Margie Huff, a second-year medical student at Northwestern University, picked up a drawing pencil and carefully sketched the upper border of an eye socket.
Huff then peered at her own reflection in a small cosmetics mirror and made a couple of small adjustments. The skull she was drawing was her own.
She and six other medical students are participating in a seminar titled The Layered Self-Portrait. The students are guided through the steps of creating an anatomically correct self-portrait, drawing the bones of their skulls, then laying down the facial muscles and finally filling in their features.
The point of the class is not to learn anatomy or how to draw, according to instructor Riva Lehrer, an artist and adjunct professor at the School of the Art Institute of Chicago. Its purpose is to help the students gain a sense of mindfulness, concentration, self-awareness and respect for human differences — all qualities necessary for the doctors they will become within a few short years, she said.
The class is part of a trend at medical schools that focuses not just on teaching the vast amount of information and clinical skills medical students must know to be good doctors, but also on the humane qualities they need to have.
"Most medical schools now recognize the responsibility to train compassionate doctors," said Dr. James Woodruff, associate dean of students at University of Chicago's Pritzker School of Medicine. "There's a sense that society is not satisfied with doctors who just make good clinical decisions, but with those who put their patients first and treat them with empathy, clarity and sensitivity to cultural diversity."
And to teach that, many medical schools are turning to the traditional arts and humanities. Based on studies that show reflective writing will help doctors become more mindful practitioners and better diagnosticians, creative writing, for instance, is becoming a growing part of medical curricula, like the University of Chicago's, as well as a medical genre in its own right.
"Writing makes better doctors," said Hedy Wald, an assistant professor at the Warren Alpert Medical School at Brown University, who studies the impact of reflective writing in medical school curricula. So does painting and the other arts, because the same intangible qualities they evoke — mindful presence, critical curiosity, self-awareness and sensitivity — are essential in a doctor.
"We're so used to paying partial attention, I tell my students there's no Twitter-length communication (of 140-character maximum) when a person is suffering and you have to understand their story," Wald said.
According to Philip Wilson, a historian of medicine and science at Penn State University's College of Medicine in Hershey, Pa., each of the 141 accredited medical schools in the U.S. offers students some exposure to medical ethics, and nearly half offer at least an occasional course or seminar in medical humanities. Rush Medical College in Chicago, for example, has been teaching medical humanities for 15 years.
Although the medical old guard throughout the country considers such lessons goofy at best, and a complete waste of time at worst, the number of courses is growing, Wilson said.
"It keeps the human at the center of things," he said.
Comedy and magic
At Northwestern University's Feinberg School of Medicine, qualities like social and communication skills, sensitivity, compassion, altruism and the ability to work in collaboration are explicitly sought in prospective students, according to Dr. Warren Wallace, associate dean of admissions.
To reinforce and develop those qualities, students are required to take two seminars from the school's Medical Humanities and Bioethics Program, part of a larger humanities and bioethics curriculum that runs through all four years. Students choose from a wide array of courses ranging from the more conventional, like health care reform, to things like personal writing, art appreciation, improvisational comedy or magic, where students learn to perform an illusion from a physician who is also a magician.
"There's a growing recognition that medicine is not simply a science, and that it's not enough to know how someone's body works, but how they work as a person within society and culture," said Catherine Belling, an assistant professor at the medical school and the director of the medical humanities seminar program.
Likewise, she said, it's important for a doctor to develop a professional identity and sense of ethics.
"There's a huge move to recognize all these things are not just decorative luxuries but an essential part of being a doctor," she said.
Observing art, for instance, helps students develop their own ability to visually examine their patients, she said. Improv gives them tools to escape from the canned clinical script and handle whatever the patient throws at them. And personal, reflective writing enables students to pay attention to and understand the narratives of their patients, because it's essential, she said, for doctors to understand patients' stories.
"When people say that doctors don't listen, it doesn't mean that doctors aren't processing facts — they're actually taking in a tremendous amount of information — but that they are not listening to feelings," said Catherine Wallace, who teaches a writing workshop at the medical school.
Wallace typically begins the class with a centering exercise by ringing a Tibetan gong and giving students a writing prompt, for example, a person gets on a train and sees an empty seat and realizes it is empty because person in the next seat is horribly burned. The students write for about 30 minutes and then they read out loud what they have written.
Their writing doesn't progress dramatically within the five-week seminar, she said. But then again, as in the class in self-portraiture, technical proficiency is nice but not the point. What really improves is the students' understanding of plot structure and image patterns, both of which will be found in any story a patient tells a doctor.
"These are teachable skills," Wallace said.
Likewise, this kind of reflective writing gives medical students and doctors the tools to help them sustain compassion in a clinical setting where it can become too easy to begin seeing patients as a body part or a disease instead of a whole person, she said. Patients want their doctors to care and show that they care. And for doctors to avoid being overwhelmed by emotion or shutting down, they need to be able to process their own feelings.
"The doctor who thinks he's God is someone who's absolutely burned out," Wallace said.
A cathartic impact
After a difficult, confusing or embarrassing encounter with a patient, Dr. Kim Grahl, an internist in Evanston, said she sometimes goes home and writes about it to gain a better understanding of what happened. When a long-term patient recently spiraled downhill from an illness and died, she wrote about her experience at his wake to help resolve her grief.
"I think we underestimate, as doctors, the need to do that," said Grahl, who because of patient confidentiality keeps her writing private. Beyond the personal satisfaction and sense of resolution writing gives her, she believes it has honed her listening skills and helped her become a better diagnostician.
"It's like reading a story or a poem," she added. "You can read it superficially or you can do this very, very close reading and bring all your powers of concentration and understanding to it, and you get so much more out of it.
"There's an incredible need among my patients for me to understand them," Grahl said.
For Josh Williams, a fourth-year medical student at the University of Chicago, writing poetry will make him a better doctor, he says. Last year, Williams's poem was a winner in a poetry contest sponsored by the medical school. It begins:
"You are G-tube, trach-dependent,
deaf, blind, devastated, orphaned,
and two years old today."
Williams oversaw this year's contest, which drew more than 100 entries. Writing the poem was cathartic, he said, and helped him wrestle with the troubling experience of caring for a deathly sick child abandoned by family. It also helped him develop the quality of mindfulness, which helps him focus on his patients.
Margie Huff, the second-year medical student at Northwestern, said the class in self-portraiture will help her be a better doctor.
"The skills I am learning," she said, "will help me listen more closely to my patients and pay attention to the details of their stories."Copyright © 2014, The Baltimore Sun