Contemporary Art and Education of Medical Students: Beauty and Truth
Diagnosing and treating a patient's illness is many times a challenge which is not easily solved with a snap judgment but requires the doctor's attention to a sequence of important considerations and actions. There is importantly the observation followed by the interpretation of what has been collected in terms of the patient's history, the physical examination of the patient and the diagnostic tests performed. Sometimes, this collection of data is complex, intertwined and frankly ambiguous and confusing. But there may appear after further contemplation and perhaps after consulting with other professionals a pattern which will direct the doctor to make the correct diagnosis and follow with the appropriate treatment. But how is the detection of patterns taught to medical students and physicians?
Many medical schools have incorporated experiences with representational or figurative art into the curriculum in an effort to improve learners' powers of observation, visual diagnostic skills, and pattern recognition skills or to enhance communication skills, foster teamwork, and/or improve empathy. The Keck School of Medicine of the University of Southern California has partnered with Los Angeles' Museum of Contemporary Art to design an educational experience with the goal of honing students' abilities to observe, describe, and interpret complex information. The authors discovered that through a constructivist approach to viewing and discussing nonrepresentational, contemporary art, students were able not only to apply their observational and interpretive skills in a safe, nonclinical setting but also to accept the facts that ambiguity is inherent to art, life, and clinical experience and that there can be more than one answer to many questions. This intervention, entailing extensive guided inquiry, collaborative thinking, and process work, has allowed students and faculty to reflect on the parallel processes at work in clinical practice and art interpretation. In patient encounters, physicians (and physicians-in-training) begin with attention and observation, continue with multiple interpretations of that which they observe, move to sorting through often ambiguous evidence, proceed to collaboration within a community of observers, and finally move to consensus and direction for action. In the worlds of both art and medicine, individuals imagine experiences beyond their own and test hypotheses by integrating their own prior knowledge and intuition and by comparing their evidence with that of others
Another way of looking at the value of such teaching is from the philosophical point of view and consider aesthetics, the beauty of a painting as a reflection of some truth. By analyzing the painting and exploring its beauty, the truth will most likely be apparent. When treating a patient, the doctor should always look for the truth. Isn't that a truism? ..Maurice.
Graphic: "Astigmatism" created by me using ArtRage 10-4-2011.
posted by Maurice Bernstein, M.D. @ 2:43:00 PM
5 comments
5 Comments:
The question is whether or not this form of didactic actually improves clinical thinking. I have no idea whether or not it does, but there are some simple ways to test the theory, and any medical school that wants to bring these innovations to its curriculum should probably test them. (Indeed, the medical schools should be testing even traditional forms to evaluate their effectiveness.)
I have no real objections to this experiment, but I do wonder why one has to switch fields in order to make the point that data interpretation is a complicated and ambiguous process. Why not simply take a difficult M & M-style case where there are genuine disagreements among faculty with different perspectives and discuss them in front of the students? I'm sure right now you'd get a very hot discussion going between urologists and internists about the recent USPSTF recommendations to stop using the PSA. Students would see that the data interpretation is filled with nuance even if everyone agrees that the numbers themselves are sound (and, of course, sometimes statisticians and whatnot don't agree on that). It's possible that the message may subconsciously sink in better through discussions of art, but I'm skeptical, particularly since there will be a fairly large slice of students who will think Art Time is so much more New Age nonsense, and that they can't be graded on it, anyway. Best, Billy
The question of whether the experience improves clinical thinking is valid and a topic we hope to pursue in the future, although this is only one aspect of the sessions. The intent is not to point out ambiguity in data interpretation but to discuss the process of understanding and dealing with ambiguity in a safe environment, removed from the stresses of the clinical situation where students often struggle with getting a “right” answer. The process avoids the usual medical school didactic format and emphasizes interactive discussions.
The message is not a subconscious one, since it is openly discussed from the reading of objectives at the beginning, through experiential activities, as described in the paper, to a group discussion at the end. With regard to a misperception of the experience as “New Age nonsense,” this has not occurred. The students choose to participate, and doubters at the beginning of the sessions have had a change in attitude by the end. This is one of many experiences from which students may choose, and it has become one of the most popular. Bob
Bob--
First, if I've caused offense by implying that I think the course is "New Age nonsense", I regret the use of the phrase and apologize forthwith. As is my wont, I was just trying to be colorful with my language, though I fear I've just come across as the kind of snot that used to exasperate me when I was a lowly med student.
