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RESEARCH REPORT

A Medical Humanities Roadshow ‘Spreading the Word’

Rowena Murray Morag K Thow

Key Words Medical humanities, literature, education, professional development, applications.

Summary This paper. written jointly by a physiotherapist and a non-physio- therapist, describes a touring Medical Humanities Roadshow (Scotland and Ireland). Medical humanities is an approach using literary texts on medical subjects to stimulate discussion among health professionals. The aim of the roadshow was to spread this approach beyond an established group in Glasgow and to assess the effectiveness of the roadshow as a method of doing this.

We provide an outline of a medical humanities discussion, for those who may be interested in trying out this approach.

Responses to medical humanities at the different venues are summarised; all were positive and enthusiastic. All participants found their first experience of medical humanities stimulating and enjoyable. Physiotherapists in education considered medical humanities in the undergraduate curriculum, or for personal reading, or for in-service education.

Specific applications of medical humanities in physiotherapy are suggested. The question of who should lead the group - physiotherapist or literary expert - is also considered, from the point of view of both authors.

In conclusion, this paper argues that there is interest in medical humanities across a variety of locations and institutions; the next challenge will be to assess how it affects practice.

Introduction This paper is a follow-up to our introduction to medical humanities in this Journal (Thow and Murray, 19911, a follow-up in the sense that we have taken the approach to other locations, to see if there is interest beyond the group we have run in Glasgow since 1990. While our previous paper defined the approach (using literary texts on medical subjects in group discussions) and introduced it to the physiotherapy context, this paper argues, on the strength of a medical humanities roadshow, that the approach can be quickly assimilated by newly formed groups, meeting for the first time and experiencing medical humanities for the first time. This confirms our initial assertion, in the 1991 paper, that medical humanities has potential in physiotherapy education.

What we found was that even a two-hour medical humanities session was enough to introduce

the approach, to illustrate the technique and to convince participants that this was a new discussion technique which had some value for them and for the people they teach.

We start with a review of our individual perspect- ives on medical humanities, from a physio- therapist’s and a non-physiotherapist’s point of view, a description of the roadshow context, an outline of the session we gave at each roadahow venue, along with a statement of our views on the role of the discussion leader, and, finally, a more fully developed (than in the previous paper) statement of applications of medical humanities for physiotherapy.

At the conclusion of this paper we provide a selection of readings, which we have used in our medical humanities p u p , in order to include a range of issues in which readers may be inbreeted.

Background: Two Perspectives Combining our different backgrounds, physio- therapy and literature, we have developed a series of workshops in which literary texts on medical topics can be used to stimulate discussion among health professionals. After four years of running the Glasgow Medical Humanities Group our own views still overlap and diverge, demonstrating the interaction of the physiotherapist and the humanities specialist. Our reflections at this stage show our different preoccupations, with continuing professional development on the one hand (Thow), and with the role of the literary text on the other (Murray).

A Physiotherapist’s Point of View Physiotherapy education at undergraduate level generally addresses ‘humanities’ issues within the collective subject title of behavioural sciences, covering sociology, psychology and communications studies. Aspects of behavioural sciences are identified and addressed throughout the under- graduate course as an integral part of physio- therapy practice.

As students progress in their training there is increasing integration of behavioural sciences with clinical reasoning and clinical skills. The student will also be experiencing personal development and change, where attitudes and emotions will be stirred and perhaps experienced for the first time! Where are these elements addressed when

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the student qualifies? Postgraduate courses are predominantly geared towards deve!oping clinical aspects of care: Where are the ‘human’ issues revisited or developed? The humanities or behavioural sciences must be very important a t undergraduate level if they are considered to be enough to sustain a whole career!

We suggest that if clinical skills and clinical reasoning should be enhanced at the postgraduate level; so should the ‘humanities’. Medical humanities has been used in undergraduate education as one method of delivery. It should also be included in our postgraduate curriculum.

