the humanities in a course on loss and grief

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Physiotherapy February 2003/vol 89/no 2 Professional articles Introduction There has been much discussion on the value of medical humanities (Calman and Downie, 1988; Downie, 1994; Jackson, 1996; Murray, 1997). Many descriptive papers illustrate how the humanities and the sciences may be integrated in discussions among healthcare groups and several analytical papers consider the conceptual processes that occur in such discussions. The question of where the humanities sit in the curriculum, however, remains open to debate. A formal course on loss and grief in University College Dublin illustrates how the humanities can complement scientific texts in the curriculum. Students’ writings under examination conditions illustrate the impact of the humanities on their development: prompting reflection on the profession and on themselves as clinicians, developing empathy through vicarious experiences and integrating personal and professional experiences. While informal medical humanities groups have their place and their value, including the humanities in the formal curriculum, and formally assessing students’ work, may increase the status of the humanities in healthcare. This course indicates how the humanities can move from the margins to the mainstream of undergraduate physiotherapy education. The need for education and training in the area of loss and bereavement has been recognised (Meredith et al , 1998; Randhawa, 1998). It has, moreover, been argued by Fallowfield (1996) that in bereavement situations ‘personal growth and awareness’ are as important as interview and communication skills training. Angus (1997) advocates health- iness in one’s self as an essential factor in caring for others, insofar as those who care for dying people need to be free of emotional stress and to have an effective support service in order to communicate well. A humanities course can guide students in this development process, using literature on grief and self- discovery to enrich their own lives and, by extension, their patients’ lives. The departure into the humanities can be justified in terms of education objectives, since literature and the arts in general help to encourage movement from the concrete to the abstract to the highest levels of knowledge, providing a safe and appropriate environment in which to practise reflection (Richardson and Maltby, 1995). Yet, with the exception of a few courses, the humanities remain marginal to mainstream medical and health professional education. For med- ical students who would like to read texts outside the curriculum, and there are many who would, the constraints of the curriculum prevent them from doing so (Hodgson and Thomson, 2000). Physiotherapy students may be no diff- erent and have to contend with equally demanding schedules. Physiotherapy The Humanities in a Course on Loss and Grief Summary This paper describes an innovative course on loss and grief, its rationale, content and assessment. This curriculum development project arose from a collaboration between University College Dublin School of Physiotherapy and the University of Strathclyde Centre for Academic Practice, drawing on the work of the Glasgow Medical Humanities Group (founded in 1989). The key section in the discussion is the students’ writing under examination conditions, providing evidence that they integrated personal experience and teaching materials. In addition, there is evidence that the students who chose the humanities option performed better in the assessment of this module than those who restricted themselves to scientific texts. It was hoped that this type of educational experience would generate in students the deep understanding which Downie (1994) considers to be essential to humane healthcare. Key Words Loss, grief, physiotherapy, humanities, education. by Mary F Mc Ateer Rowena Murray 97 Mc Ateer, M F and Murray, R (2003). ‘The humanities in a course on loss and grief’, Physiotherapy, 89, 2, 97-103.

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Page 1: The Humanities in a Course on Loss and Grief

Physiotherapy February 2003/vol 89/no 2

Professional articles

IntroductionThere has been much discussion on thevalue of medical humanities (Calman andDownie, 1988; Downie, 1994; Jackson,1996; Murray, 1997). Many descriptivepapers illustrate how the humanities andthe sciences may be integrated indiscussions among healthcare groups andseveral analytical papers consider theconceptual processes that occur in suchdiscussions. The question of where thehumanities sit in the curriculum, however,remains open to debate.

A formal course on loss and grief inUniversity College Dublin illustrates howthe humanities can complement scientifictexts in the curriculum. Students’ writingsunder examination conditions illustratethe impact of the humanities on theirdevelopment: prompting reflection onthe profession and on themselves asclinicians, developing empathy throughvicarious experiences and integratingpersonal and professional experiences.

While informal medical humanitiesgroups have their place and their value,including the humanities in the formal

curriculum, and formally assessingstudents’ work, may increase the status ofthe humanities in healthcare. This courseindicates how the humanities can movefrom the margins to the mainstream ofundergraduate physiotherapy education.

