ABSTRACT
We have developed a pedagogic strategy for exposing students to philosophical concepts embedded in the basic medical sciences. The intent of this approach is to stimulate reflection and to cultivate intellectual depth and broadness of outlook. The purpose of the present study was to determine the extent to which these goals are realized.
We asked 202 occupational and physical therapy students and science undergraduates enrolled in a neuroanatomy course to describe, in writing, the impact of addressing philosophical issues on the quality of their educational experience. Thematic content analysis was used to identify specific themes in the 93 responses received.
Fifty nine student responses (63%) were uniformly positive, comprising one or more of the following themes. The inclusion of philosophical material: 1) evoked a nonspecific positive feeling, 2) stimulated reflection, 3) engendered an appreciation of the complexity of reality, and 4) enhanced understanding of the rest of the course material. Twenty six percent of the responses contained one or more of the positive themes, as well as concerns, largely regarding the increase in material to be learned. Eleven percent of the responses were exclusively negative. Our results indicate that periodic exposure to philosophical topics appears to stimulate reflection and provides valuable insight for a significant segment of the class.
INTRODUCTION
Although few would argue that the basic sciences must play a major role in the education of health professionals, there is little agreement as to exactly what that role should be. What, and how much basic science do students really have to know in order to develop into good health care providers? The question invariably focuses on a narrow stratum of information describing the physico-chemical features of molecules, cells and tissues. The deeper dimensions, encompassing the metaphysical and epistemological implications inherent in the biochemistry, cell biology, and physiology are regularly ignored. Indeed, in view of the pressure to inculcate students with clinically pertinent material of high practical utility, there is little incentive to add seemingly superfluous philosophical content. The flaw in this approach lies in the assumption that philosophy is extraneous. By detaching the facts and mechanisms that describe normal biology from their philosophical underpinnings, do we not squander a unique opportunity to instill in students a sense of wonder, inquisitiveness, reflectiveness, appreciation and humility? The importance of cultivating these qualities in future health care professionals is well recognized by educators1, and it is reflected in the large number of medical faculties that have developed teaching initiatives in the humanities.2
A pedagogic strategy for exposing students to philosophical concepts entrenched in the basic medical sciences has recently been reported3. The method is simple and easily implemented. It does not require the addition of new subject matter, but rather entails the recognition of concepts latent within existing course material. In any given lecture hour, a single scientific fact, of the lecturer’s choosing, is probed for intrinsic philosophical content. The metaphysical or epistemological implications are identified, elaborated, and presented to the students for contemplation. Each such exercise requires no more than ten minutes. An alternative or complementary approach would be to dedicate an entire lecture hour to examining a variety of philosophical themes that occurred throughout the course.
One previously reported3 example of this strategy is the following. It is introduced at the end of a lecture on hemispheric specialization in the cerebral cortex. A slide is projected in which three faces appear. The top image (A) is a full frontal facial photograph of a colleague. At the lower left is a picture (B) constructed of the left half of face A and its mirror image. At the lower right is face C, assembled from the two right halves of face A. Face C clearly resembles the original (A) far more than does face B. The reason is that when one views a person face on, the neuroanatomy of the visual system is such that the image of the right half of the observed face ends up in the right cerebral hemisphere of the observer whereas the left half is represented in the left hemisphere. Inasmuch as the right hemisphere outperforms the left in analyzing spatial relationships and imagery, the left “defers” to the right and what we see is pretty much what our right hemispheres show us4.
Although we identify my colleague with face C, she thinks she looks more like face B. Her view of herself is what she sees in a mirror, and in a mirror image, the left half of the face is represented in the right cerebral hemisphere. The question to the students is; what does she look like? The intent of this particular exercise is to awaken the students to the realization that the observer contributes as much to any act of observation as the observed, and that indeterminacy pervades our view of reality at every level from the subatomic domain to that of ordinary daily experience. It further underscores the fact that our use of language is generally perfunctory. Rarely do we consider the complexities and ambiguities underlying the most ordinary of expressions, e.g. “she looks like…”
Although these intermittent forays into the realm of philosophical speculation seem to engage the students and generally elicit a lively response, their pedagogic value is not clear. What impact does exposure to the philosophical dimension of health science have on the intellectual perspective of the student? The intent of these exercises is to stimulate reflection and to cultivate intellectual depth and broadness of outlook. To what extent are these ends actually met? In order to begin to address this question, we have carried out a descriptive exploratory study designed to determine how integration of philosophical content is perceived by health science students enrolled in an undergraduate neuroanatomy course. Our results indicate that the introduction of philosophical material appears to stimulate authentic thought and reflection in many of the students and that the approach is worthy of further investigation.
