Will you become a better doctor if you look at art?

Student Myrthe Heikens with a “patient coat” to make invisible burdens visible

“Looking at Art” is an elective module in which third-year medical students reflect on a theme using works of art from Amsterdam UMC’s collection. This year, they do so with five artworks by Hans Eijkelenboom and Evelyn Taocheng Wang, among others, on the theme of “identity.” They write an essay and create a variation on one of the artworks. “This way we try to get students out of their comfort zone of protocols and anatomy classes and teach them to look,” says Sabrina Kamstra, head of Art Affairs at Amsterdam UMC.

Learning to look

Together with pulmonologist-oncologist Joris Veltman and Professor Emeritus of Surgery Thomas van Gulik, Kamstra is designing the module. The idea behind it is that students not only train their observation and communication skills but also tap into their creative brains, allowing them to connect with patients in a different way.

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Veltman explains. “The feelings patients carry with them can provide important information about their possible clinical picture. But work pressure and administrative burdens leave little room for this in current practice. Previously, in the old medical profession, there was much more focus on observation techniques and deferring judgment on the patient. The way a patient walks into the consultation room, how they deal with their illness, and the extent to which they build a relationship of trust with their doctor tells a lot about the patient. Our job as physicians is to look beyond lab results and radiology images. And ‘art-based’ learning and training is a proven method to further develop these skills to ultimately provide better quality care.” 

Last year, “Looking at Art” was offered for the first time. It proved a great success; within no time all 30 seats were filled. The same thing happened again this year. “We notice that students feel the need to reflect critically on certain themes within medicine,” Kamstra explains. “Last year we asked students to think about mortality and how to deal with people who are incurably ill. This year we asked students to think about the identity of doctors and patients, what it looks like, and what is behind it. This produces very special final papers in which students can show their creativity in the form of music, text, film, photography, paintings, or even clothing. Above all, it produces enormously good and instructive discussions about the interpretation of their work about the themes.”

Student Myrthe Heikens (22), who designed the “patient coat,” is, like the rest of the students present, very enthusiastic about the module: “Using art, it encourages you to think out of the box. Performing an anamnesis, for example, or other protocols to arrive at a diagnosis can cause you to work with a certain tunnel vision and miss something. By learning to look with a different perspective, you could avoid that.” Student Berk Uzunalioglu (24) agrees. “It's very much about taking into account your own and especially possibly alternative interpretations of a work of art. That principle is directly applicable to medicine. I think you can save lives with that.”

Skepticism

Although the enthusiasm for art education in medicine is there among students, it is by no means always taken seriously. “It is very difficult to substantiate in studies exactly what art education adds in medicine,” says Veltman. “The skeptics say, ‘Why do you need art education in the medical curriculum? You should just study art history or go to art school.” But some studies show that art education can change doctors’ behavior in terms of observation techniques and empathy with patients. But it remains very difficult to test this.

Master’s student in medicine and art history Stella Bult (27) is conducting one such study on that behavior change. Together with Emeritus Professor of Surgery van Gulik mentioned above, she organizes tours of the Rijksmuseum for both students and specialists. Participants must fill out questionnaires both before and after about empathy and their tolerance for ambiguity (black/white thinking). “The surveys show that they scored better on both aspects after each tour,” says Bult. “Yet it turns out to be very difficult to substantiate these results because we only measure short-term effects and it involves some form of subjectivity.”

That is one of the most difficult aspects to overcome, Kamstra continues. “Medicine is founded on doing quantitative research. Data-driven, or so-called evidence-based research is the absolute norm there. That is in stark contrast to art where, as in other disciplines in the humanities, qualitative methods of measurement are the focus. Veltman says: “Evidence-based medicine is not always meaningful, necessary, or feasible to pursue. Patients are people, too, and feelings and unexpected turns in their course of illness cannot always be captured and explained with numbers.”

Still, Kamstra sees that the skepticism surrounding art education is diminishing and more attention is being paid to the qualitative side of healthcare delivery. “There are all kinds of different initiatives within the walls of different (academic) hospitals in which art is integrated into medicine. The tours in museums such as the Rijksmuseum and Boijmans Van Beuningen in Rotterdam are examples, but there is also research into the role of art in palliative care or music in the operating room. But there is still a long way to go.”

Kamstra and Veltman hope that art education will continue to develop within the medical curriculum in the coming years. Veltman says, “Because every year we develop a new theme for the elective module ‘Watching Art’ and there is a super enthusiastic response to it, and the scientific basis is growing, we hope at some point to be able to bundle the topics and offer them as a full-fledged subject to medical students.”