A fresh perspective on medical education: the lens of the arts

Effects of Arts-Based Pedagogy on Competence Development in Nursing: A Critical Systematic Review

The integration of arts-based methods into nursing education is a topic of growing interest in nursing practice. While there is an emerging body of research on this subject, evidence on competence development remains vague, largely due to methodological weaknesses. The purpose of this review is to evaluate the effectiveness of arts-based pedagogy in nursing, specifically in terms of students' changes in knowledge, skills, and attitudes. It explores which arts-based approaches to nursing education qualify as evidence-based practice in terms of nursing competence. A systematic critical review of research on arts-based pedagogy in nursing was conducted, identifying 43 relevant studies. These studies were assessed for methodological quality based on the CEC Standards for evidence-based practice, and 13 high-quality comparative studies representing a variety of arts-based approaches were selected. Creative drama was identified as the only evidence-based practice in the field, positively affecting empathy. The findings highlight a research gap in nursing education and emphasize the need for measurement and appraisal tools suitable for the peculiarities of arts-based pedagogy.

The Use of Art Observation Interventions to Improve Medical Students' Diagnostic Skills: A Scoping Review

Introduction

Clinical observation skills are fundamental to the practice of medicine. Yet, the skill of looking carefully is rarely taught within the medical curriculum. This may be a contributory factor in diagnostic errors in healthcare. A growing number of medical schools, especially in the United States, have turned to the humanities to offer visual arts-based interventions to foster medical students' visual literacy. This research aims to map the literature on the relationship between art observation training and diagnostic skills of medical students, highlighting effective teaching methodologies.

Methods

Based on the Arksey and O'Malley framework, a comprehensive scoping review was conducted. Publications were identified by searching nine databases and hand searching the published and grey literature. Two reviewers independently screened each publication using the pre-designed eligibility criteria.

Results

Fifteen publications were included. Significant heterogeneity exists between the study designs and the methods employed to evaluate skill improvement. Nearly all studies (14/15) reported an increase in the number of observations made post-intervention, but none evaluated long-term retention rates. There was an overwhelmingly positive response to the programme, but only one study explored the clinical relevance of the observations made.

Discussion

The review establishes improved observational acumen following the intervention, however, uncovers very limited evidence towards improved diagnostic abilities. There is a need for greater rigour and consistency within the experimental designs, through using control groups, randomisation, and a standardised evaluation rubric. Further research on the optimal intervention duration and the application of skills gained to clinical practice, should be performed.

Creativity: A viable and valuable competency in medicine? A qualitative exploratory study

PURPOSE

To explore and describe medical students, postgraduate medical trainees, and medical specialists' perceptions of creativity, the importance they attach to creativity in contemporary healthcare, and, by extension, how they feel creativity can be taught in medical education.

METHODS

The authors conducted seven semi-structured focus groups with medical students (n = 10), postgraduate medical trainees (n = 11) and medical specialists (n = 13).

RESULTS

Participants had a trifurcated perception of creativity, which they described as a form of art that involves thinking and action processes. Facing complex patients in a rapidly changing healthcare landscape, doctors needed such a multifaceted perspective to be able to adapt and react to new and often complex situations that require creativity. Furthermore, participants identified conditions that were perceived to stimulate and inhibit creativity in healthcare and suggested several techniques to learn creativity.

CONCLUSION

Participants perceived creativity as a form of art that involves thinking and action processes. Creativity is important to tackle the challenges of current and future workplaces, because it stimulates the search for original solutions which are needed in a rapidly changing healthcare landscape. Participants proposed different methods and techniques to promote creativity learning. However, we need further research to design and implement creativity in medical curricula.

Nursing student learning of biosciences through movies and concept maps: A mixed study

BACKGROUND

acquisition of bioscience knowledge is challenging for nursing students. This calls for teaching methodologies that allow them to acquire this knowledge and add value in the nursing context.

OBJECTIVE

to evaluate a teaching experience using a movie clip and the collaborative use of C-Maps in first-year bioscience learning in nursing students.

DESIGN

embedded mixed methods study.

PARTICIPANTS

143 students.

METHODS

data were collected in two phases: first, collecting quantitative data through a questionnaire on utility, satisfaction and perceived competency development, and collecting qualitative data on learning, teaching materials and developed competencies through an open-question instrument. The second phase consisted of a focus group to explore in greater depth learning experience.

