Invited commentary on Roles for literature in medical education

I yield to no one in my regard for Advances in Psychiatric Treatment, but must admit that even in a journal of its quality, it is rare to find a paper that is an unalloyed joy to read. Evans's exploration of how literature can illuminate medical education was, for me, pure pleasure – to the extent that anyone watching me reading it for the first time might have concluded from my enthusiastic nods, smiles and ‘yesses’ that I was in need of psychiatric help (Evans, 2003, this issue).

Evans reminds us that every clinical contact is an encounter, and a two-way one at that. He also unravels the personal as well as the physical nature of such examinations or encounters, and offers us the memorable notion of patients being ‘meat with a point of view’. Wide reading, he argues, is one way of learning to remember the point of view as well as the meat. He might perhaps have added that literature is also one of the best windows into other peoples’ subjective experience, into their consciousness. This function of literature (which is perhaps of particular relevance to psychiatrists) is beautifully explored in David Lodge's most recent novel, Thinks (Lodge, 2001).

Evans invokes Tomorrow's Doctors, the General Medical Council's (then) radical reformulation of how medical education should be delivered (General Medical Council, 1993). This has of course recently been revised (General Medical Council, 2002). The new Tomorrow's Doctors is even more explicit in emphasising that medical education is about active learning rather than teaching, and states that such education must be intellectually challenging. In our brave new world, medical students should be able to identify their own learning needs, and reflect on their practice and that of the doctors they observe. They must also be able to ‘understand the social and cultural environment in which medicine is practised’. In this context, the critical reading of world fiction is surely central to the learning of medicine. Assessing how widely prospective medical students have read, and how they have responded to the literature they cite, is thus clearly a legitimate element in medical student selection.

The General Medical Council also now clarifies that not only must a substantial proportion of each medical school's curriculum consist of optional ‘special study components’, but that a third of these SSCs can be in subjects not directly related to medicine. The opportunities for collaborations between departments of medicine and of literature are suddenly far greater than ever before.

Evans's focus throughout his article is on undergraduate education. We should not forget, however, that such education is merely the first step in a career of lifelong learning. Wide critical reading is equally legitimate as an element of continuing professional development. Reading his article has certainly served as good CPD for me. In this context, it is appropriate and noteworthy that the article does not carry the knowledge-focused multiple choice questions that are a hallmark of APT. Far better to be encouraged to reflect on Evans's argument. In this context, my commentary can be seen as the sort of ‘reflective note’ that other Royal Colleges encourage as a crucial component of the active CPD process.

Evans has given us a spirited and persuasive defence of the benefits of wide reading to clinical practice. He has also done far more that that. He has tried – and I think succeeded – to summarise the essence of medical education as a whole. He argues that, far from being just about the bioscientific understanding of illness, it is also about embryo doctors enlarging their world view, developing their communication skills, exploring their own values and above all acquiring and maintaining ‘a sense of wonder at embodied human nature’ and thereby ‘recognising the medical privilege of intervening in frail human flesh and experience’. To this, I would add appreciation of the family dimension of health and illness, and of the need to come to terms with personal mortality as well as with that of patients – what de Botton (2002: pp. 157–179) calls the sense of ‘dust postponed’. Nonetheless, I for one am grateful indeed for so lucid an articulation of how lucky we are to be doctors and, particularly, to be psychiatrists.