METHODS
The sample population comprised 202 students enrolled in a course entitled “Circuitry of the Human Brain” (ANAT 321) at McGill University in the fall term of 2005. This course is required for second year physical and occupational therapy students who comprised 51% of the class. Thirty six percent of the enrolment comprised final year students in our undergraduate program in Anatomy and Cell Biology, many of whom hoped to pursue careers in medicine or dentistry. The remaining 25% were final year students in other undergraduate programs, such as Biology and Psychology. Sixty four percent of the class were women.
Philosophical topics that were introduced briefly and periodically over the duration of the course included the unity of consciousness, the nature of perception, innate biases and limitations in modeling neurological phenomena, teleology, the validity of abstraction and generalization, and the ontological status of subjective experience. In addition, an entire lecture hour toward the end of the course was devoted to exploring philosophical issues implicit in cortical neuroanatomy and processing. In order to insure that students would be able to distinguish philosophical topics from the standard didactic neuroscience material, the philosophical themes explored in lectures were specifically identified as such. The lecture hour devoted to the philosophical issues in cortical functioning was likewise introduced as a philosophical presentation.
During the last week of the course, the teacher distributed a questionnaire to the students. The questionnaire had been previously pilot tested for clarity on five students from the course. At the top of the page, the students were given the following instructions.
An effort has been made, in ANAT 321, to explore some of the philosophical implications inherent in the scientific subject matter. This is not generally done in science courses at McGill. In order to assess the value of including the philosophic dimension in university science teaching, it is essential to sample student perceptions. Please use the space on this page to express your views on this issue. Do you think that addressing philosophical concepts adds to the quality of your educational experience, and if so, how and why? Conversely, do you think that including philosophical subjects detracts from the quality of your educational experience, and if so, how and why? Would you like to see more philosophy integrated into science teaching or do you think that philosophy has little to add?
Underneath the instructions, space was provided (3/4 of the page) for the students’ narrative responses. The students were asked to take the questionnaires home and to submit their responses the following week in class. They were informed that their anonymous responses were to be the subject of a research project the results of which could be submitted for publication. Thematic content analysis of the student responses was performed using a constant comparison technique adapted from grounded theory5. In grounded theory, the foundation of qualitative research, one begins with observations “on the ground”, as opposed to a hypothesis to be tested. The theoretical framework then evolves from the observations as the data are collected and reviewed. The individual narratives were read by C.C. and P.M. to identify prominent themes. These two investigators met to discuss their results and to reach consensus on the list of themes, which was then corroborated independently by J.B. who checked the list against the student responses. In order to estimate the relative frequency of occurrence of the themes, C.C. and P.M. reread the responses and counted the occurrence of each theme. J.B. searched the responses for common trends and identified representative quotations.
RESULTS
Ninety three (46%) of the 202 questionnaires were returned. The responses varied considerably in length and quality of content. Some comprised no more than a few general phrases, whereas others consisted of substantive, well-structured narratives. Not every response addressed both questions. Moreover, issues were raised that did not relate directly to the questions asked.
Four predominant positive themes emerged. The inclusion of philosophical material: 1) evoked an enjoyable or otherwise nonspecific positive feeling, 2) stimulated thinking and reflection, 3) engendered an appreciation of the complexity of reality, and 4) enhanced understanding of the rest of the course material.
POSITIVE THEMES
- 1. Enjoyable/Positive Feelings
- Words and phrases such as “interesting”, “adds a lot of spice”, “nice to see a different side of things”, “helps to make the material less dry”, and “enriching” were common and indicate a pervasive, non-specific satisfaction with the philosophical material.
