Carr et al. BMC Medical Education          (2021) 21:568  
https://doi.org/10.1186/s12909-021-03002-1
RESEARCH Open Access
Health Humanities curriculum 
and evaluation in health professions education: 
a scoping review
Sandra E. Carr1*, Farah Noya1, Brid Phillips1, Anna Harris2, Karen Scott3, Claire Hooker3, Nahal Mavaddat4, 
Mary Ani‑Amponsah5, Daniel M. Vuillermin6, Steve Reid7 and Pamela Brett‑MacLean8 
Abstract 
Background: The articulation of learning goals, processes and outcomes related to health humanities teaching 
currently lacks comparability of curricula and outcomes, and requires synthesis to provide a basis for developing a 
curriculum and evaluation framework for health humanities teaching and learning. This scoping review sought to 
answer how and why the health humanities are used in health professions education. It also sought to explore how 
health humanities curricula are evaluated and whether the programme evaluation aligns with the desired learning 
outcomes.
Methods: A focused scoping review of qualitative and mixed‑methods studies that included the influence of 
integrated health humanities curricula in pre‑registration health professions education with programme evaluate 
of outcomes was completed. Studies of students not enrolled in a pre‑registration course, with only ad‑hoc health 
humanities learning experiences that were not assessed or evaluated were excluded. Four databases were searched 
(CINAHL), (ERIC), PubMed, and Medline.
Results: The search over a 5 year period, identified 8621 publications. Title and abstract screening, followed by full‑
text screening, resulted in 24 articles selected for inclusion. Learning outcomes, learning activities and evaluation data 
were extracted from each included publication.
Discussion: Reported health humanities curricula focused on developing students’ capacity for perspective, reflex‑
ivity, self‑ reflection and person‑centred approaches to communication. However, the learning outcomes were not 
consistently described, identifying a limited capacity to compare health humanities curricula across programmes. A 
set of clearly stated generic capabilities or outcomes from learning in health humanities would be a helpful next step 
for benchmarking, clarification and comparison of evaluation strategy.
Keywords: Health professions education, Medical Humanities, Health Humanities, Curriculum evaluation, Scoping 
review
Background
The medical humanities is a rapidly evolving field that 
provides an interdisciplinary approach to understand-
ing the meaning of health, illness and disease for patients 
*Correspondence:  Sandra.Carr@uwa.edu.au in the context of the social worlds in which they live and 
1 Health Professions Education, University of Western Australia, Perth, work, to enhance empathic and effective responsiveness 
Australia to their experience and needs. A broad interdisciplinary 
Full list of author information is available at the end of the article
© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which 
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the 
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or 
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line 
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory 
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this 
licence, visit http://c reat iveco mmons. org/ licen ses/b y/4. 0/. The Creative Commons Public Domain Dedication waiver (http://c reat iveco 
mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Carr et al. BMC Medical Education          (2021) 21:568 Page 2 of 10
field, ‘health humanities’ as it is increasingly referred to an “overarching theory of practice”—presenting a formi-
[1], encompasses perspectives, insights and approaches dable challenge to characterizing and evaluating health 
from diverse arts (e.g., visual arts, performing arts, music) humanities learning and teaching [11].
and humanities (history,literature,  narrative, ethics and Recognizing these difficulties, Dennhardt [12] con-
philosophy) disciplines. As stated by Shapiro p.192, the ducted a scoping review and synthesis of quantitative 
aim is to help students of the health professions “better outcome studies of medical humanities that led to the 
understand and critically reflect on their professions with development of a conceptual framework of epistemic 
the intention of becoming more self-aware and humane functions of arts-based teaching to support curriculum 
practitioners” [2]. The term “medical humanities” is development and evaluation in health professions edu-
most often associated with education of medical prac- cation [12]. They identified 1) three focuses, or different 
titioners; in contrast, the “health humanities” broadly ways arts-based teaching are used (as expertise, dialogue, 
includes health and social care professions, with the arts and expression/transformation) and 2) related knowl-
and humanities contributing to education, research and edge purposes (for mastering skills; interaction, perspec-
health care practice [3, 4]. tive-taking, relational aims; personal growth/ activism). 
In addition to enhancing knowledge and understand- Haidet [13] similarly developed a conceptual framework 
ing across a variety of realms, the ‘health humanities’ to guide careful design, contextualization, and evaluation 
are also viewed as important for developing the skills, of arts-based learning. To maximize arts-based learn-
behaviour and attitudes that  health professionals need to ing outcomes, they recommend that the unique qualities 
become clinically excellent, creative and critically reflex- and affordances of different arts-based forms be assessed 
ive practitioners. Increasing calls for humanizing medi- and used to inform engagement, meaning-making, and 
cine has seen the introduction of the medical and health knowledge translation strategies and processes when 
humanities as an expanding global movement [5]. Health facilitating arts-based approaches to health professions 
humanities offerings range from one-off co-curricular education. To date, however, an evaluation framework 
interventions, such as visits to art museums, electives, has not been proposed for health humanities teaching 
both optional and mandatory lectures and courses, to and learning. This is likely due to the tensions that exist 
fully integrated, longitudinal curricular themes. Though between scientific, positivist learning and humanistic, 
there is a wealth of evidence that the arts and humanities constructivist learning, and the  different approaches 
are highly valued as an approach [2–4, 6], the knowledge needed to measure outcomes that are believed to be 
base about the impact of these interventions is currently quantifiable and objective, compared with impacts that 
scattered and ad-hoc. The articulation of learning goals, are more subjective, subtle, and continuous  [6]. As noted 
processes and outcomes related to the introduction of by Dennhardt [12], health humanities teaching can-
the humanities into health professions curricula, requires not easily be systematised in relation to simple descrip-
synthesis. Curriculum designers and instructors need tive categories. In the context of the competence and 
a generative framework for evaluating health humani- outcome-based curriculum frameworks commonly used 
ties courses. Curriculum evaluation hinges on measur- in the health professions, the heterogeneity of the health 
ing whether the graduate learning outcomes of a course humanities can make it very difficult to integrate them 
or programme have been met, by determining whether into core curricula and may be one of the reasons why it 
the desired change in the learner’s attitudes, knowledge, often remains an elective offering. Additionally, the epis-
skills and behaviour has been achieved [7]. temological features of subjects may provide a strong 
Despite the increasing popularity of arts and humani- prima facie justification for handling those subjects in 
ties-based approaches to health professions education, certain ways within the curriculum [14].
