The Fostering Resilience through Art in Medical Education (FRAME) workshop: a partnership with the Philadelphia Museum of Art

Patients, Peers, and Personal Identity: A Longitudinal Qualitative Study Exploring the Transformative Potential of the Arts and Humanities in Intern Training

PURPOSE

Medical education initiatives incorporate arts and humanities (AHs) to foster physician competence and professionalism. However, the full potential of these initiatives is unclear. A recent conceptual framework attempts to clarify this potential but was constructed primarily from undergraduate medical education studies. To explore AH instruction in graduate medical education (GME), the authors asked: What is the potential of a longitudinal curriculum incorporating AHs for the personal and professional development of internal medicine interns throughout the intern year?

METHOD

From September 2021 to June 2022, 14 internal medicine interns at a large internal medical residency program participated in a longitudinal qualitative study, recording longitudinal audio-diaries (LADs) and participating in semistructured interviews. The LAD response rate was 91%, and the interview completion rate was 96%. The authors identified 3 themes that reflected shared meaning on the transformative potential of AHs: reclaiming personal sense of self, building community, and surfacing empathy. They constructed stories from 2 interns whose trajectories resonated most with AH instruction's potential for personal and professional development.

RESULTS

Interns valued the abstract over the concrete benefits of AHs. Interns detailed valuable abstract benefits, with reclaiming sense of self, building community, and surfacing empathy apparent across time, pointing to long-term effects of AH interventions. The intern stories revealed a steady appreciation for AHs and difficulty with the practical utility of AHs midyear before a return to recognition of its value by year's end.

CONCLUSIONS

Despite varying AHs experience levels, interns consistently appreciated AH instruction. These findings extend a prior conceptual model to a GME population by highlighting AH instruction's potential for reclaiming interns' senses of self, building community, and surfacing empathy. Future curricula can leverage this ability to create meaningful connections with one's purpose, peers, and patients to maximize the potential of AH instruction for GME learners.

Harnessing the Humanities to Foster Staff Resilience: An Annual Arts and Humanities Rounds at a Children's Hospital

Working in healthcare can be fulfilling, meaningful, and sometimes exhausting. Creative endeavors may be one way to foster personal resilience in healthcare providers. In this article, we describe an annual arts and humanities program, the Ludwig Rounds, developed at a large academic children's hospital. The event encourages staff to reflect on resilience by sharing their creative work and how it had an impact on their clinical careers. The multidisciplinary forum also allows staff to connect and learn about each other. We discuss the development of the program, its format and logistics, and lessons learned over the past 15 years.

Art is Patient: A Museum-Based Experience to Teach Trauma-Sensitive Engagement in Health Care

Psychological trauma is ubiquitous, an often hidden yet influential factor in care across clinical specialties. Interdisciplinary health professions education is mobilizing to address the importance of trauma-sensitive care. Given their attention to complex human realities, the health humanities are well-poised to shape healthcare learners' responses to trauma. Indeed, many such arts and humanities curricula propose narrative exercises to strengthen empathy, self-reflection, and sensitive communication. Trauma, however, is often unwordable, fragmentary, and physically encoded, incompatible with storying methods. This article presents a recent innovation, the Art is Patient seminar series, which focuses on aesthetic exercises to help learners access and share non-verbal, embodied, and relational responses to art. Based in an art museum context, it provides successive experiences of approaching, witnessing, and engaging with visual art as an analogue to developing trauma-sensitive relationships. Reflections on the process locate the seminar vis-à-vis health humanities practices, aesthetics, and trauma-informed approaches.

Extending Arts-Based Interventions in Graduate Medical Education through the Positive Humanities: the Re-FRAME Workshop

BACKGROUND

Arts-and-humanities-based interventions are commonly implemented in medical education to promote well-being and mitigate the risk of burnout. However, mechanisms for achieving these effects remain uncertain within graduate medical education. The emerging field of the positive humanities offers a lens to examine whether and how arts-based interventions support well-being in internal medicine interns.

AIM

Through program evaluation of this visual art workshop, we used a positive humanities framework to elucidate potential mechanisms by which arts-based curricula support well-being in internal medicine interns.

SETTING

We launched the re-FRAME workshop at the Philadelphia Museum of Art in winter 2020.

PARTICIPANTS

Fifty-six PGY-1 trainees from one internal medicine residency program.

PROGRAM DESCRIPTION

The 3-h re-FRAME workshop consisted of an introductory session on emotional processing followed by two previously described arts-based interventions.

