Community-oriented curriculum design for medical humanities.

Various recent surveys in Taiwan show physicians' decreasing satisfaction and increasing frustration with their working environment. Their major complaints are stress, long hours, salary, management's disrespect, and lack of trust from patients and society. To move towards restoration of social trust, this paper proposes incorporating the concept of "doctor as mediator in the changing relationship with patients" into the medical curriculum, as will be described in detail. This paper argues that structured community service for medical students facilitates self-learning, and will not only motivate them to develop good clinical and communication skills, but will also lead them to realize that the essence of medicine must be social trust. These effects have been seen after several years of an experimental curriculum involving more than 800 students. A program using methodology for community empowerment has been realized in a two-stage curriculum design. Students' self-assessment of achievements in these courses included further improvement in communication skills, courage to express own position, appropriate planning in advance, management of human resources, ability to deal with limited space and time, and experience of a profoundly moving learning process. In conclusion, community-based curriculum designs that facilitate self-learning for medical students should be the key element of reformed humanities education in Taiwan medical schools. Moreover, medical humanities continues to be a key element contributing to ongoing intellectual movements in Taiwan for building civil society and rooting democracy in the community.