RESULTS

six themes emerged from the qualitative analysis: using C-Maps as a learning process; developing group competencies; knowledge integration and transfer; teacher-student relationship; art as a didactic support; and difficulties encountered and proposals for improvement. Regarding utility, the students highlighted learning and relating concepts. Elements of satisfaction were working in small groups and having the teacher as a guide. Finally, the competencies most developed were teamwork and learning ability.

CONCLUSION

the combination of a movie clip and a C-Map is an innovative strategy motivating and valuable for learning biosciences.

Medical Students' Creation of Original Poetry, Comics, and Masks to Explore Professional Identity Formation

INTRODUCTION

This study examines differences in students' perceived value of three artmaking modalities (poetry, comics, masks) and whether the resulting creative projects offer similar or different insights into medical students' professional identity formation.

METHODS

Mixed-methods design using a student survey, student narrative comments and qualitative analysis of students' original work.

RESULTS

Poetry and comics stimulated insight, but masks were more enjoyable and stress-reducing. All three art modalities expressed tension between personal and professional identities.

DISCUSSION

Regardless of type of artmaking, students express concern about encroachments of training on personal identity but hoped that personal and professional selves could be integrated.

Top Ten Tips Palliative Care Clinicians Should Know About Music Therapy and Art Therapy

Palliative care is provided by an interdisciplinary team, including physicians, advanced practice providers, nurses, social workers, chaplains, and other disciplines based on need. Music therapists and art therapists are becoming increasingly available to palliative care teams and are advancing the diverse and unique clinical services available to effectively meet the holistic needs of patients with serious illnesses and their families. This article provides a concrete exploration of clinical music therapy and art therapy within palliative care and hospice paradigms, with discussion of therapists' training and expertise, therapeutic approaches within the setting of interprofessional team-based care, and discussion of evidence-based symptom management and outcomes supporting the inclusion of music and art therapies within medical education and clinical employment.

TV medical dramas: health sciences students' viewing habits and potential for teaching issues related to bioethics and professionalism

BACKGROUND

Medical dramas have been popular since their inception, especially among medical students. We hypothesized that the recent increase in the availability of TV medical series through online streaming platforms has probably changed health science students' viewing habits as well as the representation of bioethical conflicts and health professionals.

METHODS

We invited undergraduate students of medicine, nursing, and human biology to complete a self-administered questionnaire about their viewing habits and perceptions of the depictions of bioethical issues and professionalism in TV medical series.

RESULTS

Of the 355 respondents, 98.6 % had watched TV in the last year, 93.5 % watched TV series, and 49.6 % watched medical dramas more than once a week. The most-viewed medical dramas were The Good Doctor, House MD, and Grey's Anatomy. The most-remembered bioethical topics were medical errors, inappropriate professional behaviors, and death. Most students considered that ideals of professionalism were depicted positively and professionals were portrayed as intelligent, professionally qualified, and competent.

CONCLUSIONS

Medical dramas are very popular with health science students and are potentially useful as teaching tools for discussing issues related to bioethics and professionalism.

Arts and Humanities to Teach Civility in Health Professions

Incivility is defined as rude or disruptive behavior which may result in psychological or physiological distress for the people involved. These behaviors, which appear to be more pervasive than ever in today's society, both in academia and in the health-care system, negatively affect professionals' well-being and the workplace environment. Nurses have an obligation to practice with compassion and respect, and to develop creative solutions for addressing incivility. Education about incivility should begin in prelicensure programs for all health professions, so that students understand the behavior expected of them as professionals. When health-care professionals embody the ideals of respect and civility, they set an example for others to follow. The arts and humanities can be used as a pedagogical tool to provide innovative learning opportunities to teach these values through the affective domain of learning. This article discusses one of the creative avenues for facilitating such opportunity, the use of the arts and humanities to teach civility in health professions education.

Transforming Undergraduate Student Perceptions of Dementia through Music and Filmmaking

BACKGROUND

With nearly 6 million people with dementia (PWD) in the United States, there is a critical need to build an interprofessional dementia workforce. Among the novel approaches to expanding a new workforce, music and the arts show promise for engaging students and trainees. To understand how and why the arts affect attitudes about and engagement with PWD, we examined a service-learning general education undergraduate course centering on music, filmmaking, and dementia.

METHODS

The undergraduate course curriculum brought students to meet with PWD in dementia care settings, build personalized music playlists, coproduce short films about PWD, and write reflective essays. Two researchers independently completed inductive thematic analysis of the films, essays, and course evaluations. Differences were reconciled by consensus.

