Arts and the quest for healing have been expressed throughout human history. However, in the modern era of biotechnology and biomedical advancements, our society often struggles to find the interconnection and interrelation of arts, humanities, health, and health care education. Because the arts have a universality, the arts can be used to facilitate inventive and interdisciplinary approaches to open the lines of communication between learners, educators, and health care providers to improve patient outcomes.
Historical Expression of Health in the Arts
Paintings and sculptures have been used in shamanic health and healing rituals since the Paleolithic period. Some scholars have speculated that the shamanic rituals helped to reduce anxiety, with the calming and repetitive behaviors helping to assert control over stressful situations, such as coming to terms with death; further, the rituals may help to regulate emotions, thereby functioning not just as symbolic rituals but also as health-promoting activities (Fancourt, 2017). During the Middle Ages and the birth of the Renaissance in the 12th century in Europe, many medical books translated from Arabic and Jewish sources contained vast references to the role of arts in health and healing (Fancourt, 2017). Fast forward to 20th century, when arts-based training programs have been implemented in higher education as part of a growing awareness of the need to develop interpersonal skills of health care professionals to be able to deliver respectful and compassionate patient care.
At the University of Miami, the educators in the undergraduate and graduate health care programs are exploring innovative teaching strategies that focus on building these much-needed communication and collaboration skills among students. Visual thinking strategies (VTS) is an innovative teaching method that uses visual art to improve observation, communication, and problem-solving skills.
What is VTS?
VTS ( https://vtshome.org) is a research-based, student-centered methodology that uses increasing complexities of art to develop and enhance higher order thinking (Housen, 2002). The facilitator leads small groups of participants to engage in respectful conversations about the meanings of works of art, while providing evidence for their interpretations. Using three open-ended questions focusing on observation, evaluation of the evidence, and interpretation, the facilitator paraphrases participants' comments in a nonjudgmental way, while pointing out details within the artwork. During the discussion, the facilitator links participants' comments to frame a group interpretation.
The Fine Art of Healthcare Program at the University of Miami
For more than a decade, the Lowe Art Museum at the University of Miami has offered The Fine Art of Healthcare, a VTS-based program to boost communication, empathy, active listening, and detailed observation in the health professions students. The program has evolved into a 3-day workshop series held once per year and bringing together medical, undergraduate and graduate nursing, physical therapy, and psychology students.
The VTS process is modeled by trained museum educators during the introduction session. Small integrated groups of eight to 10 students are guided to various art pieces. The students begin the session by asking the three open-ended questions foundational to VTS:
- “What is going on here?”
- “What do you see that makes you say that?”
- “What more can you find?”
When comparing The Fine Art of Healthcare program to other programs that utilize VTS, the unique components include interprofessional groups in which the participants collaborate and have the opportunity to facilitate the art discussion. Participant-facilitated dialogues provide them with experience and practice in how to remain neutral in the presence of ambiguity, to develop active listening skills by paraphrasing discussions, and to link together ideas from members of the group (Housen, 2002). Chosen by the museum educators, the artwork includes fine art paintings, as well as glass art, photography, and sculptures, on display from either the museum's permanent or visiting collections. Specific artwork used in the workshops has elicited rich discussions and helped participants connect aesthetics to clinical observation and communication skills. The images and objects used include Jusepe de Ribera's painting, Saint Onuphrius (ca.1642); Pieter de Grebber's painting, Unequal Lovers (Trapped Thief) (ca.1600); Pieter Hugo's photograph, The Hyena Handlers of Nigeria (2012); and from the museum's glass collection, Jeffrey Spencer's Shattered Illusions (1997). During the workshop, students also reflect on best-practice skills and take part in a writing exercise. At the end of the VTS sessions, all participants are asked to complete an anonymous survey about their experience and their perceptions of the workshop. Overall, the students' evaluations were positive. Some of the VTS implications the students have rated highly are (a) understand how to hone their observational and listening skills, (b) has merit with regard to collaborative practice, (c) helps with patient interviewing skills, and (d) improves overall communication skills. In addition, the students pointed that the aesthetic exercises in VTS improved their attention to detail, respect for the opinions and views of others, self-awareness of personal views, and improvement in self-reflection.
Similarly, the Lowe Art Museum has conducted VTS-based exercises for interdisciplinary communication and teamwork educational purposes with the employees of a partnering medical center. The exercises, which received positive evaluations, were conducted with more than 30 nurses, physicians, and executives.
Health Care Education Implications
Thus far, the results of using VTS in nursing and medical education are promising. Several studies have reported significant improvement in observation, diagnostic skills, critical thinking, and communication among nursing and medical students following VTS (Frei et al., 2010; Jasani & Saks, 2013; Klugman et al., 2011; Miller et al., 2013).
The use of VTS appears to increase collaboration among group members to reach a cohesive conclusion and gain respect through actively listening and effectively stimulating reflection on meaningful issues and community building (Gaufberg, & Williams, 2011; Klugman et al., 2011). Our workshop evaluations demonstrated similar findings, with 93% of participants reporting they were pleased that the workshop provided an opportunity to meet and have discussions with students from other disciplines.
The Fine Art of Healthcare program complements clinical training by providing a safe environment to discuss works of art, which can be as ambiguous as the complexities of a patient's clinical picture. In addition, because students are not under the pressures of the clinical environment, they feel satisfaction in agreeing or disagreeing about an artwork's narrative in a leveled communication field where the majority of participants cannot claim competency in art appreciation.
