of populations’ health.
b. Identify sources of disparities in populations’ health and access to care.

Public Health Systems Competencies (AACOM) :
- Assesses and address the determinants of health and illness factors contributing to health promotion and disease prevention
AACN:
- VIII.5: Demonstrate an appreciation of the history of and contemporary issues in nursing and their impact on current nursing practice.
- I.2: Synthesize theories and concepts from liberal education to build an understanding of the human experience
Module 2: Lesson 1: The Epidemiological Transition
Learning Objective:
- Define and discuss the epidemiological transition.
- Analyze how shifts in the epidemiological profile of disease have caused shifts in the structure and function of the health care system.
Approximate time required for the readings for this lesson (at 144 words/minute): 7 mins

Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- The Epidemiological Transition (or What We Died, Die and Will Die From) URL
  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).
- Quiz: Module 2: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 2: Lesson 2: The Impact of the Epidemiological Transition on Humanism in Health and Healthcare
Learning Objective:

Describe how late modern epidemiological transitions have contributed to a re-emerging emphasis on humanism in health and healthcare.

Approximate time required for the readings for this lesson (at 144 words/minute): 34 mins
Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- The End of Modern Medicine: The Evolution of Disease and Transformations in Medical Practice URL
  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.
- Quiz: Module 2: Lesson 2
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 3: Medicalization and Social Control
Competencies covered in this module:
1. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioural sciences, as well as the application of this knowledge to patient care. (AAMC 2)
2. Knowledge for Practice: Apply principles of social-behavioural sciences to provision of patient care, including assessment of the impact of psycho-social and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care. (AAMC 2.5)
3. Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (AAMC 5)
4. Professionalism: Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations. (AAMC 5.6)
5. Professionalism: ETHICS - Demonstrate knowledge of and the ability to apply ethical principles in the practice and research of osteopathic medicine, particularly in the areas of provision or withholding of clinical care, confidentiality of patient information, informed consent, business practices, the conduct of research, and the reporting of research results. (AACOM V. 6)
6. Engage in ethical reasoning and actions to provide leadership in promoting advocacy, collaboration, and social justice as a socially responsible citizen. (AACN I. 6)
Module 3: Lesson 1: Medicalization and Social Control
Learning Objective:

Define medicalization.

Describe how medicalization reflects power dynamics inherent to medicine and health care.

Approximate time required for the readings for this lesson (at 144 words/minute): 20 mins
Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- Medicalization: A Historical Perspective URL
  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?
- Quiz: Module 3: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 3: Lesson 2: Medicalization and Overdiagnosis
Learning Objective:

Identify how medicalization leads to over-diagnosis and articulate why this may negatively impact patient care.

Approximate time required for the readings for this lesson (at 144 words/minute): 18 mins
Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- Medicalisation and Over-diagnosis: What Society Does to Medicine URL
  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?
- Quiz: Module 3: Lesson 2
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 4: The Biopsychosocial Model
Competencies covered in this module:
1. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. (AAMC 2)
2. Knowledge for Practice: Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations. (AAMC 2.4)
3. Medical Knowledge: Articulate basic biomedical science and epidemiological and clinical science principles related to patient presentation. (AACOM II. 1)
4. Demonstrate an appreciation of the history of and contemporary issues in nursing and their impact on current nursing practice. (AACN VIII. 5)
Module 4: Lesson 1: An Overview of the Biopsychosocial Model
Learning Objective:

Define each aspect of the biopsychosocial model and describe each interacts with the others to form a more robust picture of health and illness in contrast to the traditional biomedical model.

Describe potential shortcomings of the biopsyhosocial model; in particular, analyze whether it is a sufficient framework for humanism in health and healthcare.

Approximate time required for the readings for this lesson (at 144 words/minute): 28 mins
Click here to start this lesson
4 URLs, 1 Quiz
- Required Learning Resources and Activities
- The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry URL
  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).
- Quiz: Module 4: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- The Role of Spirituality in Healthcare URL
  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.
- The Biopsychosocial Model 40 Years On URL
  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.
- Bringing a humanistic approach to cancer clinical trials URL
  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: The Birth of Bioethics and the Evolution of Humanism
Competencies covered in this module:
1. Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (AAMC 5)
2. Professionalism: Demonstrate respect for patient privacy and autonomy. (AAMC 5.3)
3. Professionalism: Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations. (AAMC 5.6)
4. Professionalism: KNOWLEDGE - Demonstrate knowledge of the behavioral and social sciences that provide the foundation for the professionalism competency, including medical ethics, social accountability and responsibility, and commitment to professional virtues and responsibilities. (AACOM V. 1)
5. Professionalism: KNOWLEDGE - Demonstrate social accountability and responsibility (i.e. the welfare of the patient or society should supersede the physician’s self-interest). (AACOM V. 1c)
6. Professionalism: ETHICS - Demonstrate knowledge of and the ability to apply ethical principles in the practice and research of osteopathic medicine, particularly in the areas of provision or withholding of clinical care, confidentiality of patient information, informed consent, business practices, the conduct of research, and the reporting of research results. (AACOM V. 6)
7. Professionalism: ETHICS - Apply the ethical principles of autonomy, beneficence, non-malfeasance, fidelity, justice, and utility. (AACOM V. 6f)
8. Engage in ethical reasoning and actions to provide leadership in promoting advocacy, collaboration, and social justice as a socially responsible citizen. (AACN I. 6)
Module 5: Lesson 1: The Historical Evolution of Bioethics
Learning Objective:

Describe the origins of bioethics as a discipline, including watershed cases in both medical research and clinical medicine and the development of its foci from acute dilemmas to broader social and humanistic aspects of ethics.

Approximate time required for the readings for this lesson (at 144 words/minute): 60 mins
Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- What is Bioethics: A History URL
  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?
- Quiz: Module 5: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 5: Lesson 2: Clinical Ethics Analysis
Learning Objective:

Discuss the principles of clinical ethics and articulate four key domains of analysis ("the four topics") of clinical ethics issues.