PROGRAM EVALUATION

Participants completed an immediate post-workshop survey (91% response rate) assessing attitudes towards the session. Analysis of open-ended survey data demonstrated 4 categories for supporting well-being among participants: becoming emotionally aware/expressive through art, pausing for reflection, practicing nonjudgmental observation, and normalizing experiences through socialization.

DISCUSSION

Our project substantiated proposed mechanisms from the positive humanities for supporting well-being-including reflectiveness, skill acquisition, socialization, and expressiveness-among medical interns.

Character and virtue development in medical learners: another role for the arts?

Medical education serves to teach students how to think and act as future physicians. Doing so successfully requires supporting learners' acquisition of clinical skills and knowledge, but also attending to their character education and virtue development. The arts and humanities are widely embraced as a fundamental component of a complete medical education. While not frequently touted as a useful pedagogical tool for teaching character and virtue, we argue the integration of arts-based activities into medical education can promote virtue development. In this article, we use the virtues framework from the Jubilee Centre for Character and Virtues at the University of Birmingham to review existing empirical studies of arts-based programs for each of these virtue domains of intellectual, moral, civic, and performance virtues. Learners may benefit from further exploration-both conceptual and empirical-of how the arts can scaffold character development in medical education.

Quantitative metrics and psychometric scales in the visual art and medical education literature: a narrative review

The authors conduct a narrative review of the quantitative observation metrics and psychometric scales utilized in the visual arts and medical education literature in order to provide medical educators with a 'toolkit' of quantitative metrics with which to design and evaluate novel visual arts-based pedagogies. These efforts are intended to support the AAMC and National Academy of Sciences, Engineering, and Medicine's aims to formally evaluate and integrate arts and humanities curricula into traditional scientific educational programming. The scales reviewed examine a variety of domains including tolerance for ambiguity, bias, burnout, communication, empathy, grit, and mindfulness/reflection. Observation skill, given the heterogeneity of quantitative metrics, is reviewed separately.

Workplace Aesthetic Appreciation and Exhaustion in a COVID-19 Vaccination Center: The Role of Positive Affects and Interest in Art

BACKGROUND

Recently, workers employed in vaccination points around the world have been subjected to very high workloads to counter the progress of the COVID-19 epidemic. This workload has a negative effect on their well-being. Environmental psychology studies have shown how the physical characteristics of the workplace environment can influence employees' well-being. Furthermore, studies in the psychology of art show how art can improve the health of individuals.

OBJECTIVES

The aim of this research was to test a moderated mediation model to verify how appreciation of workplace aesthetics can impact the level of exhaustion of staff working in a vaccination center, the mediating role of positive and negative affects, and the moderating role of interest in art.

METHODS

Data were collected from a sample of 274 workers (physicians, nurses, reception, and administrative staff) working in the same vaccination center in Italy. Participants answered a self-report questionnaire during a rest break. We used a cross-sectional design.

RESULTS

The results show that appreciation of workplace aesthetics impacts employees' level of exhaustion. This relationship is mediated by positive and negative affects, and interest in art moderates the relationship between positive affects and exhaustion.

CONCLUSIONS

These findings indicate the central role of workplace aesthetics in influencing healthcare workers' well-being, and how interest in art can reduce exhaustion levels. Practical implications of the results are discussed.

Design, implementation, and reflections on a two-week virtual visual arts and medicine course for third- and fourth-year medical students

BACKGROUND

Medical humanities courses that incorporate the visual arts traditionally require in-person instruction and visits to museums. The COVID-19 pandemic afforded medical educators a unique opportunity to implement and evaluate virtual visual arts programming.

METHODS

A two-week, 7-module visual arts and medicine elective course for third and fourth-year medical students was conducted virtually in the Spring of 2021. The course included traditional didactic components as well as a range of hands-on creative art activities including painting, graphic medicine, photovoice, and Kintsugi (Japanese craft). Digital tools including Canvas, Google Jamboard, and Zoom facilitated student engagement. Student feedback was collected through anonymous post-course surveys.

RESULTS

We successfully conducted a virtual visual arts and medicine elective which integrated hands-on creative art activities. Most students "strongly agreed" that remote instruction was sufficient to meet course objectives. However, all students also "agreed" that in-person instruction may promote more in-depth engagement with the visual arts. The hands-on creative art activities were appreciated by all students.

CONCLUSION

Visual arts-based medical humanities courses can be delivered virtually and can include hands-on creative art activities such as painting. Future visual arts and medicine courses may benefit from incorporating a range of pedagogical methodologies, digital tools, control groups, and pre-/post-course assessments.