reviews that have explored the contributions of health Most prior reviews have focused on quantitative stud-
humanities to desired learning outcomes in health pro- ies of medical/ health humanities teaching. Compared to 
fessions education have found a paucity of evidence [6, these more reductionist approaches, the research team 
8–10]. In Moniz’s [11] recent large-scale overview of the for this study believed that qualitative and mixed meth-
rich and diverse use of arts and humanities they found ods studies would provide a more robust understand-
that just over half of the 769 publications included in ing of why and how arts and humanities are used and 
their review were evaluated; and in only 27% of the pub- evaluated in health professions education. As such, we 
lications were learners assessed. They concluded that undertook a scoping review of qualitative and mixed-
the published literature regarding arts and humanities methods studies of health humanities curricula in pre-
contributions to medical education are characterized by registration health professions education to provide a 
brief, episodic instalments and largely lacking a theoreti- basis for the development of a curriculum and evaluation 
cal lens that may support accumulation of evidence into framework for health humanities teaching and learning 
C arr et al. BMC Medical Education          (2021) 21:568 Page 3 of 10
that would enable comparability of curriculum offer- Inclusion and exclusion criteria
ings and outcomes. As an international team of scholars Population: Of interest were   health professions stu-
and practitioners with expertise in  health humanities, dents, including medicine, nursing and allied health 
health professions education and health care, we were professional students, undertaking a pre-registration 
also interested in developing a framework that would be programme or course of studies at a university. These 
applicable across a global context. could be undergraduate, or graduate-entry programmes 
The following questions guided our review: that led to the ability to become registered health practi-
tioners. Studies focused on participants or students who 
1. How, and why, are the health humanities used in were not enrolled in a pre-registration health professions 
health professions education? course were excluded.
Intervention: Learning interventions (activities) using 
a. What is the focus of health humanities teaching? health humanities integrated into curricula with a 
b. What domains, and levels of learning are focus on the achievement of stated learning outcomes/
addressed?) objectives and associated curriculum evaluation were 
included. Studies that focused on ad-hoc health humani-
2. How are health humanities curricula evaluated? ties learning experiences (e.g., a once off visit to an art 
gallery), rather than integrated course content (e.g., a 
For the purpose of this review, we considered ‘health seminar series developing students skills in observation) 
humanities’ as being inclusive of ‘medical humanities’. were excluded.
Outcome: Any assessment or programme evaluation 
of the “impact”; “outcome*”; “benefit”; AND the achieve-
Methods ment of “attributes”; “skill*”; “knowledge”; “behaviour”; 
We conducted our review in accordance with Arskey “personal growth” or “reflect*”; “transformation” were 
and O’Malley’s framework for scoping reviews [14]. searched for; only articles meeting these criteria were 
While a scoping review provides a systematic approach included. Articles that did not report clear outcomes 
to mapping literature on a given topic to provide a com- were excluded.
prehensive picture of the literature, it does not make 
discriminations based on the ‘quality’ of the studies as Article screening and selection
occurs with systematic reviews [15]. This allowed for Following removal of duplicates, 8606 titles were 
reflexivity through the process of extracting data to reviewed, each by two reviewers (CD, SC, BP, FN, KS, PB, 
develop a descriptive, narrative synthesis of the selected CH). It was at this stage that publications were screened 
publications, leading to clarification and refinement of to ensure that they were qualitative or mixed-methods 
guiding questions and methods as understanding of the studies. Clearly non-empirical (conceptual, theoretical 
literature becomes clearer. contributions, as well as descriptive articles) and reviews 
were excluded. Subsequently, 410 abstracts were each 
reviewed by two members the project team (SC, BP, CH, 
Search strategy KS, PB, FN). Additional non-empirical articles were then 
To identify the relevant articles for consideration, a com- excluded, as well as empirical studies that only reported 
prehensive search strategy was applied using the Cumu- quantitative findings. From this, 71 papers were included 
lative Index to Nursing and Allied Health Literature for full paper review, each by two members of the project 
(CINAHL), Educational Resources Information Centre team (SC, BP, PB, KS, FN, CH, MA) and 24 papers were 
(ERIC), PubMed, and Medline using keywords including then identified for full data extraction. Hand searching 
combinations of “student*”, “health professional*” AND of references for this final set was also completed, which 
“education”, “curricul*”, “programme”, “teaching”, “learn- did not identify any additional articles for inclusion (SC) 
ing”, “evaluation”, “assessment” AND “health humanities”, (Fig. 1).
