Peter Heusser, Prof. Dr. med., MME (UniBe), 2006
Universität Witten/Herdecke, Fakultät für Medizin, Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthrosposophische Medizin
Kontakt: peter.heusser@uni-wh.de
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Abstract Background: In the last decades, a growing need for holistic medical methods (an attempt to treat both the mind and the body) has been articulated in the public of most industrialized countries. Such methods are usually sought by patients in the areas of complementary or alternative medicine (CAM), whereas in conventional medicine (COM) holistic concepts and methods are felt to be lacking. But despite recent attempts to integrate some elements of CAM into medical education and practice of COM, holistic thinking seems to have remained a feature of extra-scientific practices. Educational intervention, setting and concept: At the University of Bern a new experimental elective curriculum Holistic Thinking in Basic Sciences and Medicine is planned as a credit rewarded elective course of 20 hours duration for medical students of the 1st and 2nd preclinical years. The principle of Goethe’s holistic Empiric Rationalism is applied to topics of physics, chemistry, molecular biology, morphology, sensory physiology, mind-body and other basic issues, and horizontal integration with core curricular content is sought. The course is experimental, with corresponding evaluation. Aim and instructional methods: The global aim is to introduce holistic thinking into basic medical education in a form compatible with the principles of science, namely empiric observation and logical reasoning. Specific aims are not a passive transfer of holistic concepts, but their active formation, comprehension and application, and their translation into professional attitudes and behaviour. To these aims multiple instructional methods are used: lectures, demonstrations, group work, plenary discussions, scripts, and role-plays. Planned assessment methods: Short answer questions for cognitive, self rating scales for affective, and role-play with peer assessment for behavioural course objectives, and a global rating scale for course evaluation are utilized. Curriculum development: In the academic year 2004/05 the following steps were realized: 1. A specific needs assessment among the targeted student population; 2. a pilot course of 8 hours to probe the teaching principles and instructional methods, with a special focus on role-play and peer rating of role-play; 3. a feasibility study to evaluate the pilot course, including a) a questionnaire with 63 items for the evaluation of the course globally, of course elements and instructor, subjectively perceived cognitive learner objectives, affective learner objectives, evaluation of role-play and peer assessment, and b) a calculation of interclass correlations and correlation coefficients of the peer ratings to estimate reliability. Results of the specific needs assessment: About 50% (193/394, with a majority of female students) returned the questionnaire, of whom 99% indicated that physicians should be able to think holistically, 90% expressed that holistic thinking should be taught in medical education, and 54% might inscribe to the offered course. Eventually, only 6 students took part in the pilot course. Results of the feasibility study: 1. The global acceptance of the course (with a mean global grade of 5.2 on a 6-point scale), the course elements and of the instruction were high, and so were the affective satisfaction with the course and the judgements of the cognitive course aspects and their scientific justifications. However, students sometimes felt overcharged with the level of intellectual competency addressed, the quantity of content and the pace of its delivery, and propositions for improvements were made. Also, although students liked the role-play with its behavioural and affective expression of thoughts, they found it partly difficult to translate the often basic concepts into mimicked everyday situations and to objectively rate their peers behaviour. 2. Reliability of peer assessment of the role-play could not be established in the context of the pilot course, there were practically no or only very low correlations between the ratings. The reasons and implications are discussed. Conclusions: 1. The need for the integration of holistic thinking into basic medical education seems to be given in the targeted student population. 2. The teaching principles and instructional methods of our new elective curriculum seem to provide a highly accepted and scientifically reasonable approach for interested students to holistic thinking in basic sciences and medicine; but improvements have to be made to avoid an overcharge of the competence level of students, by providing less content and more time available. 3. For this reason and with these revisions, we will expand the course to the planned 20 hours during the next phase of curriculum development. 4. During this time, the role-play with its rating by peers will be given up as an assessment method. It will be used less frequently and only as an instructional tool for the time being, and the corresponding resources in time and teaching effort will be used for optimizing the elaboration of the cognitive course aspects.