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Getting Started Guide Part 1: Select Activities for Integrating the Arts and Humanities into Medical Education

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Logo for the Fundamental Role of Arts and Humanities in Medical Education

Aligning with the Accreditation Council for Graduate Medical Education’s six general competencies, the activities included below were selected for the Getting Started Guide because they can be conducted at low cost with any group of learners, regardless of developmental stage or specialty. For a more in-depth look at the beginning steps for developing and integrating arts and humanities curricula, read The Fundamental Role of the Arts and Humanities in Medical Education. Find tips about how to start planning activities for learners in the Getting Started Guide Part 2: Nuts and Bolts of Integrating Arts and Humanities into Medical Education.

Should you have additional examples to submit for consideration, please email frahme@aamc.org with a description of the activity and suggested resources.

Explore by competency:

Select Activities for Teaching and Assessing Medical Knowledge

Physicians are expected to be competent in medical knowledge, described as “established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care.”

Visual Arts and Thinking Strategies - Observing

Illustration of a paint palette and a paint brush

Visual Arts and Thinking Strategies - Creating

Many medical schools have incorporated drawing into their curricula to aid learners studying anatomy. Life drawing for medical students: artistic, anatomical and wellbeing benefits by James et al. describes a 10-week elective course in life drawing where both anatomical and artistic concepts were taught.

Cutting deep: the transformative power of art in the anatomy lab by Grogan and Ferguson describes a course that aims to use drawing to enhance visual perception and three-dimensional understanding of the body's interior.

This video shows how Rush University Medical College invites medical illustrators to anatomy lab so that the atmosphere becomes more active than passive; learners can see firsthand how artists transform a three-dimensional body into a two-dimensional drawing.

History

The database “Contagion: Historical Views of Diseases and Epidemics” offers a collection titled Significant Diseases Throughout History where faculty can find historical documents related to various contagious diseases as well as bibliographies for further reading.

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Select Activities for Teaching and Assessing Interpersonal and Communication Skills

Physicians are expected to demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.

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Film and Television

Using film in teaching can help provide insight into the verbal and non-verbal communication patterns of cultures other than our own. A few recommended films for this purpose include:

  • Worlds Apart -- A series of 4 films, 15 min in length, that tells the story of four culturally diverse patients and families faced with critical medical decisions as they navigate the health care system. This Facilitator's Guide from the Stanford University Center for Biomedical Ethics is specifically designed for use with health professions learners.
  • Hold Your Breath -- A devout Muslim immigrant faces possible death from stomach cancer, but cultural and linguistic confusions complicate his treatment in an American hospital. This Facilitator's Guide from the Stanford University Center for Biomedical Ethics is specifically designed for use with health professions learners.
  • Departures -- A young man returns to his hometown after a failed career as a cellist and stumbles across work as a nōkanshi—a traditional Japanese ritual mortician. He struggles with the strong social taboos against people who deal with death but eventually creates meaningful interpersonal connections through the beauty and dignity of his work.
  • Bagdad Cafe -- Set in southern California desert country, a German tourist named Jasmine finds refuge in a truck-stop motel where she encounters the African American owner of the café and an Indian short-order cook. Initial unconscious/conscious biases based on cultural/racial differences are transformed through compassion that Jasmine brings to the diverse community leading to collaboration.
  • Using feature films as a teaching tool in medical schools by Baños and Bosch provides guidance on how to select films, how to prepare for discussion, how to select discussion questions and how to use assessment measures.
  • Cinemeducation: a comprehensive guide to using film in medical education by Alexander et al. provides descriptions of 450 scenes from 125 movies along with ideas for discussion questions and an index of movies listed by topic.

Music

In the article Jazz and the ‘art’ of medicine: improvisation in the medical encounter, author Paul Haidet uses examples from jazz improvisation to demonstrate communication skills critical to medical encounters such as creating space, developing voice and cultivating ensemble.

Haidet recommends the following jazz pieces for use in teaching:

Illustration of two theatrical masks

Theater and Drama

Interprofessional improv: using theater techniques to teach health professions students empathy in teams by Zelenski describes a 15-hour course at the University of Wisconsin-Madison that employs improv techniques to teach empathy. Students described the impact that these techniques had on their patient care interactions.

In the article Medical improv: a novel approach to teaching communication and professionalism skills, authors Watson and Fu offer descriptions of activities they engage in with medical learners and a video featuring the authors working with trainees.

In Twelve tips for using applied improvisation in medical education by Hoffmann-Longtin et al., authors offer practical advice on using improv with medical learners.

In the three minute video Medical improv, physician and actor Belinda Fu describes the concept of medical improv and its power to improve communication skills in the practice of medicine.

Visual Arts and Thinking Strategies

In the article Applying art observation skills to standardized patients by Monahan et al., authors describe an interprofessional curriculum where medicine, nursing and psychology students learned visual arts observation skills that enhanced their collaboration, communication, and observational skills in standardized patient encounters.