“medical humanities”, “arts”. Publications between March 
2015–November 2020, available in English, in peer Data charting
reviewed journals were searched. The initial search was We developed a standardized listing of data fields to facil-
undertaken using the keywords and inclusion/exclusion itate a descriptive, narrative synthesis of the data. Form 
criteria from April 15 to 20, 2020 identifying 8594 arti- fields that were used to extract data from the included 
cles. The search was repeated on November 22, 2020 with articles into an Excel spreadsheet included: 1) article 
a further 27 articles identified bringing the total number citation elements and 2. Health humanities curriculum 
of articles included in the scoping review to 8621.
Carr et al. BMC Medical Education          (2021) 21:568 Page 4 of 10
Fig. 1 PRISMA diagram summarising study selection process
intervention and programme evaluation details (see reviewer (SR, NM, KS, SC). Any conflicts were resolved 
Table 1). Two reviewers extracted the data (FN, DC) that by discussion (SC, FN, DC).
was subsequently checked by an independent second 
Table 1 Data extraction fields
Article citation elements Health Humanities Curriculum Intervention and Programme Evaluation Details
Authors Student Population
Title Health Humanities Discipline(s)
Year of Publication Health Humanities Learning  Focia
Journal Stated Learning Outcomes/Objectives
Country of Publication Level of Learning (Bloom)a
Article Type (Research/ Study Design or Programme Evaluation) Learning Domain (Knowledge, Skills, Attitudes)a
Type of Educational Intervention: Delivery Mode, Duration of intervention
Assessment of learning (Formative/ Summative)
Level of Programme Evaluation (Kirkpatrick’s)a
a Variables used for secondary analysis
C arr et al. BMC Medical Education          (2021) 21:568 Page 5 of 10
The process of data coding was iterative and led to practice) and classified as applying both formative and 
refinements in our approach to analysing the data as summative programme evaluation [18, 19].
our understanding of the articles included in our review 
evolved. The initial analysis was descriptive with basic Findings
information extracted including reference citation ele- Our selection strategy identified 24 articles for inclusion 
ments such as year of publication, country of publication in this scoping review. The full details of these papers 
and type of article which was coded as “evaluation”, i.e., are available as the supplementary material Additional 
focusing on programme evaluation, or “research”, i.e., file 1: Appendix A. Most of the papers were published in 
focused on answering specified research questions and 2016 (n = 6) and 2017 (n = 9); over half were published 
study design (“qualitative” or “mixed method”). In addi- in North America (n = 13); the remaining authors were 
tion in this phase the type of student participants, the based in England, Ireland, Australia, India, New Zea-
health humanities disciplines involved, mode and dura- land, Spain and Sweden. Thirteen articles were classified 
tion of learning, learning outcomes and assessments as evaluation studies, (focusing on programme evalua-
described, along with whether an educational theory or tion) and 11 were coded as research studies (answering 
framework was specified were recorded and are summa- specified research questions). Fifteen articles applied 
rised as frequencies in the findings. mixed methods approaches to data collection and nine 
The secondary analysis considered the impact of the used qualitative methods with the prevalent analysis 
learning experiences in relation to the Bloom’s domains techniques being descriptive and thematic analysis. All 
of learning: knowledge (cognitive), skills (psychomotor), the included studies reported findings that were sup-
attitudes/behaviours (affective) and six levels of learn- portive of health humanities educational activities and 
ing: remember, understand, apply, analyse, evaluate and interventions for pre-registration health professions stu-
create [16]. It also considered the foci of health humani- dents and reported positive learning environments and 
ties teaching as informed by previous reviews [8–10, 12, experiences.
17], as well as insights of the authors’ team who all have The educational interventions described in the article 
experience using and studying the arts and humanities in set covered a wide range of health humanities disciplines 
their teaching and research. Thus we identified six foci and learning activities. Interventions were mostly bal-
for health humanities teaching and learning: anced between arts-based (visual, performing arts, and 
music; n = 10); humanities-based (reflective practice, lit-
1) knowledge acquisition. erature/ narrative medicine; film/cinema; ethics/philoso-
2) mastering skills (observation, listening, reflection) phy, n = 11); and multidisciplinary approaches, (n = 3). 
[12]; Most interventions were directed to medical (n = 12) 
3) interaction, perspective taking, and relational aims and nursing (n = 10) students. The numbers of students 
(person-centred communication, compassion, empa- reported as participating in the studies included in our 
thy) [12]; data set ranged from 9 to 477 individuals. Only one inter-
4) personal growth and activism (transformation, val- vention was delivered exclusively online [20]; the remain-
ues, professionalism) [12]; der involved face to face learning. Six articles did not 
5) personal wellness and self-care (stress management, state the length of time the intervention lasted for, three 
mindfulness, resilience building) and. stated the activities lasted for a single session of between 
6) critical evaluation (evidence synthesis) [3]. 2 to 6 h and the remaining 15 health humanities learning 
innovations lasted for between 4 weeks and a year.
Ambiguous data were analytically discussed by 
research team members and final coding decisions were How, and why, are health humanities used in health 
agreed upon by consensus of three researchers (SC, FN, professions education?
DC). Synthesised results are summarised as frequencies The health humanities educational interventions 
of occurrence for the domains of learning, level of learn- described in the final set of studies were widely varying; 
ing and health humanities foci. the one commonality they all shared was that they dif-
The evaluation strategies applied in each included fered from traditional educational interventions used in 
paper were also classified using Kirkpatrick’s four-level the health professions in relation to both intent and form. 
training evaluation model, encompassing: 1) process They tended to focus on the “human side of medicine” 
evaluation (participant satisfaction), 2) content evalu- (practitioner, patient, health care systems), and tended 
ation (knowledge, skill change), 3) impact evalua- to use more active, transformational forms of learning, 
tion (change in behaviour), and 4) outcome (change in compared to more passive, informational forms (such as 
lectures, tutorials and laboratory sessions).
