Review Paper
Moderator: Gail Furman, PhD, MSN
A Methodological Review of the Assessment
of Humanism in Medical Students
Era Buck, PhD, Mark Holden, MD, and Karen Szauter, MD
Abstract
Background
Humanism is a complex construct that
defies simplistic measurement. How
educators measure humanism shapes
understanding and implications for
learners. This systematic review sought
to address the following questions: How
do medical educators assess humanism
in medical students, and how does the
measurement impact the understanding
of humanism in undergraduate medical
education (UME)?
Method
Using the IECARES (integrity, excellence,
compassion, altruism, respect, empathy,
and service) Gold Foundation framework, a
search of English literature databases from
Humanism provides the passion that
animates authentic professionalism.
—Jordan J. Cohen
T
he optimal practice of medicine
requires much more than mastering
the rapidly evolving foundational and
clinical sciences. Humanism is core to
the provision of excellent patient care.
Fostering the development of humanistic
physicians poses a great challenge
to medical educators as methods
to promote and assess humanism
throughout the educational continuum
are methodologically complex and highly
contextual.
The importance of professionalism
in health care has been described and
studied extensively over the past two
Correspondence: Era Buck, PhD, Office of
Educational Development, University of Texas
Medical Branch, 301 University Blvd., Galveston,
TX 77555-0408; telephone: (409) 772-3235;
e-mail: erbuck@utmb.edu.
Acad Med. 2015;90:S14–S23.
doi: 10.1097/ACM.0000000000000910
S14
2000 to 2013 on assessment of humanism
in medical students revealed more than
900 articles, of which 155 met criteria
for analysis. Using descriptive statistics,
articles and assessments were analyzed
for construct measured, study design,
assessment method, instrument type,
perspective/source of assessment, student
level, validity evidence, and national context.
Results
Of 202 assessments reported in 155
articles, 162 (80%) used surveys; 164
(81%) used student self-reports. One
hundred nine articles (70%) included
only one humanism construct. Empathy
was the most prevalent construct present
in 96 (62%); 49 (51%) of those used a
decades. Finding a common definition
for professionalism has been challenging,
as most agree that this construct has
many facets. Several definitions of
professionalism include a focus on
the humanistic qualities of health care
providers.1 Dr. Jordan Cohen posits a
unique relationship between these two
constructs, defining professionalism as
a “way of acting” and humanism as “a
way of being.”2 He argues that behavior
grounded in deep-seated humanistic
qualities is more likely to be sincere and
resistant to the many challenges posed
by the systems in which health care
providers train and work. The Arnold
P. Gold Foundation suggests integrity,
excellence, compassion, altruism, respect,
empathy, and service (IECARES) as the
core characteristics of humanism.3
Measuring complex attitudes and
behaviors poses a special challenge to
medical educators. What we know about
humanism—its core attributes, our
ability to reinforce desirable qualities, and
the variability of humanism within an
individual over time—is shaped by the
way we measure it. Assessment strategies
single instrument. One hundred fifteen
(74%) used exclusively quantitative
data; only 48 (31%) used a longitudinal
design. Construct underrepresentation
was identified as a threat to validity in
half of the assessments. Articles included
34 countries; 87 (56%) were from North
America.
Conclusions
Assessment of humanism in UME
incorporates a limited scope of a complex
construct, often relying on single
quantitative measures from self-reported
survey instruments. This highlights the
need for multiple methods, perspectives,
and longitudinal designs to strengthen
the validity of humanism assessments.
must offer valid measures, be practical,
and facilitate contextual interpretation.4
High-quality assessment is an essential
foundation for providing feedback to
learners, evaluating curricular strategies,
and refining our theoretical and
conceptual understanding of humanism
among medical students. Measuring
a construct as multidimensional
as humanism requires a variety of
techniques and approaches. Closely
examining the existing tools and methods
in current use is imperative to inform the
design of future educational programs
and assessment activities. We undertook
this work to better understand the
current approaches to the measurement
of humanism in undergraduate medical
education. We specifically asked, “How
do medical educators assess humanism
in medical students, and how does the
measurement impact what we know
about humanism in undergraduate
medical education?”