Analyze the four key domains of clinical ethics analysis for where notions of humanism are manifest and where normative ethics analysis may not be fully humanistic.

Approximate time required for the readings for this lesson (at 144 words/minute): 36 mins
Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- Clinical Ethical Decision Making: The Four Topics Approach URL
  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).
- Quiz: Module 5: Lesson 2
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 6: The Science of Empathy
Competencies covered in this module:
1. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioural sciences, as well as the application of this knowledge to patient care. (AAMC 2)
2. Knowledge for Practice: Apply principles of social-behavioural sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care. (AAMC 2.5)
3. Interpersonal and Communication Skills: Explore the psychosocial, occupational, and biomechanical environment in which the patient lives and/or in which health care is administered. (AACOM IV. 1m)
4. Professionalism: HUMANISTIC BEHAVIOR - Demonstrate humanistic behaviour, including respect, compassion, probity, honesty, and trustworthiness. (AACOM V. 2)
5. Synthesise theories and concepts from liberal education to build an understanding of the human experience. (AACN I. 2)
Module 6: Lesson 1: The Science of Empathy
Learning Objective:

Describe the notion of empathy, and how it differs from sympathy.

Describe the scientific basis for empathy and its contributions to interpersonal interactions and relationships.

Analyze how the concept of empathy is critical to medical practice, and particularly important after the epidemiological transition (you'll need to draw on concepts from previous modules in this course to do so adequately).

Approximate time required for the readings for this lesson (at 144 words/minute): 26 mins
Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- The Role of Empathy in Medicine: A Medical Student's Perspective URL
  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?
- The Science of Empathy URL
  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).
- Quiz: Module 6: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 6: Lesson 2: Empathy in Patient Care
Learning Objective:

Describe how empathy affects measurable patient outcomes and the evidence supporting this in the research literature.

Approximate time required for the readings for this lesson (at 144 words/minute): 22 mins
Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- Effectiveness of Empathy in General Practice: A Systematic Review URL
  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?
- Quiz: Module 6: Lesson 2
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 7: Cultivating Empathy: Practices of the Senses
Competencies covered in this module:
1. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioural sciences, as well as the application of this knowledge to patient care. (AAMC 2)
2. Knowledge for Practice: Apply principles of social-behavioural sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care. (AAMC 2.5)
3. Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. (AAMC 4)
4. Interpersonal and Communication Skills: Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics. (AAMC 4.6)
5. Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (AAMC 5)
6. Professionalism: Demonstrate compassion, integrity, and respect for others. (AAMC 5.1)
7. Personal and Professional Development: Demonstrate the qualities required to sustain lifelong personal and professional growth. (AAMC 8)
8. Personal and Professional Development: Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty. (AAMC 8.8)
9. Professionalism: KNOWLEDGE - Demonstrate knowledge of the behavioural and social sciences that provide the foundation for the professionalism competency, including medical ethics, social accountability and responsibility, and commitment to professional virtues and responsibilities. (AACOM V. 1)
10. Professionalism: KNOWLEDGE - Recognize personal values, attitudes, and biases as they influence patient care. (AACOM V. 1b)
11. Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice - Integrate theories and concepts from liberal education into nursing practice. (AACN 1)
12. Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice - Synthesize theories and concepts from liberal education to build an understanding of the human experience. (AACN 2)
13. Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice - Demonstrate tolerance for the ambiguity and unpredictability of the world and its effect on the healthcare system. (AACN 8)
Module 7: Lesson 1: Working with Literature
Learning Objective:

Articulate the value of reading stories for clinical practitioners in terms of the diagnostic process, understanding illness experiences, and wrestling with ambiguity.

Approximate time required for the readings for this lesson (at 144 words/minute): 57 mins
Click here to start this lesson
2 URLs, 2 Forums, 1 Quiz
- Required Learning Resources and Activities
- Three Things to Do With Stories Using Literature in Medical, Health Professions, and Interprofessional Education URL
  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.
- Choose a Story and Practice Reflection and Response URL
  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.
- Peer Activity: Letter to the Editor Forum
  Activity Introduction: In this activity, you will assume two roles. First, you will write a letter to the editor to demonstrate the following competencies:
  Apply principles of social-behavioral sciences to the provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care compliance, and barriers to and attitudes toward care
  
  Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics
  
  Demonstrate compassion, integrity, and respect for others
  
  Demonstrate the qualities required to sustain lifelong personal and professional growth
  
  Demonstrate tolerance for the ambiguity and unpredictability of the world and its effect on the healthcare system.
  
  Second, you will act as a peer-reviewer by reviewing the letter of one of your peers and providing them with constructive feedback.
  
  Step 1: Identify a recent article in a newspaper, magazine, or a peer-reviewed health sciences journal that has relevance to an aspect of humanism in health and health care that you would like to respond to – examples may include articles related to marginalized groups, lack of caring behaviors, ethics violations, ethical dilemmas related to global work, or another topic covered in the Humanism in Health and Healthcare Course.
  
  Step 2: Write a letter to the publication and the audience of the publication. The publication’s “Letters to the Editor” instructions should be followed. Ensure that what you write about does not create unreasonable risks and if you are unsure discuss this with a mentor who is familiar with your context. See here for a discussion of communications that could be risky for journalists and writers. And here is an additional, optional resource. Your letter should be polished and demonstrate the competencies described in Part One.
  
  Step 3: Submit your letter and a link to the publication's “Letters to the Editor” instructions in the forum I “Draft Letter, Instructions Link, and Peer Feedback” below to receive feedback from your peers. Incorporate their suggestions as appropriate. If you cannot come to a consensus with your peer about incorporating appropriate suggestions, ask a mentor for help.
  
  Step 4: Review a peer’s letter to the editor (see forum I) and evaluate it based on the reflection questions listed below.
  
  Does the letter demonstrate the competencies listed in part one?
  