Carr et al. BMC Medical Education          (2021) 21:568 Page 6 of 10
Table  2 summarizes three pertinent descriptive ele- Table 3 summarizes the foci or proposed function of the 
ments in relation to the current review: health humani- health humanities interventions included in our review. 
ties discipline(s); domains of learning addressed; and the There is overlap between Bloom’s learning domains, and 
level of learning. A broad range of arts and humanities the first three foci are listed for health humanities cur-
disciplines were used. Most of the health humanities ricula in this table. Most articles were coded as having 
interventions aimed to address attitudes and behaviour, multiple foci; the large majority used health humanities 
or the affective domain of learning (n = 10); the remain- interventions for the purpose of developing and master-
der addressed knowledge and skills-based domains about ing skills (n = 20) to promote development of capabilities 
equally. Most of the interventions were directed towards associated with patient-centred care. Interestingly, half 
expanding understanding (n = 10) and applying new of the studies included a focus on enhancing knowledge 
learning (n = 7), learning levels 2 and 3. to support humanism (n = 12; this was the primary focus 
It is noteworthy that of all the data we charted, domain in four studies), which might be considered a low-level 
and level of learning proved challenging in almost half objective. Just over half (n = 11), included a focus on per-
of the cases (n = 10). Some described interventions that sonal growth and activism (formation/ transformation). 
aimed to address attitudes and behaviour, however deliv- Fewer educational activities focused on using the health 
ered content in the cognitive (knowledge) domain [21]. humanities for critical evaluation and only one article 
In other cases, interventions directed to educating stu- used health humanities practices for promoting well-
dents about the value of seeing a situation from another’s being of the developing health professional [25].
perspective aimed to reach but did not quite meet the 
benchmark for higher learning levels beyond “under- How are health humanities curricula evaluated?
standing”. For example, Campbell [22], Centeno [23]; To begin, none of the studies referred to a specific evalu-
Gilkison [24] partially facilitated students’ exploration ation or other theoretical framework that had been used 
of attitudes and values to provide a foundation for future to guide the evaluation of their health humanities curric-
professional behaviours and practices, but did not extend ula. Many did specifically describe their evaluation effort 
the learning to the level of analysing, integration or crea- as either formative (n = 6) or summative (n = 15). With 
tion. In some cases, studies did not report clear learning respect to Kirkpatrick’s Level of Evaluation, most of the 
outcomes or levels of learning – in these cases, what was studies assessed participants’ response to and satisfaction 
reported was delivered sometimes did not align. with the learning experience (Level 1); for a quarter of 
the studies (n = 6), this was the only evaluation that was 
Table 2 Main descriptive elements of health humanities articles included for analysis (n = 24)
Health Humanities intervention Count of Articles Article #s- refer to Appendix A
Reflective practice (includes reflective writing) 5 #6, #10, #11, #13, #23
Visual arts‑based (includes art therapy) 4 #1, #5, #19, #22
Performance (drama, simulation‑based learning) 4 #3, #4, #12, #15
Multidisciplinary 4 #9 #17, #18, #20
Literature/ Narrative Medicine (includes creative writing) 2 #8, #21
Film/Cinema 2 #14, #16
Music‑based learning (includes music therapy) #24
Ethics/Philosophy 1 #7
Domains of Learning (Bloom et al. 1956)
 1. Knowledge (Cognitive) 7 #2, #4, #7, #14, #17, #19, #20
 2. Skills (Psychomotor) 7 #1, #5, #6, #9, #10, #15, #24
 3. Attitudes/Behaviours (Affective) 10 #3, #8, #11, #12, #13, #16, #18, #21, #22, #23
Bloom’s Six Levels of Learning
 1. Remember 0 NIL
 2. Understand 10 #2, #3, #4, #14, #16, #17, #18, #20, #21, #22
 3. Apply 7 #10, #11, #13, #15, #19, #23, #24
 4. Analyze 3 #7, #8, #9
 5. Evaluate 2 #1, #12
 6. Create 2 #5, #6
C arr et al. BMC Medical Education          (2021) 21:568 Page 7 of 10
Table 3 Foci of health humanities evaluation outcomes
Foci Count Article #‘s (refer to Appendix A)
of 
Articles
    1. Health Humanities for knowledge 13 #3, #4, #5, #7, #9, #10, #13, #14, #16, #18, #20, #22, #24
    2. Health Humanities for developing and mastering skills (observation, listening, 20 #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #12, #14, #16, #17, 
reflection) #18, #20, #21, #22, #23, #24
    3. Health Humanities for interaction and communication (person‑centred, compas‑ 20 #2, #3, #5, #6, #7, #8, #9,#10, #12, #13, #14, #15, #16, 
sion, empathy, inter professional,) #18, #19,#20, #21, #22, #23, #24
    4. Health Humanities for behaviour formation and transformation (personal growth, 12 #2, #3, #7, #8, #9, #10, #11, #12, #20, #21, #22, #23
values and activism, professional behaviour, cultural sensitivity)
    5. Health Humanities practices for personal wellbeing and self‑care (stress manage‑ 1 #11
ment, mental health first aid, health promotion, resilience)
    6. Health Humanities for critical evaluation (evidence synthesis) 4 #5, #8, #11, #22
conducted [22, 25–29]. For these studies, there was lit- Discussion
tle association between the evaluation and the intended The findings of this review confirm the findings of pre-
learning outcomes. Fourteen of the review studies evalu- viously published quantitative systematic reviews sur-
ated the health humanities intervention at Level 2 [20, 23, rounding health and medical humanities curricula [8, 
30–40]. These studies evaluated the capacity of the health 10, 11] but the inclusion of qualitative data adds fur-
humanities curricula to enhance a student’s knowledge, ther clarification and a depth of understanding of the 
or skills, or both - linking the intervention with the learning outcomes or core capabilities being addressed 
intended learning outcome. Only three studies [24, 41, through health humanities learning activities and how 
42] evaluated health humanities educational interven- these curricula are being evaluated. The primary finding 