The need for education and training inthe area of loss and bereavement hasbeen recognised (Meredith et al, 1998;Randhawa, 1998). It has, moreover, beenargued by Fallowfield (1996) that inbereavement situations ‘personal growthand awareness’ are as important asinterview and communication skillstraining. Angus (1997) advocates health-iness in one’s self as an essential factor in caring for others, insofar as those who care for dying people need to be free of emotional stress and to have aneffective support service in order tocommunicate well. A humanities coursecan guide students in this developmentprocess, using literature on grief and self-discovery to enrich their own lives and, by extension, their patients’ lives.

The departure into the humanities can be justified in terms of educationobjectives, since literature and the arts ingeneral help to encourage movementfrom the concrete to the abstract to thehighest levels of knowledge, providing asafe and appropriate environment inwhich to practise reflection (Richardsonand Maltby, 1995). Yet, with the exceptionof a few courses, the humanities remainmarginal to mainstream medical andhealth professional education. For med-ical students who would like to read textsoutside the curriculum, and there aremany who would, the constraints of thecurriculum prevent them from doing so (Hodgson and Thomson, 2000).Physiotherapy students may be no diff-erent and have to contend with equallydemanding schedules. Physiotherapy

The Humanities in a Courseon Loss and Grief

Summary This paper describes an innovative course on lossand grief, its rationale, content and assessment. Thiscurriculum development project arose from a collaborationbetween University College Dublin School of Physiotherapyand the University of Strathclyde Centre for AcademicPractice, drawing on the work of the Glasgow MedicalHumanities Group (founded in 1989). The key section in the discussion is the students’ writing under examinationconditions, providing evidence that they integrated personalexperience and teaching materials. In addition, there isevidence that the students who chose the humanities option performed better in the assessment of this modulethan those who restricted themselves to scientific texts. It was hoped that this type of educational experience wouldgenerate in students the deep understanding which Downie(1994) considers to be essential to humane healthcare.

Key WordsLoss, grief, physiotherapy,humanities, education.

by Mary F Mc AteerRowena Murray

97

Mc Ateer, M F andMurray, R (2003).‘The humanities in acourse on loss andgrief’, Physiotherapy,89, 2, 97-103.

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clinicians involved in medical human-ities have a feasible means of continuousactive reflection on practice as under-graduates and in continuing professionaldevelopment (Murray, 1998).

Course RationaleThe course chosen as the vehicle forintroducing the humanities in thecurriculum was ‘loss and grief’, animportant element of undergraduateeducation as clinical physiotherapists areheavily involved in assessing, educatingand treating those who have sustainedlosses. These losses occur in many forms,in patients’ physical, mental and spiritualworlds, ranging from loss of limb, breastor other body part, to loss of indep-endence or function, loss of spouse orpartner, to loss of homeland throughemigration. The underlying emotions inall losses are similar and the course isstructured around the use of bereavementas the conceptual model for under-standing other losses (Mc Ateer, 1989).The course aims to enable students torecognise manifestations of loss and griefin clinical situations and to under-stand the likely impact of cognitive andaffective states on physical, mental andspiritual health. The course is mandatoryin the fourth year of the undergraduateprogramme.

Course Content The course is delivered by lecture,workshop and discussion group andconsists of 12 contact hours over fourweeks, with a three-hour session eachweek.

The course tutor is a senior lecturer inphysiotherapy who has completed a two-year course on grief counselling andtherapy and who has extensive experienceas a (voluntary) counsellor with a nationalbereavement counselling service.

Week 1� Outline of course content� Introduction: objectives and teaching

methods� Required and recommended reading� Attachment theories� Attitudes to death in a cultural context� Terminal illness and anticipatory

grief� Needs and fear of dying patients

Literary text Beethoven’s Testament(Downie, 1994).The themes of this textare the wretchedness of deafness,disability and deprivation; uncertainty ofdiagnosis, resignation and acceptance.

Week 2� Bereavement: the conceptual model

for other losses� Tasks of mourning: reactions to

death; physical, mental and spiritualsequelae

� Health status of the survivor:implications of grief for chronic illness

Literary text A Grief Observed (Lewis,1961). The author’s description of thephysical and psychological manifestationsof the fear associated with bereavementare in sharp contrast to the language usedin scientific texts on acute grief. Lewiswrites from personal experience whereasLindemann (1944) and Murray-Parkes(1975) supply lists and tables with theirdata.

Week 3� Significant losses in physiotherapy

practice – spinal cord lesions,amputations

� Patient mourning the lost self� Goals of rehabilitation with respect to

grieving and mourning� Affective goals from the patient’s

perspective

Literary text Crushing Force – anunpublished poem (Mc Ateer, 1997)which explores the profound nature ofspinal lesions, disability, impotence, fearof loss of love.