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Select Activities for Teaching and Assessing Patient Care and Procedural Skills

Physicians must demonstrate patient care and procedural skills so they can “provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health” and “perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.”

Film and Television

The film States of Grace follows the transformation of a revered physician and her family in the wake of a life-changing accident. Learners can observe how different clinicians gather information from the patient and her family members and see how medical guidance plays out when the patient is faced with ongoing challenges. The accompanying discussion guide can help groups of learners focus on interactions between patients and providers throughout the film.

The four-part MTV documentary series 16 and Recovering follows the lives of students at a recovery high school who must navigate substance use and mental health disorders. The discussion guide offers background about these medical issues as well suggested questions for each episode.

Using feature films as a teaching tool in medical schools by Baños and Bosch provides guidance on how to select films, how to prepare for discussion, how to select discussion questions and how to use assessment measures.

Cinemeducation: a comprehensive guide to using film in medical education by Alexander et al. provides descriptions of 450 scenes from 125 movies along with ideas for discussion questions and an index of movies listed by topic.

Illustration of a lit up lightbulb

Visual Arts and Thinking Strategies

Two visual arts activities from Julia Langley can help teach the Patient Care competency. The Describe and Draw activity (PDF) invites participants to experience both giving and following instructions and is a good corollary for teaching and learning medical procedures. You can use this lesson plan and watch a video to see an example of how it is done.

Another exercise called Looking 10x2 (PDF) invites participants to make observations about a crowded painting. They can relate this to gathering information from patients when their histories are complex. You can see this exercise being conducted at the 2-minute mark of this video and use these instructions and slides to conduct the exercise with your learners.

Dance and Movement

A simple mirroring exercise, shown here as implemented by Parkinson's patients and pre-med students at Brown University's Artists and Scientists As Partners program, can give learners practice with giving their undivided attention to another person and appreciating the perspectives of being both a leader and a follower, analogous to being in conversation with a patient. You can see simple instructions for this mirroring exercise.

Another exercise, often called the Name Game, is when group members introduce themselves by creating a movement to accompany their name. Everyone repeats the person's name and gesture. This simple exercise offers learners a way to express themselves through movement, telling others how they feel in the moment. Analogous to non-verbal behavior with patients, this exercise helps learners be aware of and interpret emotions through gestures. Find instructions and the exercise.

Keeping Reflecting Fresh: A Practical Guide for Clinical Educators by Peterkin and MacLean has a chapter titled Body Language by Batalden et al. This chapter details an activity where students partnered together in learning the basics of ballroom dance then explicitly discussed analogies with patient care such as forming connections, eye contact, posture, etiquette, and comfort.

Theater and Drama

The resources in the Theatre and Dance section of Interpersonal and Communication Skills could also be adapted to teach this competency.

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Select Activities for Teaching and Assessing Professionalism

Physicians are required to demonstrate “a commitment to professionalism and an adherence to ethical principles.”

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Literature and Narrative Medicine

“Medicine and the silent oracle: an exercise in uncertainty” by Catherine Belling presents a detailed description of a simple exercise for learners. They can read the short story “Perspective Shift” by Daniel Shapiro with the last paragraph missing and create their own ending. This exercise can be used to help learners discuss ambiguity and think about the roles and perspectives of doctors and patients.

One of the sub-competencies for Professionalism is “respect and responsiveness to diverse patient populations.” The article Teaching cultural competency through narrative medicine: intersections of classroom and community by Das Gupta et al. describes a program where pediatric residents participated in a monthly narrative medicine activity with staff members from an inner-city Dominican American community organization. Physician participants reported increased understanding of this culture and improved attitudes.

Reflective Writing

Reflective writing can be useful in discussions about professional identity formation (PDF). Read the description of a two-hour session where learners read two stories by physician-writers and then participate in writing and discussion. Instructors often select pieces from Pulse: Voices from the Heart of Medicine and then prompt students to write about qualities they want to develop as a doctor.

Keeping Reflecting Fresh: A Practical Guide for Clinical Educators by Peterkin and MacLean offers several ideas for reflective activities in reading and writing. For example, the chapter “Letters to a Third Year Student” by Jones and Dhurandhar describes a publication project of fourth year students’ letters to their third-year colleagues as they begin their clinical rotations. The collection of letters includes practical advice, suggestions and reflections and is bound in a volume for their junior clinicians. Authors of the letters are rewarded with a publication credit for their CV.

“Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing” by Wald et al. offers a helpful rubric for assessment of reflective writing.

Visual Arts and Thinking Strategies

The Professionalism competency includes “compassion, integrity, and respect for others” as well as “respect and responsiveness to diverse patient populations.” The Rx/Museum Initiative (PDF) offers a collection of 52 artworks and essay reflections. Faculty could select artworks by looking at themes such as inequity, self-actualization, and autonomy and partner with art instructors from their institution or a local artist to co-facilitate learner discussion.