RESULTS

A total of 52 students from three classes completed the course; 24 (46%) were majoring in health sciences. Three key themes emerged: (1) Music helps students connect with people living with dementia in meaningful ways; (2) filmmaking offers students the opportunity to share unique, person-centered stories about dementia and music that empower the voices of PWD; and (3) reflective writing enables students to process new experiences and lessons learned. Unexpectedly, 29 students (56%) reported continued engagement with PWD in their careers, families, and communities after course completion.

CONCLUSION

This study identifies reproducible ways in which undergraduate arts courses thematically focused on dementia not only transform student perceptions about dementia but change the ways in which those students choose to engage with PWD following course completion. Arts and music departments may represent an untapped resource for building a geriatrics workforce. J Am Geriatr Soc 68:1083-1089, 2020.

Can the arts enhance postgraduate GP training?

The value of arts-based medical education is becoming increasingly well established in undergraduate curricula. However, little is known about its value, and acceptability, to qualified doctors undertaking postgraduate training. In this work we examined GP trainees' views on whether arts-based education was useful for their professional development and, if so, what they perceived its value to be. All first and second year GP trainees on the Dorset Vocational Training Scheme attended a one day course which showcased how the arts (film, poetry, painting, photography, theatre) could enhance their professional development as doctors. GP trainees rated the day as interesting, enjoyable and thought proving. The majority felt that the arts could contribute to making them more competent and humane doctors. Following this, we ran a mandatory six months arts based course for six GP trainees, and evaluated their feedback through qualitative analysis of a focus group discussion. Overall, GP trainees found the course enjoyable and valuable to their learning. It not only gave them a deeper appreciation of the patient's perspective, but also encouraged them to think about their own health and wellbeing.

The art of observation: a qualitative analysis of medical students' experiences

BACKGROUND

Although the inclusion of arts in medical school curricula has garnered attention, little is known about the effect of arts-based interventions on the behaviors, attitudes, and technical skills of students. The Art of Observation is an optional elective at the University of Texas Southwestern Medical Center (UTSW) in collaboration with educators from the Dallas Museum of Art (DMA). We utilized a qualitative approach to describe in-depth how engaging with art influences the development of medical students' observation skills and empathy.

METHODS

We analyzed evaluations from 65 medical students who completed the course between 2015 and 2017. Evaluations contained open-ended questions that asked students to reflect upon their experiences and describe their perceptions, thoughts, and feelings after guided museum visits. We used grounded theory to generate a thematic codebook, then employed axial coding to discover thematic relationships.

RESULTS

We report three main findings and several subthemes: (1) Enhanced observation skills: by engaging with art and completing relevant activities, students developed the ability to synthesize a compelling narrative in addition to learning technical skills; (2) Improved physician socialization: students reported enhanced self-awareness, increased tolerance of ambiguity, and development of a humanistic view of medicine, key components of physician socialization; and (3) Reduction in burnout symptoms: students reported an enhanced sense of well-being after each session, which mitigates the process of burnout.

CONCLUSIONS

Fine arts can be used to teach technical skills, stimulate personal reflection, and prevent burnout. A meaningful engagement with the arts can play an important role in developing physicians who are observant, empathetic, and more well-rounded.

'It's a powerful message': a qualitative study of Australian healthcare professionals' perceptions of asthma through the medium of drawings

OBJECTIVES

This study aimed to explore healthcare professionals' (HCPs') perspectives of asthma through their drawings, and their responses when viewing patients' drawings of their experiences of asthma.

DESIGN

A qualitative exploratory study with a purposive, convenience sample of participants. Participants were asked to first express their perspectives of asthma in a drawing, which was followed by a review of drawings made by patients with asthma.

SETTING

Primary and tertiary HCPs from Sydney, Australia.

PARTICIPANTS

Twenty-three HCPs from a range of health professions.

RESULTS

The HCPs illustrated their perspective of asthma through drawings which were largely biomedically framed, depicting physiological and clinical aspects of asthma. In contrast, their discussion around the patients' drawings centred on the person more than the condition. The patients' drawings triggered the HCPs to revisit their personal expectations of their patients' illness experience; prompted differing degrees of acknowledgement and empathy regarding the patient experience; and encouraged clinical reflexivity.

CONCLUSIONS

Our findings provide support for the educational application of patients' drawings in bringing HCPs closer to the patient lived experience. The drawings fostered deeper insight into patient perspectives of asthma and stimulated critical reflection on current healthcare practices.