Week 4� Communication and relationship skills

in context� Concepts of ‘quality of life’� Integration of patients’ and carers’

expectations

Literary text Florence Nightingale’s Noteson Nursing. The excerpts chosen illustratethe isolation imposed by the use ofplatitudes and other flawed forms ofcommunication.

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Briefing the StudentsThe introduction of humanities litera-ture into an existing course would beinnovative, therefore it was necessary toallocate time, over and above that given inprevious years, for discussion as to thelikely nature of student participation. Thebriefing was given before the start of thecourse. It was considered that discussionwithin the course could possibly promptsome students to share experiences of apersonal nature. It was emphasised thatwhile in such circumstances, confid-entiality and positive regard for courseparticipants would be essential cond-itions, this was not a counselling course. Itwas equally important to affirm thestudents’ autonomy and to confirm thatno one would be expected to revealfeelings or experiences they consideredprivate. The link between experience andknowledge, their integration in informedsocial experience, was discussed. Thelecturer explored the possibility of some grief-related ‘unfinished business’emerging during the course and detailedsources of help available within thedepartment on a daily basis, and from avariety of support services outside thedepartment. A comprehensive reading list was supplied.

Students at University College Dublin in their final-year course evaluationsconsistently demand courses with directrelevance to clinical practice and for thisreason, a set of observations and ass-umptions about clinical applications ofthe humanities was presented in order to demonstrate the purpose of theirinclusion. Some of these concepts were:

� Since communication is at the heart of all therapy, the language used toexpress symptoms, feelings, fears andexpectations is of central importance.Exploring the humanities broadens theuse of language and, by implication,the scope of subjective inquiry.

� We cannot think our way to humanity.We can create an environment inwhich we can celebrate our potential,and discover the way into a morehumane world (Illich, 1973). We suggest that literature helps to create this environment.

� Images of disease, illness, death andbereavement are common in literature(Downie and Macnaughton, 1998).Health professionals will perhaps offer

treatments based on a fuller under-standing of people if they engage inself-discovery when mediated throughliterature and the arts.

� University programmes in Ireland,particularly in health sciences, aremoving towards the inclusion of liberalarts modules in undergraduateprogrammes.

� The veritable explosion of interest inpoetry in Ireland has heightenedyoung people’s awareness of the valueof the poems they studied at school.Seamus Heaney, one of the mostrespected figures in contemporaryIrish society, said about poetry ‘I credit [poetry] because credit is due to it, in our time and in all time,for its truth to life, in every sense ofthat phrase’ (Heaney, 1998). Poetry is used voluntarily and with considerable facility by this andother groups of our students whenwriting reflective diaries in bothsecond and third years of the course.There is a logical case to be made forextending the scope of literature in a more structured method forinclusion in formal courses.

The foregoing considerations, in ouropinion, constitute a valid argument forthe study of non-scientific literature incourses which are of clinical importanceto practising reflective physiotherapists.

Course ReadingThe course reading list includes bothscientific literature and the humanities.Three humanities sources are suggested:de Beauvoir’s A Very Easy Death, C S Lewis’sA Grief Observed and Tolstoy’s The Death ofIvan Illych.

The students are encouraged to findother readings to reflect their personaltastes. The tutor aims to facilitate studentsin making creative choices rather thandirecting their reading and analysis ofliterature. Guidelines for reading areprovided and include the followingsuggestions:

� Observe the language used in scientificand literary texts.

� Note publication dates to see if literary expression predates scientific‘developments’; for example, Tolstoywrote informatively about terminalillness approximately 80 years before

Authors

Mary F Mc Ateer PhDMEd MISCP is asenior lecturer atUniversity CollegeDublin School ofPhysiotherapy.

Rowena E G MurrayPhD is a seniorlecturer at theUniversity ofStrathclyde Centre forAcademic Practice,Glasgow.

This article wasreceived onSeptember 17, 2001,and accepted on July19, 2002.

Address forCorrespondence

Dr Mary F Mc AteerPhD MEd MISCP,Senior Lecturer,School ofPhysiotherapy, Mater Hospital,Dublin 7.

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Kubler-Ross wrote one of thecornerstones to palliative care.

� Consider whether or not the artsprovide different insights. Do theycomplement the scientific texts?