  Is the letter written in an appropriate manner for the publication's audience?
  
  Were publication instructions for a Letter to the Editor followed?
  
  Did your peer communicate their message in a way that could expose them to excessive risk?
  
  Is the letter grammatically correct, clear, concise, and professionally written?
  
  Did you provide clear feedback to your peer and include your feedback in the forum?
  
  Step 5: Submit the letter to the publication for which you prepared it.
  
  Step 6: In the forum II, “Submitted Letter” paste the name and contact information of the publication where your letter was submitted, along with a copy of the submitted version of your letter. If your letter is accepted and you would like, please contact info@nextgenu.org so that we can proudly post it on our blog for your peers and the world to see.
- Peer Activity: Literature Reflection Forum
  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.
  Short reflection question:
  Please describe how the story you read closely disrupted, even in some small way, your assumptions about the illness experience? Describe any empathic connections with the author that you sensed in yourself while reading it. How do you imagine this type of close reading activity might shape your interactions with your current or future patients?
  Instructions to peer:
  Comment on your peer's response and raise at least three additional questions for them to consider.
- Quiz: Module 7: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 7: Lesson 2: Working with Visual Art
Learning Objective:

Practice deliberate meditation and introspection while observing visual art articulate resulting insights that relate to the experience of illness and healthcare practice.

Describe what visual art may represent about the individual that chose it.

Approximate time required for the readings for this lesson (at 144 words/minute): 50 mins
Click here to start this lesson
1 URL, 1 Forum
- Optional Learning Resources and Activities
- Last Scene URL
- Peer Activity: Photograph Reflection Forum
  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 expand the boundaries of our exploration beyond the body further, to the individual beyond the pathology. The artist Hrair Sarkissian describes their piece ’Last Scene’ (2016) as “a series of 47 photographs of places in The Netherlands that were 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 to 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 emerge. Reflect on these images.
  In 200-300 words answer the following questions about each photograph:
  What sort of image (physical, emotional, spiritual, mental, etc) of 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
Learning Objective:

Describe how your understanding of your purpose and identity has been impacted by your experiences in medicine.

Discuss what you have learned about yourself by reading poetry written by others.

Approximate time required for the readings for this lesson (at 144 words/minute): 40 mins
Click here to start this lesson
2 URLs, 2 Forums
- Optional Learning Resources and Activities
- Kindness URL
- Peer Activity: Poetry Reflection I Forum
  Reading and writing poetry is as much a tool for self-expression as a tool for self-exploration. While reading the works provided below, connect with the memories, associations, and emotions that the poems bring forward for you personally. 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?
  Short reflection question:
  How does the sorrow you experience connect you with others and what does it bring you to more deeply appreciate? How might the experience of sorrow help you connect with your current/future patients?
  Instructions to peer:
  Comment on your peer's response and raise at least three additional questions for them to consider.
- The Journey URL
- Peer Activity: Poetry Reflection II Forum
  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?
  Short reflection question:
  What bad advice/voices/pleas/expectations do you know you must ignore as a health care practitioner in order to thrive?
  Instructions to peer:
  Comment on your peer's response and raise at least three additional questions for them to consider.
Module 7: Lesson 4: Working with Music
Learning Objective:

Articulate the parallels between music and health care practice.

Analyze how a practitioner might, using a deep analytical listening of music might, at least over time, develop greater facility with the humanistic aspects of patient care.

Approximate time required for the readings for this lesson (at 144 words/minute): 22 mins
Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- Jazz and the 'Art' of Medicine: Improvisation in the Medical Encounter URL
  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.
- Quiz: Module 7: Lesson 4
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- Supplemental: More on medicine and the arts URL
  For more resources on the relationship between art and healing, including works of narrative, poetry, and visual art, please explore this journal.
Module 8: Empathy in Practice: Narrative Medicine/Narrative Communication
Competencies covered in this module:
1. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. (AAMC 2)
2. Knowledge for Practice: Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care. (AAMC 2.5)
3. Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. (AAMC 4)
4. Interpersonal and Communication Skills: Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds. (AAMC 4.1)
5. Interpersonal and Communication Skills: Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions. (AAMC 4.7)
6. Osteopathic Principles and Practices: Consider the patient’s perspective and values in diagnostic decision making. (AACOM I. 4h)
7. Interpersonal and Communication Skills: Explore the psychosocial, occupational, and biomechanical environment in which the patient lives and/or in which health care is administered. (AACOM IV. 1m)
8. Integrate theories and concepts from liberal education into nursing practice. (AACN I. 1)
9. Synthesize theories and concepts from liberal education to build an understanding of the human experience. (AACN I. 2)
10. Incorporate effective communication techniques, including negotiation and conflict resolution to produce positive professional working relationships. (AACN VI. 3)
Module 8: Lesson 1: Narrative Medicine: Connecting with Patients
Learning Objective:

Articulate the way in which narrative can enable a richer understanding of patients and their illness experiences.

Describe how a narrative approach to patient care can help connect the patient and the clinician in a relationship.

Define 7 key concepts necessary to eliciting a patient's narrative.

Describe key questions that are useful for eliciting and elaborating patient narrative in a clinical "conversation".

