Medical schools across the country are increasingly incorporating visual arts and humanities programming into their curricula to address a variety of issues and skill sets that are relevant to clinical practice such as empathy, tolerance for ambiguity, and resiliency to burnout.
The Duke Department of Medicine has done so well with its visual arts and humanities curriculum for residents that it is now in its third year—and growing.
With the help of a Duke AHEAD grant for the 2023-24 academic year, the program is expanding to include all internal medicine residents at all stages of training in an integrated, three-year curriculum utilizing the visual arts to target key areas of professional development.
The program is headed up by Pulmonary and Critical Care Medicine fellow Emory Buck, MD, rising 2024-25 chief resident for Duke University Hospital. Buck, a graduate of the University of Virginia and the Georgetown University School of Medicine, piloted the program in phases after she arrived at Duke as a resident in 2020.
Raised in an artistic environment, Buck has always found value in the humanities and particularly visual arts and humanities experiences. She is confident that more of her Duke colleagues will appreciate them, too.
Art in Medicine
“There is so much art in medicine, and the way we practice medicine,” Buck said. “We think of medicine as black and white, yet often there is plenty of gray. The current medical education system leaves little room for ambiguity with its multitude of standardized tests and correct answers. Visual art offers a unique approach to explore the power of observation, augment communication skills, enhance tolerance for ambiguity, and offer space for personal reflection.”
The first-year curriculum will focus on observational skills, team building, and communication among all first-year residents over two, three-hour sessions at the Nasher Museum of Art. The second-year curriculum will focus on tolerance for ambiguity, bias awareness, empathic development and burnout among all second-year internal medicine residents, also at the Nasher Museum of Art.
Both the first- and second-year curricula will be led by Ellen Raimond, PhD, associate curator of academic initiatives at the Nasher Museum. The third-year curriculum will focus on professional identity formation, advocacy, and social justice in small group sessions led by the curricular co-lead and Duke University hospitalist, John David Ike, MD MSc., who also works some with medical students in the Armstrong Scholars Program.
There is no mandatory requirement for credited, visual arts programming for medical students at Duke. However, beginning in the 2023-24 academic year, the School of Medicine is building a visual arts and humanities component into its MS2 Trailblazing sessions, which are half-day sessions on Wednesday mornings,” said Sneha Mantri, MD MS, an assistant professor of neurology and director of the Medical Humanities and the Armstrong Scholars Program at the Trent Center for Bioethics, Humanities, and History of Medicine. “All students will complete one of these sessions during the course of their clinical year.”
Jenny Van Kirk, MD, is working alongside Buck and Ike to implement the program for all residents.
“The visual arts curriculum within the Internal Medicine Residency adds an invaluable experience for our residents, it is an opportunity to step away from the non-stop hustle and bustle of the clinical world to connect with colleagues, reflect on shared experiences, and develop unique perspectives,” Van Kirk said. “Beyond this, it is an excellent example of how residents can truly impact our program based upon their own passions. Dr. Buck came with an idea she developed during medical school. With an incredible amount of hard work, she turned this into a reality that all of our residents will benefit from for years to come.”
Engagement Through Art
The curriculum is based on various museum–based education strategies that promote engagement with art. The activities encourage students to learn from the art rather than about the art through a balance of individual and group experiences.
Through one exercise called Visual Thinking Strategies, learners become more adept at making observations that are, over time, more and more detailed; they are encouraged to listen to peers who have different observations and interpretations; and they are forced to hold a variety of viewpoints as valid and true simultaneously, as the ultimate ‘answer’ (i.e. the artist’s intent) is never revealed.
“What we’re doing is using the humanities to uncover that half of our brain that wants to think in another way,” Buck said. “We are encouraging creativity of thought, wonder, and reflection, observation, critical thinking and reasoning.”
Buck’s measures of success to date have shown that students are finding value in the course work. A survey of first year participants, for example, showed that over 85% of participants would recommend the activity to their peers. Addressing challenges like burnout through art also translates to patient-level outcomes. Patients who are cared for by physicians who are burnt out result in longer hospital stays and experience increased morbidity, Buck added.
Back to the Future
According to the American Associate of Medical Colleges (AAMC) report The Fundamental Role of the Arts and Humanities in Medical Education, most medical schools now offer arts and humanities to varying degrees. However, the potential impact of the activities is unmet because of significant variation in the content, curricula integration, teaching methods, and evaluation methods. AAMC urges greater humanities integration into curricula and better evaluation of how these experiences make better doctors.
Buck agrees, noting that there is still a paucity of this kind of programming from the graduate medical education perspective and most arts and humanities courses are offered only as electives. They are also not generally being taught to residents, which is arguably when the need is highest due to burnout, Buck added, so Duke’s program is unique in that it will be required of all internal medicine residents.
It has been incredibly gratifying and fruitful for Buck to see colleagues take enjoyment, wonder and peace from art in the same way that she has throughout her life, especially those for whom the museum was an intimidating place.
“My hope is that this represents a small step towards the re-centering of the humanities within medicine,” she said.