Method
We conducted a systematic narrative
examination of the literature to better
Academic Medicine, Vol. 90, No. 11 / November Supplement 2015
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Review Paper
understand how constructs of humanism
were represented throughout work
related to medical students. The review
process and data abstraction were
conducted according to guidelines for
systematic reviews, and the synthesis was
primarily narrative rather than statistical.
This approach allowed inclusion of
qualitative and quantitative research
studies in the review. Specifically, we
sought to examine approaches to the
assessment of humanism, anticipating
that this might illuminate types of bias
present in the literature and identify
gaps in the assessment of humanism in
undergraduate medical education.
Search strategy
In consultation with a reference librarian,
we conducted electronic searches for
English-language articles published
between 2000 and 2013 in PubMed,
ERIC, CINAHL, and Web of Science
databases. Search terms included
undergraduate medical education
combined with each of the humanism
constructs included in IECARES:
integrity, excellence, compassion,
altruism, respect, empathy, and service, as
well as the term humanism.3
We identified additional articles
during the review process by carefully
examining the titles in the reference
lists of all included and excluded
articles. In addition, we conducted
forward citation searches for 76 review
articles and conceptual or theoretical
articles identified in the review process.
This iterative process was continued
throughout the study period until
saturation was reached—that is, all
articles identified in reference lists as
potentially relevant for review were
already in the database of retrieved
articles.
Inclusion and exclusion criteria
An initial review of each article
determined whether it met basic
inclusion or exclusion criteria. To
progress to full review, an article must
have met all inclusion criteria and none
of the exclusion criteria.
Inclusion criteria. (1) Peer-reviewed
articles; (2) assessment of medical
students; (3) sufficient description
of assessment to allow validity
assessment; and (4) assessment
of one of the following: integrity,
excellence, compassion, altruism,
respect, empathy, service, humanism, or
identity development. We relied on the
designation within each article of the
construct being assessed as well as the
following definitions3:
• Integrity is congruence between values
and behavior.
• Excellence is defined in our review as
a commitment to clinical competence
stemming from a sense of duty to
do what is best for patients. We did
not include articles assessing levels
of competence at performing clinical
skills.
• Compassion refers to an awareness and
acknowledgment of suffering coupled
with a desire to relieve it.
• Altruism is the willingness and ability
to put others’ needs before one’s own.
• Respect is regard for autonomy and
values of another including patients
and colleagues.
• Empathy is defined broadly as the
ability to put oneself in another’s
situation.
• Service refers to giving beyond what is
required.
• Humanism in health care is
characterized by a respectful and
compassionate relationship between
physicians, as well as all other members
of the health care team, and their
patients. It reflects attitudes and
behaviors that are sensitive to the
values and the cultural and ethnic
backgrounds of others.
• Identity development refers to the
transformative process of becoming a
humanistic physician.5
Exclusion criteria. (1) Review articles,
(2) duplicate reports, or (3) insufficient
description of assessment method.
Articles were reviewed independently by
at least two members of the study team to
determine whether they met the criteria
listed above, and discrepancies were
resolved by consensus.
Data abstraction
Data abstraction began with an iterative
process of developing a data collection
form. The coinvestigators met for an
intensive training over two days. During
Academic Medicine, Vol. 90, No. 11 / November Supplement 2015
that time, common articles were reviewed
individually by each member of the team,
followed by group discussion of each
article. Coding criteria were explicated
through consensus. As data collection
proceeded, we met weekly to discuss
coding issues and maintain consistency
among the team as reviewers.
For each article, the following
information was considered:
Target(s) of assessment. We coded
each article for integrity, excellence,
compassion, altruism, respect, empathy,
service, humanism, and/or identity
development. We allowed multiple
categories to be coded for a single article.