A Non-physiotherapist’s Point of View As an outsider, physiotherapy seems to me to be a very humanely practised science; physiotherapy education frequently does include the human side of care, yet physiotherapists raise interesting questions about the integration of science and the humanities. Their lingering questions partly explain physiotherapists’ enthusiasm for medical humanities; they are strongly oriented towards caring as a humane role, but are unclear about how to integrate human issues and scientific knowledge at undergraduate or postgraduate level. For example, one response we received to our previous paper on medical humanities in this Journal began ‘At last, someone is looking at the patient’s point of view’, suggesting frustration at the increasing scientific (or management?) emphasis in physio- therapy.

Perhaps the answer is to consider varieties of views explicitly, and perhaps literary texts which deal with medical topics can offer this, since they, by their very nature, integrate two kinds of experience, the scientific and the non-scientific. Literary texts also deal with medical subjects in a different way, sparking the imagination of the reader. Discussing them has perhaps a different effect, integrating personal and professional responses, allowing both into the same discussion.

I would suggest that literary discussions can do things scientific discussions cannot: because the literary text is open to more than one interpre- tation it provokes debate; and because the text is about a medical subject that debate is tied to a medical context. The medical subject is thereby open to debate. In this debate participants will remain aware of the validity of other interpre- tations, because these other interpretations can be seen in the text, even as they formulate their own. This, I think, is where medical humanities can make a contribution to physiotherapy education: helping people to develop the skills not of arriving at one final answer, but of developing an answer that suits the context of the problem. It also encourages us not only to talk through complex

health questions but also to voice the assumptions and personal values which we inevitably take to work.

The Roadshow Context Two roadshow staff, one physiotherapist and one literary expert, travelled to six venues in one week: Aberdeen, Dundee, F’erth, Edinburgh, Glasgow and Dublin. Local contacts in each venue organised the advertising, location facilities, etc. A total of 41 people participated, a mixture of physiotherapists, doctors, nurses, and two of the sponsor’s staff. (The majority were physiotherapists.)

The short-term goal of the roadshow was to spread the word, to take medical humanities to locations beyond the well-established Glasgow group. The long-term goal was to support those who were interested in setting up their own group. More specifically, the aims and intended outcomes were as follows:

Aims To demonstrate medical humanities in areas of Scotland and Ireland where we know there is an interest among health professionals and educators, but where little work has been done on this topic.

To provide a clinical update on specific topics.

To show how medical humanities and clinical studies can be integrated.

To introduce selected texts which can be used in medical humanities (see list a t the conclusion of this paper).

Outcomes For colleges and universities Reconsideration of the role of discussion and reflection in delivery of the curriculum.

For participants

Examples of texts and methods for running a medical humanities workshop, a network of contacts, ease of ordering texts.

For roadshow staff

Study of responses to this approach among health professionals, educators and students in new locations.

The Roadshow Workshop The sessions were two hours long, allowing time for a coffee break and for browsing through our exhibition of new clinical texts and other literary works. The medical humanities meetings took place in physiotherapy departments; other discussions took place in individuals’ offices.

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Briefing the group as a whole. later, work is undertaken In small groups

At all the roadshow venues, with all the roadshow groups, we used the same text and structured the discussion in the same way. We did this in order to gather information about reactions to the medical humanities process: would different groups have similar interests, encounter similar difficulties, raise similar questions - or would each group produce a different set of issues and questions? Would each group report the same benefits for themselves? Would the discussion make them reflect on their own practice?

The groups were usually mixed, including different health professionals, in education and practice, some worked together and some did not. Group size ranged from six to 14.

In briefing each group (see photograph) we gave a simple definition of medical humanities (using literary texts in medical education) and reassured them that this was not a test of their skills of literary analysis. A flexible outline for the session was provided: individual reading of the poem, individual writing in answer to a question on the content of the poem, pairs and group discussions of answers, and, finally, open discussion of responses to medical humanities and its role in physiotherapy. In other words, following the pattern we have developed in the Glasgow group, this session contained three main phases:

Phase 1 Introduction: (1) What is medical humanities? (2) W h y have a roadshow?

Reading the poem individually (since reading aloud would have given only one interpretation).

Answering a question: ‘Has this person fully recovered? (Open, general question, requiring definition: what does ‘recovered’ mean?)

Individual written answers to the queetion (five minutes, in sentences - grammar, punctuation, spelling not important - allowing each person to put down their own views).