tions in relation to their impact on changing participant of this review was that  there is an absence at present of 
behaviour (Level 3). The study by Haidet [43], aimed at a consistent framework for health humanities learning, 
the highest level of evaluation and was able to demon- teaching and assessment, and hence, little capacity for 
strate that compared to students in the control group, systematic evaluation within or across curricula. Many 
students in the health humanities course demonstrated included articles did not report clear learning outcomes 
statistically significant and educationally meaningful or levels of learning meaning that in some instances, 
gains in adaptability and listening behaviours [13]. what they intended to teach and what they delivered 
With respect to evaluation methods, most of the stud- sometimes did not align. Other articles identified that the 
ies conducted a post-curriculum evaluation, via a sur- learning was not a linear process, which meant that the 
vey instrument, focus group, or interview. Three studies achieved learning outcomes were not always the planned 
included pre−/post-test evaluation [25, 33, 35]. Assess- learning outcomes. For example, Patterson [21] identified 
ment of learning is often used to evaluate health humani- the heterogeneous nature of learning outcomes achieved 
ties curricula: reflective writing and narrative essays were by students engaged in a medical humanities module. 
used to assess the value of health humanities curricula While many papers made generalised statements about 
in seven studies [20, 29, 35, 39–42]. These were not used enhancing students’ knowledge, skills and values, spe-
to assess higher levels of learning (such as creating new cific learning outcomes were not presented in a cohesive 
understandings) but aimed at developing and practising or consistent manner that would facilitate comparisons 
the skills of reflection so they could be applied to future across schools in different contexts. This made it very dif-
health care practice. The students also identified in the ficult to comment on the similarities and differences in 
evaluations that they had learned about themselves in approaches taken or in the learning that was achieved 
each of these seven papers. The risk of bias due to miss- and is a limitation of this review. Combined, these fac-
ing results was minimised by having two team members tors mean there is currently a limited capacity to com-
agree on the data extraction, which also enhanced the pare health humanities curricula across programmes. 
confidence in the reported synthesis of results. An internationally developed, empirically based, locally 
adaptable set of clearly stated generic capabilities or out-
comes from learning in health humanities would be help-
ful for benchmarking, clarification and comparison.
Carr et al. BMC Medical Education          (2021) 21:568 Page 8 of 10
Insofar as there was a key learning outcome, frame- evaluation. The critical health humanities or practise of 
work or focus across the studies, a second finding was evidence synthesis are seen as being very important in 
that health humanities teaching focuses on developing ensuring the capability of having perspective and is sup-
students’ perspectives and hence, on developing skills ported by evidence in health humanities [3].
in reflexivity. Development of perspective involves the 
capacity to see the complexity of situations surround- Limitations
ing health. For example, Gilkison [24] analysed reflec- The data charting and data extraction processes required 
tive writing and discussed how the students had learned interpretation of the findings reported in the included 
about themselves, others, and their health professional articles. While steps were taken to minimise any mis-
practice, through experiencing emotional responses interpretation or the introduction of bias during the 
contained within narratives. Another common learning data charting and data extraction process, this may be a 
outcome across several of the educational interventions limitation of the review. Other limitations of the review 
was the development of capacity for self-reflection or include the possibility that  the search strategy missed 
introspection. Others reported similar evaluation find- publications that would have met the inclusion criteria or 
ings where the students re-conceptualized their future an article may have been excluded incorrectly.
roles as health professionals and how they would interact 
with patients and families in a more reflective and per- Conclusions
son-centred way [21, 23]. This person-centred approach The findings of this review suggest the next step is to 
focused on communication that is empathetic and which articulate a set of core capabilities for health humani-
is reported elsewhere as one of the main aims of health ties. The value of core capabilities for developing health 
humanities-based curricula [6, 12]. However, there was humanities curriculum within a programme would be 
little published evidence that these aspirations are car- twofold: first, to more systematically develop integrated 
ried through to observable changes or outcomes later in learning activities that can achieve some of the higher-
the curriculum or post-graduation. order educational outcomes desired; and secondly, to 
The studies captured in this review also indicated more accurately and systematically evaluate whether 
some of the tensions or challenges that health humani- these core capabilities are being achieved. If we are to see 
ties teaching must confront. For example, a third find- health humanities education realise changes in socialised 
ing was that some of the included studies aimed to health care practices that put the patient/person at the 
address the affective domain in Bloom’s Taxonomy of centre of care, they must move towards expecting stu-
Learning [16] but often delivered content in the cog- dents to analyse, integrate, evaluate and create or form 
nitive domain. We suggest that this common situa- new knowledge, new perspectives and enact new behav-
tion arises in part because of the intensive resourcing iours. A framework of core capabilities will enable edu-
required for affective learning  (for example for small cators to identify where current activities do not achieve 
group or one to one teaching and guided reflection). It these aims despite their intentions.