Method(s) of assessment. We coded each
method as quantitative or qualitative;
survey, interview, observation, or
reflection; and cross-sectional or
longitudinal. For qualitative studies,
prompts were recorded on the data
abstraction form. We allowed for multiple
methods to be coded for a single article.
Measurement and variable types. We
coded assessments as dichotomous,
continuous, ordinal, or descriptive and as
independent or outcome variables. There
were multiple categories coded for each
article.
Setting or context of assessment. We
coded the nation where data were collected;
level of training for students assessed; and
setting of assessment.
Perspective or source of assessment.
We coded perspectives as self, patient,
peer, investigator, faculty, standardized
patient (SP), or clinical team member.
Each assessment in an article was coded
for perspective—for instance, an article
could be coded as having a self-report
survey and an observation by an SP.
Validity evidence. Sources of evidence
were coded as content, response process,
internal structure, relationship to other
variables, or relationship to consequences.
Threats to validity. We coded for
construct underrepresentation and/
or construct-irrelevant variance. When
considering the validity of the assessment,
we used criteria based on the work
of Downing and Haladyna.6,7 When
authors identified specific constructs
as the target of assessment, we coded
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Review Paper
them to be consistent with the authors’
designation. In articles where the author
was not explicit about target constructs,
we made coding decisions as a team. For
example, unless otherwise designated
by the authors, we included articles
assessing patient orientation or patient
centeredness as respect, and we coded
assessments of emotional intelligence as
compassion.
Analysis
From the plethora of potential analyses
for these articles, we focused on those
that most directly informed our
research question, cataloging assessment
strategies and synthesizing that
information to understand the impact
on the understanding we derive from
the literature. We sought to identify
areas of strength, gaps, and potential
bias that may impact the understanding
of medical educators as consumers of
the literature. We employed descriptive
frequencies and proportions to analyze
the data as a whole. On the basis of
an initial examination of the data, we
also examined subgroups of data, most
notably studies assessing empathy
among medical students. We assessed
the strength of the validity evidence
provided by authors as well as threats to
the validity of the assessments provided.
Because we were not synthesizing the
study results, we did not evaluate the
quality of study designs.
Results
Trial flow
Figure 1 summarizes the results of the
search process. Through the literature
search based on key words along with
forward and backward citation searches,
over 900 articles received at least an
initial review. Initial review resulted
in exclusion of over 660 articles not
meeting the complement of inclusion
criteria. Additional articles were
excluded after full review when in-depth
reading revealed that the assessment of
humanism was not of medical students
or the description of the assessment
approach was not sufficient for the
reviewer to determine what might
contribute to or detract from the validity
of the information in the article. After full
review, 155 articles8–162 were included in
the database for analysis.
Study characteristics
The literature we reviewed was
published entirely in English yet was
very international in origin. Studies with
multiple assessments resulted in a total of
202 assessments recorded in our database.
Some analyses consider data at the article
level and some at the assessment level as
needed to provide the most informative
results. A summary of articles, organized
by construct, is shown in Table 1.
Of the assessments (n = 202), 80%
(n = 162) were surveys; 12% (n = 25)
were observations (21 of which were
ratings by SPs); and the remaining 8%
(n = 16) were interviews and assessments
of medical students’ reflective writing.
Similarly, 81% (n = 164) were from the
perspective of the students (self-report),
10% (n = 20) from the perspective of
an SP, and the remainder distributed
among faculty and peers. We reviewed
a single paper23 using information from
actual patients about students. The total
number of citations to these articles is
4,551. Six (3%) articles have been cited
more than 100 times, an additional 6
were cited between 50 and 99 times, and
28 articles were cited 25 to 49 times.
The remainder (n = 115) were cited
less than 25 times. Whereas integrity,
altruism, and service were infrequently
assessed and most often in combination
with additional constructs, global
humanism, compassion, respect, and
Figure 1 Trial flow for review.
