University of Alberta, Edmonton, Canada
Shirley Serviss, Artist on the Wards, 2011
Medicine is frequently described as both an art and science, with science focused on objective, technical knowledge (competency, or cure) and the artistic elements focused on the human side of medicine (empathy, or care). Herman (2001), among others, has suggested artistic and scientific activity converge, suggesting that “when an artist makes a penetrating observation, it often foreshadows a more formal one by a scientist and when science completes a convincing demonstration it can have the same aesthetic appeal as a work of art” (p. 42). The increasing presence of the arts in medical education suggests a need to explore how the arts can help students learn about the inherent artistry of medicine.
Rodenhauser, Strickland, and Gambala (2004) conducted a survey of medical schools in the US and found that over half of those that responded reported offering curricular or cocurricular arts-based learning opportunities. Recent articles have also identified the increasing presence of the arts in Canadian medical schools (Kidd & Connor, 2008; Cox, Lafreniere, Brett-MacLean, Collie, Cooley, Dunbrack, & Frager, 2010). Complementing this trend, there is increasing interest in exploring links between art, health, and well-being (Staricoff, 2004; Stuckey & Nobel, 2010), including the positive contributions of aesthetic environments and arts programs in healthcare settings (e.g., Daykin, Byrne, Soteriou, & O’Connor, 2008).
Medical students typically appreciate their physician preceptors as having the most to teach them about becoming doctors. But clinical shadowing electives sometimes expose students to a configured view of patients as a set of symptoms requiring a diagnosis, rather than viewing a patient as a whole person. This is not always the case, of course. Many preceptors are inspiring role models who are mindful and receptive, honoring patients’ stories of illness and helping students learn to apply medical science in relationship to a person. However, in the midst of a pressured, hospital environment, we wondered what medical students might learn from other members of the healthcare team. In particular, we wondered what artists working with patients on hospital wards might teach medical students about the art of medicine.
Based in Edmonton, Alberta, the Friends of University Hospitals is a charitable fund-raising organization that is dedicated to enhancing patient care in three local hospitals. It is recognized as having developed one of the leading arts and health programs in Canada (Pointe & Serviss, 2008; Cox et al., 2010). Through its “Arts in Healthcare" program, the Friends’ organization manages: 1) a permanent art collection of 1,400 pieces; 2) special arts projects and installations throughout the linked hospital sites it serves; 3) special exhibits in the McMullen Gallery, located on the main floor of the University of Alberta Hospital; and 4) a drop-in art studio available to hospital patients, staff, and visitors once a week.
In addition, the "Artists on the Wards" program offers patients the opportunity to engage in art-making and creative expression at the bedside. Supportive and caring artists (professional and volunteer) encourage and facilitate patients’ self-expression by visiting with them one-on-one. Together they make music, create art, share stories, and enjoy poetry; patients are encouraged to keep journals. Through the course of the visit, many patients begin the process of translating their anxiety, pain, hopes, and dreams into art, writing, and poetry. These activities have many beneficial impacts, including helping to comfort and ease patient distress.
Building on the success of these earlier collaborations (Brett-MacLean, Casavant, & Young Kennedy, 2010), we discussed the possibility of providing our medical students at the University of Alberta with an opportunity to learn about the many intersections between the arts and medicine. In 2010, we introduced a 12-hour “Shadowing Artists on the Wards” elective for first- and second-year students. This program was a unique collaboration between the medical school’s Arts & Humanities in Health & Medicine program and the Friends of University Hospitals in Edmonton. It has also been a success, enjoying slow but sure growth.
How is the program organized? To begin, it is emphasized that student participants need not demonstrate previous experience, skill, or talent in the arts; students are simply expected to actively work alongside the Friends’ staff artists. As a flexible, interprofessional shadowing elective, the course provides medical students an opportunity to learn about: 1) the role of artists who work in healthcare settings and various approaches used to incorporating the arts into healthcare environments and delivery of care; 2) the benefits of the arts in healthcare, including ways in which the arts enhance the hospital experience and healing process for patients and staff.
After their one-hour orientation, medical student participants shadow one or more musicians or visual and literary artists and actively participate with artists and patients in creating art. At the end of the 3-month elective, the students develop a short bibliography and a reflective essay, which is shared as part of a group discussion involving the students, artists, and elective coordinators. A pass/fail grade is assigned; students are also encouraged to complete a feedback form that will help the facilitators to improve the experience for other students.