Approximate time required for the readings for this lesson (at 144 words/minute): 41 mins
Click here to start this lesson
4 URLs, 1 Quiz
- Required Learning Resources and Activities
- Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust URL
  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.
- What is Narrative Based Medicine URL
  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.
- Quiz: Module 8: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- Professional identity (trans)formation in medical education: reflection, relationship, resilience URL
  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.
- Making it “More Real”: Using Personal Narrative in Faculty Feedback to a Medical Student’s Reflective Writing – An Illustrative Exemplar URL
  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: Self Care: Caring for Self to Care for Others
Competencies covered in this module:
1. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. (AAMC 2)
2. Knowledge for Practice: Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care. (AAMC 2.5)
3. Personal and Professional Development: Demonstrate the qualities required to sustain lifelong personal and professional growth. (AAMC 8)
4. Personal and Professional Development: Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors. (AAMC 8.1)
5. Personal and Professional Development: Demonstrate healthy coping mechanisms to respond to stress. (AAMC 8.2)
6. Professionalism: PROFESSIONAL AND PERSONAL SELF-CARE - Ensure that his/her mental, physical, or health condition does not have a negative impact on patient care or welfare. (AACOM V. 8b)
7. Professionalism: PROFESSIONAL AND PERSONAL SELF-CARE - Identify personal sources of stress, and apply appropriate interventions. (AACOM V. 8f)
8. Recognize the relationship between personal health, self renewal, and the ability to deliver sustained quality care. (AACN 14)
Module 9: Lesson 1: Understanding Burnout in Healthcare: Causes and Consequences
Learning Objective:

Define burnout and articulate its various causes among health care professionals.

Approximate time required for the readings for this lesson (at 144 words/minute): 19 mins
Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- Burnout in United States Healthcare Professionals: A Narrative Review URL
  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.
- Quiz: Module 9: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- The Problems With Burnout Research URL
  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
Learning Objective:

Describe ways that burnout can be mitigated in healthcare, both at the individual and system levels.

Describe the potential consequences of burnout for both the provider and for patient care.

Approximate time required for the readings for this lesson (at 144 words/minute): 158 mins.
Click here to start this lesson
5 URLs, 1 Quiz
- Required Learning Resources and Activities
- Developing resilience to combat nurse burnout URL
  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).
- Case Study: Dealing with Burnout URL
  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.
- Compassion Fatigue and Substance Use Among Nurses URL
  Read the entire article except for the Methods section. (24 minutes)
- Addressing Alcohol and Substance Use Disorders among Refugees: A Desk Review of Intervention Approaches URL
  Read the section under the section "Introduction" on the pages 9-12. (18 minutes)
- Quiz: Module 9: Lesson 2
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- Cultivating Moral Resilience URL
  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
Learning Objective:

Analyze the dilemmas of empathy among health professionals with respect to humanistic commitment to patients and maintaining an appropriate professional detachment.

Approximate time required for the readings for this lesson (at 144 words/minute): 10 mins
Click here to start this lesson
3 URLs, 1 Quiz
- Required Learning Resources and Activities
- Empathy and Burnout in Medicine: Acknowledging Risks and Opportunities URL
  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?
- Quiz: Module 9: Lesson 3
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- Compassion and self-compassion in medicine: Self-care for the caregiver URL
  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.
- The dangerous practice of empathy URL
  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: Problems of Otherness and Dilemmas of Difference
Competencies covered in this module:
1. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. (AAMC 2)
2. Knowledge for Practice: Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care. (AAMC 2.5)
3. Patient Care: Demonstrate cultural awareness and sensitivity when communicating with the patient, family, and caregivers. (AACOM III. 5g)
4. Professionalism: ACCOUNTABILITY - Demonstrate accountability to patients, society, and the profession, including the duty to act in response to the knowledge of professional behavior of others. (AACOM V. 4)
5. Professionalism: ACCOUNTABILITY - Demonstrate commitment to underserved, vulnerable, disadvantaged, disenfranchised, and special populations. (AACOM V. 4h)
6. Essential VII: Clinical Prevention and Population Health - Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations. (AACN 3)
7. Essential VIII: Professionalism and Professional Values - Reflect on one’s own beliefs and values as they relate to professional practice. (AACN 6)
Module 10: Lesson 1: Problematics of Otherness
Learning Objective:
- Identify the notion of otherness/othering and how it manifests in the health care setting.
- Describe the dilemma of otherness with respect to attempts to address social inequalities and analyze whether it is possible to engage inequality without contributing to the othering of marginalized groups.
Approximate time required for the readings for this lesson (at 144 words/minute): 56 mins

Click here to start this lesson
3 URLs, 1 Quiz
- Required Learning Resources and Activities
- Ethics Explainer: The Other URL
  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.
- The Face of James URL
  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.
- Othering in the Nursing Context: A Concept Analysis URL
  Read the conceptual review article on othering by Roberts and Schiavenato, which elucidates how practices of othering occur within patient care.
- Quiz: Module 10: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 11: Marginalization
Competencies covered in this module:
1. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. (AAMC 2)
2. Knowledge for Practice: Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations. (AAMC 2.4)
3. Knowledge for Practice: Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care. (AAMC 2.5)
4. Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (AAMC 5)
5. Professionalism: Demonstrate accountability to patients, society, and the profession. (AAMC 5.4)
6. Professionalism: Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. (AAMC 5.5)
7. Patient Care: Demonstrate cultural awareness and sensitivity when communicating with the patient, family, and caregivers. (AACOM III. 5g)
8. Professionalism: CULTURAL COMPETENCY - Demonstrate awareness of and proper attention to issues of culture, religion, age, gender, sexual orientation, and mental and physical disabilities. (AACOM V. 7)
9. Professionalism: CULTURAL COMPETENCY - Demonstrate how to cope with differences in people in a constructive way. (AACOM V. 7d)
10. Practice-Based Learning and Improvement: Describe and apply systematic methods to improve population health. (AACOM VI. 5)
11. Practice-Based Learning and Improvement: Identify the determinants of populations’ health. (AACOM VI. 5a)
12. Practice-Based Learning and Improvement: Identify sources of disparities in populations’ health and access to care. (AACOM VI. 5b)
13. Practice-Based Learning and Improvement: Identify vulnerable or marginalized populations within those served, and respond appropriately. (AACOM VI. 5c)
14. Cultural Competencies: Demonstrate an understanding of the scope of culture and the elements that form and define it. (AACOM IX. 1)
15. Cultural Competencies: Recognize personal and professional tendencies toward bias and stereotyping, and work to counter them. (AACOM IX. 2)
16. Cultural Competencies: Understand the public health implications of cultural competence in health care. (AACOM IX. 3)
17. Cultural Competencies: Demonstrate familiarity with basic religious and cultural beliefs that affect patients’ understanding of the etiology of their illness and/or the efficacy of their treatment. (AACOM IX. 4)
18. Cultural Competencies: Use the cultural profile and history in the treatment of individual patients and record them appropriately in the medical record. (AACOM IX. 10)
19. Cultural Competencies: Use the cultural profile and history with individual patients to assess health care needs in the community. (AACOM IX. 11)
20. Public Health Systems Competencies: Assesses and address the determinants of health and illness factors contributing to health promotion and disease prevention. (AACOM X11. 2)
21. Public Health Systems Competencies: Apply basic public health principles, practices, and sciences to the practice of osteopathic medicine.(AACOM X11. 4)
22. Public Health Systems Competencies: Understand and apply knowledge of cultural differences to improve public health among divergent populations. (AACOM X11. 7)
23. Global Health Competencies: Identify and treat individual patients with varying cultural beliefs regarding health, disease, and patient care. (AACOM XIII. 6)
24. Essential VII: Clinical Prevention and Population Health - Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations. (AACN 3)
25. Essential VIII: Professionalism and Professional Values - Reflect on one’s own beliefs and values as they relate to professional practice. (AACN 6)
26. Professionalism: Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation (AAMC 5.5)
Module 11: Lesson 1: Global Health and Cross-Cultural Practice
Learning Objective:
- Articulate best practices for conducting ethical and humanistic global health work.
- Analyze the ethical dilemmas inherent to global health work and offer insights into how to navigate the potential for harm by medical volunteers to underresourced countries by drawing on global health best practices.
Approximate time required for the readings for this lesson (at 144 words/minute): 82 mins

Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- Global Health Training: Ethics and Best Practice Guidelines for Training Experiences in Global Health URL
  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.
- More harm than good? The questionable ethics of medical volunteering and international student placements URL
  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?
- Quiz: Module 11: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 11: Lesson 2: Issues of Class and Poverty
Learning Objective:
- Articulate the impact of socioeconomic status on patients’ health status and health behaviors.
- Demonstrate critical thinking about the needs of patients who face socioeconomic disadvantage and articulate creative approaches to clinical care that are sensitive to the challenges they face.
Approximate time required for the readings for this lesson (at 144 words/minute): 87 mins

Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- Socioeconomic Disparities in Health Behaviors URL
  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.
- Structural Violence and Clinical Medicine URL
  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.
- Quiz: Module 11: Lesson 2
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 11: Lesson 3: Race/Ethnicity and Health
Learning Objective:
- Articulate the impact of race/ethnicity on patients’ health status and experiences with health and health care.
- Demonstrate critical thinking about the needs of patients who face race/ethnic health disadvantages and articulate creative approaches to clinical care that are sensitive to the challenges they face.
Approximate time required for the readings for this lesson (at 144 words/minute): 56 mins

Click here to start this lesson
3 URLs, 1 Forum, 1 Quiz
- Required Learning Resources and Activities
- Race: A Starting Place URL
  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.
- Race, Ethnicity, and the Health of Americans URL
  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.
- Avoiding Racial Essentialism in Medical Science Curricula URL
  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.
- Peer Activity 1: Race/Ethnicity and Health (270 minutes) Forum
  In this activity, you will compare and contrast the health status and experiences of two different races and discuss, focused on substance use disorders, how race influences a patient’s health status and experiences.
  Step 1. Select [10 minutes]
  Select one racial minority in your country or region.
  Example: Hispanics in the United States
  Step 2. Compare and contrast [30 minutes]
  Compare and contrast your selected racial minority with a racial privileged or majority, i.e., “White” Americans, in terms of the following indicators:
  Health status
  Health care access and affordable coverage
  Access to substance use and abuse care and treatment
  Step 3. Respond [210 minutes]
  Imagine yourself as a contributing writer for a medical journal, tasked to write an article for this month’s theme on Race and Health.
  Prepare a 300-700 word article that discusses the following key components:
  Difference between your selected racial minority and racially privileged group in terms of
  Health status
  Health care access and affordable coverage
  Access to substance use and abuse care and treatment
  Needs of the racial minority facing health disadvantages
  Creative approaches to address the problem and promote racial health equity and better access to substance use and abuse care and treatment.
  Step 4. Share [10 minutes]
  To share your audio recording, click on the “Add a new discussion” button under this post and paste your work into the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B. references are excluded from word counts).
  Step 5. Interact [10 minutes]
  Evaluate and categorize the work from one of your peers based on items A - E of the rubric below. Provide a rationale for the grade you have provided, as well as comments or suggestions for improvement. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.” You can use the list below as an example:
  Item A is .…. because…. My suggestions for improvement are….
  Item B is .…. because…. My suggestions for improvement are….
  Item C is .…. because…. My suggestions for improvement are….
  Item D is .…. because…. My suggestions for improvement are….
  Item E is .…. because…. My suggestions for improvement are….
- Quiz: Module 11: Lesson 3
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 11: Lesson 4: The Health of Immigrants, Refugees, and Displaced Persons
Learning Objective:
- Discuss different perspectives on the ethical obligation to provide health care to undocumented immigrants.
- Articulate the impact of immigration and/or refugee status on patients’ health and their experiences with health and health care.
- Demonstrate critical thinking about the needs of patients who face health disadvantages because of their immigrant/refugee status and articulate creative approaches to clinical care that are sensitive to the challenges they face.
Approximate time required for the readings for this lesson (at 144 words/minute): 88 mins

Click here to start this lesson
3 URLs, 1 Quiz
- Required Learning Resources and Activities
- Illegal Immigrants, Health Care, and Social Responsibility URL
  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.
- Immigration as a Social Determinant of Health URL
  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.)?
- PD 24 - Migrant and Refugee Health - World Health Summit 2020 URL
  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)
- Quiz: Module 11: Lesson 4
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 11: Lesson 5: Gender and Health
Learning Objective:
- Articulate the impact of gender on patients’ health and their experiences with health and health care.
- Demonstrate critical thinking about the needs of patients who face health disadvantages because of gender norms and associated stigmas and articulate creative approaches to clinical care that are sensitive to the challenges they face.
Approximate time required for the readings for this lesson (at 144 words/minute): 97 mins