Pairs discussion: comparing written answers (participants decide whether or not to share their writing).

Phase 2 Plenary discussion.

Comment: recurring issues in medical humanities.

Phase 3 Reflective questions: Collecting initial reactions to medical humanities, comparing this with other kinds of reading and talking in physiotherapy.

The text we used in each roadshow session is Elizabeth Jennings’s poem ‘After An Operation’ (Jennings, 1987). It is given here in full, with permission of the author and publisher.

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After An Operation what to say fim I learnt I WBS afraid Noi frightened in the way thet I had been Mwn Wb-mdrrdl. I rrknplv mern FearbecameabaolUteandIbecame SubjscI to it; it bedponed, I Obeyed.

Fear whi i be(0re had always been particular. Attrrchedtothhwthetscene. word, event, Here became general. Past, future meant Nathing. Only the presemt moment bore Thin huge, vague fear, this wish for nothing more.

MI life still stlned and n e m themselves became Ub shoals which hurt while growing, sensitive To find not death but further ways to live. And now I’m convakwcent, feer can claim No general pamw. Mt I am not the same.

Elizabeth Jennings

Responses to this poem, and to the question ‘Has this person M y recovered?: were varid some gave strong, definite views; others were more hesitant. Some gave straight medical readings, while others wem more concerned with the patient’s experience 0s the illness and operation.

EIleryone was fascinated by the range of views and by the quality of h r v a t i o n a made by the group, from ‘Yes, this person has ymered‘ to ‘No, clearly not’. The literary expert was able to facilitate some simple analysis of the text, helping participants to locate their interpretation in the text, ie to support their ‘gut feeling’ with references to the poem. For example, most readers will observe that fear is a powerful force in the poem. Closer analysis shows how fear dominates the middle of the poem, by becoming the subject of the verbs, replacing ‘I! More specifically, the facilitator can point out the number of times ‘I’ is the subject of the verb in the fmt verse (61, compared with the second verse (01, and the third verse (2). Initially the facilitator dram attention to this, leaving participants to consider its implications. Then the facilitator can make an explicit connection between one of the group’s interpretations - this person has not psychologically recovered, for example - and one reading of the words of the poem - fear still predominates. Some instruction in this kind of analysis is useful at this stage: looking at the vocabulary, the verbs, the personal pronouns, the sentence structure, the weighting of each line, etc, helps participants to track their own interpretations in the poem itself. More importantly, it enables them to check the validity of their reading: is the poem, on closer analysie, saying what they think it is? This is important because readers sometimes digre& from the text towards their own experience or presuppositions. A medical humanities discuss- ion illustrates this beautifully.

Since the text is not a case study, it is open to more than one interpretation. There need not be a sense of ‘being wrong’. Gradually the group develops the confidence to revise readings in the light of discussion, analysis and comparison with other interpretations.

Reactions to Medical Humanities Reading and Writing Explaining the medical humanities approach, allowing participants to experience this kind of discussion and allowing most of the time for the three phases outlined above were the primary functions of the roadshow. Participants did indeed offer Merent interpretations of the poem and different answers to the question ‘Has this person fully recovered?’ Most of them agreed that the writer had not ‘filly recovered: (For further details ofreaders’ responses to this question, on this poem, see Murray, 1994).

However, one of the aims of the roadshow was to find out more about people’s reaction to this kind of discussion; how did they deal with this new kind of reading and writing? More specifically, we asked them three questions and have summarised their answers as follows: 1. What did you think of literature befire you came to this meeting? ‘Literature was something snobby’ . . . ‘formal’ . . . ‘difficult’. . . . ‘Something we did for an exam.’ ‘Not pleasurable!’ ‘The only reading I do is for work.’ ‘I feel guilty if1 read something that’s not for work: ‘There were always right and wrong answers.’ ‘Literature is good for escapism.’ ‘Literature can have a powerful effect on people: ‘Pleasure.’ ‘It’s separate from work.’ This summary of responses to the first question indicates, first, a range of responses. The anticipated fear of literature is there There is some ‘positive uncertainty’ about the value of literature in the work context.

