In the paper “The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents” Dr. Zazulak and colleagues address the role of an arts-based curriculum as an instrument to increase empathy and stimulate mindfulness and well-being in medical residents (1). I would like to extend the discussion and include cinema as a powerful tool able to not only provide a meaningful educational experience but also improve residents’ empathy and decrease exhaustion.
Little has been studied and although reported in a few sporadic papers, there is no clear evidence that the use of arts can improve residents’ awareness and sensitivity (2-4). Regardless, there is a current trend of increased theoretical knowledge and objectivity among doctors suffering from a dogmatic approach that lacks empathy and emotion(5). As clearly defined by the authors in an era of increasing burnout among residents, films can not only educate and increase empathy but also serve as a social gathering as well as a way of having fun and relaxing(6). They not only offer an opportunity to face the meaning of being a doctor but also to arouse emotions yet hidden(5, 7). From a personal perspective I can be transported to a reality not clearly seen behind the desk and white coat and other perspectives now appear more tangible; I can see families suffering at home while taking care of their loved ones (Amour), the relation between nurses and paralyzed pati...
In the paper “The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents” Dr. Zazulak and colleagues address the role of an arts-based curriculum as an instrument to increase empathy and stimulate mindfulness and well-being in medical residents (1). I would like to extend the discussion and include cinema as a powerful tool able to not only provide a meaningful educational experience but also improve residents’ empathy and decrease exhaustion.
Little has been studied and although reported in a few sporadic papers, there is no clear evidence that the use of arts can improve residents’ awareness and sensitivity (2-4). Regardless, there is a current trend of increased theoretical knowledge and objectivity among doctors suffering from a dogmatic approach that lacks empathy and emotion(5). As clearly defined by the authors in an era of increasing burnout among residents, films can not only educate and increase empathy but also serve as a social gathering as well as a way of having fun and relaxing(6). They not only offer an opportunity to face the meaning of being a doctor but also to arouse emotions yet hidden(5, 7). From a personal perspective I can be transported to a reality not clearly seen behind the desk and white coat and other perspectives now appear more tangible; I can see families suffering at home while taking care of their loved ones (Amour), the relation between nurses and paralyzed patients (The Intouchables), and sometimes I can even see fixedly through the eyes of a quadriplegic restricted to a wheel chair (The diving Bell and the butterfly).
As a junior neurology resident at the University of Miami/Jackson Memorial Hospital, the third largest neurology residency program in the US, I have plans to organize frequent movie clubs for faculty, residents and medical students. In addition to the classic medical education, a complementary approach focused on humanities and art may improve resident’s empathy and help them unbury subjects hidden by the overuse of technical medical issues.
References:
1. Zazulak J, Sanaee M, Frolic A, Knibb N, Tesluk E, Hughes E, et al. The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents. Med Humanit. 2017 Apr 27;
2. Wershof Schwartz A, Abramson JS, Wojnowich I, Accordino R, Ronan EJ, Rifkin MR. Evaluating the impact of the humanities in medical education. Mt Sinai J Med N Y. 2009 Aug;76(4):372–80.
3. Wolters FJ, Wijnen-Meijer M. The role of poetry and prose in medical education: the pen as mighty as the scalpel? Perspect Med Educ. 2012 Mar;1(1):43–50.
4. Skelton JR, Macleod JA, Thomas CP. Teaching literature and medicine to medical students, part II: why literature and medicine? Lancet Lond Engl. 2000 Dec 9;356(9246):2001–3.
5. Gramaglia C, Jona A, Imperatori F, Torre E, Zeppegno P. Cinema in the training of psychiatry residents: focus on helping relationships. BMC Med Educ. 2013 Jun 21;13:90.
6. Hassan A, Wijdicks EFM. The Mayo Clinic experience. Pract Neurol. 2014 Feb;14(1):68–9.
7. Izod J. Active imagination and the analysis of film. J Anal Psychol. 2000 Apr;45(2):267-285-293.
We welcome the response from Kamath et al and their insight into the issues and culture within medicine in India, and their thoughts about how to address these issues. We also agree that a drama-based approach is not sufficient on its own to deal with entrenched power issues which affect students adversely. As we have indicated, we believe “a multipronged approach is needed to generate systemic change.” These authors similarly advocate that student mistreatment be dealt with “in a comprehensive manner” including a ‘grievance redressal system’ and other measures to withhold accreditation where there are issues of abuse of power.