Click here to start this lesson
3 URLs, 1 Quiz
- Required Learning Resources and Activities
- Gender Disparities in Health: Strategic Selection, Careers, and Cycles of Control URL
  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."
- The promises and limitations of gender-transformative health programming with men: critical reflections from the field URL
  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?
- How gender affects the relationship between physician and patient URL
  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)?
- Quiz: Module 11: Lesson 5
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 11: Lesson 6: LGBTQ + Persons and Health
Learning Objective:
- Articulate the social and humanistic factors affecting the health of patients who identify as LGBTQ+, including their experiences in society at large, and the health care system in particular.
- Demonstrate critical thinking about the needs of patients who face health disadvantages because of their identification as LGBTQ+ and associated stigmas and articulate creative approaches to clinical care that are sensitive to the challenges they face.
Approximate time required for the readings for this lesson (at 144 words/minute): 59 mins

Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- Understanding the Health Needs of LGBT People URL
  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?
- Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide URL
  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.
- Quiz: Module 11: Lesson 6
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 11: Lesson 7: Incarcerated and Formerly Incarcerated Persons
Learning Objective:
- Articulate the social and humanistic factors affecting the health of patients who are incarcerated or formerly incarcerated, including their experiences in society at large, and the health care system in particular.
- Describe ethical dilemmas that can emerge for clinical practitioners caring for patients who are incarcerated or were formerly incarcerated.
- Demonstrate critical thinking about the needs of patients who face health disadvantages because of incarceration status and associated stigmas and articulate creative approaches to clinical care that are sensitive to the challenges they face.
- Compare the difference between the minimum care a physician is obligated to provide within a criminal justice setting from the standard they are held to in the free world and describe measures that you could take as a physician to anticipate and meet the health needs of incarcerated or formerly incarcerated patients (see in particular the AMA Journal of Ethics case study.
Approximate time required for the readings for this lesson (at 144 words/minute): 53 mins

Click here to start this lesson
5 URLs, 1 Quiz
- Required Learning Resources and Activities
- Linkages Between Health and Incarceration URL
  Please read this essential resource that further elaborates the connection between incarceration and health.
- Caring for ex-prisoners presents management challenges URL
  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?
- What Does Health Justice Look Like for People Returning from Incarceration? URL
  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.
- Quiz: Module 11: Lesson 7
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- Correctional Health: Recommendations and Guidance URL
  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.
- Federal Bureau of Prisons: Health Management Resources URL
  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
Learning Objective:
- Articulate the social and humanistic factors affecting the health of patients who are living with disability.
- Describe different models used for understanding disability and the advantages and disadvantages that come with seeing disability in terms of each of these models.
- Demonstrate critical thinking about the clinical needs of patients who are living with disabilities and articulate creative approaches to clinical care that are sensitive to the challenges they face.
Approximate time required for the readings for this lesson (at 144 words/minute): 77 mins

Click here to start this lesson
3 URLs, 1 Quiz
- Required Learning Resources and Activities
- Prevalence of Disability and Disability Type Among Adults — United States, 2013 URL
  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.
- Disability: Definitions, Models, Experience URL
  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?
- Three Things Clinicians Should Know About Disability URL
  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?
- Quiz: Module 11: Lesson 8
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 11: Lesson 9: Health, Humanism, and Aging
Learning Objective:
- Articulate the social and humanistic aspects of aging, particularly with respect to how older people experience aging.
- Describe ways that ageism manifests in the health care setting at both systemic and clinical levels and articulate ways that practitioners can challenge ageism and its effects.
Approximate time required for the readings for this lesson (at 144 words/minute): 89 mins

Click here to start this lesson
4 URLs, 1 Quiz
- Required Learning Resources and Activities
- Inequalities Later in Life URL
  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?
- Ageism in the Health Care System: Providers, Patients, and Systems URL
  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?
- “Tho’ much is taken, much abides”: A Good Life within Dementia URL
  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?
- Quiz: Module 11: Lesson 9
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- Realizing and Maintaining Capabilities: Late Life as a Social Project URL
  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
Learning Objective:
- Articulate the social and humanistic aspects of childhood, particularly with respect to how children experience illness.
- Describe ways that clinical care for children can use humanistic practices to improve children's illness experiences and coping.
Approximate time required for the readings for this lesson (at 144 words/minute): 70 mins

Click here to start this lesson
3 URLs, 1 Quiz
- Required Learning Resources and Activities
- Connecting a sociology of childhood perspective with the study of child health, illness and wellbeing: introduction URL
  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?
- Minimizing pediatric healthcare-induced anxiety and trauma URL
  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?
- Quiz: Module 11: Lesson 10
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- Levels and Trends in Child Mortality: United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME), Report 2019 URL
  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
Learning Objective:
- Articulate how religion and spirituality affect patient experiences of illness and their relationships with their health care practitioners.
- Describe ways that clinical care for children can use humanistic practices to improve children's illness experiences and coping.
Approximate time required for the readings for this lesson (at 144 words/minute): 57 mins

Click here to start this lesson
3 URLs, 1 Quiz
- Required Learning Resources and Activities
- Religious Involvement, Spirituality, and Medicine: Implications for Clinical Practice URL
  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.
- How Should Clinicians Respond to Requests from Patients to Participate in Prayer? URL
  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.
- Quiz: Module 11: Lesson 11
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
- Additional Learning Options
- Religion, Spirituality, and Health: The Research and Clinical Implications URL
  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
Learning Objective:
- Apply sensitivity and responsiveness to address stigma surrounding mental health and substance use disorders.
Approximate time required for the readings for this lesson (at 144 words/minute): 68 mins

Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- Addressing the Stigma that Surrounds Addiction URL
  Read the entire article (5 minutes)
  NIH-2020
- Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change URL
  Read the entire chapter, including Figure 2-1 under the heading "Consequences of Stigma" (52 minutes)
  National Academies of Sciences, Engineering, and Medicine-2016
- Quiz: Module 11: Lesson 12
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 12: From Cultural Competency to Cultural Humility: Habits of Respectful Curiosity
Competencies covered in this module:
1. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. (AAMC 2)
2. Knowledge for Practice: Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations. (AAMC 2.4)
3. Knowledge for Practice: Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care. (AAMC 2.5)
4. Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (AAMC 5)
5. Professionalism: Demonstrate accountability to patients, society, and the profession. (AAMC 5.4)
6. Professionalism: Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. (AAMC 5.5)
7. Professionalism: CULTURAL COMPETENCY - Demonstrate awareness of and proper attention to issues of culture, religion, age, gender, sexual orientation, and mental and physical disabilities. (AACOM V. 7)
8. Professionalism: CULTURAL COMPETENCY - Treat all patients, colleagues, and others fairly, ensuring that no group is favored at the expense of any other. (AACOM V. 7a)
9. Professionalism: CULTURAL COMPETENCY - Openly discuss cultural issues, and be responsive to cultural cues. (AACOM V. 7c)
10. Professionalism: CULTURAL COMPETENCY - Demonstrate how to cope with differences in people in a constructive way. (AACOM V. 7d)
11. Cultural Competencies: Demonstrate an understanding of the scope of culture and the elements that form and define it. (AACOM IX. 1)
12. Cultural Competencies: Recognize personal and professional tendencies toward bias and stereotyping, and work to counter them. (AACOM IX. 2)
13. Cultural Competencies: Understand the public health implications of cultural competence in health care. (AACOM IX. 3)
14. Cultural Competencies: Demonstrate familiarity with basic religious and cultural beliefs that affect patients’ understanding of the etiology of their illness and/or the efficacy of their treatment. (AACOM IX. 4)
15. Cultural Competencies: Use the cultural profile and history with individual patients to assess health care needs in the community. (AACOM IX. 11)
16. Essential VII: Clinical Prevention and Population Health - Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations. (AACN 3)
17. Essential VIII: Professionalism and Professional Values - Reflect on one’s own beliefs and values as they relate to professional practice. (AACN 6)
18. Essential VIII: Professionalism and Professional Values - Communicate to the healthcare team one’s personal bias on difficult healthcare decisions that impact one’s ability to provide care. (AACN 8)
Module 12: Lesson 1: From Cultural Competence to Cultural Humility
Learning Objective:
- Interrogate and discuss the limits of cultural competence as a humanistic enterprise in healthcare.
- Analyze and describe the differences between cultural competency and cultural humility.
Approximate time required for the readings for this lesson (at 144 words/minute): 27 mins

Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- The Ethics of Cultural Competence URL
  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"?
- Addressing culture within healthcare settings: the limits of cultural competence and the power of humility URL
  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?
- Quiz: Module 12: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 12: Lesson 2: Practices of Humility in Healthcare
Learning Objective:
- Describe best practices for integrating cultural humility into patient care.
Approximate time required for the readings for this lesson (at 144 words/minute): 13 mins

Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- Cultural humility: The key to patient/family partnerships for making difficult decisions URL
  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.
- Quiz: Module 12: Lesson 2
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 12: Lesson 3: From Cultural Humility to Structural Competency and Social Justice
Learning Objective:
- Describe the limitations of "cultural humility" even insofar as it improves on the concept of "cultural competency."
- Analyze and describe the implications of "structural competency" for patient care.
Approximate time required for the readings for this lesson (at 144 words/minute): 46 mins

Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- Structural competency: Theorizing a new medical engagement with stigma and inequality URL
  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?
- Quiz: Module 12: Lesson 3
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 13: The Future of Humanism in Health and Health Care
Competencies covered in this module:
1. Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (AAMC 5)
2. Professionalism: Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations. (AAMC 5.6)
3. Systems-Based Practice: Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. (AAMC 6)
4. Personal and Professional Development: Demonstrate the qualities required to sustain lifelong personal and professional growth. (AAMC 8)
5. Personal and Professional Development: Provide leadership skills that enhance team functioning, the learning environment, and/or the health care delivery system. (AAMC 8.6)
6. Professionalism: HUMANISTIC BEHAVIOR - Demonstrate humanistic behavior, including respect, compassion, probity, honesty, and trustworthiness. (AACOM V. 2)
7. Professionalism: HUMANISTIC BEHAVIOR - Demonstrate openness, honesty, and trustworthiness during direct communication with patients and their families and in the writing of reports, the signing of forms, and the provision of evidence in litigation or other formal inquiries. (AACOM V. 2d)
8. Systems-Based Practice: Demonstrate understanding of how patient care and professional practices affect other health care professionals, health care organizations, and society. (AACOM VII. 2)
9. Systems-Based Practice: Demonstrate understanding of how current issues in the world are affecting the delivery of health care to patients and to the community. (AACOM VII. 2g)
10. Engage in ethical reasoning and actions to provide leadership in promoting advocacy, collaboration, and social justice as a socially responsible citizen. (AACN I. 6)
Module 13: Lesson 1: The Future of Humanism in Medicine
Learning Objective:
- Revisit and describe the value of humanism for health and health care now and in the coming decades (in ways that now draw on all that you've learned in this course).
Approximate time required for the readings for this lesson (at 144 words/minute): 33 mins

Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- How clinicians integrate humanism in their clinical workplace—‘Just trying to put myself in their human being shoes’ URL
  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.
- Humanism increasingly important in a changing health care landscape URL
  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.
- Quiz: Module 13: Lesson 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 13: Lesson 2: Humanism and Technology: Threat or Opportunity
Learning Objective:
- Discuss how increasing technocratization and autonomation may threaten the humanistic elements, but also how technology might be used to amplify the humanistic elements, of health and healthcare.
Approximate time required for the readings for this lesson (at 144 words/minute): 28 mins

