The University of Miami is adding Baroque paintings and Greek vases to its diagnostic arsenal.
Medical, nursing and physical therapy students at UM are supplementing their clinical training with visits to the Lowe Art Museum at the university’s Coral Gables campus. There, they discuss works of art in small groups and make connections to health care.
Hope Torrents, the Lowe’s school programs coordinator, calls these visits the Fine Art of Health Care. She runs the workshops, which began in 2008.
Torrents hopes a visit to a museum can inspire a more humanistic generation of physicians.
“I have no idea what it means to sort of step into the shoes of a doctor and nurse. But I have been a patient and I have been a patient’s advocate,” she says. “It’s important for patients to connect with their health care practitioners and engage with them and to be heard.”
A 2013 Johns Hopkins study showed that first-year medical residents spent 12 percent of their time interacting with patients. Residents spent more than 40 percent of the day in front of a computer.
Torrents says conversations about art can be applied to people working in stressful, clinical environments.
“Art is a perfect tool to get people to look harder and think longer,” she adds.
QUESTION, PARAPHRASE, REPEAT
In the June workshop, about 80 students wearing green scrubs and white lab coats gathered at the Lowe. They were there as part of UM’s annual patient safety week.
The 80 students were then divided into small groups of 10 to 12 people. Each group had a volunteer from the museum to help steer the conversation, which Torrents also does.
She guided a group of third-year medical students from the Miller School of Medicine in downtown Miami. These students were about to start clinical rotations where they'd learn from doctors in many specialties, such as internal medicine, pediatrics, surgery and psychiatry.
Torrents’ group first discussed a painting of an encounter between a man in uniform and a woman in peasant clothing.
Richard Striker and Amanda Pechman, third-year medical students at UM's Miller School of Medicine, lead the discussion. They ask open-ended questions to kick off the conversation.
“What do you guys see happening?” Striker asks the group.
Patrick Robbins, a third-year medical student at UM, says: “He seems to be administering some sort of treatment to a woman who appears blind or at least has some sort of vision problems."
Striker then has to paraphrase Robbins’ response. Torrents says this proves whether the group leader is actively listening, not just “parroting.”
“It means that that person who is facilitating the discussion is really trying to put into their own words what you’re saying,” she explains.
In addition to active listening, Torrents says these discussions can help science-minded health care providers confront situations that can have more than one possible right answer.
“So many works of art are open to interpretation… which is true of people who are making a diagnosis,” she says. “Sometimes there isn’t one right answer right away.”
The idea of ambiguity is especially present in more abstract works. A large blue sculpture depicts three bodies upside down. Nadege Green, a third-year medical student in Torrents’ group, says she thought the three figures represent the same person in different phases of his life.
“A lost soul in a world with so many people,” she says.
Torrents then pointed out the work could be a family, because one of the statues appears female.
This no-one-answer approach can be difficult for some students -- like Kabi Patel, a third-year medical student in Torrents’ group.
“It’s really not comfortable for me, like, this kind of subject, I guess,” he says. “And I don’t feel like I’ve got much to share.”
Patel soon warmed up, however, as he was leading the discussion of the blue statues. He says he preferred standing in front of the group and asking the questions.
“I didn’t have to explain what I kind of had an inkling of,” he says. “It was more just 'follow the script.'”
Aside from the art itself, Torrents says students sometimes find the process too repetitive and formulaic – until they understand how it can apply to health care.
“We answer, ‘What happens when you have a patient who comes in and presents the same symptoms all the time? Are you just going to say this is so boring? This is so redundant? I don’t want to hear this anymore,’” Torrents says.
NUTS AND BOLTS OF LOOKING
This process of open-ended questions isn’t new. In fact, it’s been around since the late 1970s.
Museums have been using visual-thinking strategies or VTS to help anyone engage with art. They don’t take into account people’s previous experiences in museums, so no one is at a disadvantage.
“It keeps the playing field level,” Torrents says.
Doctors Gauri Agarwal and Meaghan McNulty from the Miller School are analyzing the effects of VTS on medical students’ observational skills. They gathered data from a study conducted last year.
“The big wall, I guess, that we are at right now is... proving that this has some real long-term outcomes on their clinical ability with patients,” Agarwal says.
The researchers divided medical students into two groups. One used VTS at the Lowe while the other visited the Vizcaya museum but received no training.
Students then collected patient histories for a set of standardized patients. Agarwal and McNulty then timed how long each of the students took with each of these patients.
Studies at Yale University and the University of Texas Health Science Center at San Antonio have shown that discussing art improves students’ observational skills.
In Yale’s 2001 study, students who talked about art scored better in exams that asked for descriptions of photographs of medical disorders.
Yale School of Medicine was the first institution to collaborate with a museum, according to Linda Friedlaender, the senior curator of education at the Yale Center for British Art.
Friedlaender is compiling a database of all the museum-medical collaborations exploring the relationship between art and medicine. She’s found more than 50 of these programs across the country.
UT San Antonio’s 2011 study specifically dealt with the effects of VTS. Results showed that students who spent time looking at art spent more time looking at patient images.
Soon after the 2001 study was published, Yale incorporated observing art into the first-year medical students’ curriculum.
That’s what both Agarwal and Torrents hope to see happen at the Miller School. Right now, the Fine Art of Health Care workshops are a required part of the curriculum for students earning their medical degree along with a master’s in public health.
Agarwal says results from an in-house study can help expand the program for the general MD curriculum.
FROM CANVAS TO CLINIC
Practicing physicians and medical students say they have benefited from participating in the workshops.
Third-year medical student Katyayini Aribindi has attended five Fine Art workshops, including the one held in June.
Aribindi says they’ve helped her zone in on details and slow down her thinking when meeting with patients. In one instance, she noticed that the patient history did not match with what was presented in the chart.
“I put the chart down and like, OK, let’s figure out what’s going on actually because there’s a huge disconnect between what he was saying and what the patient history was,” she says.
Agarwal, who has been practicing medicine for about 15 years, says the art workshops have also had an impact on her. She’s been going to them for four years.
The internal medicine specialist says the museum visits have shown her that the extra time spent looking and connecting with the patient can be as powerful as the most advanced medical knowledge.
“I think art can really teach students to do that very early on and they can build it when they start to see patients,” she says.
Agarwal recalls this happening when she was treating a Spanish-speaking patient at a free clinic in Palm Beach County. Agarwal doesn’t speak Spanish so a medical student helped translate.
But Agarwal says something in the patient’s eyes clued her in.
“And I just put my hand on her and was just looking at her," she says, "and she broke down in tears and started telling us about the stresses in her life."
The Fine Art of Health Care workshops are organized just for UM students, but the Lowe Art Museum can accommodate outside groups looking for a similar experience. For more information, visit miami.edu/Lowe.