Nevertheless, we note that Kamath et al have responded positively to our approach—as a part of that mix—and it would be of great interest to see whether drama-based workshops could support medical students developing embodied acting skills in their institution and whether they may have similar transformative effects. We’d like to refer the authors to an excellent Medical Humanities paper we referenced that outlined drama-based activities in medical education in India: Gupta S, Singh S. Confluence: understanding medical humanities through street theatre. Medical Humanities. 2011;37(2):127-128.
Despite the above article, the authors note that medical education in India has not embraced the medical humanities. We would draw a distinction within the medical humanities between activities which are primarily studious (re...
We welcome the response from Kamath et al and their insight into the issues and culture within medicine in India, and their thoughts about how to address these issues. We also agree that a drama-based approach is not sufficient on its own to deal with entrenched power issues which affect students adversely. As we have indicated, we believe “a multipronged approach is needed to generate systemic change.” These authors similarly advocate that student mistreatment be dealt with “in a comprehensive manner” including a ‘grievance redressal system’ and other measures to withhold accreditation where there are issues of abuse of power.
Nevertheless, we note that Kamath et al have responded positively to our approach—as a part of that mix—and it would be of great interest to see whether drama-based workshops could support medical students developing embodied acting skills in their institution and whether they may have similar transformative effects. We’d like to refer the authors to an excellent Medical Humanities paper we referenced that outlined drama-based activities in medical education in India: Gupta S, Singh S. Confluence: understanding medical humanities through street theatre. Medical Humanities. 2011;37(2):127-128.
Despite the above article, the authors note that medical education in India has not embraced the medical humanities. We would draw a distinction within the medical humanities between activities which are primarily studious (reading literature, studying medical history) and workshops that are based on participative and embodied activity. Our experience has indicated the effectiveness of drama-based workshops in addressing both the cognitive and emotive aspects of harmful practices and we believe that it is the embodied nature of acting skills workshops that is transformative.
One of the indirect outcomes of workshops of this kind is how they draw attention to the issues of harassment and bullying within medical education and could support reflection within Indian medical schools and the wider culture. However the broader political context is also important. Our workshops occurred following widespread media attention and criticism of the abuse of power within medicine. Furthermore medical associations (including the Royal Australasian College of Surgeons) had taken steps to challenge these abuses. We note that there are similar responses from politicians in India critical of The Medical Council for corrupt practices, and this may indicate a political climate conducive to change.
We read with great interest “Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students”,Scott et al, in the March 2017 issue.The percentages of medical students in American and Australian settings who faced discrimination, harassment and “teaching by humiliation” were pretty significant.
An observation that we would like to make is that we feel that the form of intervention outlined in this paper would be of even more relevance in Indian settings,where one has the additional influences of patriarchal and sometimes misogynistic beliefs and practices, caste hierarchies,a culture of marked deference to seniors,and starkly contrasting socio-economic backgrounds.To add to the mix,the regulatory environment in which medical institutions function in India is already a compromised one.The Medical Council of India has been widely panned for corruption,with an Indian parliamentary committee report calling it a “club” of influential medical practitioners who act without any fear of governance and regulations.1A sitting Union health minister has been no less scathing.2When this is the situation with regard to compliance with “hard” requirements like infrastructure,manpower,equipment and admission criteria,one would have to be a die-hard optimist to believe that what is perceived as a “soft” issue like student mistreatment would get the attention that it deserves on a large scale.A significant number of students who face...
We read with great interest “Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students”,Scott et al, in the March 2017 issue.The percentages of medical students in American and Australian settings who faced discrimination, harassment and “teaching by humiliation” were pretty significant.
