Teaching Medicine through Art

The ability to tolerate uncertainty can make a good physician great, but medical school traditionally has not taught students how to develop that ability. Physicians often work without having a clear answer and must make decisions under the pressure of uncertainty, but medical students are given multiple choice tests or clinical cases that have a right or wrong answer. This can create a false sense of appreciation of clinical reality among students, says Deepthiman Gowda, MD, associate professor of medicine until he left VP&S earlier this year to become assistant dean for medical education at the new Kaiser Permanente School of Medicine in California.

A new study by Dr. Gowda proposes a solution, which suggests that training students to tolerate uncertainty should be done within the walls of a museum instead of a medical setting. “Art allows us to grapple with ambiguity. Paintings are dynamic, complex, and can continually be discovered. They act on the observer in emotional, social, and intellectual ways.”

Dr. Gowda studied the progress of 47 medical students enrolled in an art course from 2014 to 2017 as part of the VP&S narrative medicine selective requirement for all first-year students. During the six-week course, students visited the Metropolitan Museum of Art on a weekly basis. One of the first objectives of the course was to train the students to slow down and appreciate details to help them develop the skill of close observation. In discussion groups, students shared their observations and listened to those of their peers, acknowledging the limits to what each of them can see. “Our perceptions and observations are affected by our own biases and histories,” says Dr. Gowda. “Just because you see something doesn’t mean you’re looking closely. By asking our students ‘what else do you see?’ we can show them that observation is a tool to be harnessed.” 

To assess the impact of the course, students were given the Groningen Reflection Ability Scale for reflective ability, the Tolerance for Ambiguity Scale for ambiguity, and Best Intentions Questionnaire for personal bias awareness. In addition, the students participated in focus groups to explore their experience with the course. The data collected over four years suggest a notable improvement among the students who participated in the course, including a statistically significant improvement in GRAS scores. Through the process of looking at art and having conversations about their experience of viewing art, students became more reflective than they were before.

In their evaluation of the course, students noted that the course helped them to better perceive easily missed details, taught them how to describe elements that first seemed indescribable, heightened their curiosity, and encouraged them to be more aware of their surroundings. Students realized how they can directly impact what they are perceiving whether by thoughts or emotional state. In addition to noting the professional value of the class, most students included in their evaluations something Dr. Gowda did not anticipate: self-care. The students referred to the class as a place for restoration where they can deeply connect to their classmates, and one student described the course as a healing “sanctuary.” Given the rates of burnout in the medical field, these attributes can build resilience among students and create for them a healthy and flourishing training environment, says Dr. Gowda. 

Also offered through the narrative medicine track, which infuses medical education with humanities, are courses about narrative in film, fiction writing, philosophy, and dance to better understand how people express themselves through their bodies and movements. “Bringing the humanities back into health care training helps to develop our students in a more holistic way as thinkers and observers,” says Dr. Gowda. “Humanities and science are not two separate worlds; creativity is a part of being a clinician.” – Avichai Assouline