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Comics and Graphic Novels

“A novel graphic medicine curriculum for resident physicians: boosting empathy and communication through comics” by Ronan and Czerwiec describes a four week curriculum focusing on empathy, compassion and cultural competency. Residents read about neurological conditions from graphic memoirs, then participated in discussion and drawing exercises. The article includes a list of texts that were used along with the specific drawing prompts that were given to learners.

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Practice-based Learning and Improvement

The ACGME's Practice-based Learning and Improvement competency requires learners to demonstrate “the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning.”

Reflective Writing

An oft-used format for reflective writing is the 55-word story. The article Fifty-five word stories: "small jewels" for personal reflection and teaching by Colleen Fogarty offers instructions on how to write in this format along with examples of student writing. Other examples include the AAMC's own 55-word Creative Expressions During Times of Uncertainty and the 55-word Stories from the University of Wisconsin School of Medicine, all written during the COVID-19 pandemic.

Another approach to trigger reflection is to offer writing prompts to learners. Whole Health: Change the Conversation -- Exercises and Readings for Narrative Medicine Groups by the VA Office of Patient Centered Care and Cultural Transformation outlines general writing prompts as well as those that can be completed after reading a recommended short piece of literature as a group.

“Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing” by Wald et al. offers a helpful rubric for assessment of reflective writing.

Visual Arts and Thinking Strategies - Creating

Illustration of a quill and an ink bottle

A key outcome of the practice-based learning and improvement competency is that learners engage in professional identity formation. Reflecting on one's identity can be accomplished through the creation of visual art. Examining professional identity formation through the ancient art of mask-making by Stephens et al, describes an activity that promotes self-reflection. Learners use a blank papier-mâché mask to represent their sense of themselves as a professional within the broader context of medicine. This activity can offer learners a way to explore identity in a non-linguistic manner.

The resources in the Visual Arts and Thinking Strategies section of the Professionalism page could also be adapted to teach this competency.

Mixed

The MedEdPORTAL course Pain and the humanities: exploring the meaning of pain in medicine through drama, literature, fine arts and philosophy challenges participants to reflect deeply on their professional values in relation to arts and humanities materials that portray reactions to pain. The files are available for download from the course include a syllabus, instructor's guide, and a student workbook.

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Select Activities for Teaching and Assessing Systems-Based Practice

Physicians are required to demonstrate an understanding of systems-based practice, which is defined as -- “an awareness of and responsiveness to the larger context and system of health care, including the social determinants of health, as well as the ability to call effectively on other resources to provide optimal health care.”

Narrative Medicine

One of the sub-competencies for Systems-based Practice is “working in interprofessional teams to enhance patient safety and improve patient care quality.” The article Implementing an interprofessional narrative medicine program in academic clinics: feasibility and program evaluation by Gowda et al. describes how 30 minute narrative medicine sessions were used during monthly meetings at three academic primary care clinics with the goal of increasing interprofessional collaborative practice.

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History

The 1619 Project from the New York Times focuses on the consequences of slavery in the United States. Learners can engage with a variety of material to learn specifically about how Black people have been systematically denied access to healthcare over time.

  • Read the short story “Bad Blood” by Yaa Gyasi about the Tuskegee Study of Untreated Syphilis in the Negro Male. Use the questions in this discussion guide.
  • Read “A Broken Health Care System” by Jeneen Interlandi in the written component of the 1619 Project. Use the accompanying questions in this reading guide.
  • Listen to the podcast, or read the transcript of, Episode 4: How the Bad Blood Started which starts out with a personal story about the author's Uncle and delves into a the story of the first Black woman doctor in the country, hospital segregation, the development of the first federal healthcare programs, and ends with a short story about the Tuskegee Experiment. Use the questions from either of the above reading guides for discussion.

Mixed

The Health Humanities Approach described in Centering patients, revealing structures: the health humanities portrait approach by Sufian et al. pairs patient narratives with humanities scholarship from history or literature and invites learners to explore how patients navigate their worlds without necessarily invoking disease symptomatology. This approach cultivates an understanding of health, illness, disability, and healthcare within social, political and historical context. The nine existing Health Humanities Portraits include social themes such as immigration, gun violence, trauma, and transgender care. A website including these portraits will be launching by the end of 2020.

Film

Film can be a useful medium in examining systems. Recommended films for this use include:

  • The Waiting Room - A documentary film about access to and affordability of healthcare. There is an accompanying discussion guide and a follow-up storytelling project provides additional videos about topics such as language barriers, poverty and violence.
  • Keeper of the House - A 15-minute documentary video featuring environmental service workers at Duke Hospital talking about their contributions to healing. Learners could read this related article about a COVID patient and the support he received from a hospital housekeeper and discuss hierarchy and the role of different staff in their institutions.

Using feature films as a teaching tool in medical schools by Baños and Bosch provides guidance on how to select films, how to prepare for discussion, how to select discussion questions and how to use assessment measures.

Cinemeducation: a comprehensive guide to using film in medical education by Alexander et al. provides descriptions of 450 scenes from 125 movies along with ideas for discussion questions and an index of movies listed by topic.

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