AssessmentThe course is examined at the end of theyear in accordance with the university’sexamination system. This assessmentconstitutes one-sixth of the marks avail-able for written work in professionalsubjects taken under examination cond-itions. The first examination offered achoice of questions:

1. Discuss the varied physical andemotional reactions to the death of asignificant person. Your response maybe illustrated by reference to

(a) The scientific literature

(b)humanities literature such as proseand poetry

or A combination of (a) and (b).or

2. Discuss concepts of attachment andloss within the specific context of thepractice of physiotherapy. Illustrateyour response with reference to thetransition that is required when apreviously active young man sustainstraumatic paraplegia, has extensivephysiotherapy and becomes wheel-chair-bound as a result of his injuries.

Of the 34 students, 25 (73%) chosequestion 1, while 9 (26.5%) chosequestion 2. Of the 25 choosing question1, 22 (88%) chose a combination of (a)and (b) but with the humanitiespredominating as evidenced by analysis ofthe candidates’ reference material.Looking at the group as a whole, 64.7%chose a predominantly humanitiesapproach. This high proportion may haveresulted from directed reading, althoughit entailed more effort on the part of thestudents, since the nature of the questionprompted work in areas other than in themedical library. (At University CollegeDublin, the medical library is at the 19th-century city-centre medical school siteawaiting re-location to the moderncampus. The arts and humanities libraryis in the main campus – a distance ofsome six miles from the medical library).

Marks were awarded as follows:

Question 1 (a) + (b) out of a possible 33.3,marks ranged from 21 to 30, mean 25.7.

Question 2 (paraplegia), out of apossible 33.3, marks ranged from 20 to 26, mean 23.1.

It could be argued that the range ofmarks for the humanities question reflectsthe proclivity of the lecturer-examiner.However, students awarded high markswere those exhibiting comprehensive andcohesive responses through the use ofwide-ranging sources. While all studentsare expected to make value judgements,marks in a first-class honours band (in thiscase 23 and upwards) were awarded onlyto those exhibiting high skills in synthesisand ability to make mature judgements inrelation to the world of physiotherapypractice.

Marking was subject to both internaland external moderation. A scrutiny ofassessment results across all subject areasat end of year indicates that of the 22humanities students in this module, two achieved first-class honours, 19 hadupper second-class (65%-69%), and oneachieved lower second-class (60%-64%).

Taking the 22 students as a group, 50% had achieved consistent resultsthroughout the four years while the rem-aining 50% improved their grades in thefinal year.

In their answers students cited 57 non-scientific sources, including prose, poetry,music, drama and the visual arts. Thefollowing is a representative sample:

Poetry Auden, Clarke, Dickinson,Hopkins, Heaney, Keats, Tennyson, Wilde,Wordsworth, Yeats.

Prose Bronte sisters, Dickens, Hardy,Joyce, Solzhenitsyn.

Drama Shakespeare, O’Casey.

Music Beethoven, Garth Brooks, EricClapton, Paul McCartney, Mahler, VanMorrison.

Art Exhibitions in the Irish Museum ofModern Art.

This list shows how students broughttheir own awareness of the humanities tothe examination. Student writing showedthat they integrated knowledge gained in the course with their personal ex-periences

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Student WritingStudent writing under examinationconditions was remarkable not only forthe range of sources they used but also for the range of processes they revealed;in the important mix of experience,understanding and judgement – hall-marks of a true learning experience – 22to 24-year-olds may not have all therequisites for learning but three examplesillustrate the range of mature reflectionsin these writings.

In the first example, the student Emmaargues that literature offers vicarious exp-erience. It has long been argued that thisis a potential outcome of studying thehumanities; what is significant is that thestudent defined it as an outcome:

‘[Clinicians] can use the characters inthe novels, poems and short stories assurrogates for the vast range of people,for as T S Eliot (1964) put it, "we readbecause we cannot know enoughpeople".

‘When [clinicians] respond to thesecharacters, they develop a core ofexperiences and understanding whichcan be used to respond to patients insimilar clinical situations. In thescientific texts the emotions purportedto be experienced by the bereaved aremerely written in a list – it can belearnt by rote. This contrasts stronglywith the literary texts – C S Lewis onanger and guilt, Simone de Beauvoir onremorse and castigation. Emotions inthe literary texts are so intenselypersonal that it invites the reader toenter the mind of the bereavedpatients, leading to a deepening of thetherapeutic relationship.’

