Physicians Benefit from Visual Arts

History

In prior centuries, physicians' training used to be more inclusive of the liberal arts. In fact, there have been a plethora of physicians historically, and today, who are also writers, musicians, poets, and painters. History also reveals the significant link between medicine and visual art. Bell and Evans comment: “The link between art, anatomy, and medicine has been well established for hundreds of years. During the 16th century, Leonardo da Vinci (1452–1519) produced a dossier of anatomical drawings, which are still admired today for their anatomical accuracy and intricate drawing technique.” ¹ In the article “Physicians as Painters,” Ohry described a long list of physicians as painters from around the world and through the eras—some of whom even left medicine to pursue their art. ² In an article on medicine and the humanities, Seggie states: “Luke the Greek physician, patron saint of artists, physicians, students and surgeons (and, interestingly, also of butchers), was an early physician/painter and the first painter of icons (including those of the Virgin Mary and child and Saints Peter and Paul).” ³

Today, however, a complex medical system emphasizing productivity can limit the focus of clinicians' educational training and even squash personal artistic pursuits. The good news is that the return of the arts in medicine is occurring, as educators, clinicians, and medical students recognize the need for and role of the arts in medicine. In fact, a recent online survey of nearly 740 medical students revealed that involvement in the humanities, including active exposure to literature, theater, music, and visual arts, was inversely correlated with burnout and associated with “positive personal qualities.” ⁴ Those qualities included empathy, tolerance for ambiguity, wisdom, and self-efficacy. Specifically, the survey authors noted: “…observing drama increases empathy, as does the performance of acting techniques; an elective course in medical humanities nurtures empathy; reflective writing may help improve medical students' well-being; drawing enhances the reading of faces; and observation of art improves the art of observation.” ⁴ The authors added, “Even good literature prompts better detection of emotions—all fundamental skills for a physician, although not prerequisites for medical school admission. Lastly, creativity, a quality we did not measure, has also been linked to a broad education and a multifaceted mind.” ⁴

Interestingly, in an article looking at the role of avocation on vocation, McManus et al. found that among 2,845 surveyed physicians, avocation and leisure activities such as drawing, painting, sculpting, playing an instrument, reading poetry, and many other activities correlated significantly with a greater sense of vocation and engagement. ⁵ The article quoted Osler as having said that physicians should, along with their vocation, have an avocation and “no matter what it is have an outside hobby.” ⁵

Medical Students and Art Museum Experiences

As part of their humanities curriculum, medical schools are including trips to art museums in order for students to observe and respond to artwork with the goal of enhancing their clinical skills. One article described an Art of Observation course, a collaborative course between the Department of Family Medicine at the University of Cincinnati and the Cincinnati Art Museum, which facilitated observational skills in medical students. ⁶ The authors commented that “Communication is a complex process, which depends on both verbal and nonverbal skills. In medical education, the verbal communication skills of question asking, listening, and talking are emphasized more, and often separated from, the nonverbal skill of observation. Even within the patient-centered model of care, talking and listening activities are stressed.” ⁶ The primary goal of the Art of Observation course was to improve communication and observational skills used in the patient–doctor relationship by guided instruction in observation, description, interpretation, and reflection of the visual arts. The eight-month elective course designed for second-year medical students included six sessions at the art museum observing and responding to artwork such as paintings, photographs, and sculptures; two discussion sessions at the university; and seven to nine sessions observing family physicians in their practices where students write and sketch observations of patients. The authors stated: “Many of our student participants noted that important components of communication were covered only in the Art of Observation course. The need for improved communication education in medical school has been highlighted in recent years, specifically noting that ‘Students develop communication skills by observing others and then practicing these skills.’ However, actually teaching students how to observe is not mentioned. Our course fills that gap for many students who take it.” ⁶

In fact, medical schools in collaboration with art museums around the world are working to create innovative programming using the visual arts to enhance students' and clinicians' communication skills. Katz described the benefits of visual arts training in three programs used at Harvard Medical School. ⁷ Katz said, “Each of these programs draws on Visual Thinking Strategies (VTS), which is an evidence-based, widely used method of museum art education that lends itself well to cross-disciplinary, immersive, and sustained learning.” ⁷ Katz added: “Art is simultaneously emotional and intellectual and allows the student to narrow the perceived wide gap between bioscience and human experience. Finally, art can take students out of their ‘comfort zone’; in the confines of the museum they can escape preconceptions, distance inhibitions, and minimize performance anxiety. The art museum provides a unique environment where participants can relax, share clinical stories, reflect on professional concerns, and collaborate with one another outside the pressing demands of a busy hospital.” ⁷

Some of the visual arts teaching approaches, however, may be adapted in the classroom/lecture setting if necessary. Bentwich and Gilbey described the benefits of a mandatory single VTS session—a 90-minute discussion of works of art—for first-year medical students as part of their humanities and ethics coursework. ⁸ This medical humanities course aimed to “encourage learners to look carefully, verbalize their observations and ideas, and interact with others regarding their interpretations of the images.” ⁸ The main goal of the session was to enhance students' visual observation and visual literacy. Results of a survey following the VTS session, which included two consecutive first-year student groups, showed that more than half of the students thought the session enhanced their acceptance of multiple possible meanings and their visual observation ability. In addition, 34% of the students thought that their ability to feel the suffering of others was enhanced. The authors commented: “Accordingly, works of art teaching, such as the case of VTS, is understood as potentially contributing not merely to visual literacy and visual diagnostic skills of students, but also to their ability for self-reflection, communication skills with patients (and colleagues) and an increased sense of empathy.” ⁸

The possibilities appear endless when it comes to creative approaches for engaging students and clinicians in the visual arts. Michael Flanagan, MD, assistant dean for curriculum and student affairs at the University Park Regional Campus at Penn State's College of Medicine, University Park, Pennsylvania, started a hands-on Impressionism in the Art of Communication course, where medical students actually paint and learn about the correlations between impressionism and the doctor–patient relationship. ⁹ On the Penn State Web site, Flanagan is quoted as saying, “We are working hard to develop and expand our focus on the humanities … and will hopefully create more humanistic and caring physicians in the process.” ⁹

Conclusion

It makes sense that engagement in the visual and other arts might lead to expansiveness in thinking and observations in the world, and in one's personal life. Now, emerging evidence suggests that the visual arts may also beneficially impact one's professional life. In a paper on the synergy of art and medicine, the author—a fourth-year medical student—commented: “I believe that the arts, more than any other human creation, truly reflect human life and the human condition, as they are vested with the real circumstances and emotional narratives of the artists who endow them with meaning. There are more writers and artists among physicians than in possibly any other professional field, because many practitioners realize that by synthesizing their experiences in the written word or canvas, they are richer for it.” ¹⁰

In the world of medicine, further innovation and research may increase the number of curricular offerings that draw from the arts in their teaching. Katz stated: “Compared to traditional didactics and clinical immersion, medical humanities have the potential for trainees at all levels to step outside their comfort zone, become open to new methods of learning, and access competencies in tangential ways that are not possible through the traditional medical school curricula.” ⁷    ■