The Benefits of Health/Medical Humanities
The AAMC has launched an NEH-funded initiative named FRAHME (Fundamental Role of the Arts and Humanities in Medical Education) to support and champion the integration of arts and humanities in medicare. The AAMC recommends that medical education should firstly "assert that the practice of medicine is an art and a science, requiring a grounding in humanistic values, principles, and skills, including a deep understanding of the human condition." 
1. The first two decades of 21st-century medicine have witnessed significant transformation in health care delivery, marked health disparities, civil unrest, unprecedented rates of physician burnout and suicide, and unforeseen public health crises in the forms of the opioid epidemic and the coronavirus pandemic. Physicians must be adaptive life-long learners who can effectively respond to these and future challenges. 
2. Physicians must learn to interweave their developing scientific knowledge with emotional intelligence, critical thinking skills, and an understanding of social context. The integration of the arts and humanities into medicine and medical education is essential to educating a physician workforce that can effectively contribute to optimal health care outcomes for patients and communities. 

2. Empathy
75% of medical students become more cynical about academic life and the medical profession as they progress through medical school.
 Physician empathy is correlated with patient clinical outcomes 
- Retrospective correlational study included 20,961 patients with type 1 or type 2 diabetes mellitus from a population of 284,298 adult patients in the Local Health Authority, Parma, Italy, enrolled with one of 242 primary care physicians for the entire year of 2009 
- Patients of physicians with high empathy scores, compared with patients of physicians with moderate and low empathy scores, had a significantly lower rate of acute metabolic complications (4.0, 7.1, and 6.5 per 1,000 patients, respectively, P < .05). 
Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, Gonnella JS. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med. 2012 Sep;87(9):1243-9. doi: 10.1097/ ACM.0b013e3182628fbf. PMID: 22836852. 
3. A Tolerance for Ambiguity
Comfort with ambiguity, mostly associated with the acceptance of multiple meanings, is a core characteristic of successful clinicians. Yet, studies indicate that medical students and junior physicians feel uncomfortable with ambiguity. 
Simpkin AL, Schwartzstein RM. Tolerating uncertainty — the next medical revolution? N Engl J Med. 2016;375(18):1713–1715. doi: 10.1056/NEJMp1606402. 
Luther VP, Crandall SJ. Commentary: ambiguity and uncertainty: neglected elements of medical education curricula? Acad Med. 2011;86(7):799–800. doi: 10.1097/ACM.0b013e31821da915. 
Hancock J, Roberts M, Monrouxe L, Mattick K. Medical student and junior doctors’ tolerance of ambiguity: development of a new scale. Adv Health Sci Educ. 2015;20(1):113–130. doi: 10.1007/ s10459-014-9510-z.
Knight LV, Mattick K. When I first came here, I thought medicine was black and white’: making sense of medical students’ ways of knowing. Soc Sci Med. 2006;63(4):1084–1096. doi: 10.1016/ j.socscimed.2006.01.017. 

4. Clinical Skill Enhancement and Burnout Prevention 
Communication skills training improves patient satisfaction and reduces burnout. 
- System-wide relationship-centered communication skills training improved patient satisfaction scores (HCAHPS Respect score 91.08 vs. 88.79, p = 0.02) (CGCAHPS score 92.09 vs. 91.09, p < 0.03), improved physician empathy (116.4 ± 12.7 vs. 124 ± 11.9, p < 0.001), self-efficacy, and reduced physician burnout (<0.001). Less depersonalization and greater personal accomplishment were sustained for at least 3 months. 
- Course: 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model. 
- 1537 attending physicians from 08/2013-04/2014 
Boissy A, Windover AK, Bokar D, Karafa M, Neuendorf K, Frankel RM, Merlino J, Rothberg MB. Communication Skills Training for Physicians Improves Patient Satisfaction. J Gen Intern Med. 2016 Jul;31(7):755-61. 
Role-playing improved the self-efficacy, and communication skills in health workers and improved client satisfaction overall.