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Academic Medicine, Vol. 90, No. 11 / November Supplement 2015
Data Summary Organized by Constructs
Citationsj
(range)
Articlesa
Designb
Methodc
Instrumentd
Perspectivee
QNf
QLg
Mixedh
Validityi
Nationsk
Integrity8–12
5
Cr (3)
Lon (2)
Survey (5)
Int (1)
Multi (1)
All study specific
3
1
1
Hi (3)
Mod (2)
170
(3–95)
(range)
4
Commitment to excellence8,13–17
6
Cr (5)
Lon (1)
Survey (4)
Obs (2)
Reflect (1)
Multi (1)
All study specific
Self (4)
Invest (1)
Peer (1)
Multiple (1)
Self (4)
Faculty (1)
SP (1)
Peer (4)
Multi (2)
5
1
0
Hi (2)
Mod (4)
70
(3–21)
1
Compassion9,18–49
33
Cr (21)
Lon (12)
Survey (25)
Int (2)
Obs (7)
Reflect (5)
Multi (6)
Study specific (12)
PPOS (6)
Self (25)
Faculty (2)
Patient (1)
SP (3)
Invest (8)
Multi (6)
22
8
4
Hi (12)
Mod (18)
Low (3)
544
(0–104)
11
Altruism8,10,18,19,50–56
11
Cr (8)
Lon (3)
Survey (7)
Int (2)
Reflect (2)
All study specific
Self (7)
Invest (3)
Faculty (1)
Peer (1)
Multi (2)
7
2
2
Hi (4)
Mod (6)
Low (2)
207
(0–95)
5
Respect8,9,13,18–34,50,57–75
40
Cr (27)
Lon (13)
Survey (28)
Obs (14)
Reflect (5)
Int (2)
Multi (8)
Study specific (18)
PPOS (13)
Doctor patient
scale (3)
Self (30)
Invest (8)
Faculty (2)
Patient (1)
Peer (1)
Team (1)
Multi (9)
27
8
5
Hi (17)
Mod (18)
Low (5)
1,003
(1–163)
12
Empathy20–26,35–44,51,57–62,76–147
96
Cr (66)
Lon (30)
Survey (86)
Int (3)
Obs (13)
Reflect (6)
Multi (14)
JSE (49)
Study specific (17)
IRI (8)
BEES (4)
Self (87)
Invest (9)
SP (7)
Faculty (6)
Patient (1)
Peer (2)
Multi (17)
80
10
7
Hi (27)
Mod (46)
Low (23)
2,147
(0–165)
23
Review Paper
Construct
(Table continues)
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Table 1
4
388
(7–104)
Hi (3)
Mod (7)
The articles (n = 155) represented data
from 34 countries, with 56% (n = 87)
occurring in North America. Seventy
percent (n = 109) of articles considered
a single construct, with 18% (n = 28)
of articles considering two and 12%
(n = 18) three or more constructs.
Study quality
Articles column is the number of articles included in the review addressing the specified construct.
Design identifies how many studies in the category were cross-sectional (Cr) and how many were longitudinal (Lon).
c
Method indicates how many articles used surveys (Survey), interviews (Int), observation (Obs), reflection (Reflect), and combinations of these (Multi).
d
Instrument identifies published assessment tools used multiple times in the category and the number of tools developed for a single study (study specific).
e
Perspective indicates who completed the assessment, the student being assessed (self), a faculty evaluator (faculty), a peer, a standardized patient (SP), clinical team
member(s) (team), the article author (invest), patient, and a combination of these (multi).
f
QN indicates the number of articles reporting only quantitative assessment.
g
QL indicates the number of articles reporting only qualitative assessment.
h
Mixed indicates the number of articles reporting both quantitative and qualitative assessments.
i
Validity indicates the number of categories of validity threats: 0 (Hi), 1 (Mod), 2 (Low).
j
Citations provides the total number of citations for the set of articles and the range of citations per article.