Using visual thinking strategies with nursing students to enhance nursing assessment skills: A qualitative design

This qualitative design study addressed the enhancement of nursing assessment skills through the use of Visual Thinking Strategies and reflection. This study advances understanding of the use of Visual Thinking Strategies and reflection as ways to explore new methods of thinking and observing patient situations relating to health care. Sixty nursing students in a licensed practical nursing program made up the sample of participants who attended an art gallery as part of a class assignment. Participants replied to a survey of interest for participation at the art gallery. Participants reviewed artwork at the gallery and shared observations with the larger group during a post-conference session in a gathering area of the museum at the end of the visit. A reflective exercise on the art gallery experience exhibited further thoughts about the art gallery experience and demonstrated the connections made to clinical practice by the student. The findings of this study support the use of Visual Thinking Strategies and reflection as effective teaching and learning tools for enhancing nursing skills.

Arts-based interventions in healthcare education

Healthcare education institutions are increasingly including arts-based interventions in their programmes. We analysed 62 studies of arts-based interventions to understand how these interventions may be beneficial, and why providing evidence continues to be a challenge for the field.Our analysis highlighted two issues. We found that 79% of the included studies reported that their interventions were successful, but without always defining this success or how it was measured. This lack of clarity was apparent in descriptions of both what arts-based interventions aimed to do, and in descriptions of how they might do this. We also found that only 34% of studies involved a collaboration with artists or arts educators, raising questions over who had the necessary experience and specialism in the arts to design and deliver such interventions.Our analysis revealed that arts-based interventions are failing to acknowledge, and subsequently capture through assessment, the process of learning in the moment. This is particularly important because arts-based pedagogies typically use embodied, practical, physical methods, in which what is being learnt cannot be separated from the process of learning. Involving artists and arts educators throughout the process of designing and delivering these interventions may help to bring clarity over what arts-based interventions are aiming to do and how they may do this, and ensure that appropriate evaluation methods are used. We suggest that close observation with feedback, and the use of reflective portfolios are two ways of assessing the process of learning in arts-based interventions.

Effectiveness and experience of arts-based pedagogy among undergraduate nursing students: a mixed methods systematic review

BACKGROUND

To develop well rounded professional nurses, educators need diverse pedagogical approaches. There is growing interest in arts-based pedagogy (ABP) as the arts can facilitate reflection, create meaning and engage healthcare students. However, the emerging body of research about ABP needs to be systematically examined.

OBJECTIVES

To synthesize the best available evidence on the effectiveness of ABP in enhancing competencies and learning behaviors in undergraduate nursing education and to explore nursing students' experiences with art-based pedagogy.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

The review considered studies that included participants who are undergraduate nursing students.

TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST

The qualitative (QL) component considered studies investigating nursing students' experiences of ABP, and the quantitative (QN) component considered studies evaluating the effectiveness of ABP in undergraduate nursing education.

TYPES OF STUDIES

The QL component considered QL studies including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. The QN component considered studies that examined the effectiveness of ABP including designs such as randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies, case series, individual case reports and descriptive cross-sectional studies.

OUTCOMES

The following QN outcomes of ABP were assessed: knowledge acquisition, level of empathy, attitudes toward others, emotional states, reflective practice, self-transcendence, cognitive/ethical maturity, learning behaviors and students' perspectives of ABP.

SEARCH STRATEGY

An extensive three-step search strategy was conducted for primary research studies published between January 1, 1994 and April 7, 2015. The strategy included searching CINAHL, MEDLINE, ERIC, PsycINFO, Academic Search Complete, Arts and Humanities Citation Index, Art Full Text, Scopus, ProQuest Dissertations and Theses, A&I, and gray literature. Only studies published in English were included.

METHODOLOGICAL QUALITY

Two reviewers assessed all studies for methodological quality using appropriate critical appraisal checklists from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) or the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

DATA EXTRACTION

Data were extracted from included articles using the standardized data extraction tool from JBI-QARI or JBI-MAStARI.

DATA SYNTHESIS

Qualitative studies were pooled through a meta-synthesis. Data from the QN studies were combined using a narrative synthesis as a meta-analysis was not possible. The researchers used a segregated mixed methods approach to integrate the QL and QN components.

RESULTS

Twenty-one QL studies of high methodological quality were included. The two synthesized findings revealed that art forms could create meaning and inspire learning in undergraduate nursing education and that ABP can develop important learner outcomes/competencies for professional nursing. These synthesized findings received a moderate ConQual rating. Fifteen experimental/quasi-experimental studies of moderate methodological quality were included. The narrative synthesis suggested that ABP improved nursing students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. In five cross-sectional studies, the majority of students had a positive perspective of ABP. When the QL and QN findings were interpreted as a whole, ABP appeared to facilitate learning in the cognitive and affective domains and may be especially useful in addressing the affective domain.