Click here to start this lesson
2 URLs, 1 Quiz
- Required Learning Resources and Activities
- Pursuing Humanistic Medicine in a Technological Age URL
  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?
- The digital transformation of medicine can revitalize the patient-clinician relationship URL
  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?
- Quiz: Module 13: Lesson 2
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Module 13: Lesson 3: Directions Forward
Learning Objective:
- Describe goals and strategies for integrating the insights throughout this course into clinical practice, particularly at the bedside, but also within the structures and functions of your institutions and the workflow of your practices.
Approximate time required for the readings for this lesson (at 144 words/minute): 12 mins

Click here to start this lesson
1 URL, 1 Quiz
- Required Learning Resources and Activities
- Taking Humanism Back to the Bedside URL
  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.
- Quiz: Module 13: Lesson 3
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
Final Exam

Click here to start Final Examination
- Final Exam Quiz
  Restricted Not available unless any of:
  All of:
  All of:
  The activity Quiz: Module 1: Lesson 1 is marked complete
  The activity Quiz: Module 2: Lesson 1 is marked complete
  The activity Quiz: Module 2: Lesson 2 is marked complete
  The activity Quiz: Module 3: Lesson 1 is marked complete
  The activity Quiz: Module 3: Lesson 2 is marked complete
  The activity Quiz: Module 4: Lesson 1 is marked complete
  The activity Quiz: Module 5: Lesson 1 is marked complete
  The activity Quiz: Module 5: Lesson 2 is marked complete
  The activity Quiz: Module 6: Lesson 1 is marked complete
  The activity Quiz: Module 6: Lesson 2 is marked complete
  The activity Quiz: Module 7: Lesson 1 is marked complete
  The activity Quiz: Module 7: Lesson 4 is marked complete
  The activity Quiz: Module 8: Lesson 1 is marked complete
  The activity Quiz: Module 9: Lesson 1 is marked complete
  The activity Quiz: Module 9: Lesson 2 is marked complete
  The activity Quiz: Module 9: Lesson 3 is marked complete
  The activity Quiz: Module 10: Lesson 1 is marked complete
  The activity Quiz: Module 11: Lesson 1 is marked complete
  The activity Quiz: Module 11: Lesson 3 is marked complete
  The activity Quiz: Module 11: Lesson 4 is marked complete
  The activity Quiz: Module 11: Lesson 5 is marked complete
  The activity Quiz: Module 11: Lesson 6 is marked complete
  The activity Quiz: Module 11: Lesson 7 is marked complete
  The activity Quiz: Module 11: Lesson 8 is marked complete
  The activity Quiz: Module 11: Lesson 9 is marked complete
  The activity Quiz: Module 11: Lesson 10 is marked complete
  The activity Quiz: Module 11: Lesson 11 is marked complete
  The activity Quiz: Module 11: Lesson 12 is marked complete
  The activity Quiz: Module 12: Lesson 1 is marked complete
  The activity Quiz: Module 12: Lesson 2 is marked complete
  The activity Quiz: Module 12: Lesson 3 is marked complete
  The activity Quiz: Module 13: Lesson 1 is marked complete
  The activity Quiz: Module 13: Lesson 2 is marked complete
  The activity Quiz: Module 13: Lesson 3 is marked complete
  All of:
  The activity Peer Activity: Letter to the Editor is marked complete
  The activity Peer Activity: Literature Reflection is marked complete
  The activity Peer Activity: Photograph Reflection is marked complete
  The activity Peer Activity: Poetry Reflection I is marked complete
  The activity Peer Activity: Poetry Reflection II is marked complete
  The activity Peer Activity 1: Race/Ethnicity and Health (270 minutes) is marked complete
  All of:
  The activity Quiz: Module 2: Lesson 1: DATA is marked complete
  The activity Quiz: Module 2: Lesson 2: DATA is marked complete
  The activity Quiz: Module 3: Lesson 1: DATA is marked complete
  All of:
  You belong to Miami Med
  The activity Course Registration is marked complete
  The activity Pre-Test is marked complete
  You belong to Public Health U
  All of:
  You belong to Georgetown Med
  The activity Course Registration is marked complete
  The activity Pre-Test is marked complete
  
  To take the final exam, you must complete all quizzes and complete all the required activities. The final exam consists of 25 questions, and you will have 25 minutes to complete it. When the time is over, you will have two minutes to submit your attempt before it expires, and your progress is discarded. You will not be able to answer additional questions in the grace period.
  To access the exam, click on the name of the exam provided above. On the following screen, click the Preview quiz now button to respond to the questions.
Course and Self Evaluation & Certificate

In this section, you can provide feedback about this course to help us make NextGenU.org better. Once evaluations are completed, you will be able to download your certificate of completion.

Click here give your feedback
- Course Evaluations Questionnaire
  Restricted Not available unless: The activity Final Exam is marked complete
- Self Evaluation Questionnaire
  Restricted Not available unless: The activity Final Exam is marked complete
  Please take the time to reflect on how you would evaluate your self as a learner.
Course Activities

1 Page
- Peer Activities Page

To obtain a certificate

To obtain credit

Before starting this first module, please take a moment to take the short knowledge Pre-test above. It allows us to assess various aspects of the course itself and is mandatory to receive your certificate upon completion of the course.

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Competencies covered in this module:

Learning Objective:

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Required Learning Resources and Activities

Learning Objective:

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Required Learning Resources and Activities

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Additional Learning Options

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Learning Objective:

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Optional Learning Resources and Activities

Learning Objective:

Learning Objective:

Optional Learning Resources and Activities

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Additional Learning Options

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Additional Learning Options

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Additional Learning Options

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Additional Learning Options

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Additional Learning Options

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities

Competencies covered in this module:

Learning Objective:

Learning Objective:

Required Learning Resources and Activities