2. Have you changed that view now? ‘It’s more enjoyable.’ ‘I can say what I think.’ ‘I can use this in my work.’ Answers to the second question show enjoyment and enthusiasm for the potential of medical humanities in the work context, which come partly from the freedom to ‘say what you think’.

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3. Has your attitude to writing - ie doing the writing - changed? ‘I can say what I think.’ ‘I like the act of writing.’ ‘It’s important that no one else is going to read it.’ ‘There’s a difference between scientific writing and creative writing; one has only one interpretation, the other has many.’ The third question, finally, was intended to probe assumptions and values about writing: would participants value the freer form of writing they were invited to do in this session? The summary conveys that they did.

Talking and Interacting We asked participants to reflect on the discussion and written reflection we had asked them to do. We then asked them to consider the talking and interacting they did in their work:

How would you describe the kind of talking and interacting you have done in this session?

How would you describe the kind of talking and interacting you normally do in your work?

This simple comparison was designed not to draw out complaints about constraints or the decay of the culture of care; instead, the aim was to define the differences first and assess their significance second. The sum of participants’ comments is that the medical humanities discussions were ‘less competitive’ and ‘more supportive’.

This response confirms our observations of the Glasgow Medical Humanities Group over the past four years; we had observed that even as participants disagreed about interpretations, about treatments, about definitions of care, and so on, even as they faced up to the challenge of ‘literature’, and even as they drew on their own deep-seated values and assumptions, they were still giving co- operation and support. The roadshow participants reported the same experience.

However, participants also said that talking and interacting might be quite different in the workplace; there is not always the element of safety or support in the discussion of difficult issues, of personal definitions and professional practice, of responses to current changes and new pressures.

An important finding of this roadshow, therefore, is that medical humanities does provide, for some health professionals, a unique forum for reflection on professional matters. Because the subject of the literary text is medical it inevitably connects the discussion to their workplace, and yet the individual’s personal interpretation of a literary text particularises the discussion for each

participant; personal views are valued in this discussion. That this discussion can be both safe and productive, relevant to both personal and professional agenda, is an added advantage if the group leader can facilitate the discussion of both.

Concentrating on the literary text helps to focus the discussion generally, preventing it from straying too far, from becoming too diffuse. Furthermore, because the literary text is open to more than one interpretation, and if the group leader draws out these interpretations, there is less competition between interpretations; no one can say that their reading of the poem is ‘right’. This immediately defuses confrontation: the debate can be heated without being destructive.

People who are new to this kind of discussion may have to learn to operate in this way, yet it should be noted that all of the roadshow groups were able to do so in a one-off session. Similarly, those who have done little work with literary texts might fear that this kind of reading and talking would be beyond them; again, the roadshm groups made it clear that this is not a stumbling block. It has to be admitted that sometimes they surprised themselves with their observations on the poem. They were able to put their fears to one side and make up their minds about their own answers to the question. In other words, lack of cooperative group work was not a problem; unfamiliarity with literature was not a problem.

One issue which we have not yet considered is the value of working in mixed groups. The Glasgow group includes physiotherapists, nurses and other health professionals in education and practice, along with other non-medical people. Presentations to groups of physiotherapists a t the CSP Annual Congress, for example, have included people who work together and those who do not. The roadshow groups were also mixed, bringing together those who worked together and those who worked in different departments, different professions, or different institutions. In other words, none of these groups has involved people who work together all the time, and so the question remains about whether or not the impact of medical humanities depends on this mix. Would it be as effective among people who work together? Is it more effective if there are people from the same profession, but from different institutions? Does the success of the discussion depend on the presence of people from differing professions, including non-medical professions?

Because these questions remain unanswered we would suggest that the roadshow format is highly suitable for an initial meeting of a mixed group Thereafter, participants could move to, or perhaps develop, a medical humanities group for physio- therapists.

