We conducted our review in accordance with Arskey’s framework for scoping reviews (15). While a scoping review provides a systematic approach to mapping literature on a given topic to provide a comprehensive picture of the literature, it does not make discriminations based on the ‘quality’ of the studies as occurs with systematic reviews (16). This allowed for reflexivity through the process of extracting data to develop a descriptive, narrative synthesis of the selected publications, leading to clarification and refinement of guiding questions and methods as understanding of the literature becomes clearer.
Search strategy
To identify the relevant articles for consideration, a comprehensive search strategy was applied using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Centre (ERIC), PubMed, and Medline using keywords including combinations of “student*”, “health professional*”, AND “education”, “curricul*”, “programme”, “teaching”, “learning”, “evaluation”, “assessment” AND “health humanities”, “medical humanities”, “arts”. Publications between March 2015- November 2020, available in English, in peer reviewed journals were searched. The initial search was undertaken using the keywords and inclusion/exclusion criteria from April 15 to 20, 2020 identifying 8594 articles. The search was repeated on November 22, 2020 with a further 27 articles identified bringing the total number of articles included in the scoping review to 8621.
Inclusion and exclusion criteria
Population: of interest was identified as health professions students, including medicine, nursing, and allied health professional students, undertaking a pre-registration programme or course of studies at a university. These could be undergraduate, or graduate-entry programmes that led to the ability to become registered health practitioners. Studies focused on participants or students who were not enrolled in a pre-registration health professions course were excluded.
Intervention: Learning interventions (activities) using health humanities integrated into curricula with a focus on the achievement of stated learning outcomes/objectives, and associated curriculum evaluation were included. Studies focused on ad-hoc health humanities learning experiences (e.g., a one off visit to an art gallery), rather than integrated course content (e.g., a seminar series developing students skills in observation), were excluded.
Outcome: Any assessment or programme evaluation of the “impact”; “outcome*”; “benefit”; AND the achievement of “attributes”; “skill*”; “knowledge”; “behaviour”; “personal growth” or “reflect*”; “transformation” were searched for, and only articles meeting these criteria were included.
Article screening and selection
Following removal of duplicates, 8606 titles were reviewed, each by two reviewers (CD, SC, BP, FN, KS, PB, CH). It was at this stage that publications were screened to ensure that they were qualitative or mixed-methods studies. Clearly non-empirical (conceptual, theoretical 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, KS, PB, FN). Additional non-empirical articles were then excluded, as well as empirical studies that only reported quantitative findings. From this, 71 papers were included for full paper review, each by two members of the project team (SC, BP, PB, KS, FN, CH, MA) and 24 papers were then identified for full data extraction. Hand searching of references for this final set was also completed, which did not identify any additional articles for inclusion (SC).
Data charting
We developed a standardized listing of data fields to facilitate a descriptive, narrative synthesis of the data. Form fields that were used to extract data from the included articles into an Excel spreadsheet included: 1) article citation elements and 2. Health humanities curriculum intervention and programme evaluation details (see Table 1). Two reviewers extracted the data (FN, DC) that was subsequently checked by an independent second reviewer (SR, NM, KS, SC). Any conflicts were resolved by discussion (SC, FN, DC).
Table 1
Article citation elements
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Health Humanities Curriculum Intervention and Programme Evaluation Details
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Authors
Title
Year of Publication
Journal
Country of Publication
Article Type (Research/ Study Design or Programme Evaluation)
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Student Population
Health Humanities Discipline(s)
Health Humanities Learning Foci*
Stated Learning Outcomes/Objectives
Level of Learning (Bloom)*
Learning Domain (Knowledge, Skills, Attitudes)*
Type of Educational Intervention: Delivery Mode, Duration of intervention
Assessment of learning (Formative/ Summative)
Level of Programme Evaluation (Kirkpatrick’s)*
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*variables used for secondary analysis |
The process of data coding was iterative and led to refinements in our approach to analysing the data as our understanding of the articles included in our review evolved. The initial analysis was descriptive with basic information extracted including reference citation elements such as year of publication, country of publication, and type of article, which was coded as “evaluation”, i.e., focusing on programme evaluation, or “research”, i.e., focused on answering specified research questions, and study design (“qualitative” or “mixed method”). In addition in this phase the type of student participants, the health humanities disciplines involved, mode and duration of learning, learning outcomes and assessments described, and whether an educational theory or framework was specified were recorded and are summarised as frequencies in the findings.
The secondary analysis considered the impact of the learning experiences in relation to the Bloom’s domains of learning: knowledge (cognitive), skills (psychomotor), attitudes/behaviours (affective), and six levels of learning: remember, understand, apply, analyse, evaluate and create (17). It also considered the foci of health humanities teaching as informed by previous reviews (8–10, 12, 18), as well as insights of the authors’ team who all have experience using and studying the arts and humanities in their teaching and research. Thus we identified six foci for health humanities teaching and learning:
1) for knowledge acquisition
2) for mastering skills (observation, listening, reflection) (12);
3) for interaction, perspective taking, and relational aims (person-centred communication, compassion, empathy) (12);
4) for personal growth and activism (transformation, values, professionalism) (12);
5) for personal wellness and self-care (stress management, mindfulness, resilience building) and
6) for critical evaluation (evidence synthesis) (3).
Ambiguous data were analytically discussed by research team members and final coding decisions were agreed upon by consensus of two researchers (SC, FN, DC).Synthesised results are summarised as frequencies of occurrence for the domains of learning, level of learning and health humanities foci.
The evaluation strategies applied in each included paper were also classified using Kirkpatrick’s four-level training evaluation model, encompassing: 1) process evaluation (participant satisfaction), 2) content evaluation (knowledge, skill change), 3) impact evaluation (change in behaviour), and 4) outcome (change in practice) and classified as applying both formative and summative programme evaluation (19, 20).