In the current academic year, we have arranged to have both fall and winter “student orientation” sessions, with a maximum intake of six students per term. In previous years, we have had only one intake of students. When we first piloted the elective in 2009/2010, two of three students who signed up for the elective completed it. In 2010/2011, four of six students completed the elective. The number of students we are able to accommodate is limited by the number of artists available and the need to match their part-time schedules with the students’ busy, full-time schedules.
A patient creates art during a visit with an Artist on the Wards, 2011
What we have found is that students who sign up for the elective also sometimes shadow physicians in other settings (on clinical wards and other community health settings) and so do not need to complete the elective to satisfy their required elective hours. Some of these students have shared that they overcommitted themselves and could only manage to spend a few hours with the artists, which they still found to be a valuable and satisfying investment of time. What is impressive is that the students who have completed the elective have expressed being very satisfied with their elective experience (in 2010, an average satisfaction rating of 4.3/5; in 2011, 5/5).
Over the past two years, most of the students have shadowed three or four artists (covering all of the arts disciplines—music, literary, and visual arts) over three to four sessions. They experienced both individual and group art-making sessions alongside the artists. Comments shared during our debriefing discussions suggest that art-making provided a sense of freedom from the medical “mask” and expectations associated with wearing a “white coat,” which helped the students to connect meaningfully with patients. Through the process of making art, medical students became more confident in gaining insights into the personal lives of their patients. Alyssa Cruz (currently a third year medical student) completed our Shadowing Artists on the Wards elective in our pilot year. She shared the following:
I thought this shadowing experience would be of value to me, as creativity, art, and the power of the written word have all played important parts in my decision to become a physician. I had an interest in drawing and literature prior to medical school, but quickly found that the rigorous curriculum didn’t leave much room for me to enjoy the creative facets of myself anymore. Also, I feel that nurturing “that something extra” might be helpful in how I interact with patients—being human before being a professional. For me, witnessing the kind of relief a poem brought to a patient that seemed inconsolable and unreachable was priceless. Connecting with a patient over poetry or stories shifted my focus and the patient’s focus from them as a sick patient, to them simply as a person. I think that’s often forgotten in the hospital—nurses forget, doctors forget, even patients themselves seem to forget that patients are people first, and that requires a connection beyond a clinical history, diagnosis, and discussing treatments. Shadowing an artist from the “Artist on the Wards” program opened my eyes to a more healing way of interacting with patients—addressing their emotions.
Almost all of the students said they appreciated connecting with patients on a personal level. The role modeling of the artists helped students become more comfortable with emotional situations and responding to the feelings patients share.
Some students said that the program enhanced their awareness of the aesthetic aspects of the healthcare environment, and almost all had a greater appreciation and respect for the role of artists on the wards as part of the healthcare team. Participants reported increased insight into the role of art as part of a holistic approach to healthcare, acting as an aid in connecting with patients and in reducing patient pain and anxiety. After shadowing with the artists, one student spoke of how he noted an important symptom as a result of taking more time to listen to a patient. Students have also commented on the positive impact of art on staff morale, many sharing that they had personally benefited from their experience of the arts. The artists have also commented how the patients appreciate that the medical students took the time to visit and make art with them. Students who complete the elective state that they would not only recommend, but that some would even encourage other students to complete the elective. As a result, a couple of medical students have continued with the program after completion—as volunteers with the “Artists on the Wards” program.
Despite a growing literature that provides evidence of the role the arts can play in enhancing the healing process, undergraduate medical education rarely covers this aspect of education. Our new “Artists on the Wards” shadowing elective provides an opportunity for pre-clinical medical students to learn about arts-based approaches to integrating science and humanism in medicine and gain additional insights into patient-centered, or “patient-engaged,” care. Through this elective our medical students are beginning to learn about the value and role of the arts in healthcare. By gaining experience and confidence in connecting with patients expressively through the arts, they are learning to connect more emotionally with patients relating to them as people.
Strange medicine, indeed! While it may be considered unusual or offbeat, we believe this shadowing elective offers a powerful means of helping students learn about the art of medicine as they also focus on clinical skills and other more science–based aspects of their learning. Following from our experience, we welcome discussion regarding the value of interdisciplinary approaches in stimulating growth in innovative arts and medicine educational experiences and collaborations. We also look forward to learning about the kinds of doctors our students will become, given their experience of arts-based learning in medical education. We think they are becoming the physicians we would like to have as our own doctors in the future—we can’t wait until they graduate!