may also represent tensions and challenges in achiev- Comparison across and between programmes is an 
ing authentic affective learning, for example, between important source of innovation in education, becoming 
learning offered on the basis of intrinsic value, whose all the more important in a globally connected world. 
qualities may be altered by the very act of assessment. Because the health humanities are heterogeneous glob-
These findings support the need to scaffold health ally, any framework for comparison must be sufficiently 
humanities specific teaching vertically through the flexible as to allow for localised priorities, cultural needs, 
whole curriculum rather than being confined to the and learning traditions and practices.
earlier years as is often the case. However, it is well Finally, this review revealed a continued absence of 
known that this is more challenging to accomplish later, an overarching conceptual or theoretical framework for 
in what is typically the clinical space in curricula. the health humanities  in health professions education, 
Related to this was the fourth finding that most of the either in any single study, or emerging from what might 
evaluations focused on process and content, with only be regarded as an international (albeit unequal) ‘com-
three of the studies evaluating changes in behaviour [24, munity of practice’ in the area. While there was general 
41, 42]. Interestingly, only four papers focused on devel- convergence on ‘perspective’, this was largely untheorized 
oping skills in critical evaluation [20, 25, 33, 40]. So, while beyond a broad notion centring on ‘empathy’. There was a 
the focus of health humanities learning in the remaining persistent disconnection from critical and social studies 
studies, was to develop knowledge, communication and in health and medicine being undertaken in humanities 
interaction skills, for personal growth and professional scholarship. Future developments in health humanities 
behaviours, the activities reported did not include critical will benefit not only from the findings of this review but 
C arr et al. BMC Medical Education          (2021) 21:568 Page 9 of 10
also by pushing the frontiers of what can be achieved Competing interests
through health humanities to address future oriented The authors are not aware of any competing interests.
issues such as climate change and artificial intelligence. Author details
1 Health Professions Education, University of Western Australia, Perth, Australia. 
2
Supplementary Information  Faculty of Arts and Social Sciences, Maastricht University, Maastricht, Neth‑
erlands. 3 Medical School, University of Sydney, Sydney, Australia. 4 Medical 
The online version contains supplementary material available at https:// doi. School, University of Western Australia, Perth, Australia. 5 College of Health 
org/1 0.1 186/ s12909‑ 021‑0 3002‑1. Sciences, University of Ghana, Accra, Ghana. 6 Institute for Medical Humanities, 
Peking University, Beijing, China. 7 University of Cape Town, Cape Town, South 
Africa. 8 Faculty of Medicine & Dentistry, University of Alberta, Edmonton, 
Additional file 1: Supplementary Appendix. Alberta, Canada. 
Acknowledgements Received: 1 September 2021   Accepted: 27 October 2021
Dr. Christina Davies (CD) from the University of Western Australia is acknowl‑
edged for her part in developing the first draft of the scoping review protocol 
and initial review of article titles. Dianne Carmody (DC) from the University of 
Western Australia is acknowledged for her part in supporting the extraction 
and charting of data. References
 1. Jones T, Blackie M, Garden R, Wear D. The almost right word: the move 
Authors’ contributions from medical to health humanities. Acad Med. 2017;92:932–5. https:// doi. 
SC developed the review questions and formed the research team. CD and org/1 0. 1097/ ACM.0 0000 00000 0015.
SC drafted the review protocol that was revised and confirmed by all other  2. Shapiro J, Coulehan J, Wear D, Montello M. Medical humanities and 
members of the research team. FN and SC developed the data extraction tool their discontents: definitions, critiques, and implications. Acad Med. 
and process. Each author contributed to the conduct of the review as outlined 2009;84(2):192–8. https://d oi.o rg/ 10. 1097/ ACM.0 b013 e3181 938bca.
in the methods section and each author commented on each draft of the  3. Crawford P, Abrams B, Baker C, Brown B, Tischler V. Health Humanities. 
manuscript. All authors read and approved the final manuscript. London: Palgrave Macmillan Limited; 2015.
 4. Macnaughton J. Medical humanities’ challenge to medicine. J Eval Clin 
Authors’ information Pract. 2011;17(5):927–32. https:// doi. org/1 0. 1111/j.1 365‑ 2753. 2011. 01728.x.
The contributors have formed the Worldwide Universities Network: Health  5. Wei L, Goez H, Hillier T, Brett‑MacLean P. A Visiting Professorship in 
Humanities Initiative. Undergraduate Medical Education at the University of Alberta: Reflec‑
Affiliations tions on possibilities for medical humanities in China, and elsewhere. 
The University of Western Australia, School of Allied Health MedEdPublish [Internet]. Accessed 24 Aug 2021 https:// doi.o rg/ 10. 
Professor Sandra E Carr, Dr. Farah Noya, Dr. Brid Phillips, 15694/m ep. 2020. 000190.1
The University of Western Australia, Medical School  6. Bleakley A. When I say … the medical humanities in medical education. 
Associate Professor Nahal Mavaddat Med Educ. 2015;40:959–60. https://d oi. org/1 0.1 111/ medu.1 2769.
Maastricht University, Faculty of Arts and Social Sciences  7. Gandomkar R, Sandars J. The importance of context in medical education 
Dr. Anna Harris program evaluation. Med Teach. 2018;40:109. https:// doi. org/1 0. 1080/ 
University of Sydney, Medical School 014215 9X.2 017.1 39021 5.
Dr. Claire Hooker, Associate Professor Karen Scott  8. Ousager J, Johannessen H. Humanities in undergraduate medical educa‑
University of Ghana, College of Health Sciences tion: a literature review. Acad Med. 2010;85(6):988–98. https:// doi.o rg/ 10. 