An observation that we would like to make is that we feel that the form of intervention outlined in this paper would be of even more relevance in Indian settings,where one has the additional influences of patriarchal and sometimes misogynistic beliefs and practices, caste hierarchies,a culture of marked deference to seniors,and starkly contrasting socio-economic backgrounds.To add to the mix,the regulatory environment in which medical institutions function in India is already a compromised one.The Medical Council of India has been widely panned for corruption,with an Indian parliamentary committee report calling it a “club” of influential medical practitioners who act without any fear of governance and regulations.1A sitting Union health minister has been no less scathing.2When this is the situation with regard to compliance with “hard” requirements like infrastructure,manpower,equipment and admission criteria,one would have to be a die-hard optimist to believe that what is perceived as a “soft” issue like student mistreatment would get the attention that it deserves on a large scale.A significant number of students who face mistreatment do not report it because the system does not respond adequately and appropriately.
One way that a felt need to deal with medical student mistreatment could creep into the collective Indian medical education consciousness would be if a functional grievance redressal system became an accreditation requirement as part of a quality initiative.In this way,at least the academic institutions that go in for accreditation would deal with student mistreatment in a comprehensive manner.After some time,when a critical mass of policy makers and academics become familiar with this concept,it could be brought in as a statutory requirement.
We feel that novel techniques like the drama based approach must be made part of sensitisation modules for all faculty and students.A sub-theme in the qualitative workshop evaluation data that touched us was some attending the workshop for preventative reasons(“I don't want to be a [bully] … I want to be involved in [the workshop] so I could be more aware.”)It would be interesting to do a study on how many healthcare professionals believe that they may be actually indulging in bullying or mistreatment.Suffice it to say that a great many wouldn’t be aware that they are doing it.It is our belief that there is a very large untapped benefit from attending workshops like these for purely preventative reasons.
The field of medical education in India and we suspect in most of the rest of the world, has been left largely untouched by the medical humanities. Initiatives like this workshop would go a long way in facilitating a syncretism between these disciplines that would hopefully dispel the darkness of arrogance and superciliousness that seem to cloud so much of medical education discourse.
A book written by Jeremy Holmes, Psychoanalyst,(which I came across
on the web) aimed mainly at psychotherapists, 'The Therapeutic
Imagination' has used a novel approach to deepen understanding of the
two way process involved in understanding self and others, by applying
extracts from poetry and novels to explore 'what goes on' from a
psychological perspective in a professional relationship- in order to
better underst...
A book written by Jeremy Holmes, Psychoanalyst,(which I came across
on the web) aimed mainly at psychotherapists, 'The Therapeutic
Imagination' has used a novel approach to deepen understanding of the
two way process involved in understanding self and others, by applying
extracts from poetry and novels to explore 'what goes on' from a
psychological perspective in a professional relationship- in order to
better understand another's situation and experience. Though written from
a psychoanalytic perspective I would think It can be applied to other than
therapy situations both by people whose work involves making
relationships with clients (and also outside professional
relationships). The book could be paradoxically , helpful both for those
who do not have a great imagination to start with as it is not a book to
be read or analysed simply as a novel but can be applied as a learning
tool and for those who do value the imagination already it can be enjoyed
as a way of developing it in more focused ways that would benefit
practice. The problem is possibly that in the present climate there is so
little time to read and reflect that that practice will become even more
dehumanised and the message in such books will not be heard widely
enough..
When children come up with unique words they do not just show a stage
of the technical development of language but also their unique
understanding of aspects of their lives. Parents or those who look after
them often 'get it' whilst nobody else does just because they are tuned
in. These words are often kept as unique memories of a child's inner
world.
I would like to offer one of my own. 'Imaginating' which ha...
When children come up with unique words they do not just show a stage
of the technical development of language but also their unique
understanding of aspects of their lives. Parents or those who look after
them often 'get it' whilst nobody else does just because they are tuned
in. These words are often kept as unique memories of a child's inner
world.
I would like to offer one of my own. 'Imaginating' which has features
of 'imagination' but is experienced as a state of a more active
development to a stage of 'what is' rather than 'what if'. Maybe if
taken too far even 'false memories' of all sorts of things could be
created this way.
The changes to the aims of Humanities described in the Editorial by
Deborah Bowman - and to the articles published in this edition are so
enormous it seems as though the Journal has been incubating and is now
emerging into a new, more exciting form! This is so interesting, thank
you for such stimulating reading.
This is an awesome article...thank you for it. I had supposed
previously that the practices exposed here would be in contravention of
Codes of Practice/Codes of Ethics of psychology and therapy based
organisations so it is shocking to find they are explicitly implicated in
the humiliating and dehumanising practices described. Surely professional
codes state in various forms the obligation 'to do no harm'? (physical or
m...