- Quasi-experimental study was conducted in health centers of Saveh University of Medical Science in Iran 
- Primary healthcare (PHC) worker mean scores of self-efficacy and communication skills after the educational program were increased in the intervention group compared to the control group (p < 0.05). Also, mean satisfaction scores for service recipients of the intervention group (PHC workers) generally significantly increased compared to the control group (p < 0.001). 
Shahnazi H, Araban M, Karimy M, Basiri M, Ghazvini A, Stein L. A quasi-experimental study to improve health service quality: implementing communication and self-efficacy skills training to primary healthcare workers in two counties in Iran. BMC Med Educ. 2021 Jul 6;21(1):369. doi: 10.1186/s12909-021-02796-4. PMID: 34229675; PMCID: PMC8258999. 
Arts engagement increases empathy, wisdom, emotional appraisal, tolerance for ambiguity, reduced burnout. The humanities are significantly correlated with empathy, tolerance for ambiguity, wisdom, emotional appraisal, self-efficacy, and spatial skills
- 739/3107 medical students completed the survey (23.8%). Regression analyses revealed that exposure to the humanities was significantly correlated with positive personal qualities, including empathy (p < 0.001), tolerance for ambiguity (p < 0.001), wisdom (p < 0.001), emotional appraisal (p = 0.01), self-efficacy (p = 0.02), and spatial skills (p = 0.02), while it was significantly and inversely correlated with some components of burnout (p = 0.01). 
- Schools: five U.S. medical schools: 1) Sidney Kimmel Medical College at Thomas Jefferson University, 2) Tulane University School of Medicine, 3) The Warren Alpert Medical School of Brown University, 4) Oregon Health & Science University School of Medicine, and 5) Cooper Medical School of Rowan University. 
- Humanities engagement operalization: three clinicians, an art educator, and an industrial/organizational psychologist developed a questionnaire measuring variables that included both “active” and “passive” involvement: engaging in visual arts, singing, playing musical instruments, listening to music, dancing, writing for pleasure, reading for pleasure, attending theater, going to museums/galleries, and attending concerts. Students answered on a scale of 0 (never) to 4 (daily). As there were 10 such questions, a composite score of “humanities exposure” was calculated, with a possible range of 0 to 40. 
- Mangione S, Chakraborti C, Staltari G, Harrison R, Tunkel AR, Liou KT, Cerceo E, Voeller M, Bedwell WL, Fletcher K, Kahn MJ. Medical Students' Exposure to the Humanities Correlates with Positive Personal Qualities and Reduced Burnout: A Multi-Institutional U.S. Survey. J Gen Intern Med. 2018 May;33(5):628-634. doi: 10.1007/s11606-017-4275-8. Epub 2018 Jan 29. PMID: 29380213; PMCID: PMC5910341. 
Arts and culture courseS correlated with improved empathy score outcomes 
- The Jefferson Scale of Empathy Student Version (JSE-S) 
- Of students not enrolled in humanities courses, 71% declined or failed to increase in JSE-S score over the academic year. Of those who took humanities coursework, 46% declined or failed to increase in JSE-S scores. 
- Course: Topics included social and cultural studies, the history of western medicine, and exercises in the interpretation of visual arts and literature. Films and art were viewed and discussed in-session. The core activity in all sessions was an in-session participatory discussion based on the art or literature chosen for the session. 
Graham J, Benson LM, Swanson J, Potyk D, Daratha K, Roberts K. Medical Humanities Coursework Is Associated with Greater Measured Empathy in Medical Students. Am J Med. 2016 Dec;129(12):1334-1337. doi: 10.1016/j.amjmed.2016.08.005. Epub 2016 Aug 24. PMID: 27566497. 
Improv elective impvoes improved proactivity, study engagement, and communication —> burnout prevention 
- UCSD SOM students enrolled in the elective between Fall 2019 and Fall 2020 were surveyed pre- and post- course completion using both qualitative and quantitative methods. Students noted significant improvement in domains related to proactivity in their professional career (3.15 to 4.00, p = 0.02), wellbeing (3.0 to 4.4, p < 0.001), engagement with their studies (3.85 to 4.52, p = 0.02), and communication (3.75 to 4.3, p = 0.04) after completion of the medical improv elective. 
