1. Incorporating Humanities into the Surgical Curriculum Karen J. Brasel MD, Amy J. Leisten BA, Robert Treat PhD, Brian Lewis MD, Cynthianne Morgenweck MD, Bruce Campbell MD, Nancy Havas MD, Julia Uihlein MA, Arthur R. Derse MD, JD Medical College of Wisconsin Milwaukee, WI

2. Background Loss of empathy during medical school Reflective experiences concentrated in nonprocedural clerkships or electives

3. Background July 2009, students on the surgical clerkship were creative option in lieu of 25% of required histories and physicals. Requirement: relate to something the student experienced during the clerkship. Students shared their projects at the end of the rotation and completed evaluations of the creative session.

4. Objective To analyze the impact of the creative option on student performance.

5. Methods Project themes were categorized using a grounded theory approach. Residency specialty choice was categorized as procedural/nonprocedural. ANOVA was used to determine effect on clerkship grades. specialty choice participation in project

6. Results 388 students during 3 year period 143 students participated in creative project No participation difference by rotation or year 300 non-procedural

7. Results--Format poems additional writing forms mixed media baked goods performances painting/drawing

8. Results--Themes anatomy and physiology specific procedures patient as person student role death physician responsibilities reflection on career choice surgery as a specialty

9. Results Soap and Water The first scrub is best, peeling open the sponge while a high-pitched rush of water splashes into the stainless sink. My mind empties, meditative, counting rapid brush strokes under every nail, over every plane. The bristles are soft and harsh, simultaneously. This is the cleanest I feel all day.

10. Results--Specialty OutcomeSpecialtyMean Score (SD)P* Final gradeNon-procedure 70.5 (5.6) 0.001 Procedure 73.9 (5.0) Clinical gradeNon-procedure 69.1 (7.7) 0.001 Procedure 73.7 (6.6) NBME subject exam Non-procedure 72.6 (8.5) 0.028 Procedure 75.3 (7.9) *Mean score differences determined by two-factor (specialty x project) ANOVA *No statistically significant interaction between specialty and project

11. Results--Project OutcomeProjectMean Score (SD)p Final gradeNo 71.8 (5.7) 0.051 Yes 70.4 (5.5) Clinical gradeNo 71.0 (7.5) 0.024 Yes 68.8 (8.0) NBME subject exam No 73.3 (8.7) 0.681 Yes 73.0 (8.1) After accounting for specialty choice, NO differences in any outcome by project participation

12. Results—Survey evaluation Offered learning not included in the standard curriculum: to better see their patients as whole persons—79% strongly agree to learn something new or important about themselves--72% strongly agree to learn something new or important about their patients--63% strongly agree Overwhelming agreement that the creative option should be continued (94%).

13. Summary Clerkship experience for a wide variety of students First experience with death Creative option provides a valuable learning experience Positively reviewed by students No impact on overall grade