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Flipped classroom on humanities: medicine, narrative and art

What problems were addressed? Encouraging empathy in medical students is important in medical education, as the core of medical practice is the relationship between doctors, patients and families. Stories generated by illness experiences and interpretation of signs of disease are the basis for clinical reasoning construction. Empathy with patients is not only learned through reasoning (theory) but also through sensitivity. Increasingly, virtual learning environments have been used in medical curricula because of the potential for interaction, mobility and time management. To support the development of humanistic skills, the dialogue between science and art in virtual environments is simultaneously a challenge and an opportunity, especially in traditional lecture-based curricula. What was tried? A module was developed in a virtual learning environment (https://edulify.com/nesa-disciplina-de-medicina-de-adolescentesfcm-uerj/atencao-a-saude-do-adolescente-dialogo-entre-ciencia-e-arte) based on narrative medicine, with the purpose of discussing key subjects of adolescent health care. A group of multiprofessional teachers and students was recruited. The course included individualised online mentoring and was organised into thematic units. The initial activity of each unit was the discussion of questions on a clinical case. Then, two exercises were completed. Students were required to construct narratives based on material available on the platform (theoretical framework, basic concepts, literature, movies, paintings and newspaper articles) and the students’ previous experiences. The second exercise was the collective construction of a review and synthesis of a tale that could be used with students in subsequent classes. The course included four topics: growth and development; sexuality and reproductive health; nutrition and culture; youth work and future outlook. In the module on nutrition and culture, for instance, several materials were presented: a case on a black teenager living in a quilombo, who presented a set of risk factors for developing cardiovascular disease (metabolic syndrome); the tale Ball of Fat (Boule de Swif; de Maupassant); the movie Precious by Lee Daniels; the paintings of the Colombian artist Botero; and videos on Mauritania, where obesity is a sign of health and prestige among women. Students also had access to a lecture developed by a professional with expertise in each studied area, containing concepts and epidemiological data to add clinical context to the discussions. The exercises sought to develop narrative competence in the student, and promote consideration of culture as a mediator of patient conception of health, disease and health care. Students were encouraged to communicate and to carry out team activities, which are essential in daily work. What lessons were learned? In students’ evaluation of the discipline, they reported their approval, acknowledging the relevance of the association of science and art. They also highlighted the innovative nature of the course and the establishment of an engaging and exciting learning environment. Students recommended the use of music and comics in the future. Students wanted more opportunities for communication with each other. The faculty members found that students engaged with the materials provided more readily than expected. Use of a virtual environment that promotes the sharing of ideas, teamwork and collective construction of knowledge is an effective teaching strategy.