Neel N, Maury JM, Heskett KM, Iglewicz A, Lander L. The impact of a medical improv curriculum on wellbeing and professional development among pre-clinical medical students. Med Educ Online. 2021 Dec;26(1):1961565. doi: 10.1080/10872981.2021.1961565. PMID: 34412576; PMCID: PMC8381956. 
Arts visual analysis improved empirical observational skills and awareness of emotional and character expression in the human face
Bardes CL, Gillers D, Herman AE. Learning to look: developing clinical observational skills at an art museum. Med Educ. 2001 Dec;35(12):1157-61. doi: 10.1046/j.1365-2923.2001.01088.x. PMID: 11895244. GRAHAM J 2016 BOISSY 2016 
4. Structural Competency
Using art to address racial disparities in medicine —> empathy, anti-racism and structural competency 
There is an urgent need for medical school curricula that address the effects of structural influences, particularly racism, on health, healthcare access, and the quality of care for people of color. Structural competency, a framework for recognizing and understanding social influences on health, provides a means for understanding the structural violence that results from and perpetuates racism in classroom and clinical education. Few programs use art to address racial disparities in medicine specifically 
- Course: facilitated discussion about race through art. In these sessions, students and their SHS instructor gathered in an hour-long discussion about The Means to an End. . .A Shadow Drama in Five Acts (1995) by the artist Kara Walker followed by a 30-minute reflection. 
- 64 students randomly selected to participate in the course 
- 48% of students noted an increased comfort level discussing race during the program. 
Godley BA, Dayal D, Manekin E, Estroff SE. Toward an Anti-Racist Curriculum: Incorporating Art into Medical Education to Improve Empathy and Structural Competency. J Med Educ Curric Dev. 2020 Oct 29;7:2382120520965246. doi: 10.1177/2382120520965246. PMID: 33195801; PMCID: PMC7604985. 
5. Media Skills for Effective Communication
"The ubiquitous nature of social media platforms and increasing access to such platforms has created an information ecosystem defined by an unprecedented quantity of data that includes both true and false information [15]. As a result, social media companies and policymakers are facing increasing challenges related to mitigating fake news, disinformation, and hate speech [16–18]. Related to health topics specifically, public health professionals have observed similarly an increase in false, inaccurate, or incomplete health-related information [19]. As the Internet allows for the rapid spread of vaccine arguments, both pro- and anti- [20] there is an opportunity to harness the strength of online platforms to persuade and nudge individuals toward vaccine acceptance."
Limaye RJ, Holroyd TA, Blunt M, Jamison AF, Sauer M, Weeks R, Wahl B, Christenson K, Smith C, Minchin J, Gellin B. Social media strategies to affect vaccine acceptance: a systematic literature review. Expert Rev Vaccines. 2021 Aug;20(8):959-973. doi: 10.1080/14760584.2021.1949292. Epub 2021 Jun 30. PMID: 34192985. 
15. Chou WS, Oh A, Klein WMP. Addressing health-related misinformation on social media. Jama. 2018 Dec 18;320(23):2417–2418. 
16. Ajao O, Bhowmik D, Zargari S Fake news identification on twitter with hybrid CNN and RNN models. Proceedings of the 9th International Conference on Social Media and Society; Copenhagen, Denmark: Association for Computing Machinery; 2018. p. 226–230. 
17. Brummette J, DiStaso M, Vafeiadis M, et al. Read all about it: the politicization of “Fake News” on Twitter. J Mass Comm Quart. 2018;95(2):497–517. 2018/06/01. 
18. Campan A, Cuzzocrea A, Truta TM, editors. Fighting fake news spread in online social networks: actual trends and future research directions. 2017 IEEE International Conference on Big Data (Big Data), Boston, MA; 2017 11-14 Dec. 2017. 