k
Nations indicates the number of nations represented in the set of articles for the specified construct.
a
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b
5
3
Self (6)
Invest (5)
Multi (1)
Study specific (8)
Survey (5)
Reflect (2)
Int (3)
Obs (1)
Multi (1)
Cr (7)
Lon (3)
10
Identity formation9,29,30,45,54,77,159–162
Cr (18)
Lon (5)
23
Humanism11,14,15,18,20,28,35,45,52,53,56,77,78,149–158
Cr (2)
Lon (2)
4
Service
14,27,76,148
empathy were assessed frequently and
often independently of other constructs.
The most prevalent assessment in this
literature was some form of the Jefferson
Scale of Empathy, a self-report survey.
2
8
304
(0–38)
Hi (10)
Mod (13)
Self (7)
Faculty (1)
Peer (1)
Invest (6)
Team (1)
Multi (6)
Study specific (20)
Survey (8)
Reflect (6)
Int (2)
Obs (2)
Multiple (3)
13
10
1
1
59
(5–45)
Mod (4)
0
0
Study specific (2)
PVIPS
MSATU
Survey (4)
4
All self
Instrumentd
Methodc
Designb
Articlesa
Construct
(Continued)
Table 1
Perspectivee
QNf
QLg
Mixedh
Validityi
Citationsj
(range)
Nationsk
Review Paper
Construct underrepresentation was
identified as a threat to validity for
50% (n = 101) of assessment reports;
construct-irrelevant variance was found
for 28% (n = 56) of measurements. Both
threats to validity were seen in 12.3%
(n = 25) of all assessments. No threats to
validity were coded in 36.2% (n = 73),
whereas 51.5% (n = 104) were coded as
having one category of threat. Examples
of construct underrepresentation include
using single observations as the basis
for scoring a student on a construct and
an instrument containing questions
regarding students’ beliefs about the
importance of physician empathy as a
measure of the construct of empathy.
Examples of situations leading to a threat
of construct-irrelevant variance include
poor interrater agreement and poor
response rates.
Synthesis
Some assessments addressed multiple
constructs; for instance, a rating scale
completed by an SP might address
compassion and respect. Thus, some
articles are reported related to more than
one construct.
Integrity. An assessment of student
integrity appeared in 3% (n = 5) of
the total set of 155 articles. All of the 5
articles assessing integrity also assessed
at least one additional construct, and
2 of the articles assessed more than
three constructs. The assessments
reported for integrity in these articles
were all designed specifically for the
study reported in the article; none
used assessment tools with published
psychometric data.
Excellence. Four of the six articles
assessing students’ commitment to
clinical excellence also contained
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Review Paper
assessments of additional constructs. The
articles all (n = 6) reported study-specific
assessments.
Compassion. Compassion was assessed in
22% (n = 34) of the included articles. Selfreport surveys in cross-sectional designs
were the modal approach of these articles.
Assessments of emotional intelligence
constituted 20% (n = 7) of the assessments
of compassion, 6 of which also measured
empathy. The most frequently used
instrument for assessing compassion
was the Patient–Practitioner Orientation
Scale,163 a measure of patient centeredness
comprising two factors (caring and
sharing), reported in 6 studies.26,28,30–32,34
Altruism. Altruism was assessed in 7%
of the included articles (n = 11). This was
accomplished primarily using self-report
surveys developed specifically for the study
(see Table 1 for details). Ten of the 11
articles included assessments of additional
constructs associated with humanism.
Respect. Respect was assessed in 26%
(n = 40) of all included articles. Whereas 8
contained multiple assessment strategies,
17 used surveys. Most articles relied on
self-report data. The most common
instrument used for assessing respect
was the Patient–Practitioner Orientation
Scale.163 Most of the studies were crosssectional and used quantitative measures
(see Table 1 for details).
Empathy. Empathy was the most
commonly assessed construct, included in
62% (n = 96) of the articles. The articles
represent work conducted in 23 countries
(n = 51 conducted in the United States).