Dr. Mary Ani‑Amponsah 1097/ ACM.0 b013 e3181 dd226b.
Peking University, Institute for Medical Humanities  9. Perry M, Maffulli N, Willson S, Morrissey D. The effectiveness of arts‑based 
Dr. Daniel M. Vuillermin, interventions in medical education: a literature review. Med Educ. 
University of Cape Town, Faculty of Health Sciences 2011;45(2):141–8. https:// doi. org/1 0. 1111/j. 1365‑ 2923.2 010. 03848.x.
Professor Steve Reid  10. Schwartz AW, Abramson JS, Wojnowich I, Accordino R, Ronan EJ, Rifkin 
University of Alberta, Medical School MR. Evaluating the impact of the Humanities in medical education. 
Professor Pamela Brett‑MacLean Mount Sinai J Med. 2009;76(4):372–80.
 11. Moniz T, Golafshani M, Gaspar CM, Adams NE, Haidet P, Sukhera J, et al. 
Funding How are the arts and Humanities used in medical education? Results 
This project was funded by the Worldwide Universities Network‑ Collaboration of a scoping review. Acad Med. 2021. https:// doi.o rg/ 10. 1097/ ACM. 
Grant Scheme in 2020. 00000 00000 004118 Epub ahead of print. PMID: 33830951. [Acessed 24 
Aug 2021].
Availability of data and materials  12. Dennhardt S, Apramian T, Lingard L, Torabi N, Arntfield S. Rethinking 
Summarised data extracted from each individual included study is available research in the medical humanities: a scoping review and narrative 
in the supplementary material contained in Additional file 1: Appendix A. The synthesis of quantitative outcome studies. Med Educ. 2016;50(3):285–99. 
unpublished scoping review protocol is available from the corresponding https://d oi.o rg/ 10.1 111/m edu. 12812.
author.  13. Haidet P, Jarecke J, Yang C, Teal CR, Street RL, Stuckey H. Using jazz as a 
metaphor to teach improvisational communication skills. Healthcare 
(Basel). 2017;5(3):41Published 2017 Aug 4. https:// doi. org/ 10. 3390/ healt 
Declarations hcare5 0300 41.
 14. Arksey H, O’Malley L. Scoping studies: towards a methodological frame‑
Ethics approval and consent to participate work. Int J Soc Res Methodol. 2005;8(1):19–32.
As this scoping review used all published journals, no ethical approval was  15. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the meth‑
required. odology. Implement Sci. 2010;5:1–9.
 16. Monrad SU, Bibler Zaidi NL, Grob KL, Kurtz JB, Tai AW, Hortsch M, et al. 
Consent for publication What faculty write versus what students see? Perspectives on multiple‑
All contributing authors consent to publication of this scoping review. choice questions using Bloom’s taxonomy. Med Teach. 2021:1–12. https:// 
doi. org/1 0. 1080/ 01421 59X.2 021. 18793 76.
Carr et al. BMC Medical Education          (2021) 21:568 Page 10 of 10
 17. Pfeiffer S, Chen Y, Tsai D. Progress integrating medical humanities  32. Kerr AM, Biechler M, Kachmar U, Palocko B, Shaub T. Confessions of a 
into medical education: a global overview. Curr Opin Psychiatry. reluctant caregiver palliative educational program: using Readers’ theater 
2016;29(5):298–301. https://d oi. org/ 10. 1097/ YCO. 00000 00000 000265. to teach end‑of‑life communication in undergraduate medical educa‑
 18. Infante ME. Part 6: formative and summative evaluation and action tion. Health Commun. 2020;35(2):192–200. https://d oi.o rg/ 10. 1080/ 10410 
research. Learning Teach. 2019;12(3):104–19. 236.2 018. 15504 71.
 19. Reio TG, Rocco TS, Smith DH, Chang E. A critique of Kirkpatrick’s evalua‑  33. Clark Z, Ashbrooke L, Price J. Creating meaningful learning for Children’s 
tion model. New Horizons Adult Educ Human Res Dev. 2017;29(2):35–53. nursing students: can museum field trips offer added value? Comprehen‑
 20. LeBlanc RG. Digital story telling in social justice nursing education. Public sive Child Adoles Nurs. 2019;42(1):71–84. https://d oi. org/1 0. 1080/2 4694 
Health Nurs (Boston, Mass). 2017;34(4):395–400. https://d oi. org/ 10.1 111/ 193. 2017. 13900 08.
phn. 12337.  34. Greenberg RA, Kim C, Stolte H, Hellmann J, Shaul RZ, Valani R, et al. 
 21. Patterson A, Sharek D, Hennessy M, Phillips M, Schofield S. Medical Developing a bioethics curriculum for medical students from divergent 
humanities: a closer look at learning. Med Human. 2016;42(2):115–20. geo‑political regions. BMC Med Educ. 2016;16(1):193. https://d oi.o rg/1 0. 
https:// doi. org/ 10. 1136/m edhum‑ 2015‑ 010834. 1186/s 12909‑0 16‑ 0711‑4.
 22. Campbell B, Treat R, Johnson B, Derse A. Creating reflective space  35. Brand G, Osborne A, Carroll M, Carr SE, Etherton‑Beer C. Do photographs, 
for reflective and “unreflective” medical students: exploring seminal older adults’ narratives and collaborative dialogue foster anticipa‑
moments in a large‑group writing session. Acad Med. 2020;95(6):882–7. tory reflection ("preflection") in medical students? BMC Med Educ. 
https://d oi. org/1 0. 1097/ ACM.0 0000 000000 03241. 2016;16(1):1–9. https:// doi. org/ 10.1 186/s 12909‑ 016‑ 0802‑2.