This student, like others in this cohort,has identified different modes of learn-ing about the subject. There is someindication that metacognition has oc-curred, in the sense that the students havedemonstrated an ability to think abouthow they think about bereavement, andto the extent that they recognise this asvalid material for an examination. In addition, learning is represented by the students as an active process, inwhich readers can ‘enter the mind of thebereaved patients’. Interestingly, thestudent quoted observes not only thelearning effect of literary texts, but also their impact on the ‘therapeuticrelationship’. This suggests a perceivedor potential impact beyond the courseand the examination.

The second example illustrates howSheera drew on her extra-curricular ex-periences of the humanities:

‘Modern artists have started to look inwards at the body celebrating its frailty and its mortality [as wasevident at] a recent exhibition at theIrish Museum of Modern Art, by artistKiki Smith. Artists and writers arebeginning to reject the air-brushedimages so long favoured by the massmedia. In my view, humanities andscientific literature complement eachother in much the same way as thesubjective and objective physio-therapeutic assessments.’

This writing shows the student not onlyengaging with works of art but alsorelating them to scientific literature.Perhaps, more importantly, they reflect on the contrast between ideal and realrepresentations of the human body.

The final example was so cathartic forthe student Barry, that confidentialitydemands a third-person account:

He felt he inhabited a fantasy worldwhich was never touched by death orgrief. Never having lost anyone close tohim he had no idea of the effects ofloss. The death of a close friend poseda dilemma – whether to go to thefuneral some long distance away, or tostay at college and finish assignments.The decision not to go to the funeralhas resulted in lingering regret.Attendance at a church memorial for the dead friend some time laterresulted in a profound shock intoreality that, yes, he was dead and no matter what words were used thefinality of death was real.

Barry went on to say:

‘There I must halt my thoughts andattempt to justify exploring them in anexam question. Experiences of loss andthe grief that follows cannot belearned as we learn anatomy andbiomechanics. They are personalexperiences unique to each individual.However, both medical humanities andscientific literature can give us someinsight into the emotional and physicalreactions to death.’

This writing included a narration ofpersonal loss, but the student stands backfrom personal feelings, indicated by thestylistic shift from ‘I’ to ‘we’, revealing anability to be both subjective and objective,

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and evidencing the important emotionaldimension of learning as expressed byBoud and Walker (1998).

These writings, selected by the tutor/examiner as being representative of thegroup, show an acceptance by students ofthe appropriateness of the humanities aspart of learning and practice. Some showan understanding of the development ofskills relevant to practice; others indicatean awareness of the possibility of deep-ening the therapeutic relationshipthrough the humanities.

ConclusionsThese student writings suggest thatliterature has an important role inhelping students understand aspects ofpractice. This can be seen as playing acomplementary role to other aspects of clinical education. While clinicalexperience is essential, there is evidencethat the extent to which it can producedevelopment or knowledge is variable(Rosie and Murray, 1998). Clinicalexperience alone may not, therefore,develop the skills required for loss andgrief situations.

A formal humanities course can test clinicians’ understanding of thecomplexities of loss and grief (Jackson,1996); understanding that may lie‘beyond the merely scientific’, in contrastwith more informal programmes, such asthose suggested by Calman et al (1988),that is, those that sit outside formal,institutional curricula and are not ass-essed. Genuinely reflective practition-ers, like the students in our sample, donot confine themselves to one form ofreading or writing. The students’ writinganalysed in this paper shows that study ofthe humanities can develop the skills of

metacognition, stimulate reflection onmodes of learning, and prompt reflectionon themselves as people and aspractitioners, a capacity acknowledged asa key goal of higher education (Barnett,1997). The quality, richness and maturityof these students’ writing underexamination conditions suggest that thehumanities can enhance the scientificapproach.

It has been argued by Mc Lellan andJones (1996) that the medical humanitiesliterature has moved from the descriptiveto the analytical; similarly, this paperprovides not only a description of acourse, but also an analysis of one form ofmedical humanities assessment. Thisanalysis raises further questions about thepotential tensions between reflection andassessment, between professional distanceand empathy and between emotion andmetacognition. These would merit furtherscrutiny. However, the students whoattended this course had opportunities tobegin to address these questions duringtheir studies. Their writings includeconsideration of these questions and showdeveloping understanding of theircomplexity.