This is an awesome article...thank you for it. I had supposed
previously that the practices exposed here would be in contravention of
Codes of Practice/Codes of Ethics of psychology and therapy based
organisations so it is shocking to find they are explicitly implicated in
the humiliating and dehumanising practices described. Surely professional
codes state in various forms the obligation 'to do no harm'? (physical or
mental). Thousands of people have been harmed. If quasi legal avenues of
redress for those who wish to make complaints are closed by psychological
organisations who are condoning coercive behaviour on behalf of the state
- there needs to be a higher authority than the state which claimants can
turn to. Not knowing enough about this I would like to know if there has
been any action by campaigners to overturn the practices exposed here, by
maybe individual complaints to psychology organisations or against
individual psychologists who participate in harmful behaviour,appeals to
the Court of Human Rights when conditions under which citizens are forced
to live are dehumanising and intimidating. Maybe NGO's from other
countries such as Scandinavia or areas where these conditions are not
imposed on citizens,should come to Britain to investigate and make
reports. It would also be interesting by the way to have a similar work
undertaken from the perspective of those who feel it is legitimate to
treat their fellow citizens in such ways.
I was interested to read that only one person wished to read
transcripts which described such an intimate part of their lives. Do you
think if given another opportunity later when the experience was not as
raw the chance may have had a higher take up? I wonder if anybody has
asked to read the published article? I had a friend who used to cut his
arms. He decided not to request access to his notes as he mistrusted how...
I was interested to read that only one person wished to read
transcripts which described such an intimate part of their lives. Do you
think if given another opportunity later when the experience was not as
raw the chance may have had a higher take up? I wonder if anybody has
asked to read the published article? I had a friend who used to cut his
arms. He decided not to request access to his notes as he mistrusted how
he would have been described ie he would not have been understood and
worse it may have been offensive. (Many people are still too anxious to
read their notes where others' opinions about them are recorded ]. His
decision was realistic. When rushing him up to hospital after the
cutting went too deep he was obliged to go through a door labelled
'Poisons Unit' - it was used for all sorts of self harming including
pumping the stomache. The nurse in an aside which he could clearly hear
stated that 'We don't make people feel too comfortable as they will only
keep coming back'. It would be useful if people were given the opportunity
to add their own account to their notes. He claimed that he had the right
to do what he wanted to his own body. The scars were a kind of badge
almost like a tattoo. Although the article is hugely respectful to the
participants it may be that to read the transcripts in such a format would
be embarrassing or even a bit of a betrayal. My friend is no longer around
but he would have been respectful of the attempt to understand in such a
compassionate way.
I was really interested in the Corrupted Blood incident and I want,
first of all, thank the author for this article.
I only wanted to write a little note about two in-game nouns that are
used in the article:
1) The name of the new playable area released by Blizzard
Entertainment in September 2005 is called "Zul'Gurub", not "Zul'Gurunb";
2) the final boss of Zul'Gurub is called "Hakkar", not "Hakka".
I know that these nouns are not that important for the global content
of the article, but I thought it could have been useful to inform you
about these little "mistakes".
In the paper “The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents” Dr. Zazulak and colleagues address the role of an arts-based curriculum as an instrument to increase empathy and stimulate mindfulness and well-being in medical residents (1). I would like to extend the discussion and include cinema as a powerful tool able to not only provide a meaningful educational experience but also improve residents’ empathy and decrease exhaustion.
Show MoreLittle has been studied and although reported in a few sporadic papers, there is no clear evidence that the use of arts can improve residents’ awareness and sensitivity (2-4). Regardless, there is a current trend of increased theoretical knowledge and objectivity among doctors suffering from a dogmatic approach that lacks empathy and emotion(5). As clearly defined by the authors in an era of increasing burnout among residents, films can not only educate and increase empathy but also serve as a social gathering as well as a way of having fun and relaxing(6). They not only offer an opportunity to face the meaning of being a doctor but also to arouse emotions yet hidden(5, 7). From a personal perspective I can be transported to a reality not clearly seen behind the desk and white coat and other perspectives now appear more tangible; I can see families suffering at home while taking care of their loved ones (Amour), the relation between nurses and paralyzed pati...
