VCU’s Megan Lemay, MD, focuses on primary care, addiction medicine, medical education, and narrative medicine. The brainchild of Rita Charon, MD, PhD, of Columbia, narrative medicine originated with the observation that patients come to doctors with stories, and physicians become part of those stories. Part of the doctor’s role, says Dr. Lemay, is to develop narrative competence, to permit understanding and to honor the patient’s story. The theory is that narratives can improve the physician -patient relationship, and enhance understanding, leading to better outcomes.

VCU’s Medicine, Arts and Humanities curriculum arose in 2019. Endocrinologist John Nestler, MD, formerly Chief of Medicine, had served as physician in residence at the School of Art, “one of the first residencies of its kind in an arts school.” Dr. Nestler knew Dr. Lemay had an interest in the field, and connected her to Sara Wilson McKay, PhD, Associate Professor of Art Education, VCUarts. The goal was to Increase medical students’ skills.

Dr. Wilson McKay co-developed and led “The Art of Nursing,” described as a collaboration among “the VCU School of Nursing, VCU Department of Art Education, and the Virginia Museum of Fine Arts.“ Dr. Wilson McKay and her colleagues had published on how the humanities can build clinical skills. They described an “interdisciplinary art-based educational program for beginning baccalaureate traditional and accelerated nursing students.” They found that “nursing students’ metacognitive awareness (an understanding of one’s own thought processes) benefits from a museum- based arts experience despite demographic and educational differences and (2) the arts-exposed students exhibited higher metacognitive awareness at baseline as compared with the traditional student group. [1] Dr. Wilson McKay’s insights have also gained from the work of Elizabeth Gaufberg, MD, MPH, who co-directs an international health professions education fellowship based at the Museum of Fine Arts, Boston.

Dr. Wilson McKay started The Art of Nursing in 2012 after VCU nurse Susan Lindner attended The Clinical Eye, a professional development session at Yale, and wanted to replicate it at VCU. The VCU Art of Nursing program (which ended in 2020 owing to COVID and retirements) used art education strategies to enhance the clinical reasoning skills of nursing students, integrating works of art into the curriculum. Often, students worked in a clinical setting in the morning, and in an arts environment in the afternoon; frequently, they referred to their clinical experience in interacting with art. The course emphasized acuity of observation and “dialogic looking,” in which one observer looks and shares questions with another, to see more than either would alone, and more than they could by relying on a textbook. Part of the experience is for a student-observer to describe a work of art to another student-observer farther away, who repeats the process, as does the next student, and so forth. The result is often akin to what happens in the children’s game of Telephone, where the first child repeats what he or she has been told to the second, the second to the third, and so forth. This exercise sheds light on what happens, and what can go wrong, at change of shift when the oncoming crew takes report from those going off-duty.

Dr. Wilson McKay emphasizes that the same skills are valuable, and available, to medical students. By confronting different points of view concerning an artwork, and sharing questions and observations, the students improve their critical thinking. By questioning authoritative interpretations of art works, they learn to accept ambiguity in decision- making and to build trust in one another. The emphasis is on close observation, reflection, and empathy. Students are encouraged to look at their own biases in communication.

An aspect of the medicine and the arts curriculum spotlighted by both Drs. Wilson McKay and Lemay, in fact, is the program’s ability to help students understand and cope with their own biases. As one example, they described students’ reaction Ebony Patterson’s Three Kings Weep, exhibited at the Virginia Museum of Fine Art and featuring videos of three black men dressing. Students are asked what they notice, and how to describe it. One student observer commented on jewelry worn by one of the men, describing it as “cheap” and “throw away.”

Another noted that one of the figures held his head in a “defiant position.” Other students were more impressed by the men’s humanity as evidenced by the tears on their faces. Comparing and contrasting these reactions and characterizations enabled the students to note, and thus to better understand, their own views about the men in the artwork. These perceptions are helpful to students learning how to interpret lab data created by tests taking race into account, for example, and how bias, including unrecognized bias, can influence one’s approach to medicine. Probing one’s sensitivity to one’s own biases, how to detect them, and how they influence clinical reasoning, are all designed to diminish the impact of subtle, often unrecognized biases to which we are all susceptible.

Arts courses for VCU healthcare students are offered on a first-come, first-served basis. They attract a mix of students, with and without arts backgrounds. Some come to the program believing they have to abandon their artistic pursuits. Others enhance their existing skills, while still others come in with none, and no expectations of gaining any. So far, there has been too little feedback to gauge how residency directors view educational experiences such as these. Drs. Wilson McKay and Lemay are persuaded, however, that the experiences of the students who take advantage of the arts programs on offer sharpen their crucial thinking skills.

While residents have few comparable opportunities, they do sometimes embark on artistic projects. Among the best examples: sculpture for surgery residents. Additionally, at VCU, Semi Ryu, MFA, is an associate professor with joint appointments in the Department of Kinetic Imaging at VCUarts and the Department of Internal Medicine at the School of Medicine. She is an artist who works with virtual reality in palliative care.

By no means is VCU alone in offering programs such as these. Quite a few schools, including some of the nation’s most prominent, house Centers for Medicine and the Humanities or the like. These institutions stress such concepts as ethics, the doctor-patient relationship, the patient’s perspective and experience of illness, the impact of social and cultural factors on health and disease, and the role of art and creative expression in healthcare. Among the medical schools where such offerings can be found are Mayo, Hopkins, UCSF, and Stanford.

Drs. Lemay and Wilson McKay suggest that exposure to and participating in the arts might be part of the solution to the near-ubiquitous “burnout” problem. Clinicians of all stripes may react to the stresses of their work with an unhealthful gumbo of emotional exhaustion, loss of enthusiasm, cynicism, depersonalization, or a low sense of self-esteem. Instead of a pizza party in the doctors’ lounge, they argue, use art to build skills and enhance resilience. Apparently, this approach has been used to advantage in Europe for some time now, with demonstrable benefits for practitioners. Given the severity and prevalence of burnout here, and the value of the arts in combating it elsewhere, the professions might well benefit from examining the results of bringing the arts to healthcare, at VCU and at many other centers.