by:  Robert H. Blank, Ph.D.

Traditionally, medical training contained little content from other disciplines. In recent years, the advent of biomedical ethics and the creation of medical humanities programs has added other perspectives though usually these have taken on a secondary role and not been highly integrated into medical training. More importantly, most of these endeavors tend themselves to be rather narrow and focused on several disciplines, eg. philosophy, literature, or other humanities, at the exclusion of a genuine interdisciplinary approach. As will be argued here, this context is not unique to medical training, though it produces special problems for the education of physicians who will be faced with life and death decisions.

In much simpler times, Plato and other classical thinkers were able to master the known areas of knowledge and engage in true interdisciplinary dialogue. A more complicated world however requires specialization in minute dimensions of the world, thus making a Plato impossible in our times. As a result, disciplines and subspecialties within those disciplines have become the focus of activity. Each of these disciplines, carved from the total, develop unique perspectives and concurrently establish turfs to defend from interlopers from outside. The resulting divisions over time have become quite rigid. As a result, calls for interdisciplinary perspectives are often perceived with skepticism and seen as threats. Moreover, in academic settings where tenure and budgets are largely department based, there are often insurmountable logistical problems in teaching interdisciplinary courses and faculty members who do so are frequently disadvantaged.

Interdisciplinary journals, likewise, tend not to enjoy the prestige accorded to top disciplinary journals. Instead of being rewarded for their insight, faculty members who publish in journals outside their own discipline, often find themselves being criticized or even penalized. As a result faculty members with interdisciplinary teaching and research interests often must volunteer for such teaching beyond their "normal," ie., department, load and make sure they also publish in acceptable disciplinary journals as well. Fortunately these distractions have not stopped many dedicated scholars and teachers from many disciplines to push for a more integrated view of the world and work at bridging the disciplines.

Interdisciplinary teaching/research is especially problematic in medical training because medicine itself has become so segmented and specialized. As one rotates among the units it is clear to see priorities, perspectives, and even language change. Although there is some essential communication across specialties, seldom does this appear to be sufficient to produce an interdisciplinary environment, rather one set of experts getting needed information from another set of experts. Given the high demands on physicians just to keep up with their own specialties, it is understandable that first priority is there, but in the end it makes continued interdisciplinary education improbable.

The problem of interdisciplinary education in medicine is compounded significantly if the term is expanded to include traditional disciplines outside of health care, particularly the humanities and social sciences. This of course cuts both ways—in fact most social science and humanities scholars are less likely to appreciate medical science than vice-versa. The insular views of these disciplines have produced barriers that make real communication amongst themselves, much less medicine and the biological sciences difficult at best. This also makes it difficult to develop meaningful interdisciplinary programs for medical education. At least physicians have some shared experience in medical school that can be drawn upon and they live in the world and thus have some knowledge of other disciplines.

The Interdisciplinary Fellowship Program at the Medical University of South Carolina (MUSC) is an attempt to bridge some of the canyons dividing disciplines by bringing into the clinical setting persons trained in a range of non-medical professions. The purpose is twofold, first to expose these medical novices to the context and perspectives of a medical university, and second to expose the medical community to persons trained in an array of other fields all of whom are especially interested in health care. As noted above, this is no easy task because of the in built biases and backgrounds on all sides.

The Interdisciplinary Fellowship Program has the added effect of exposing the Fellows themselves to the disciplines of the other Fellows. Persons trained in law, bioethics, sociology, political science, economics, and communications are likely to find wide variation in the views they each bring to the Fellowship and experience an opportunity to better understand the interdisciplinary dynamics of health care. The wide diversity of the Fellows surprised many of the residents and attendings who expected a single and largely critical appraisal of what they were doing. Instead they found often-conflicting views, again indicating the complexity of medical decision making. To the extent that the Program engenders communication among all the medical and non-medical disciplines involved, it represents a step toward better understanding of what is needed to strengthen this context.

The Interdisciplinary Fellowship Program itself, of course, cannot transform either the way medicine is practiced or how it’s viewed by those scholars outside medicine. Disciplinary boundaries are too engrained to give way easily to more enlightened interdisciplinary approaches. However, for those who believe that the solution to increasingly complicated social issues and personal problems lies in multifaceted approaches that transcend any single discipline, fellowships of this type are most encouraging because they signal a willingness to explore new ways to resolve these problems—ways that depend on a broadened dialogue among persons trained formally in medicine and those trained outside but with a strong interest in contributing to a sound health care system.

Editor's note:  Robert H. Blank, Ph. D. is a 1999 visiting fellow at the Institute of Human Values in Health Care at the Medical University of South Carolina.  Professor Blank is currently Professor and Chair of Political Science at the University of Canterbury in Christchurch, New Zealand.