CONCLUSION

Nurse educators should consider using ABP as students found that this approach offered a meaningful way of learning and resulted in the development of important competencies for professional nursing. The QN studies provide a very low level of evidence that ABP improved students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. Although the QN findings can inform future research, the evidence is not robust enough to demonstrate improved outcomes.

The study of art and its influence on the education of surgeons

A look back at some key figures in the crossover between the two disciplines.

Creative art and medical student development: a qualitative study

OBJECTIVES

Although many medical schools include arts-based activities in their curricula, empirical evidence is lacking regarding how the creation of art might impact medical students and their professional development. We used a qualitative research design in order to understand this process.

METHODS

We conducted and analysed interviews with 16 medical students who had created and presented original artwork in the context of a required narrative-based undergraduate medical education programme. Teams of students collaborated to create interpretive projects based on common themes arising from conversations with individuals with chronic illness and their families. Open-ended questions were utilised to explore the conceptualisation and presentation of the projects, the dynamics of teamwork and the meaning(s) they might have for the students' professional development. We identified themes using repeated contextual reading of the transcripts, which also enhanced accuracy of the interpretations and ensured saturation of themes.

RESULTS

Several major themes and sub-themes were identified. The creation of art led to a sense of personal growth and development, including reflection on past life experiences, self-discovery and an awareness of art as a creative outlet. Students also reported an enhanced sense of community and the development of skills in collaboration. Lastly, students reflected on the human dimensions of illness and medical care and identified an enhanced awareness of the experience of those with illness.

CONCLUSIONS

A programme involving the creation of art based on stories of illness encouraged students' explorations of conceptions of the self, family and society, as well as illness and medical care, while enhancing the development of a collaborative and patient-centred worldview. Creative art can be a novel educational tool to promote a reflective, humanistic medical practice.

Looking and listening for learning in arts- and humanities-based creations

CONTEXT

The arts and humanities are gradually gaining a foothold in health professions education as a means of supporting the development of future clinicians who are compassionate, critical and reflexive thinkers, while also strengthening clinical skills and practices that emphasise patient-centredness, collaboration and interprofessional practices. Assignments that tap into trainee creativity are increasingly used both to prepare learners for the demands of clinical work and to understand the personal and professional challenges learners face in these contexts. Health professions educators need methods for interpreting these creations in order to understand each learner's expressions. This paper describes two theoretical frameworks that can be used to understand trainees' unique learning experiences as they are expressed in arts- and humanities-based creations.

METHODS

The authors introduce the philosophical underpinnings and interpretation procedures of two theoretical frameworks that enable educators to 'hear' and 'see' the multilayered expressions embedded within arts- and humanities-based student creations: Gilligan's Listening Guide and Kress and van Leeuwen's approach to visual rhetoric. To illustrate how these frameworks can be used, the authors apply them to two creative summaries that learners made as part of a humanities-informed, interprofessional education intervention that took place in a non-acute-care teaching hospital. The interpretations of two creative summaries, a poem and a pair of paintings, highlight how applying these theoretical frameworks can offer important insights into learners' experiences.

CONCLUSIONS

This cross-cutting edge paper describes how the Listening Guide and visual rhetoric can help health professions educators listen to and read the arts- and humanities-based creative expressions made by learners. Insights gained from these interpretations can advance the understanding of students' personal experiences in different learning environments and can inform curriculum development.

Progress integrating medical humanities into medical education: a global overview

PURPOSE OF REVIEW

The article reviews the most recent developments in integrating humanities into medical education. Global implications and future trends are illustrated.

RECENT FINDINGS

The main concern of medical humanities education is teaching professionalism; one important aspect that has emerged is the goal of nurturing emotion through reflexivity. Relating effectively to all stakeholders and being sensitive to inequitable power dynamics are essential for professional social accountability in modern medical contexts. Mediating doctors' understanding of the clinical encounter through creative arts and narrative is part of most recent pedagogic innovations aimed at motivating learners to become empowered, engaged and caring clinicians. Scenario-based and discursive-oriented evaluations of such activities should be aligned with the medical humanities' problem-based learning curriculum. Medical humanities education fosters professional reflexivity that is important for achieving patient-centered care.

SUMMARY

Countering insufficient empathy with reflective professionalism is an urgent challenge in medical education; to answer this need, creative arts and narrative understanding have emerged as crucial tools of medical humanities education. To ensure competent professional identity formation in the era of translational medicine, medical humanities programs have adopted scenario-based assessments through inclusion of different voices and emphasizing personal reflection and social critique.