Editorial Board Q&A: Arno K. Kumagai

Arno Kumagai photo (2)
Arno K. Kumagai, MD, professor of internal medicine and medical education, and director, Family Centered Experience and Longitudinal Case Studies Programs, University of Michigan Medical School

1. Describe your current activities.

By training I’m an endocrinologist, and I direct the Intensive Insulin Therapy Clinic at the University of Michigan Diabetes Center, which specializes in working with people with type 1 diabetes. Most of my time, however, is spent in medical education. For the past 12 years, I have directed two unique programs at the medical school: the Family Centered Experience and Longitudinal Case Studies. These are small, group-based courses for first- and second-year medical students. They incorporate patient narratives from longitudinal conversations with volunteer patients and their families; reflective writings, readings, small group dialogues, and activities; and creative art to provide students with opportunities to explore experiences of illness and doctoring, and to develop their individual humanistic, patient-centered approaches to medical care. We’ve published a fair amount in the pages of Academic Medicine on these programs over the past several years.

My most recent research has built on my work in these educational programs. Over the past 10 years, I have developed interests in the use of narratives, dialogue, theater, and creative art in medical education, and have had a long-standing interest in educational approaches to diversity and social justice for physicians-in-training. I’m particularly interested in how one can draw on ideas and perspectives from fields as varied as literature, philosophy, sociology, psychology, anthropology, political theory, art criticism, and cultural studies to understand and clarify challenges and processes in educating students to practice medicine with humanity and justice. To give you a recent example, a colleague, Thirusha Naidu, and I published a piece in Academic Medicine, called “Reflection, Dialogue, and the Possibilities of Space.” It was meant to describe the conditions needed to allow for reflection and dialogue-based exploration of the human dimensions of illness and doctoring, and was intended to answer the question, “given busy schedules, brief patient contact times, and competing clinical demands, how can medical schools create space for this type of reflection and dialogue?” To understand this issue, we ended up drawing on works as varied as the anthropological theories of rites of passage, discussions of the “poetics of space,” and the Japanese tea ceremony, in an effort to conceptually “fill in the blanks” where we felt current medical educational scholarship was lacking.

2. What gaps do you see in today’s scholarship?

As a general field, scholarship in medical education is, I believe, relatively young compared with more established areas of research in the biomedical, clinical, or social sciences. In terms of methodological and conceptual considerations, however, I have seen an increasing emphasis on rigor and clarity over the past decade, which has benefited the field tremendously. A great example of this type of rigor is a study recently published in Academic Medicine by Don Boudreau and colleagues from McGill University. This was a careful, longitudinal qualitative study in which the authors investigated changes in medical student professional self-identity—from the perspective of medical students and the faculty who taught them in an innovative four-year Physician Apprenticeship course. This was an obviously demanding, difficult study to complete that documented one of the most important aspects of professional development—the development of each individual’s self-identity as a physician. I believe that it is a model for the type of high-quality qualitative research so desperately needed in this field, and it has served as an elegant and powerful counter-weight to the emphasis placed on competency-based educational approaches that are so much in vogue these days. This type of methodological thoroughness is complemented by equal theoretical complexity and sophistication in this same group’s discussions of this important theme.

3. Why do you read Academic Medicine?

I read the journal to encounter really thoughtful and thought-provoking studies, perspectives, and commentaries, such as those I mentioned above. There are other articles that I’ve run across in the journal over the years that have permanently impacted the ways I think about certain subjects—subjects that have become major areas of interest of mine. One such piece is Delese Wear’s “Insurgent Multiculturalism,” published in 2003, which framed my own approaches to thinking about multiculturalism, cultural competency, disparities, and medical education. The coverage that the journal has given to areas such as enhancing racial/gender diversity in medical schools or in the physician workforce, global medical education, professionalism, and student mistreatment are unprecedented and clearly set the pace for discussions on these important topics.

4. What issues will we be reading about in five years?

I think we’ll be reading about articles looking at:

  • Opportunities and challenges in academic medicine in the face of (1) a rapidly changing health care environment, (2) a more diverse society, and (3) a different funding climate for research, education, and patient care.
  • Tensions between “big data” and patient-centered, humanistic care, including challenges between advanced technologies and individuals.
  • How to engage in truly collaborative initiatives in teaching, learning, doing research, and providing health care to a global constituency.The interconnections between the education and practice of medicine, and the ever-changing needs of society.

5. What book(s) are you reading right now?

I recently stumbled across a fascinating book by the French philosopher Jacques Rancière, The Ignorant Schoolmaster: Five Lessons in Intellectual Emancipation. In it, Rancière tells the story of an early 19th century teacher, Joseph Jacotot, who made the startling claim that all people were equally intelligent. When given the right resources and emancipated from experts’ “correct” interpretations of knowledge, he argues, people could learn more thoroughly and authentically on their own. Jacotot tested his claim (after being chased out of France) by teaching Flemish students to speak, read, and write French without their knowing a single word of French and without his knowing a single word of Flemish. His (and I assume Rancière’s) overall point is that education should be a process of liberation in which individuals question the seemingly obvious, the status quo, in order to free themselves from prejudice and rigid ways of thinking, acting, and feeling. In this sense, it is very similar to the work of Paulo Freire, who once described teaching as the practice of freedom. Although it seems like a stretch to connect this to medical education, I’ve been interested in making such connections for some time now.

In terms of “guilty pleasure” reading, it’s either mysteries by Michael Connelly, Ian Rankin, or Henning Mankel, or children’s books for my 6-year-old, such as I Want My Hat Back or If You Give a Mouse an iPhone. Given my own constant electronic distractions these days, I’ve learned as much from the latter book as I have from many of the other works mentioned above.

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