The authors would like to acknowledge the contributions of the Artists on the Wards who helped to make this educational innovation a success: Lorna Bennett, Al Brant, Nancy Corrigan, Bev Ross, and, of course, Shirley Serviss! We would also like to acknowledge the contributions and support of Don Robinson, Diana Young Kennedy, and Don Trembath, with the Friends of the University Hospitals, and also the support of Dr. Kent Stobart, Associate Dean, Undergraduate Medical Education (UME), Dr. Joan Robinson, Undergraduate Electives Coordinator, and Melissa Coumont, Administrative Assistant, Pre-Clinical Education in the Faculty of Medicine & Dentistry at the University of Alberta. Appreciation is also extended to the pioneering medical students who have participated in this elective to date and also to all the patients who have taught our medical students so well.
An early, preliminary version of this article, entitled “Learning about the art of medicine at the University of Alberta: Some examples, including our new Artists on the Wards shadowing elective” was published in the CAME-ACEM Newsletter in May, 2010—see listed references. Another somewhat more developed, yet still preliminary version of this article was presented at the Society for the Arts in Healthcare conference in San Francisco, CA, on April 15, 2011, entitled “Shadowing Artists on the Wards: Promoting patient-centered care through an arts-based medical elective at the University of Alberta.”
Brett-MacLean, P. (2010, May). Learning about the art of medicine at the University of Alberta: Some examples, including our new Artists on the Wards shadowing elective,” CAME-ACEM Newsletter, 4-5, 9. Available at: http://www.came-acem.ca/docs/newsletters/20_1/newsletter_20_1_en.pdf. Accessed October 14, 2011.
Brett-MacLean, P., Casavant, M., Young Kennedy, D. (2010, Summer). Artists among us: Happiness as an element in health professionals’ artist statements. Atrium: The report of the Northwestern Medical Humanities and Bioethics Program, 8, 18-20.
Cox, S.M., Lafreniere, D., Brett-MacLean, P., Collie, K., Cooley, N., Dunbrack J., & Frager, G. (2010). Tipping the iceberg? The state of arts and health in Canada. Arts & Health: An International Journal for Research, Policy and Practice, 2 (2), 109–124.
Daykin, N., Byrne, E., Soteriou, T., & O’Connor, S. (2008). The impact of arts, design and environment in mental healthcare: A systematic review of the literature. Journal of the Royal Society for the Promotion of Health, 128 (2), 85–94.
de la Croix, A., Rose, C., Wildig, E., & Willson, S. (2011). Arts-based learning in medical education: The students’ perspective. Medical Education, 45 (11), 1090–1100.
Herman, J. (2001). Medicine: The science and the art. Medical Humanities, 27 (1), 42-46.
Kidd, M., & Connor J.T.H. (2008). Striving to do good things: Teaching humanities in Canadian medical schools. Journal of Medical Humanities, 29 (1), 45-54.
Pointe, S. & Serviss, S. (2008). Friends’ Arts in Healthcare Programs at the University of Alberta Hospital. In B. Warren (Ed.), Using the creative arts in therapy and healthcare: A practical introduction. New York: Routledge.
Rodenhauser, P., Strickland, M.A., & Gambala, C.T. (2004). Arts-related activities across US medical schools: A follow-up study. Teaching and Learning in Medicine, 16 (3), 233–239.
Stuckey, H.L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health, 100 (2), 254-263.
Staricoff, R. L. (2004). Arts in health: review of the medical literature. Available at: http://www.artscouncil.org.uk/media/uploads/documents/publications/phpc0eMaS.pdf. Accessed October 14, 2011.
PAMELA BRETT-MACLEAN holds a PhD in Interdisciplinary Studies from the University of British Columbia. She is an Assistant Professor and Director of the Arts & Humanities in Health & Medicine (AHHM) Program in the Faculty of Medicine & Dentistry at the University of Alberta. She is also a cofounding and continuing cochair of the Canadian Association for Medical Education's "Arts, Humanities and Social Sciences in Medicine" (AHSSM) Educational Interest Group.
MICHELLE CASAVANT, BFA is a graduate of the theatre design program at the University of Lethbridge. She has been working with the Friends of University Hospitals since 1999 and currently manages the Arts in Healthcare program in Edmonton, Alberta.
, MTS has worked as a staff literary Artist on the Wards for the Friends of University Hospitals since 1999. She has published three collections of poetry and coedited an anthology of women's writing on depression. Her writing also appeared in numerous literary magazines and anthologies. She facilitates writing workshops at the University of Alberta and MacEwan University, as well as in the Cross Cancer Institute's Arts and Medicine program.
ALYSSA CRUZ, BN, RN is a member of the 2013 Medical Class at the University of Alberta, and also the immediate past president of the Medical Students’ Association. She is currently enrolled in the third year of her undergraduate medical program. She continues to apply a well-honed artistic sensibility to all she is learning as a medical student and indulges her passion for writing when she can.