Essay: What can the arts bring to medical training?

Abstract

There is clearly more to being a doctor than clinical expertise. In the UK, medical schools are recommended to ensure that students know about and understand the rights of patients, are able to communicate eff ectively, to accept the moral and ethical responsibility involved in providing care, and to respect patients irrespective of lifestyle, culture, beliefs, race, colour, gender, sexuality, disability, age, or social or economic status. These are excellent ideals, which raise complex questions that cannot easily be answered scientifi cally. The concepts— lifestyle, culture, even gender—have shifting meanings and are diffi cult to measure. So, how can they be taught? Over the past 5 years I have implemented a range of arts programmes in medical schools, delivered by cuttingedge contemporary artists and thinkers who are specialists in their fi elds. The aim is to get outsiders in, to cross cultures, to demonstrate that there are many voices at play within health care, and to benefi t from diff erent perspectives on the cultural context in which medicine takes place. I believe that arts can have a role in medical education in three key ways: practical skills; examination of cultural and ethical issues through the arts; and introduction to artists working in health. In conventional medical training, students do things to other people’s bodies rather than gathering an awareness of their own. But charisma or bedside manner isn’t something innate. A person can improve. An understanding of the practical skills of voice, body language, and use of space can make a huge diff erence to the way doctors communicate and perhaps even to the way they diagnose. Training methods common to performance can bring confi dence to students, many of whom are nervous of interacting with patients. Physical awareness and exercise can help students build up the skills and stamina they need to sustain a work practice that is highly demanding. There is so much well-deserved focus on patient-centred practice, but the physical and mental well-being of the health worker should not be ignored. My approach to teaching practical skills to medical students is not to apply them immediately to a clinical context. Possibilities of learning should be opened up before skills are honed to suit specifi c scenarios. For example, students might experiment with tones of voice by working on a dramatic text with a voice coach before applying these skills to a context of breaking bad news. Non-verbal communication can be taught in a physical theatre class, allowing students to experiment with wildly inappropriate and ridiculous ways of behaving so that they eventually fi nd a fl exibility and physical openness that can be adapted to a range of possible scenarios. Appreciation and interpretation of narrative can be developed in literature classes. Anatomy courses can be complemented with dance, yoga, life drawing, or state-ofthe-art body imaging, inspiring students about the landscape of the body, bringing the science to life, providing students with physical and visual ways to remember information. The body can be enjoyed and respected as poetic, beautiful, rich in possibility, ready for change and transformation. Obviously, medicine always takes place within a cultural and ethical context. Treatment of someone in a war zone is very diff erent from a consultation in a family doctor’s surgery in a safe suburban area. Doctors need to be able to relate to people from whom they feel culturally diff erent. The more knowledge that can be bought to bear on the rather abstract concept of respecting patients irrespective of their lifestyle, gender, and so on, the better. Arts can provide a colourful and provocative platform from which to examine ideas of identity, control, sexuality, and ownership, a platform that actually embraces subjectivity. A look at photographic theory can address the ways in which we see. The work of Susan Sontag, John Berger, and Jo Spence can help students to refi ne their judgments in the visual domain. An examination of medical photography itself sheds light on how a medical gaze has been constructed and reveals tensions in the doctor– patient relationship, especially in terms of power; photographs of 19th century psychiatric hospitals are an interesting example. Contemporary performance artists such as Franko B, Ron Athey, and Orlan cause controversy by taking control of their bodies using surgical techniques unsanctioned by the medical profession. Some medical students are Suzy Willson is the Artistic Director of the theatre company The Clod Ensemble and an Honorary Senior Lecturer at Bart’s and The London, Queen Mary’s School of Medicine and Dentistry. She is currently Director of the Performing Medicine Project, which programmes arts workshops, courses, and events for medical students and health-care professionals.