The Medical and Health Humanities Institute
The Medical and Health Humanities Institute (MHHI) has been running since 2018 at three baccalaureate institutions (Centre College, Rhodes College, and Sewanee: The University of the South). Our goal is to develop structural competency and cultural humility skills in participants while learning from patients and providers about health in underserved areas. Each summer, students spend six weeks serving full-time in a community healthcare setting in Memphis, rural Tennessee, or rural Kentucky with medical / health humanities seminars. After an opening day introducing the medical / health humanities and health equity, we meet for reading- and discussion-based seminars two or three times per week. Units on Patients, Providers, and Policy hone in on specific health issues facing racially- and/or economically-marginalized communities in the service areas. Students document their daily clinical experience in a journal for reflective practice. Seminars are devoted to discussing readings as well as their observations of patient-provider interactions, processing their emotions, and sharing person-centered care and self-care strategies with each other. We close with a small creative or research project designed by participants on a related theme.
Program Impacts
We conducted 10 interviews with students who participated in the MHHI program between 2019-2023. The research team collaboratively developed an interview guide to identify impactful aspects of the program from the student perspective. Many of the questions were open-ended, which allowed for participant reflection and elaboration. Semi-structured interviews were conducted via videoconference in 2022 and 2023. Interviews were transcribed verbatim, independently coded by each researcher, and analyzed using Thematic Content Analysis (Boyatzis, 1998). Any disagreements in the coding process were reconciled collaboratively.
In January 2024, we sent a follow-up survey via email to the 10 participants in the study to assess longitudinal impacts of the MHHI program. We had a 100% response rate. Questions were formatted using a 10-point Likert scale.
During our thematic analysis four larger categories emerged: key takeaways from the program, skills, results of participation, and continuing skills. Throughout our analysis, we sorted themes into these four overarching categories. We differentiated “major” themes (mentioned in ≥6 transcripts) from “minor” themes (mentioned in ≥3 transcripts). About half of the major themes (6/13) and half of the minor themes (4/9) related specifically to health equity or social determinants of health (see Figure 1).
In the Key Takeaways overarching category, new knowledge about health disparities was noted in 100% of participant interviews and increased awareness of inequity was noted in 50% of interviews. One participant remarked: “I definitely think some of the most influential things that we talked about was the disparities in medicine.” (P2-2021) In the Skills category, 70% of participants mentioned communication and 30% mentioned leadership as new or developing skills they came away with in the program. Results from Participation had the most ties to SDOH topics for students. Almost all (90%) of students highlighted deciding on a pathway centering health equity or SDOH work as a result of participation in the program. Service was discussed by 60% of participants given the connections students made with organizations throughout the program. Independent information seeking (30%) and advocacy (40%) were also important outcomes for students related to SDOH. Finally, in the Continuing Skills overarching category, 60% of students mentioned seeing patients in social context as a skill they used after the program, and 50% talked about how the program informed their continuing educational choices. Specifically, many students chose to pursue medical school programs with an emphasis on health equity or reoriented their graduate school plans to public health or related fields.
The follow-up survey (Table 1) demonstrates the effects of the MHHI program over time in content, skills, interpersonal experience benefits, and choosing to focus on health disparities in further education. As a result of the MHHI program, a majority of students decided (or affirmed their intention) to continue work in SDOH and health disparities as they progressed in their educational journeys.
Table 1. Results of follow-up survey (January 2024)
| Participant | 1. Content, seminar work (1-10) | 2. Skills (1-10) | 3. Interpersonal Experience (1-10) | Post-program Pathway – SDOH or Health Disparities Focus |
| P1-2021 | 9 | 10 | 10 | Yes |
| P2-2021 | 8 | 7 | 10 | Yes |
| P3-2021 | 1 | 6 | 9 | No* |
| P4-2021 | 10 | 6 | 8 | Yes |
| P5-2019 | 8 | 8 | 7 | Yes |
| P6-2020 | 9 | 6 | 7 | Yes |
| P7-2021 | 8 | 4 | 6 | Yes |
| P8-2021 | 10 | 10 | 10 | Yes |
| P9-2023 | 10 | 9 | 8.5 | Yes |
| P10-2023 | No score | No score | No score | Yes |
| Mean | 8.1 | 7.3 | 8.4 |
*After completing and returning the follow-up survey, the participant contacted SB again and expressed intention to pursue graduate study in public health with a health equity focus.
KEY
| Enrolled or accepted to MD / DO program |
| Working in public health and applied to MPH |
| Applied to clinical psychology graduate programs |
| Completed internship with health disparities |
| Intends to apply to PT programs |
Key Insights
Overall, this study found that health humanities education strongly supports pre-clinical student engagement with SDOH and health disparities in community healthcare settings. What is more, this engagement persists over time as students move into their graduate and professional healthcare training. The MHHI program supports ongoing value-based professional identity formation for participants, including developing knowledge and skills essential to addressing SDOH: communication, independent information-seeking about health disparities, seeing patients in social contexts, and leadership and advocacy. Students developed critical thinking and interpersonal skills that bridged concepts they were learning about in class with patient and provider experiences in the community. This translation of SDOH concepts with real-world impacts of structural inequity from historical, social, and narrative standpoints is a distinct contribution of medical / health humanities in preparing a healthcare workforce invested in mitigating health inequity. The follow-up survey shows that the program may have had an even greater impact (up to 5 years) on participants than they verbalized during interviews, making it possible that participants will impact their own communities in the future.
Further study with more MHHI participants is warranted. We would also like to extend the period of data collection to examine the impacts of participation over time – how do participants incorporate SDOH and health equity into their work as healthcare practitioners? Finally, we want to promote similar programs across institutions for pre-health professions education and encourage those interested to reach out for collaboration. Pooling data from other programs that integrate medical / health humanities approaches to SDOH and health disparities will help grow the collective impact on health equity across the health professions continuum.
-Sarah Berry, PhD and Rita Dexter, MA
- Sarah L. Berry, PhD is the faculty lead at Centre College in Danville, KY for the Medical and Health Humanities Institute, which is funded by a grant from the Mellon Foundation.
- Rita Dexter, MA is a research assistant at the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston, TX.
References
- Balhara KS, Ehmann MR, Irvin N. Antiracism in health professions education through the lens of the health humanities. Anesthesiol Clin. 2022 Jun;40(2):287-299. https://doi.org/10.1016/j.anclin.2021.12.002.
- Boyatzis RE. Transforming qualitative information: Thematic analysis and code development. Sage 1998.
- Hirshfield, LE, Yudkowsky, R and Park, YS. Pre-medical majors in the humanities and social sciences: impact on communication skills and specialty choice. Med Educ. 2019; 53: 408-416. https://doi.org/10.1111/medu.13774
- Petty J, Metzl JM, Keeys MR. Developing and evaluating an innovative structural competency curriculum for pre-health students. J Med Humanit. 2017; 38 (4): 459-471. https://doi.org/ 10.1007/s10912-017-9449-1
- Pitcher C, Prasad A, Marchalik D, et al. A pilot study to understand the role of medical humanities in medical education. Med Sci Educator 2022; 32:1269-1272.