Journal for Learning through the Arts

This special issue of Journal for Learning through the Arts focuses on the uses of literature and arts in medical education. The introductory article addresses current debate in the field of medical humanities (MH), namely the existential question of what is the purpose of integrating humanities/arts in medical education; and then examines how the submissions included in the issue illuminate this conversation.  Specifically, I frame the discussion as critiques of models of acquiescence in medical education contrasted with calls for medical educators employing the humanities to adopt models of resistance. After deconstructing some of the arguments against models of acquiescence, and examining both examples of resistance and acquiescence included in this issue, I conclude that the dichotomy, while in some ways providing valuable insight into the various ways humanities and arts can be understood within a medical context and the various uses to which they can be put in medical education, nevertheless does not do justice to the complexity of actual medical humanities teaching experience.

Abstract: Developing and nurturing empathy in medical trainees has been recognized as an essential element of medical education. Theater may be a unique instructional modality to increase empathy training.

Methods: A multi-disciplinary team developed a theater workshop for first year medical students.  Through the use of theater games, art images and reflective writing, the workshop was designed to enable students to: 1) consider the concept of empathy within the context of theater; 2) experience art, theater and narrative as reflective tools to build empathy /self-reflection. The workshop was evaluated by students through a written questionnaire. It was evaluated by faculty and actors though narrative dialogue. The faculty and actors shared their perceptions about 1) students’ ability to demonstrate empathy through a written narrative based on an art image;  2) students’ use of reflection as part of empathy awareness; 3) students’ ability to demonstrate awareness of body language and emotion as diagnostic and clinical tools. The student questionnaire surveyed the 1) overall quality of the session; 2) ability of the session to help students understand the importance of body language in the doctor-patient relationship; 3) the effectiveness of actors in stimulating discussion about empathy, body language and communication in the doctor-patient relationship.

Results: A description of the workshop’s content is described at length. Medical faculty and actors’ narrative comments reflect their positive perceptions of the workshop’s ability to promote empathy through the use of theater /narrative. Medical students evaluated, with less enthusiasm, the effectiveness of the actors in stimulating discussion on the role of empathy, body language and communication.

Discussion: The workshop provided an innovative method to foster empathy in medical students.  Faculty and actors’ narrative comments were positive overall, as they commented on the importance of helping learners build skills in self-reflection and empathic communication. Mixed student feedback indicates the challenges in teaching clinical empathy and the diversity of students’ personalities and learning styles. Inadequate faculty development and the number of activities included in the session may have contributed to the discrepancy between faculty and student perceptions of the workshop.

Forum Theatre (FT) was created by Brazilian theatre director Augusto Boal (1985) as an approach for promoting dialogue between the audience and those performing on stage for his “Theater for the Oppressed.” FT offers an accessible, interactive approach to exploring challenging topics and situations.  In FT, a short scene is performed.  It is then replayed again and again with audience members invited to intervene and offer different options for addressing various aspects of the problematic situation.  Originally directed to helping people address and transform oppressive conditions that characterized their lives, FT has evolved and found expression in many different communities and contexts, including health professional education.  Inspired by David Diamond’s (2008) “Theatre for Living” model (which approaches living communities as a complex, living entities), we introduced FT in the “Introduction to Medicine & Dentistry” (DMED 511) course offered as part of the Undergraduate Medical Education program in the Faculty of Medicine & Dentistry (FoMD).  In this article, we describe how we have successfully engaged first year medical and dental students in discussion and critical reflection of professionalism issues relevant to their experiences of small group learning using FT.

Theater of the Oppressed (TO) is used in a variety of setting and communities to explore ways of recognizing and overcoming oppressions. The main purposes of TO is to become more critically aware of oppressions and power relationships, to rehearse alternative solutions for real life, and to ultimately to be able to make change for social justice. This article describes the use of TO in a baccalaureate nursing education classroom as a way to rehearse for real life situations, confronting the status quo, experience positive communication techniques for empowered thinking, and practice their role as change agents within the healthcare arena. The methods of "cops in the head," "forum theater," and "image theater" will be described along with a discussion of how these methods were used in a community health nursing course. Although the examples provided here are specifically for a nursing class, they could be used in any health related field with potential to transform healthcare and ultimately to improve the care experience of patients from the most vulnerable populations.

The aims of this report are to highlight the shortcomings in medical education. To use a student made short film as an example of how issues that cause medical student distress can be displayed. To show that the process of film-making is a useful tool in reflection. To display that film is an effective device in raising awareness.

A vast literature exists on teaching reflection and reflective practice to trainees in small groups, yet with few exceptions the literature does not address the benefits of these interactions to faculty. Like multiculturalism or cultural competency, the literature assumes that faculty have themselves “achieved” these propensities and that trainees are the only recipients of the benefits of such inquiry. One of the noticeable exceptions is Arno Kumagai and colleagues’ article, “The Impact of Facilitation of Small Group Discussions on Psychosocial Topics in Medicine on Faculty Growth and Development,” which found that small group teaching stimulated not only students’ personal and professional growth, but also that of the faculty themselves. Our intent is to continue and enlarge the questions posed in this important article. Specifically, this inquiry focuses on the meanings that clinical faculty derive from teaching medical students in discussion- and reflection-driven small group formats. Why do faculty leave the comfort zone of clinical teaching and take time away from income-generating patient care activities? What is it about this teaching experience that calls them back each year?