Leading the Group: Two Perspectives A Physiotherapist’s Point of View Do you need a literature specialist for a medical humanities group to work? There is a feeling that physiotherapists are not ‘qualified’, especially if over time they isolate themselves from literature. The use of humanities at postgraduate level could help to redress this imbalance, with physiotherapy being discussed as much in terms of art as of science. There is also scope for physiotherapists, perhaps in collaboration with a literary expert, to research the impact of medical humanities. Physio- therapists could, however, lead their own groups once they had some experience of a medical humanities group or some further education. However, as with any new idea or type of delivery - eg student-centred learning - confidence will grow with time and participation.

A Non-physiotherapist’s Point of View My own view is that it is a good idea to have a literature specialist lead the group; otherwise the discussion returns too often to medical matters, often at the expense of the poem. This means that participants reinforce their own views, values and assumptions rather than reviewing them. People in this kind of group discussion tend, understand- ably, to be more comfortable talking about what they know.

My contribution to the work of the group is to respond to observations on the poem: ‘Yes, but is that what the text says? to make readers check their readings of the text, and ‘Where do you see that in the poem? which is my way of pushing for more detailed observation of the words. I am not sure that physiotherapists, or other health professionals, would be able to do this without some training, and the physiotherapists and nurses in the Glasgow group have confirmed this. Perhaps someone from the local English department or adult education centre could start off the group. Group work skills are also needed.

Having said that, physiotherapists (and others) in the more experienced Glasgow group have developed the skills of talking about literary texts. They now draw out different interpretations and illustrate their interpretations with references to the text. Not all members of the group attend all of the meetings, but most have built up confidence in commenting on literary works, to the point that they will now puzzle over an obscure section of a poem, with some prompting from me as to key words. In fact, literary specialists who have participated in the Glasgow group’s discussions have found their skills of analysis to be superior to those of undergraduates in literature. All of this work suggests that, over time and with some

coaching, physiotherapists can develop medical humanities skills. The roadshow illustrated that one session was adequate to initiate this kind of discussion; the barriers which formal education places between science and the humanities are not insurmountable.

Furthermore, some physiotherapists have a relevant background: for example, one roadshow participant had studied literature, and therefore felt ready to take the step of leading a new group in her area. For her it was a chance to bring literature back into her life.

So far as text selection is concerned, finally, literary texts can be ordered in the same way as medical texts, through the same bookseller. Two reading lists, which we used on the roadshow, taking copies of all recommended books to all venues, are attached to this paper. Participants will also usually provide ideas, suggesting texts from their own reading.

Medical Humanities Applications The emphasis in our discussion so far has been that medical humanities can quickly be made accessible to physiotherapists. This raises the questions of where this kind of discussion group might be introduced and how it might be integrated.

In a previous paper we simply put forward some suggestions about possible uses of this approach in physiotherapy (Thow and Murray, 19911, speculating about how medical humanities could work with different groups for different purposes. In light of our roadshow discussions we are now able to develop some of these suggestions.

Clinical Reasoning If clinical reasoning and problem solving continue to develop a t postgraduate level without aspects of the humanities, are we producing holistic practitioners? We would argue that it is integral, as at undergraduate level, to encompass ‘human’ issues both to benefit patient care and for the personal growth of the physiotherapist.

Moreover, ‘problem solving’ has recently been defined as ‘assessment, evaluation, [andl clinical decision-making’, giving the student quite a gap to bridge between full-time college attendance and clinical practice. Learning contracts have been used to encourage autonomy, with work diaries and peer group reflection to help assessment of learning. However, this presents students with new problems: ‘Many students had difficulty differentiating between problem-solving and treatment-manage- ment objectives’: ‘The majority of students found the writing of work diaries repetitive’ (Hay-Smith, 1993, page 106). This suggests that the students had not really learned what reflection was, nor

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had they learned its uses for them, nor had they learned, it seems, that it can be enjoyable.

Medical humanities could be used to enable students to develop skills of reflection in speaking and writing: the readings and writings are varied and students can relate to their own experience of clinical practice. Clearly, the more open format of medical humanities creates problems for assess- ment: learning outcomes in the Glasgow group and in the roadshow were neither fixed nor formalised. Perhaps participating in a debate on the meaning of ‘recovery’ is in itself a learning outcome (ie not having anything to say, or not developing the skills of saying it, would, in the course of a termisemester constitute a ‘fail’?)