While scientific texts are, of course,established in the mainstream curr-iculum, with literary texts normally in themargins, this paper has contributed to thedebate about the value of making room inthe mainstream curriculum for medicalhumanities, in order to develop thisimportant aspect of clinical practice. This,of course, also raises further quest-ions about the balance of the importantsubjects of loss, bereavement and griefalong with other elements of currentcurricula.

References

Angus, C W G (1997). ‘Caring for others:Consider the emotional issues’, British Journalof General Practice, 47,12, 784-785.

Barnett, R (1997). Higher Education: A criticalbusiness, Society for Research in Education, OpenUniversity, Buckingham.

Boud, D and Walker, D (1998). ‘Promoting reflection in professional courses: The challenge of context’, Studies in Higher Education, 23, 191-206.

Calman, K, Downie, R S, Duthie, M andSweeney, B (1988). ‘Literature and medicine:A short course for medical students’, MedicalEducation, 22, 265 -269.

Downie, R S (ed) (1994). The Healing Arts: An Oxford illustrated anthology, OxfordUniversity Press.

Downie, R S and Macnaughton, R J (1998).‘Images of health’, Lancet, 351, 823-825.

Fallowfield, L J (1996). ‘Things to considerwhen teaching doctors how to deliver good,bad and sad news’, Medical Teacher, 18, 2-30.

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Heaney, S (1998). ‘Crediting Poetry: TheNobel Lecture, 1995’ in Opened Ground, Faber and Faber, London.

Hodgson, K and Thomson, R (2000). ‘What domedical students read and why? A survey ofmedical students in Newcastle-upon-Tyne,England’, Medical Education, 34, 622-629.

Illich, I (1973). Celebration of Awareness,Penguin Books, Harmondsworth.

Jackson, M (1996). ‘Medical humanities inmedical education’, Medical Education, 30, 395-396.

Mc Ateer, M F (1989). ‘Some aspects of grief inphysiotherapy’, Physiotherapy, 75, 55-58.

McLellan, M F and Jones, A H (1996). ‘Whyliterature and medicine?’ Lancet, 348, 109-111.

Meredith, C, Symonds, P, Webster, L, Pyper, E,Lamont, D and Fallowfield, L (1998). ‘Talkingto patients about cancer: No excuse now fornot doing it’, British Medical Journal, 20, 247-249.

Murray, R (1997). Ethical Dilemmas inHealthcare, Chapman and Hall, London.

Murray, R (1998). ‘Measurement of the effectof participation in a medical humanities groupon the practice of physiotherapists’,Physiotherapy, 85, 1, 1-7.

Nightingale, F (1994). ‘Notes on Nursing’, inDownie, R S (ed) The Healing Arts, OxfordUniversity press.

Randhawa, G (1998). ‘Coping with grievingrelatives and making a request for organs:Principles for staff training’, Medical Teacher,20, 247-249.

Richardson, G and Maltby, H (1995).‘Reflection-on-practice: Enhancing studentlearning’, Journal of Advanced Nursing, 22, 235-242.

Rosie, J and Murray, R (1998). ‘An evaluationof learning on clinical placements inradiography’, Medical Teacher, 20, 227-235.

Required Reading

The sources listed here were required readingfor students on the loss and grief course. A comprehensive list of contemporary sources was designated ‘recommended’reading.

de Beauvoir, S (1966). A Very Easy Death,Penguin Books, Harmondsworth.

Kubler-Ross, E (1969). On Death and Dying,Tavistock, London.

Lamerton, R (1980). Care of the Dying, Pelican,London.

Lewis, C S (1961). A Grief Observed, Faber andFaber, London.

Lindemann, E (1944). ‘Symptomatology andmanagement of acute grief’, American Journalof Psychiatry, 101, 141-148.

Mc Ateer, M F (1997). Crushing Force,unpublished poem presented to Writers’Workshop, Naas, Co Kildare.

Murray-Parkes, C (1975). Bereavement, Pelican,London.

Tolstoy, L (1969 translation). The Death of IvanIllych, Raduga, Moscow.

Key Messages

� Knowledge of loss and grief isfundamental to physiotherapyeducation.

� Personal growth and awareness are as important as physiotherapy skills.

� Incorporating the humanities isjustified in terms of educationalobjectives.

� The humanities enhance the scientific approach and promotequality writing.

� Students’ use of the humanitiesfacilitates reflection on practice andlearning.

� Deep learning occurs when personalexperience informs understandingand judgement.