The approach most commonly used was
self-report survey. Seventy-three articles
used only surveys, and an additional 8
combined survey with another approach.
Just over 50% (n = 49) of the articles
used a form of the Jefferson Scale of
Empathy164 including versions in eight
languages in addition to English. The
next most commonly used instrument
to assess empathy was the Interpersonal
Reactivity Index165 in 5% (n = 8) of
articles. Assessment tools developed
specifically for the study reported and
having no published psychometric data
were used in 11% (n = 17) of the articles
assessing empathy.
Service. Assessments of service were
reported in 2.5% (n = 4) of the articles;
three of the four articles included
additional humanism constructs from
IECARES. The fourth article148 used
the Physician Values in Practice Scale
comprising scales for prestige, service,
autonomy, lifestyle, management, and
scholarly pursuits. Thus, none of the
articles assessed only the construct of
service. All of this small set of articles
contained data collected in the United
States.
Humanism. Humanism was assessed
broadly in 14% (n = 22) of the articles
included in this review. Less than half
(n = 8) of these used survey alone, and
45% (n = 10) used qualitative or mixed
methods for assessment. These studies
were conducted in seven countries, with
16 of the 23 conducted in the United
States.
Identity formation. Identity formation
as a humanistic physician was assessed
in 6% (n = 10) of the articles. Half of
the set used survey assessments, and half
used qualitative methods. Four of the five
surveys were developed specifically for
the study reported in the article.
For the entire set of articles, 67.7%
(n = 105) used only surveys as
assessment tools, and 13.5% (n = 21)
used multiple assessments. Likewise,
64.5% (n = 100) used assessments based
solely on the perspective of the students
(i.e., self-report), and 13.5% (n = 21)
included assessments from multiple
perspectives. Articles analyzing only
quantitative data constituted 74.2%
(n = 115), whereas 17.4% (n = 27) used
a qualitative approach. Mixed methods
were identified in 8.4% (n = 13). Designs
were predominantly cross-sectional
(69% [n = 107]), with only 31% (n = 48)
employing a longitudinal approach.
Discussion
Analysis at both the level of assessment
and article revealed a predominance
of surveys in this literature on
the assessment of humanism in
undergraduate medical education.
Notable exceptions to this pattern
were for the constructs of respect and
humanism. Articles assessing these two
constructs used analysis of reflective
writing and a combination of multiple
methods more than other constructs
examined in this review. Extending across
instrumentation was a preponderance of
quantitative measurement and cross-
Academic Medicine, Vol. 90, No. 11 / November Supplement 2015
sectional design. Although surveys
are an efficient method for gathering
information about large groups of
students, they are vulnerable to the
influences of social desirability bias. As
we consider the implications for the
assessment of humanism, it is necessary
that we balance the use of surveys with
other methods to check for congruence
across methods to judge whether
there may be bias resulting from social
pressures to be humanistic. The work of
Chen and colleagues135 comparing survey
results with observed behavior found
only a weak correlation. Assuming a
long-term concern with student–patient
interactions, medical educators must
investigate whether the relationship
between survey results and actual
interaction is strong enough to warrant
relying heavily on surveys as the current
literature does.
Some of the constructs embedded within
humanism have very little representation
in this literature; altruism and service
have been reported relatively infrequently.
It is not clear why empathy, compassion,
and respect have been examined
more frequently than other aspects of
humanism. It may be a reflection of the
availability of established assessment
tools (e.g., the Jefferson Scale of
Empathy). It is also possible that medical
educators consider these attributes
to be more amenable to educational
intervention.
The impact of this body of literature
is reflected in geographic diversity as
well as the large number of citations. It
is a vibrant area of inquiry conducted
in every region of the globe. Our need
for human connection in health care
transcends culture. This underscores the
need for authors to be attentive to issues
of validity. Although few articles were
coded as having threats to validity in both
categories (construct underrepresentation
and construct-irrelevant variance), most
assessments were identified as having
at least one of these threats. Rarely did
authors discuss validity unless the aim of
the article was to provide psychometric
data about an instrument.