That said, my overall concern is that the purpose of med school is to train doctors of medicine, and in a period where there is ever more medicine to know and understand, curriculum time becomes likewise more precious. What kind of docs should we be trying to produce? Well, I'd say humanists as much as dispassionate scientists and clinicians. (What is meant by "humanist" is a topic worth discussing, but for the moment I'll assume that we have some vague level of agreement as to its definition.) But how to train a good humanist? I don't pretend to know the answer and so I don't want to cast aspersions on the genuinely creative people who are willing to try unorthodox methods such as this class. As I've moved up the ladder in my medical school (still only junior faculty, so somewhere in between being a med student and a Grand Old Man) however, I've felt that there are ways where one can "discuss the process of understanding and dealing with ambiguity in a safe environment" while still explicitly discussing matters that relate to medicine.
I'm certain that a group reading of Susan Sontag's "Illness As Metaphor" would generate a lot of differing viewpoints as to its significance, as would a reading of Abraham Verghese's "My Own Country", or a viewing of the heartbreaking Japanese film "1778 Stories of Me and My Wife". These could all accomplish the objectives you describe, and are sufficiently removed from the direct responsibilites of the classroom or the wards such that students shouldn't worry about getting "right" answers. Needless to say, these sessions wouldn't be in a traditional classroom format and would emphasize interactive discussions--but it would still be about medicine.
One other question: you state that "the students choose to participate". Do you mean that the students choose to participate in the discussion, or that the seminar itself is optional? If the latter, its success may only be an indication of the kind of student drawn to it in the first place, in which case the class may be successful, but only for the kind of student predisposed to meet its objectives.
Best, Billy
Billy--
You have caused no offense at all, and I don’t mind colorful language. Your comment does express something that needs to be addressed in the academic community. Quantitating the results of such experiences is a difficult task and one that is being addressed by educators working in the field.
Of the three facilitators of our group discussions, one is an art educator, one a physician with strong interest in literature and narrative, and one physician with strong interest in visual art and perception. We frequently bring up clinical correlations and clinical examples from our own experience during the sessions. In the paper, including in the section on Logistics and Progression of Learning Activities, there are references to the clinical situation.
Our overall medical humanities approach at the school also embraces literature, including that of the writers you mentioned and others, such as Chekov and William Carlos Williams. Abraham Verghese has spoken at our school. We have a student and faculty book discussion group, a student, faculty and staff art gallery, an optional 5-session “selective” on medicine and the arts, a student group playing music for patients at our cancer hospital, and other humanities based experiences.
You commented that the kind of student predisposed to meet the objectives contributes to the positive outcome. This is true, but many students participate in these activities, and all do at least some writing about their personal experiences in learning to be doctors.
Bob
Pertinent to this discussion is the paper by Ousager and Johannessen titled "Humanities in Undergraduate Medical Education: A Literature Review" published in Academic Medicine, June 2010. The Abstract of the paper follows:
Purpose: Humanities form an integral part of undergraduate medical curricula at numerous medical schools all over the world, and medical journals publish a considerable quantity of articles in this field. The aim of this study was to determine the extent to which the literature on humanities in undergraduate medical education seeks to provide evidence of a long-term impact of this integration of humanities in undergraduate medical education.
Method: Medline was searched for publications concerning the humanities in undergraduate medical education appearing from January 2000 to December 2008. All articles were manually sorted by the authors. Two hundred forty-five articles were included in the study. Following a qualitative analysis, the references included were categorized as “pleading the case,” “course descriptions and evaluations,” “seeking evidence of long-term impact,” or “holding the horses.”
Results: Two hundred twenty-four articles out of 245 either praised the (potential) effects of humanities on medical education or described existing or planned courses without offering substantial evidence of any long-term impact of these curricular activities on medical proficiency. Only 9 articles provided evidence of attempts to document long-term impacts using diverse test tools, and 10 articles presented relatively reserved attitudes toward humanities in undergraduate medical education.
Conclusions: Evidence on the positive long-term impacts of integrating humanities into undergraduate medical education is sparse. This may pose a threat to the continued development of humanities-related activities in undergraduate medical education in the context of current demands for evidence to demonstrate educational effectiveness.
This review of the literature confirms what both Billy and Bob have advised. The value of this medical educational adventure into the art and literature should be documented by statistical studies as effective toward meeting the professional goals. Apparently, to date, this has not been satisfactorily accomplished. Though, another view would be that voluntary exposure of medical students to art and literature could be simply looked upon as a pleasant gift, a respite from the trials and tribulations of a daily medical education. And that certainly would be a "humanistic" behavior toward the medical school's students. ..Maurice.
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