Clinical Studies: Undergraduate IS enough time given to preparing students for clinical experience? Do they have enough time to discuss and process their experiences when they return to the classroom? Briefing for the clinical experience could take place during discussion of literary texts and textbooks, using these texts as a mechanism for prompting discussion. A medical humanities discussion could help students address the human side of care a t this stage. In a similar way, a medical humanities discussion after clinical experience could be used for debriefing, allowing students to express feelings, assess their learning, and address difficult issues which may have come up during their placement, such as the death of a patient, the differences between clinical practice they observe and standards or Codes of Practice promoted in their course, or redefining their role as physiotherapists.

Clinical Studies: In-service Within a clinical setting, as part of ongoing in- service education, medical humanities could perform an important function; for example, integrating medical humanities within a case study could address the humanities issues while still remaining within the clinical ‘envelope’.

Course Design For those facing ever-increasing burdens of course design and curriculum development, medical humanities could be included as a mechanism - not just another module - for students (and staff) to develop the reflective skills needed for many of the current innovations in student-centred learning.

Special Interest Group The Medical Humanities Roadshow has, for selected centres in Scotland and Ireland, begun a network which has the potential to become a special interest’group, where those who wish to develop in this area can meet and work with others

with a similar interest, locally, nationally or internationally. (A sign of interest in France: our previous Physiotherapy paper has been republished, in translation, in Annales de Kinesitherapie.)

Postgraduate Module Medical humanities could form an element in a postgraduate qualification, as a module in an honours or master’s degree, eg within a health promotion or health education topic. The future development and integration of this role in physiotherapy are at an exciting threshhold. The enhancement of care for the patient is developing hand-in-hand with the nurturing of the physio- therapist in personal development as a human being.

Ethics: A Growing Concern How we deal with ethical education is currently being widely debated in the pages of this Journal and elsewhere:

‘Professional treatment decisions must be based on ethical analysis; ethical decision making must take place as a component of clinical decision making. Development of the ability to make ethical decisions is an essential component of professional gmwth without ethical decision making, the treatment decisions made by physical therapists have the potential to jeopardise the advancement of the profession’ (Clawson, 1994, page 14).

’Applied ethics courses require interdisciplinary expertise, but demand a sufficient basis in moral philosophy to allow for the critical appraisal essential to ethics, and to go beyond a narrow discourse about professional codes of conduct. . . . The ethical should engage the technical and professional reality’ (Preston. 1992, page 9).

Medical humanities does cross boundaries between disciplines and can help participants ‘to recognise distinctions between theories, values and beliefs which emerge during practice’ (Fish, 1991, p 26).

Personal Development From school years on we are taught that the art5 and the sciences are separate. In focusing on one we quickly learn to neglect the other. As students of one we lose sight of the importance of the other. As scholars and practitioners in the scientific environment we are not encouraged to read novels, short stories, poems or plays, when there are scientific journals to be read.

Now we need to bridge this gap, to use, as one medical humanities participant put it, both sides of our brains. If we are to be holistic practit- ioners, and holistic human beings, we need to stop behaving as if art, the emotions and creativity are irrelevant to science.

Medical humanities is bridging this gap for physiv- therapists in the Glasgow group: reading, thinking, writing, developing in a completely different way from scientific reasoning. Medical humanities creates a new environment: unplanned thoughts and unstructured discussions, free of learning

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outcomes and assessment criteria. In this context we are not judged, and this means that we can move on in our thinking.

Research and Development Return visits .Consolidate interest in each area. .Set up other groups. 0 Involve more people.

Support new groups .Share texts used in Glasgow group. 0 Describe discussions and debates. .Train in textual analysis. .Show and discuss video of Glasgow group.

Medical humanities textbook 0 Overcome copyright problems. 0 Describe discussion management. .Ideas for group to use.

New roadshow venues .Spread the word further afield. .Visit new locations: interested readers can contact us directly.