Thinking outside the box: students positive about visionary elective curricula in medical school

Objective: Space for personality development as well as for the development of critical, creative and interdisciplinary thinking is rarely found in medical curricula in Germany. To be prepared for the challenges of modern medicine, future physicians need a visionary mindset. The aim of this study is to determine the need for teaching such content among medical students in the context of visionary elective curricula and to examine these with regard to the desired topics and organizational structure. Methods: This is a cross-sectional study with 236 medical students from all semesters of the Ludwig-Maximilians-University Munich. The survey consists of 50 questions and includes single choice, multiple choice, matrix questions, open-ended questions and Likert scales. Responses were examined using descriptive statistics and compared parametrically in sub-aspects. Results: Three-quarters of respondents would like to see curricular content on interdisciplinary interfaces with other disciplines. A suitable framework for this is seen by 87% of the respondents in a visionary elective curriculum. Students would like to see a broad range of specific content such as global health, politics, business, and computer science. The majority of respondents would like to see 1 unit of instruction per week and would participate in an appropriate program. Such an offering would promote creative (53.6%), critical (63.7%), and interdisciplinary thinking (69.0%) and train to become better physicians (87%). Conclusion: Participants in this study are positive toward the introduction of visionary content in medical school. Faculties should build visionary elective curricula according to the graduate profile requirements of the new NKLM 2.0 to make medical education sustainable.

From Burnout to Wholehearted Engagement: A Qualitative Exploration of Psychiatry Residents' Experience of Stress

PURPOSE

Physician burnout is endemic across medical education and has numerous deleterious effects. Given the prevalence and negative effects of burnout, there is an urgent need to understand how residents experience and cope with stress and develop explanatory models that inform the development of more effective interventions.

METHOD

Using a qualitative, constructivist approach informed by grounded theory, the authors conducted semistructured interviews from March to April 2019, in which psychiatry residents were asked about their experiences of stress and how they coped. First- through fourth-year trainees at Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, were invited. Two authors independently and inductively coded deidentified transcripts. A constant comparative approach was used to analyze data and support construction of themes. Theoretic sufficiency was observed after 14 interviews.

RESULTS

The authors constructed an explanatory model for how residents cope with stress and whether they tended toward burnout or wholehearted engagement. The model included 3 themes: self-care, work relationships, and meaning making. Self-care, including time spent with others, provided connection and belonging that bolstered physicians' developing identities. Interpersonal relationships at work profoundly influenced the experience of residents. Positive peer and supervisor relationships enhanced confidence and perseverance. Negative role models and conflict engendered feelings of inadequacy. The ability to shift perspective and build meaning through examining moral values in the face of challenges was crucial for residents who reported success at coping with stress. Residents identified personal psychotherapy as an especially important strategy to facilitate meaning making.

CONCLUSIONS

These findings provide guidance for how residency programs may help residents cope with stress and move away from burnout toward wholehearted engagement. Strategies may include reducing barriers to self-care and to accessing help early in training, creating spaces that promote peer connection and providing training in addressing conflict, and facilitating engagement in meaning-making activities.

Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review

BACKGROUND

A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME.

METHODS

We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool.

RESULTS

Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups.

CONCLUSIONS

Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.

Art in Medical Education: A Review

BACKGROUND

The use of fine art in medical education has a long history. Numerous studies have investigated the potential benefits of incorporating art in medical education; however, there are gaps in knowledge regarding the efficacy, methodology, and clinical significance of these studies.

OBJECTIVE

This scoping review of the literature aims to describe the available literature on the incorporation of art education in medical school and residency.

METHODS

PubMed, Google Scholar, and MedEDPortal were queried from their inception dates through December 2019. English-language studies providing a detailed methodology and detailed analysis were included. A total of 37 studies were identified. Upon further screening of the studies' methodologies and results, 16 studies describing art education implemented with medical students and 12 studies describing art education implemented with residents were included for final review.

RESULTS

Various methods of art education exist, including Visual Thinking Strategies (VTS), rigorous curricula, and unstructured roundtable discussions with art curators or artistically minded clinicians. Studies range in duration, art media, and type of analysis.

CONCLUSIONS

There has been an increasing effort to incorporate fine art education into medical training, primarily to enhance visual perception skills and empathy. Although there is limited research on its efficacy, and wide variations in study methodologies exist, results consistently indicate that participants find the incorporation of art into curricula beneficial. Further research analyzing which methodologies are most likely to yield statistically and clinically significant improvements in visual perception and empathy may lead to increased utilization of this teaching method.

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.