It is worth mentioning that many of the aforementioned studies lack research rigor; others involved elective courses, which limited enrollment to only those students with an interest in the fine arts. Certainly, future research should expand on these areas, as the usefulness of incorporating the visual arts into medical and nursing education is worth investigating (Perry et al., 2011)
Multidisciplinary Education Implications
With an art-based program as popular as the VTS among our diverse student body, we believe that similar programs may be successfully adapted for continuing multidisciplinary education of health care professionals with the goals of improving communication and team building. Health care educators can incorporate innovative learning strategies to build communication and cultural competency by using the VTS method. As participants explore the complexities of artwork, they can generate new thinking patterns to increase cultural awareness of health, illness, and self-care practices in different time periods and societies through artistic expressions.
Art can be a powerful tool to teach health care professionals to acknowledge their own bias, how to move away from making assumptions, and to avoid biases and assumptions that can influence patient care in a negative way (Klugman & Beckmann-Mendez, 2015; Ross & Lypson, 2014). Unconscious bias is something that we, as museum and health care educators, feel is important for the patient outcomes. Raising awareness of unconscious and cultural bias can be done by using artifacts from different time periods and cultures. Although it is hard to prove or disprove that unconscious bias is mitigated and cultural sensitivity is raised by observing art, some specific art objects have been used in our VTS program from artists such as Titus Kaphar and Viola Frey, as well as some of the Native American, African, and Asian artifacts and art pieces from the Lowe Museum's collections. Eighty-one percent of our students responded that the VTS exercises have increased their self-awareness of their own personal views.
Similar VTS interdisciplinary programs can be implemented in institutions that do not partner with fine art museums (Table 1). High-resolution images or 3D-printed art objects from different time periods and cultures can be displayed in a classroom setting to facilitate group discussions. Although no specific type of art is recommended, usually the art objects that are selected should be narrative in content from a range of time periods and cultures.
Walking Through the Interprofessional Fine Art of Healthcare Program for Working Health Care Professionals
In light of the discussions in this article, we would like to bring awareness about the role of art and humanities in health care educations. Health care professionals from all backgrounds have more in common than different, and art can be a uniting theme. Furthermore, globalization, bringing with it the need to embrace the broad cultural diversity around how personal and societal philosophies interoperate, will put a premium on finding more effective ways to communicate with one another.
- Fancourt, D. (2017). Arts in Health. Oxford Scholarship Online. doi:10.1093/oso/9780198792079.001.0001 [CrossRef]
- Frei, J., Alvarez, S. E. & Alexander, M. B. (2010). Ways of seeing: Using the visual arts in nursing education. The Journal of Nursing Education, 49(12), 672–676 doi:10.3928/01484834-20100831-04 [CrossRef]
- Gaufberg, E. & Williams, R. (2011). Reflection in a museum setting: The personal responses tour. Journal of Graduate Medical Education, 3(4), 546–549 doi:10.4300/JGME-D-11-00036.1 [CrossRef]
- Housen, A. (2002). Aesthetic thought, critical thinking and transfer. Arts and Learning Research Journal, 18, 99–132.
- Jasani, S. K. & Saks, N. S. (2013). Utilizing visual art to enhance the clinical observation skills of medical students. Medical Teacher, 35(7), e1327–e1331 Advance online publication. doi:10.3109/0142159X.2013.770131 [CrossRef]
- Klugman, C. M. & Beckmann-Mendez, D. (2015). One thousand words: Evaluating an interdisciplinary art education program. The Journal of Nursing Education, 54(4), 220–223 doi:10.3928/01484834-20150318-06 [CrossRef]
- Klugman, C. M., Peel, J. & Beckmann-Mendez, D. (2011). Art rounds: Teaching interprofessional students visual thinking strategies at one school. Academic Medicine, 86(10), 1266–1271 doi:10.1097/ACM.0b013e31822c1427 [CrossRef]
- Miller, A., Grohe, M., Khoshbin, S. & Katz, J. T. (2013). From the galleries to the clinic: Applying art museum lessons to patient care. The Journal of Medical Humanities, 34(4), 433–438 doi:10.1007/s10912-013-9250-8 [CrossRef]
- Perry, M., Maffulli, N., Willson, S. & Morrissey, D. (2011). The effectiveness of arts-based interventions in medical education: A literature review. Medical Education, 45(2), 141–148 doi:10.1111/j.1365-2923.2010.03848.x [CrossRef]
- Ross, P. T. & Lypson, M. L. (2014). Using artistic-narrative to stimulate reflection on physician bias. Teaching and Learning in Medicine, 26(4), 344–349 doi:10.1080/10401334.2014.945032 [CrossRef]
Walking Through the Interprofessional Fine Art of Healthcare Program for Working Health Care Professionals
|Selection of Participants||Nurses, Physicians, Health Care Organization Leaders, and Other Staff|
|Goals and objectives of the workshop||Discuss in a safe and inclusive environment strategies for (a) team collaboration, (b) learning to navigate ambiguity, (c) honing observation and communication skills, (d) bias awareness and cultural humility|
|Selection of art objects on view in the museum||Art objects include sculptures, paintings, and photographs and should be selected accordingly, simple to more complex narratives, and appropriate for group participation|
|Agenda of the workshop (approximately 2.5 to 3 hours)|
Introduction connecting clinical practice to aesthetic meaning (15 to 20 minutes)—emphasize that there is more than one correct answer to the meaning of a work of art and all perspectives by the participants are valid. This connects to the working or differential diagnosis of a complex clinical case, where different disciplines can weigh inon their specific areas of expertise.
Demonstration of Visual Thinking Strategies by museum educator and deconstructing process to all participants (15 minutes)
Mixed small groups with eight to 10 participants, discussing six to eight works of art (approximately 75 minutes):
Cofacilitation with participants
Reflective practice led by museum educator
Writing or drawing exercises
Debrief session with the entire group (15 minutes)