In May 2016 Berna Gerber, Guddi Singh, Megan Wainwright, Michelle Pentecost, Thomas Cousins, Lizahn Cloete and Ferdinand Mukumbang, ran a workshop with 25 participants on “The Humanization of Health Sciences through Innovation in Health Professions Education” at the Brocher Foundation in Hermance, Switzerland. In preparation for the Brocher workshop, and in order to extend the conversation to more colleagues in South Africa, the organizers held a pre-Brocher workshop at Stellenbosch University’s Tygerberg Campus on March 16th 2016. Here, Megan Wainwright and Thomas Cousins share their reflections on the debates and themes that emerged over the course of the day.
It is a pleasure to be writing on behalf of the organizing group about this workshop. The one-day workshop brought together 40 researchers, students and practitioners to discuss the topic of integrating the social sciences and humanities into health sciences education and to share pedagogical and curricular approaches. Before turning to an overview of the emergent topics from the day’s discussions, first let us say a bit about how the organizers began working together.
In March 2015, Chris Colvin (UCT) and Hayley McGregor (University of Sussex), organized a 5-day workshop in South Africa on “Building the Critical Health Social Sciences in Southern Africa” (funded by the British Council and SASH Programme). The workshop was aimed at early career researchers from Southern Africa and the UK. We were fortunate to be selected to participate alongside Berna Gerber (SU), Guddi Singh (MedAct), Michelle Pentecost (Oxford), Lizahn Cloete (SU) and Ferdinand Mukumbang (UWC). The seven of us met at the workshop at which we were grouped together by the organizers for our common interest in health sciences education. Over the course of the workshop we established that we shared a common interest: the integration of the social sciences and humanities into health sciences curricula, whether it be medicine, nursing, speech-language therapy, physiotherapy or rehabilitation. The workshop organizers challenged the groups to continue meeting after the workshop and to develop a project. We decided to apply to hold a workshop on the topic of “The Humanization of Health Sciences through Innovation in Health Professions Education” at the Brocher Foundation, Switzerland. To our delight, we were successful!
In order to expand the conversation to include more South African colleagues and prepare our contributions for the Switzerland workshop, we held a one-day pre-Brocher workshop at the Faculty of Medicine and Health Sciences of Stellenbosch University (Tygerberg Campus). The call was deliberately broad and welcomed submissions from those who studied for a health science degree, those who teach, and those who research. Our hope was to create a space for sharing, dialogue and networking. Without too narrowly defining the topic, we hoped to get a sense of who, out there, is drawn to this topic and what that could tell us about the meanings it holds in this context. We did however set out some broad aims which included: to explore and critically reflect on the opportunities and challenges for integrating the humanities and social sciences into health sciences curricula in South Africa; to share experiences of pedagogical and curricular innovation in our various institutions and contexts; to think critically about what ‘problems’ this integration seeks to redress, and whether there is evidence of ‘effectiveness’ and how we go about researching this. We were interested in how debates about these intersections might be relevant to the national health priorities in Southern Africa, and how we might move between the global North and global South in fostering critical thought on education in the health sciences.
From our perspective, a key theme that emerged was the argument that biological sciences alone are inadequate for preparing health professionals to work ‘out there, in the real world’, meaning, in this context, the South African public sector. Notions of ‘what is a human being’, and the separation of mind and body emerged. The experience of health professionals training in South Africa emerged as one of stress, competition, fear and a sense of helplessness and even humiliation.
The question this then provoked was “what is needed to bring about change?” In relation to the organisers’ suggestion that social sciences and humanities could bring needed perspectives, practices and ways of thinking to the mix, a number of different responses emerged. One was a medical humanities approach which emphasizes interdisciplinary thinking around particular issues, including the role of arts in fostering “resilient” health professionals, and thinking in new ways (i.e. in ways that might shape one’s practice or actions as a health professional). Another suggestion was an orientation in health sciences toward ‘politicization’ of health – i.e. a more “conscientised” or politicised health professional motivated by strong commitments to a broader and just social/political project. Another orientation to the question was training and teaching qualitative research theory and methods as a way of expanding what is seen as the ‘relevant’ body of evidence for questions of health and illness. Qualitative research was seen as a way of answering those questions RCTs cannot. While it seemed that the formal health professions curricula at many South African universities proceeds by means of a distinction between scientific and non-scientific, it was less clear what might be meant by “non-scientific”. This connects the challenge of integrating knowledge and methodology from the humanities and social sciences into health sciences, to the wider challenge of countering a socially constructed hierarchy of knowledge that labels the qualitative and philosophical as ‘non-scientific’ and therefore unimportant or irrelevant. When its importance and strengths are understood and acknowledged the next question is how this knowledge might be best “internalised” (for example in classroom-based teaching or experiential learning?) and at what stage of a student’s training. In these discussions we realised that such debates need to be thought of in relation to whether we are concerned with undergraduate or postgraduate training.
There were also important discussions around classroom strategies. We heard of the benefits and new opportunities that come with online classrooms. We thought critically about who teaches what, and how we teach or not with ourselves as examples – that is, to allow one’s self, or ‘the self’, to be the means by which we teach, learn, or practice. We thought about who speaks for who; the power of first hand narrative; and the risk of essentializing and homogenizing experience. A skilled facilitator who is academically (not just personally) grounded in the topic was considered key.
In thinking critically about disciplines and interdisciplinarity, several people cautioned against a common tendency to privilege the figure of the medical doctor when thinking about health professions training. How best to bring into view nurses, physiotherapists, occupational therapists, speech-language therapists, community health/care workers, administrators, clerks, etc, as crucial contributors to a well functioning health care system? Given the range of skills and scope of professional practice, what “graduate attributes” are most needed or valued, both in training and in professional support systems? While there are clearly different needs and expectations amongst the health professions, there are also quite different visions for how health professionals might be expected to carry themselves between urban and rural contexts, and even between different contexts within cities or districts.
While the conversations provoked by the presentations were wide ranging, we realised the value of a soft or broad focus as an initial point of departure for starting a more reflexive debate on the relationship between health professions training and the humanities and human sciences. An ethnographic approach to the workshop suggests that the range of people who are interested in these questions is broad, coming from quite different disciplinary and professional contexts, and that finding a common language through which to establish questions of mutual concern requires a careful and sensitive exploration of the fields of mutual concern. Our conversations raised many questions, but answered few. For the organizers at least, the workshop led to new insights, new connections within and across institutions, and a better understanding of the issues and debates surrounding this topic in the context of South Africa. We now look forward to our meeting at the Brocher Foundation.
By Megan Wainwright and Thomas Cousins
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Megan Wainwright is a Postdoctoral Research Fellow in the Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town. She is also an Honorary Research Associate in the Department of Anthropology, and collaborator on the Life of Breath project in the Centre for Medical Humanities, at Durham University, UK.
Thomas Cousins is a lecturer in the Department of Sociology and Social Anthropology at Stellenbosch University.
Thank you to all who attended and to the presenters (listed in order of presentation):
- David Sanders (UWC)
- Steve Reid (UCT)
- Chris Colvin (UCT)
- Carla Tsampiras (UCT)
- Susan Levine (UCT)
- Elizabeth Jahncke (SU)
- Alwyn Louw (SU)
- Lori Lake (UCT)
- Graeme Hoddinott (SU)
- Rose Richards (SU)
- Ben van Wyk (SU)
- Alex Muller (UCT)
- Janet Bell (SU)
- Donald Skinner (SU)
- Reneé van der Wiel (Wits)
- Kristen Daskilewicz (UCT)