Limitations
Our work represents an extensive
review of the literature from a limited,
albeit recent time period (January
2000–December 2013). We focused
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Review Paper
our analysis on the tools and types of
assessment methods employed, and
we did not analyze the validity of the
methodology related to the specific study
questions. We included articles published
only in English which may have restricted
the representation of some constructs
in our review. The analysis of articles we
undertook focused specifically on work
that described the assessment of medical
students, thereby potentially limiting
some of the assessment methods used.
Assessments of physician humanism from
the perspective of actual patients are more
often reported for physicians in practice.
Finally, we limited our analysis to articles
specifically describing humanism. Many
of the papers that we excluded from our
analysis addressed parallel or overlapping
concepts including professionalism,
ethics, or communication skills.
By using the IECARES framework as
an organizing principle for this review,
we accepted the assumptions that the
constructs are indeed part of humanism
and that there is benefit to examining the
constructs independently in addition to
a more holistic approach to humanism
assessment.
Implications for practice and
future work
We recommend that medical educators
employ a programmatic approach166
to the assessment of humanism. As
described by van der Vleuten and
colleagues,167 this approach strengthens
the validity of assessment by including
multiple methods and assessments from
multiple perspectives. This will provide
opportunities to more fully capture
the complexity of humanism and the
constructs embedded therein. Humanism
might be likened to a fine symphony, best
appreciated with a full complement of
instruments, melodies, and percussion. So
might humanism best be understood with
information from diverse perspectives with
a balanced view of the full complement
of IECARES constructs. We encourage
diversifying assessment by including
multiple perspectives of assessment.
Self-report can differ from the report of a
third party168 and both provide valuable
information to students and faculty.
In addition, we recommend that increased
attention be given to validity issues in
publications. Authors must be expected to
provide validity evidence beyond previous
S20
publication of an instrument. The use
of instruments developed for a specific
investigation was a common finding in
this literature along with the adaptation
of instruments without providing any
evidence of the validity in the context
used. Validity applies to the interpretation
of test scores in a particular context, not
to an instrument. Even instruments with
published psychometric properties cannot
be assumed to be valid in a different
context or if modified in some way.7,166
Another gap in this body of literature
that may be shaping our understanding
of humanism in medical education is the
paucity of longitudinal studies. Many of
the studies coded as longitudinal in this
review were of relatively brief time spans.
We can expect that students mature
over time and are shaped by cumulative
experiences. Longitudinal investigations
can provide valuable insight into the
nuances of the development or possible
loss of humanistic characteristics.
Fostering humanism among medical
students is essential to the quality of
health care and foundational for the
reform of medical education.169 We must
maintain high standards for investigating
and assessing this important and complex
phenomenon to ensure that educational
practice supports humanistic clinical
practice.
Acknowledgments: The authors wish to thank
Julie Trumble, MLIS, for her unfailing support
with literature searching; Julia Buck, MS, for data
manipulation and analysis; and the support staff
in the Office of Educational Development for
many forms of assistance provided throughout
the project.
Funding/Support: This project was made possible
with a Mapping the Landscape, Journeying
Together grant from the Arnold P. Gold
Foundation Research Institute.
Other disclosures: None reported.
Ethical approval: Reported as not applicable.
Previous presentations: Portions of this work
were presented at the International Association
of Medical Science Educators, San Diego,
California, June 2015; Association of American
Medical Colleges Southern Group on Educational
Affairs regional annual meeting, Charlotte,
North Carolina, April 24–26, 2015; Annual
Meeting of the Generalists in Medical Education,
Chicago, Illinois, November 2014; 11th Annual
Innovations in Health Science Education
Conference, sponsored by the University of Texas
Academy of Health Science Education, Austin,
Texas, February 20, 2015.
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