Creatively Integrating Medical Ethics, Sociology and Humanities into Clinical Care

Students collaborate with faculty leaders to reimagine the Medical Ethics, Sociology and Humanities (MESH) course at the UC Irvine School of Medicine, helping future physicians broaden their understanding of clinical care.

Do doctors need to understand body language? Does it matter how they write their medical notes? How does their understanding of race as a social construct impact patient care?

These are the types of questions tackled in UC Irvine’s Medical Ethics, Sociology and Humanities (MESH) course, a requirement for both first- and second-year medical students. This year, the course was reimagined, with four students at the heart of the revision process.

“One of our goals was to get rid of this idea that these are just soft skills that aren’t as important as learning anatomy or physiology,” says Zoe Adams, a third-year student in the UC Irvine School of Medicine who helped revamp the course with classmates Emma Boyles, Alison Lawrence and Herschel Uchitel. “You’re not going to be the best doctor you can be unless you’re addressing all these components of health.”

Under the guidance of Juliet McMullin, PhD, the previous director of MESH, and Ronald J. Rivera, MD, an assistant professor of clinical emergency medicine who took over when McMullin retired in 2025, the students took on MESH as a research project. Working together, the group proposed changes to the course to increase engagement and better highlight the curriculum’s relevance to clinical outcomes.

A Bridge to Humanities

Before 2023, topics related to medical ethics, sociology and the humanities were primarily housed in the clinical foundations course, led by Alisa V. Wray, MD. Wray always made space in her curriculum for relevant lectures, activities and online modules as needed.

Then, before the start of the 2023 academic year, Jeffrey R. Suchard, MD, associate dean of Basic Science Education, initiated the development of a more formalized two-year course. He recruited McMullin, in her role as director of the Medical Humanities and Arts Program (MHAP), to spearhead the effort, and the incoming class of 2027 was the first to take MESH 1 and MESH 2.

“The four of us had the inaugural MESH experience,” says Adams, who majored in molecular and cell biology at UC Berkeley and minored in English. As a student with an interest in creative writing and literary analysis, Adams appreciated the topics covered in MESH, but the course wasn’t as highly rated as others within the School of Medicine.

“Dr. McMullin asked how we could make it better, and I had some ideas,” says Adams. Together, they assembled this team of students to evaluate the course.

Lawrence, who studied both biology and women’s gender & sexuality studies at Augustana College before coming to medical school, noticed the disconnect for many of her peers between the topics discussed in MESH and their practical applicability to clinical medicine.

Boyles, who graduated from UCLA with a degree in physiological sciences and a minor in history, saw a need to better connect even mundane tasks, such as writing notes and reading charts, to patient care outcomes.

“We all know how to treat diabetes, but can we connect with patients and get them to actually engage with the treatment?” asks Uchitel, who studied art history at Washington University in St. Louis and taught high school before applying to medical school. “That’s where these skills come in.”

MESH Reimagined

Lawrence designed a survey assessing the knowledge of incoming students and measuring what they learned throughout the course. “The initial goal was to assess the incoming class’s baseline comprehension of the three pillars of MESH,” she says. The pre-course survey asks students how they would handle an ethical scenario, how humanities applies to clinical practice, and how social determinants of health impact medicine.

“We also used the survey to create small groups, because some studies have shown that students learn better in groups that are skill-matched,” she says. “We wanted students to grow together, starting at their own level.”

Adams led the focus on case development. “We wanted to make sure there was a heavy emphasis on clinical ties,” she says.

For example, after an introduction to social determinants of health and a primer on how to have difficult conversations, students now break into small groups to discuss the case of a patient with chronic kidney disease. The patient has a new concern about a possible pulmonary embolus after a recent surgery. Students debate the pros and cons of a CT Angiogram, with some representing the interests of a surgical team and others of a nephrology team. The students must practice respectful communication skills as well as identify social determinants contributing to health complications.

MESH also includes panel discussions, and Boyles helped recruit speakers from local organizations.

“We had community partners from Project Kinship speak to our students,” she says, referring to the nonprofit organization that supports and employs formerly incarcerated people. “Being able to learn what these patients are experiencing and hearing from them directly was impactful.”

One guest, for example, talked about how being in a gang offered resources and support that his parents couldn’t provide, so he remained in the gang even after being shot on three separate occasions. Other panels included LGBTQ+ patients from UC Irvine and the community as well as an interprofessional panel of allied colleagues from nursing, social work and care management.

Uchitel took the lead on developing faculty materials, such as the new “power of documentation” activity built into the updated version of McMullin’s “data and narrative” lesson. Working in small groups, students receive a patient chart and develop a care plan. “What the students don’t know is that the charts, all for the same patient, are written in varying styles and emphasize different details,” says Uchitel. When the students realize how this impacts the care plan, they rewrite the patient chart.

Rivera values such thought-provoking activities. “The goal is to have the students use a neutral, non-judgmental tone and present all elements of the patient’s care needs, including contextual information,” he says.

He also enjoyed implementing the team’s suggested lessons on spirituality, technology and ethics, body language, and individuals with disabilities, yet he appreciated how they maintained effective material on topics such as Asian American and Pacific Islander data disaggregation. For example, the course still tackles why certain biostatistics and epidemiological data falls along racial or ethnic lines as students discuss how social, political or cultural elements can sometimes get written off as race, and how specific genetic risk factors can be obscured by data aggregation.

The course similarly maintains its strong focus on ethics, and Jennifer Elia, MD, an associate clinical professor of anesthesiology, has designed engaging group activities to better explore medical ethics as guiding principles in practice.

The team also reinstated the final project as initially designed by McMullin — a creative work of the students’ choosing that addresses a core concept from the course — but it now involves a class presentation. “Adding in a presentation component and peer review was really important to us,” says Lawrence.

Rivera hopes to build on this, eventually having MESH 2 students present their work at an Art & Activism event open to the community. “I want to drive home the point that creative pieces can generate dialogue,” says Rivera, “illustrating to students how their ability to connect with people through narrative is an incredibly important part of being a good physician.”

Institutionalizing “Not So Soft” Skills

Initial feedback has been positive, with course evaluations already coming in one point higher (on a five-point scale) than the last two years. Second-year students who took the original MESH 1 course have noticed how topics are now more clearly tied to the practice of medicine.

“That was really the goal,” says Uchitel. “To have them understand why this is a clinical skill.”

As Adams, Lawrence, Boyles and Uchitel head into their fourth year, they are working to ensure the changes continue beyond their graduation.

“It is important to recognize that sociology isn’t currently a required prerequisite for medical school and that many trainees — and even clinicians — have never had formal instruction about these topics despite their relevance to clinical practice,” says Adams. “This makes it all the more important that their coverage is institutionalized.”

MESH goes a long way in ensuring future physicians have a broader understanding of the skills needed for clinical care. “It’s a new concept in medical education, presenting evidence-based knowledge from the humanities that can inform future practice,” says Rivera, who is grateful to Wray, Suchard, Elia and McMullin for making it happen. “UC Irvine is leading the way with this course.”

— Shani Murray