Dear Editor,
We welcome the response from Kamath et al and their insight into the issues and culture within medicine in India, and their thoughts about how to address these issues. We also agree that a drama-based approach is not sufficient on its own to deal with entrenched power issues which affect students adversely. As we have indicated, we believe “a multipronged approach is needed to generate systemic change.” These authors similarly advocate that student mistreatment be dealt with “in a comprehensive manner” including a ‘grievance redressal system’ and other measures to withhold accreditation where there are issues of abuse of power.
Nevertheless, we note that Kamath et al have responded positively to our approach—as a part of that mix—and it would be of great interest to see whether drama-based workshops could support medical students developing embodied acting skills in their institution and whether they may have similar transformative effects. We’d like to refer the authors to an excellent Medical Humanities paper we referenced that outlined drama-based activities in medical education in India: Gupta S, Singh S. Confluence: understanding medical humanities through street theatre. Medical Humanities. 2011;37(2):127-128.
Despite the above article, the authors note that medical education in India has not embraced the medical humanities. We would draw a distinction within the medical humanities between activities which are primarily studious (re...
Show MoreDear editor,
We read with great interest “Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students”,Scott et al, in the March 2017 issue.The percentages of medical students in American and Australian settings who faced discrimination, harassment and “teaching by humiliation” were pretty significant.
An observation that we would like to make is that we feel that the form of intervention outlined in this paper would be of even more relevance in Indian settings,where one has the additional influences of patriarchal and sometimes misogynistic beliefs and practices, caste hierarchies,a culture of marked deference to seniors,and starkly contrasting socio-economic backgrounds.To add to the mix,the regulatory environment in which medical institutions function in India is already a compromised one.The Medical Council of India has been widely panned for corruption,with an Indian parliamentary committee report calling it a “club” of influential medical practitioners who act without any fear of governance and regulations.1A sitting Union health minister has been no less scathing.2When this is the situation with regard to compliance with “hard” requirements like infrastructure,manpower,equipment and admission criteria,one would have to be a die-hard optimist to believe that what is perceived as a “soft” issue like student mistreatment would get the attention that it deserves on a large scale.A significant number of students who face...
Show MoreA book written by Jeremy Holmes, Psychoanalyst,(which I came across on the web) aimed mainly at psychotherapists, 'The Therapeutic Imagination' has used a novel approach to deepen understanding of the two way process involved in understanding self and others, by applying extracts from poetry and novels to explore 'what goes on' from a psychological perspective in a professional relationship- in order to better underst...
Please note author's change of email address.
Conflict of Interest:
None declared
When children come up with unique words they do not just show a stage of the technical development of language but also their unique understanding of aspects of their lives. Parents or those who look after them often 'get it' whilst nobody else does just because they are tuned in. These words are often kept as unique memories of a child's inner world.
I would like to offer one of my own. 'Imaginating' which ha...
The changes to the aims of Humanities described in the Editorial by Deborah Bowman - and to the articles published in this edition are so enormous it seems as though the Journal has been incubating and is now emerging into a new, more exciting form! This is so interesting, thank you for such stimulating reading.
Conflict of Interest:
None declared
This is an awesome article...thank you for it. I had supposed previously that the practices exposed here would be in contravention of Codes of Practice/Codes of Ethics of psychology and therapy based organisations so it is shocking to find they are explicitly implicated in the humiliating and dehumanising practices described. Surely professional codes state in various forms the obligation 'to do no harm'? (physical or m...
I was interested to read that only one person wished to read transcripts which described such an intimate part of their lives. Do you think if given another opportunity later when the experience was not as raw the chance may have had a higher take up? I wonder if anybody has asked to read the published article? I had a friend who used to cut his arms. He decided not to request access to his notes as he mistrusted how...
I was really interested in the Corrupted Blood incident and I want, first of all, thank the author for this article.
I only wanted to write a little note about two in-game nouns that are used in the article:
1) The name of the new playable area released by Blizzard Entertainment in September 2005 is called "Zul'Gurub", not "Zul'Gurunb";
2) the final boss of Zul'Gurub is called "Hakkar", not "Ha...
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