 23. Centeno C, Robinson C, Noguera‑Tejedor A, Arantzamendi M, Echarri  36. Saiyad SM, Paralikar SJ, Verma AP. Introduction of medical Humanities in 
F, Pereira J. Palliative care and the arts: vehicles to introduce medical MBBS 1 st year. Int J Appl Basic Med Res. 2017;7(Suppl 1):S23. https://d oi. 
students to patient‑centred decision‑making and the art of caring. BMC org/1 0. 4103/i jabmr. IJABMR_ 138_ 17.
Med Educ. 2017;17(1):257. https:// doi. org/ 10. 1186/ s12909‑ 017‑ 1098‑6.  37. Arveklev SH, Berg L, Wigert H, Morrison‑Helme M, Lepp M. Learning 
 24. Gilkison A, Giddings L, Smythe L. Real life narratives enhance learn‑ about conflict and conflict management through drama in nursing 
ing about the “art and science” of midwifery practice. Adv Health education. J Nurs Educ. 2018;57(4):209–16. https://d oi. org/ 10.3 928/ 01484 
Sci Educ: Theory Pract. 2016;21(1):19–32. https:// doi. org/ 10.1 007/ 834‑ 20180 322‑ 04.
s10459‑ 015‑9 607‑z.  38. McCann E, Huntley‑Moore S. Madness in the movies: an evaluation of the 
 25. Komattil R, Hande SH, Mohammed CA, Subramaniam B. Evaluation of a use of cinema to explore mental health issues in nurse education. Nurse 
personal and professional development module in an undergraduate Educ Pract. 2016;21:37–43. https://d oi. org/1 0.1 016/j.n epr.2 016.0 9. 009.
medical curriculum in India. Kor J Med Educ. 2016;28(1):117–21. https://  39. Thompson BM, Vannatta JB, Scobey LE, Fergeson M, Humanities Research 
doi. org/ 10. 3946/k jme.2 016. 17. G, Crow SM. Providing context for a medical school basic science cur‑
 26. Nguyen M, Miranda J, Lapum J, Donald F. Arts‑based learning: a riculum: the importance of the humanities. Med Teach. 2016;38(1):82–7. 
new approach to nursing education using andragogy. J Nurs Educ. https://d oi.o rg/1 0.1 5694/ mep.2 017. 000090.2.
2016;55(7):407–10. https:// doi. org/ 10. 3928/ 014848 34‑ 20160 615‑ 10.  40. Emmanuel EN. Teaching humanity to nursing students: evaluation of an 
 27. Scott KM, Berlec Š, Nash L, Hooker C, Dwyer P, Macneill P, et al. Grace innovative teaching strategy. Nurse Educ. 2016;41(5):E1–3. https:// doi. 
under pressure: a drama‑based approach to tackling mistreatment of org/ 10. 1097/ NNE.0 0000 000000 00299.
medical students. Med Human. 2017;43(1):68–70. https://d oi. org/ 10.  41. Levin SR, Cai F, Noronha N, Wald HS, Daniel MM. Diseases, Doctors, and 
1136/m edhum‑ 2016‑0 11031. divas: cultivating reflective capacity in preclinical medical students 
 28. Rice R, Hunter J, Spies M, Cooley T. Perceptions of nursing stu‑ through a critical examination of opera. J Learn Arts. 2018;13(1). https:// 
dents regarding usage of art therapy in mental health. J Nurs Educ. doi.o rg/ 10.2 1977/D 9131 28321
2017;56(10):605–10. https:// doi. org/ 10. 3928/ 01484 834‑2 0170 918‑ 05.  42. Isaac C, Behar‑Horenstein L, Lee B, Catalanotto F. Impact of reflective writ‑
 29. Day L, Ziehm SR, Jessup MA, Amedro P, Dawson‑Rose C, Derouin A, et al. ing assignments on dental students’ views of cultural competence and 
The power of nursing: an innovative course in values clarification and diversity. J Dent Educ. 2015;79(3):312–21.
self‑discovery. J Prof Nurs. 2017;33(4):267–70. https://d oi.o rg/ 10. 3390/  43. Haidet P, Madigosky WS. Towards an evolution of interprofessional 
admsc i8040 079. practice: lessons learned from two jazz piano trios. Patient Educ Couns. 
 30. McCaffrey G, Venturato L, Patterson JD, Langille J, Jackson R, Rosenal T. 2020;103(10):2173–7. https:// doi. org/ 10. 1016/j. pec. 2020. 06. 008.
Bringing a novel to practice: an interpretive study of reading a novel in an 
undergraduate nursing practicum course. Nurse Educ Pract. 2017;24:84–
9. https:// doi. org/1 0. 1016/j. nepr. 2017. 04. 001. Publisher’s Note
 31. Thorp L, Bassendowski S. Caring values and the simulation environment: Springer Nature remains neutral with regard to jurisdictional claims in pub‑
an interpretive description study examining select baccalaureate nursing lished maps and institutional affiliations.
students’ experiences. Int J Hum Caring. 2016;3:68–81.
Ready to submit your research ?  Choose BMC and benefit from: 
• fast, convenient online submission
•  thorough peer review by experienced rese archers in your field
•   rapid publication on acceptance
•  support for research data, including large and complex data types
•  gold Open Access which fosters wider collaboration and increased citations 
•  maximum visibility for your research: over 100M website views per year 
 
At   BMC, research is always in progress.
Learn more biomedcentral.com/submissions