19. Southwell BG, Thorson EA, Sheble L. The persistence and peril of misinformation. Am Scientist. 2017;105(6):372–375. 
20. Kata A. Anti-vaccine activists, Web 2.0, and the postmodern paradigm--an overview of tactics and tropes used online by the anti-vaccination movement. Vaccine. 2012 May 28;30(25):3778–3789. 
Vaccine hesitancy was named one of the top 10 threats to global health by the World Health Organization in 2019 — even before the COVID-19 pandemic took over the public health discourse
World Health Organization. Ten threats to global health in 2019 [Web]. 2019 [cited 2019 Sept 3]. Available from: https://www.who. int/emergencies/ten-threats-to-global-health-in–2019 
The antivaccination movement uses social media as its primary channel for communication 
Dredze M, Broniatowski DA, Smith MC, et al. Understanding vaccine refusal: why we need social media now. Am J Preventive Med. 2016 Apr;50(4):550–552. 
Dunn AG, Leask J, Zhou X, et al. Associations between exposure to and expression of negative opinions about human papillomavirus vaccines on social media: an observational study. J Med Internet Res. 2015 Jun 10;17(6):e144 
Social media interventions have a significant effect on behavior change among populations with health disparities (d = 0.303, 95% CI: 0.156, 0.460, p < .001)
Vereen RN, Kurtzman R, Noar SM. Are Social Media Interventions for Health Behavior Change Efficacious among Populations with Health Disparities?: A Meta-Analytic Review. Health Commun. 2021 Jun 21:1-8. doi: 10.1080/10410236.2021.1937830. Epub ahead of print. PMID: 34148445
Social marketing is a strongly researched strategy for planned social change. A Nature-published randomized-controlled trial on 794,000 participants showed how online advertisements changed population health behaviors by over 50%. 
Yom-Tov, Elad et al. “Erratum: Author Correction: The effectiveness of public health advertisements to promote health: a randomized-controlled trial on 794,000 participants.” NPJ digital medicine vol. 1 38. 16 Aug. 2018, doi:10.1038/s41746-018-0047-z 
Social norms and personal discussion networks significantly predict individuals’ information avoidance 
Qu Y, Saffer AJ, Austin L. What Drives People Away from COVID-19 Information?: Uncovering the Influences of Personal Networks on Information Avoidance. Health Commun. 2021 Jun 30:1-12. doi: 10.1080/10410236.2021.1944457. Epub ahead of print. PMID: 34187260. 
Kaiser Family Foundation’s 2010 study reported that US children and teens aged 8-18 years spend 7.5 hours a day consuming media 
Rideout, V. J., Foehr, U. G., & Roberts, D. F. (2010). Generation M2. Media in the Lives of 8–18 Year Olds. Menlo Park: Kaiser Family Foundation. 
Common Sense Media’s 2015 study reported that US teenagers aged 13-18 average about 9 hours of entertainment media a day 
Common Sense Media. (2015). The CommonSense Census: Media Use by Tweens and Teens. San Francisco: Common Sense Media 
Media is/ARE a well-researched socialization factor that impactS the social norms, schemas and self-identities governing behavior, including health behavior. 
Gerbner, G., Gross, L., Morgan, M., Signorielli, N., & Shanahan, J. (2002). Growing Up with Television: Cultivation Processes. In Bryant, J. & Zillmann, D. (Eds.), Media Effects: Advances in Theory and Research, 2nd edn. (43–67). Mahwah: Lawrence Erlbaum.
Gottfried, J. A., Vaala, S. E., Bleakley, A., Hennessy, M., & Jordan, A. (2013). Does the Effect of Exposure to TV Sex on Adolescent Sexual Behavior Vary by Genre? Communication Research, 40, 73–95. doi:10.1177/0093650211415399. - 
Harris, A. L. (2015). Urban Lit and Sexual Risk Behavior: A Survey of African-American Adolescent Girls. Journal of National Black Nurses’ Association: JNBNA, 26, 58–63. 1668292. 
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