In answering these questions, we conducted a qualitative study consisting of interviews and focus groups with 11 clinical faculty participants who teach in Reflections on Doctoring, a required, longitudinal course for medical students. The data of our study provides insight into the thoughts, attitudes, and motives of our faculty who not only view themselves as teachers and mentors, but also as co-learners who engage personally with the medical humanities content being taught. They confront, reveal and resolve challenges presented by literary perspectives and find enjoyment and sense of purpose in teaching non-jaded medical students. Furthermore, what emerged from our study was a deeper understanding of what inspires our faculty to sacrifice their time and effort to facilitate medical humanities discussions with young medical students and how this experience contributes to the ongoing development of their own professional identities.

A course was designed for medical students in which literature and writing exercises were used to promote reflection on cross-cultural patient encounters. Students were encouraged to consider Kleinman’s principles of open-ended questioning as the basis for enhancing these patient conversations and were prompted to develop skills in close reading of texts, specifically recognition of the reader’s response to narrative, understanding of point of view, and recognition of the impulse to create story, or plot. Transcriptions of class discussion and material from written essays were used to inform the instructor’s understanding of learners’ progress. This study may offer a new conceptual lens for viewing ways in which cultural competency and other features of physician-patient communication may be taught using narrative skill training. When anchored to exercises in reflective writing, student learners develop a framework with which to view and interpret their patient stories.

Humanities in medicine (HIM) is an important aspect of medical education intended to help preserve humanism and a focus on patients. At the University of Massachusetts Family Medicine Residency Program, we have been expanding our HIM curriculum for our residents including orientation, home visit reflective writing, didactics and a department-wide narrative writing list serve. In this article we describe the program and our early assessment of the curriculum.

While JJ was a medical student, the authors worked on a two-part study of the stories of “good death” as they were told by palliative care patients, caregivers, physicians and nurses. In this personal reflection, de Jong (JJ), now a family practitioner and Clarke (LC), an artist and educator in medicine and health care, consider the value of such “story work” in the development of key skills for a physician. While this is the experience of two individuals, the conclusions have relevance for those engaging in story work within the context of medicine, medical education and the health care community.

A group of nursing, social work, education, and English faculty worked together for a year to explore how literature experiences designed for medical education might enhance professional preparation in their fields and address their common dilemmas of caregiving. The resulting insights reveal the ways in which adaptations of narrative medicine models offer benefits for students in these “caring professions.” They also indicate the promise of interdisciplinary reading experiences among students from these fields and suggest how these frameworks might address their common challenges of burnout and erosion of empathy in early clinical experience. This “open letter” to future students who will participate in an interdisciplinary reading group describes the challenges facing the professions of nursing, social work, and education, and explores the ways that doing narrative work together will prepare students to meet them.

Art of Analysis (AoA) is a cooperative effort of the Ohio State University College of Medicine (OSUCOM) and Columbus Museum of Art (CMA) aimed at medical students who are participating in learning communities, groups formed in pre-clinical medical student education to emotionally support and encourage students through the arduous process of medical training, to develop critical thinking skills; engender empathy; increase tolerance for ambiguity; build team problem solving abilities; and consider multiple perspectives through the observation of artwork. While several medical education institutions in the past have described similar programs, AoA uses a unique critical thinking strategy called “ODIP” (Observe, Describe, Interpret, Prove). Group participants include medical students, the learning community faculty (faculty members from OSUCOM) and CMA educators who facilitate and direct the AoA program. The groups set expectations before the program, emphasizing the goals and objectives of the program. Students then use the ODIP strategy to interpret one work of art as a group before they individually venture into the galleries to find artwork that answers a question posed by facilitators. Students present their theories and defend these ideas in a group discussion format during the two-hour program. The formalized ODIP process provides a framework for students to express their ideas, and by utilizing learning communities create an opportunity for openness and discussion that may not exist between new acquaintances participating in the AoA program de novo. The ODIP strategy is not unique to the AoA program but has been developed by CMA in its efforts to aid critical and personal interpretations of artwork. It is designed to apply to various learners, and is easily applicable to the adult-style learners with varying backgrounds unique to medical training. It is the goal of the AoA program to create abilities in teamwork, tolerance of alternate ideas, an empathy particular to the visual arts, and critical thinking skills. Correlation between the AoA program and ODIP format can easily be made with medical rounds and the process of developing a differential diagnosis as healthcare continues to transition into a more inclusive, multi-disciplinary team approach to health and disease prevention. The AoA program at CMA serves as an important tool in the education of physicians at OSUCOM, helping in the development of skills essential to the clinical practice of medicine.

According to the American Board of Family Medicine, “The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.” What makes the seemingly daunting task of practicing family medicine possible is that family physicians learn to utilize similar clinical reasoning for all of their patients regardless of age, and that they care for patients in the context of their families. In our work with residents, we utilize a multimedia presentation that incorporates poetry by Shel Silverstein, the song, He Was Walking Her Home, by Mark Schultz, and the Pixar/Disney movie, Up, to help teach these concepts and demonstrate how caring for multiple generations simultaneously enriches the care of each generation.

Practicing medicine and creating art are both informed by observation and perception, yet how artists and doctors view the world and their place in it might be quite different. By bringing two populations together – RISD students and Warren Alpert Medical School students – into one experimental course, “No Innocent Eye: Knowledge and Interpretation in Art and Medicine,” art and medical students were asked to engage in topics and work with skills and processes that might not be considered typical fare in art and medical school curriculums, but which we hope gave doctors-in-training creative ways of rethinking medical practice and patient care, and presented art students with new conceptual and material tools to push their art-making.