2. Stimulated Thinking and Reflection
- The most commonly encountered specific positive reaction (occurring in about 1/3 of all responses) related to intellectual stimulation. Comments reflecting this theme were fairly similar and included: “…forces us to ask ourselves important questions.”, “…forces students to think outside the factual box.”, “…allows you to think rather than memorize.”, “…allowed students to ask questions like why.”, and “…helped me to realize that we need to question ourselves.”
3. Appreciation of the Complexity of Reality
- Statements emphasizing the value of exposure to a different view of reality were encountered slightly less frequently than those above. They were, however, more diverse, more extensive, and generally expressed in richer language. The following are notable quotes.
“I think that it is important that we at least be aware that our knowledge of the brain isn’t rigid facts that are always true and always apply exactly as we learned them”.
“It (philosophy) provides depth and insight to the reasons we are studying science in the first place”.
“Science was invented by human beings, so this is how we mostly perceive reality. But is it the absolute truth? “
“…science doesn’t hold all the answers.”
“To adequately represent what the science means, or what it might mean is extremely important since it is not a unidimensional discipline”.
“…it pushes the student to see the subject from a very different angle.”
“It also makes us appreciate the wonders of life”.
“It makes me understand that what we learn in class is not the ultimate truth.”
4. Enhanced Understanding of the Course Material
- The fourth positive theme ( identified in 16% of the responses) was that the exposure to the philosophical dimension facilitated the understanding of the rest of the course material. The typically brief reactions included: “Helps to remember stuff.”, “Easier to memorize.”, “Better understanding”, and “…helped me drill the visual system better”
In many instances, one or more of the four positive reactions described above occurred in tandem with an expression of dissatisfaction with the emphasis in science courses on the rote memorization of facts. The intent of these comments was clearly to underscore a perceived defect in the educational process which was, at least partially, addressed by the inclusion of philosophical content. This perception is exemplified in the following statements. “Science should not be just memorization and regurgitation…” , “most anatomy courses are only brainless memorization of facts.” “In science …we are bombarded with large chunks of material to memorize…”, “…memorize and vomit out as much as you can on the exam.”
MIXED RESPONSES
Whereas 59 of the 93 student responses (63%) were uniformly positive, composed of one or more of the themes detailed above, 24 (26%) were mixed. In addition to the one or more positive themes, these narratives expressed concerns about the inclusion of philosophy in science courses. The most common worry was that the volume of material to be learned in science courses was already excessive, and that the inclusion of new subject matter added to the burden. In many cases students approved of the philosophical content as long as is was not tested (which it was not). Other more sporadic concerns were the following. “Philosophy might make things a little bit more confusing…”, “it could sometimes mix us up…”, ”…science students aren’t taught to think in philosophical terms.” “…not much relation to our profession.”
NEGATIVE RESPONSES
Ten of the 93 responses (11%) were exclusively negative, expressing concerns similar to those in the mixed responses, but often worded more aggressively. Examples are the following. “… to ponder every application of science is a waste of time.” “…too much to turn to philosophy issues…” “I don’t think that this type of teaching should make its way into an objective science class…” “I think that our university has enough philosophy courses for students to take if they are interested.”
Reactions to the question of whether the students would like to see more philosophy in science courses followed the general response pattern. The positive responses were often affirmative, the mixed responses were less so, and the exclusively critical responses were sharply negative.
DISCUSSION
Our objectives in introducing philosophical material into a basic medical science course were to stimulate reflection and to cultivate intellectual breadth and depth3. Inasmuch as this approach was designed to engender insight, rather than to advance factual knowledge or to develop specific intellectual skills, we evaluated its efficacy by assessing its impact on the student ’ perceptions. We selected a qualitative research methodology for two reasons. First, it allowed us to canvas student views while minimizing bias. Rather than asking the students to indicate, on a Likert scale, to what extent our particular aims were met, thereby pre-selecting the parameters, the students themselves identified and described the strengths and weaknesses of the strategy. Secondly, the qualitative technique allowed unforeseen and unintended outcomes to surface. In the present study, for example, we did not anticipate that exposure to the philosophical dimension would facilitate the understanding of the rest of the course material for a number of the students.
