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Essay: What can the arts bring to medical training?

2006; Elsevier BV; Volume: 368; Linguagem: Inglês

10.1016/s0140-6736(06)69909-1

1474-547X

Suzy Willson,

Innovations in Medical Education

There is clearly more to being a doctor than clinical expertise. In the UK, medical schools are recommended to ensure that students know about and understand the rights of patients, are able to communicate effectively, to accept the moral and ethical responsibility involved in providing care, and to respect patients irrespective of lifestyle, culture, beliefs, race, colour, gender, sexuality, disability, age, or social or economic status. These are excellent ideals, which raise complex questions that cannot easily be answered scientifically. The concepts—lifestyle, culture, even gender—have shifting meanings and are difficult to measure. So, how can they be taught? Over the past 5 years I have implemented a range of arts programmes in medical schools, delivered by cutting-edge contemporary artists and thinkers who are specialists in their fields. The aim is to get outsiders in, to cross cultures, to demonstrate that there are many voices at play within health care, and to benefit from different perspectives on the cultural context in which medicine takes place. I believe that arts can have a role in medical education in three key ways: practical skills; examination of cultural and ethical issues through the arts; and introduction to artists working in health. In conventional medical training, students do things to other people's bodies rather than gathering an awareness of their own. But charisma or bedside manner isn't something innate. A person can improve. An understanding of the practical skills of voice, body language, and use of space can make a huge difference to the way doctors communicate and perhaps even to the way they diagnose. Training methods common to performance can bring confidence to students, many of whom are nervous of interacting with patients. Physical awareness and exercise can help students build up the skills and stamina they need to sustain a work practice that is highly demanding. There is so much well-deserved focus on patient-centred practice, but the physical and mental well-being of the health worker should not be ignored. My approach to teaching practical skills to medical students is not to apply them immediately to a clinical context. Possibilities of learning should be opened up before skills are honed to suit specific scenarios. For example, students might experiment with tones of voice by working on a dramatic text with a voice coach before applying these skills to a context of breaking bad news. Non-verbal communication can be taught in a physical theatre class, allowing students to experiment with wildly inappropriate and ridiculous ways of behaving so that they eventually find a flexibility and physical openness that can be adapted to a range of possible scenarios. Appreciation and interpretation of narrative can be developed in literature classes. Anatomy courses can be complemented with dance, yoga, life drawing, or state-of-the-art body imaging, inspiring students about the landscape of the body, bringing the science to life, providing students with physical and visual ways to remember information. The body can be enjoyed and respected as poetic, beautiful, rich in possibility, ready for change and transformation. Obviously, medicine always takes place within a cultural and ethical context. Treatment of someone in a war zone is very different from a consultation in a family doctor's surgery in a safe suburban area. Doctors need to be able to relate to people from whom they feel culturally different. The more knowledge that can be bought to bear on the rather abstract concept of respecting patients irrespective of their lifestyle, gender, and so on, the better. Arts can provide a colourful and provocative platform from which to examine ideas of identity, control, sexuality, and ownership, a platform that actually embraces subjectivity. A look at photographic theory can address the ways in which we see. The work of Susan Sontag, John Berger, and Jo Spence can help students to refine their judgments in the visual domain. An examination of medical photography itself sheds light on how a medical gaze has been constructed and reveals tensions in the doctor–patient relationship, especially in terms of power; photographs of 19th century psychiatric hospitals are an interesting example. Contemporary performance artists such as Franko B, Ron Athey, and Orlan cause controversy by taking control of their bodies using surgical techniques unsanctioned by the medical profession. Some medical students are horrified by artists who use their own bodies in extreme ways, such as by bleeding themselves. For students to see these images outside a medical gaze is interesting, to read them instead within a cultural context, as a response to the devastating cultural discourse around AIDS and HIV, for example, rather than as self-harm or abuse. These artists provoke questions. Who has control of our bodies? Who is allowed to do what to whom? These questions are highly charged; they are of concern to patients, to policy-makers, and to hospital ethics committees and therefore important to medical students. Carravagio's The Incredulity of St Thomas caused a furore in its day by depicting Thomas poking his finger into an open wound on Christ's body. The painting still