Reply to Helmers et al.: Beyond Evaluation: Resisting Quantification in the Medical Humanities

From the Authors:

We thank Helmers and colleagues for their comments on our recent publication in ATS Scholar and appreciate the opportunity to further describe the objectives of our study. Helmers and colleagues highlight crucial qualitative work done by their group regarding participants’ response to a medical humanities curriculum for pediatric critical care trainees and faculty as well as thematic analysis of previously published narratives written by critical care providers (1, 2). We agree that the impact of the medical humanities cannot be captured through quantitative means alone, and their publications provide valuable insight into the role of the humanities and narrative practice for critical care providers. However, we hope to make the case that quantitative analysis can be a valuable addition to other methods of demonstrating acceptability, feasibility, and impact of narrative medicine and other applications of medical humanities.

Helmers and colleagues identify two challenges in implementing medical humanities: facilitating trainees’ engagement and assessing impact. The objective of our study was not to assess the impact of our narrative medicine workshops (3). Our study was centered on engagement facilitation by quantifying the acceptability of narrative medicine workshops. To that end, we adapted an existing questionnaire developed to assess domains of the theoretical framework of acceptability and administered this survey to participants of our narrative medicine workshops. In the context of implementation science, acceptability is a quantifiable outcome that can guide intervention modification to improve its uptake by potential participants. Given the paucity of medical humanities activities in our own training program and in the published literature, we believe there is merit to quantifying whether pulmonary and critical care trainees find value in these sessions as a preliminary step to rollout of a broader humanities curriculum. Our hope was to provide data supporting the use of such workshops in a fellowship program and to contribute to the small but growing body of literature describing such activities in training. As Helmers and colleagues point out, the institutional openness that allowed their robust curriculum to flourish may not be present at other centers (1). Demonstrating interest in novel educational programs is necessary to justify the time and resources needed to implement and sustain such efforts. This drove our efforts to quantify acceptability in this arena.

We agree that measuring the impact of a medical humanities curriculum is a complex endeavor, to which qualitative assessments are crucial. But this should not preclude the use of any quantitative work. Both the National Endowment for the Humanities and the National Endowment for the Arts support quantitative research to measure the value and impact of arts and humanities (4, 5). We see the value of using qualitative and quantitative research to tell a more complete story about the use of medical humanities in medical training and practice, especially in high-burnout fields such as critical care.

We wish to acknowledge the importance of the work done by Helmers and colleagues. Noting the rarity of publications describing medical humanities in critical care training to date, we are encouraged to find others engaged in this endeavor and hope that this robust discussion can serve as a stimulus for continued dialogue, collaboration, and research.