Conclusion Our experience in running medical humanities groups has concerned mainly the postqualification, or post-registration, sector. The neglect of human issues, after the undergraduate years, can leave physiotherapists without a means to develop ideas, to process problems or to react to change. Personal development is often seen, at this stage in a physiotherapist’s career, in terms of clinical skills or scientific knowledge - another course, another workshop. Medical humanities, running over a number of months, with meetings every six to eight weeks, can provide sustained reflection time and the flexible structure to extend reflective skills. Precisely how this affects physiotherapy practice is, as with many forms of reflective practice, the challenge for future research.

Acknowledgments The authors wish to thank Elizabeth Jennings. and Macmillan publishers, for permission to use her poem ‘After an Operation’ in full. Credit and thanks for the photograph are due to Neil MacLennan. Audievisual Services, University of Strathclyde. This work was supported by Ferriers, Medical Booksellers. Edinburgh.

Authors Dr R m n a Murray PhD MA is a lecturer in the Centre for Academic Practice, University of Strathclyde. Glasgow. Moreg K Thow Bsc MCSP D/pfE is a Wumr in the physiotherapy department of Glasgow Caledonian University.

Addmss for Comrspondence Miss M K Thow. Physiotherapy Department, Glasgow Caledonian University, Southbrae Campus, Glasgow 613 1PR

Reading LIsf f: Lifemry Texts Dunn. D (1985). Elegies. Faber, London. Fraser, C M (1980). 8lueAbove the Chimneys, Fontana, Glasgw. Galloway, J (1992). The Tricks to Keep Breathing. Minerva, London. Kydd. R (1987). Auld Zimrnery, Mariscat. Glasgow, Lapierre. 0 (986). City of Joy. Arrow, London. Gilman, C P (1892). The Yellow Wallpaper, Virago (1992), London. McWilliams, C (1989). A Liftle Stranger, Picador, London, Sarton, M (1988). After the Stroke. Women’s Press, London. Shaw. G B (1906). The Doctor’s Dilemma, rpt Penguin, Harmondsworth. Whitaker, (1992). All in the End is Harvest: An anthology for those who grieve, Darton, Longman and Todd, London.

Reading List 2: Non-Literary Texts Burnard, P (1992). Effective Communications Skills for Health Professionals, Chapman and Hall, London. Casement, P (1990). Further Learning from the Patient: The analytic space and process, Routledge, London.

Christensen, C R et a/ (eds) (1991). Education for Judgement: The artistry of discussion leadership, Harvard Business School, Boston.

Ley, P (1988). Communicating with Patients, Chapman and Hall, London. Macdonald. C (1992). Could it be Stress? Reflections on psychosomatic illness, Glendaruel, Argyll. Morris, J ed (1989). Able Lives: Women’s experience of paralysis, Women’s Press, London. Sacks, 0 (1990). Awakenings, Picador, London. Schon, D (1987). Educating the Reflective Practitioner: Towards a new design for teaching and learning in the professions, Jossey- Bass, San Francisco. Sontag, S (1991). lllness as Metaphor; AlDS and its Metaphors (one volume), Penguin, Harmondsworth. White, M and Epstein, D (1990). Narrative Means to Therapeutic Ends, Norton, New York.

Refewnces Clawson. A L (1994). ‘The relationship between clinical decision making and ethical decision making’, Physiotherapy, 80, 1. 10-14. Fish, D (1991). ‘But can you prove it? Quality assurance and the reflective practitioner’, Assessrnenr and Evaluation in Higher Education, 16, 1, 22-36. $iay-Smith, J (1993). ‘Negotiating learning contracts for fieldwork placements in physiotherapy’, in: Stephenson, J and Laycock, M (eds) Using Learning Contracts in Higher Education. Kogan Page, London. Jennings. E (1987). Collected Poems 1953-86, Carcanet, Manchester. Murray, R (1994). ‘Medical humanities: A practical introduction’, Physiotherapy Ireland, 15, 1, 25-29. Preston, N (1992), ’Issues for higher education in the teaching of ethics’, Higher Education Research and Development, 11.1, 9-19. Thow. M and Murray, R (1991). ‘Medical humanities in physiotherapy: Education and practice’, Physiotherapy. 77,

Thow. M and Murray , R (1994). ‘Literature et mbdecine en kinbsitherapie: Formation et pratique’, Annales de Kinbsitherapie, 21, 4, 191-197.

11, 733-736.

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