raises controversial questions about intimacy and eroticism, which are relevant to medical students trying to establish a safe, respectful relationship with patients. Images by Vesalius and Rembrandt provide a platform from which to discuss dissection and the role of the physician. Has the 19th century idea of a "necessary inhumanity" developed into a tacit acceptance of detachment within the medical establishment? What does detachment mean exactly? These thorny questions need to be asked afresh in each generation. Arts can provide a lateral, reflective way of learning, important to a student population who are outcome oriented. In my experience, medical students seem shy about challenging received ideas or criticising each others' opinions. This is a shame. Science was, after all, born from a spirit of inquiry and to critique a profession you intend to enter is to invigorate it rather than to undermine it. Some students will inevitably be resistant and worry how to apply these ideas. But to measure all learning by its usefulness in a clinical scenario is reductive. Medicine is not an objective pure science. Students need help to nourish the parts of medicine in which subjectivity is inevitable and indeed useful. By introduction of students to the many ways that artists can collaborate with health-care professionals, perhaps arts work will become more widely embraced within the health-care system. Since this is a relatively new and burgeoning area of work, it is difficult to assess the extent of the part arts might play and the possible influence on medical outcomes. A broad palette of work is being undertaken that not only improves the environment in which health care takes place but also finds a new language with which to discuss health, often empowering patients to feel visible at a time when their sense of identity is fragile. Deborah Padfield's work on chronic pain, Rosetta Life's work with patients in hospice care, and People's Palace Project's work in the Brazilian prison system raising awareness of HIV/AIDS, are all pioneering projects that collaborate with health-care workers to provide better care and information. Bobby Baker's collaboration with psychologist Richard Allam resulted in the critically acclaimed performance "How to Live", an affecting testimony and urgent alarm call to the sometimes brutalising ways the medical establishment treats people who have mental health problems. These are just a few examples of excellence that come under the broad heading of arts in health. In the target-driven, evidence-based culture of medicine, arts work within the UK NHS is interrogated for being a potential waste of time and money; this goes for medical training also. The proliferation of arts work in medical schools relies on the willingness of staff to collaborate with artists and arts departments, as well as a commitment from medical schools to rethink ways to access a packed core curriculum. In my experience, the desire to collaborate is there. These are exciting times. Art can help doctors develop the skills required to touch, to listen, to see, and to hear, encouraging students to challenge, subvert, and question institutional hierarchies, to ask the question "Who am I looking at and how am I looking at them?". Artists can provide students with valuable insights into human experience and difference, challenging them to think seriously about the aesthetics of medicine, helping to restore a sense of dignity to a profession that feels somewhat beleaguered. Of course, this style of learning will not be to everyone's taste but, in my experience, students are remarkably open, eager to talk and experiment, and relieved to have a space to reflect on their chosen profession away from the varying pressures of the lecture theatre, ward, or pub. And perhaps this is one of the biggest responsibilities we have to medical students—actively to encourage them to nurture their curiosity and enthusiasm for medicine and avoid the cynicism and defensiveness so deadly to any institution or profession. We need many strategies to inspire future doctors to be rigorous, vital, creative, respectful, healthy, and engaged human beings. Suzy Willson is the Artistic Director of the theatre company The Clod Ensemble and an Honorary Senior Lecturer at Bart's and The London, Queen Mary's School of Medicine and Dentistry. She is currently Director of the Performing Medicine Project, which programmes arts workshops, courses, and events for medical students and health-care professionals. Suzy Willson is the Artistic Director of the theatre company The Clod Ensemble and an Honorary Senior Lecturer at Bart's and The London, Queen Mary's School of Medicine and Dentistry. She is currently Director of the Performing Medicine Project, which programmes arts workshops, courses, and events for medical students and health-care professionals. Feature: Medical interventions—visual art meets medical technologyArtists have had an experimental romance with science for centuries, unravelling its complexities to form new taxonomies with which we can organise and relate to our world. Nowhere is this relationship more evident than in the countless historical and contemporary representations of the human body. During the late 19th and early 20th centuries, the dominance of the body in post-Renaissance art was challenged by a shift from figurative representations to dehumanised depictions of the body in conditions of disintegration, decay, or deformity. Full-Text PDF