Limitations of the study include sample population size, heterogeneity of the sample population, and the possibility of subjective bias. While 202 questionnaires were distributed, only 93 (46%) were returned, leaving open the question as to the perceptions of the non-responding students. Although it is likely that these students were too busy to expend effort on a task of no practical importance, it is possible that non- responses could reflect indifference or dissatisfaction. In view of the size of our sample, what conclusions can we draw? It depends on how we view the data. Although 89% of our sample population was positively effected by exposure to philosophical themes, this represents only 41% of the class. We can, therefore, conclude little about the impact of philosophy on the class as a whole. On the other hand, that 41% comprises 83 individual learners for whom the inclusion of philosophical content stimulated reflection and provided valuable insight. Philosophical inquiry is, therefore, of real significance to a sizeable number of students regardless of the percentage of the class that they comprise. Additional data gathered in future studies should provide the basis for a more quantitative approach. The study did not address the question as to whether the physical and occupational therapy students, as a group, might have responded differently from the science students. Classes are heterogeneous in a variety of ways (gender, age, background), and our goal was simply to asses the overall impact of philosophy on a class of health science undergraduates. Finally, teacher popularity is a potential source of bias. In view of the esteem in which the teacher is held, the students, aware of his enthusiasm for teaching philosophic topics, may have weighted their replies accordingly. However, the fact that so many of the narratives were insightful, logical and cogent suggests that the responses , by and large, reflected independent thought.
It was evident, before the present investigation, that a sizeable percentage of the class was positively effected by the presentation of philosophical subject matter. Many students were noticeably attentive and animated. The significance of this apparent enthusiasm was, however, unclear. Were the philosophical interludes merely entertaining, or did they provide something meaningful and substantial? The non-specific positive responses do indeed imply that entertainment contributed to student satisfaction. The prevalence of specific, well thought-out responses, however, suggests that many students perceived the exposure to philosophical issues as a valuable intellectual experience. Thus, the results of the study suggest that the inclusion of philosophical thought in a basic medical science course accomplishes what we had intended for a sizeable segment of the class.
The results also indicate that the beneficial effect of imparting philosophical concepts was associated with the amount and pattern of exposure. Student worries concerning the quantity of material presented in science courses were frequently encountered. The main priority for professional and pre-professional students is the mastery of subject matter immediately relevant to their future careers. In order to be effective, the inclusion of philosophical content should not be perceived as conflicting with that priority. The results, therefore, support the practice of periodic presentation of philosophical subject matter in limited amounts.
CONCLUSIONS
Intermittent exposure to philosophical subjects in a neuroanatomy course is perceived by many of the students as having a positive impact on their educational experience. According to most student narratives, philosophical inquiry stimulates reflection and provides insight into the meaning of scientific knowledge. It remains to be shown whether philosophical thought can be effectively integrated into other health science courses, whether the impact would be similar for other health professional students (medical, dental), and whether the awareness gained contributes to professional development.
ACKNOWLEDGEMENTS
The Authors gratefully acknowledge the advice of Dr. Mary Ellen Macdonald in designing the study and in the preparation of the manuscript.
REFERENCES
- 1. Evans, M. Reflections on the humanities in medical
education. Medical Education. 2002; 36: 508-513.
2. Strickland, M.A. Gambala, C.T., and Rodenhauser, P. Medical education and the arts: a survey of U.S. medical schools. Teaching & Learning in Medicine. 2002; 14: 264-267.
3. Brawer, J.R. The value of a philosophical perspective in teaching the basic medical sciences. Medical Teacher. 2006; 28: 472-474.
4. Milner, B.. Complementary functional specializations of the human cerebral hemispheres. In: R. Levi-Montalcini (Ed.). Nerve Cells, Transmitters and Behaviour. (pages 601-625). Vatican City, Pontificia Academia Scientiarum Scripta Varia, 1980
5. Glaser, B., and Strauss, A. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, Aldine Publishing Co. 1967