Bray Fellowship in Medical Humanities

The Bray Fellowship in Medical Humanities supports projects that take original angles to understanding healthcare challenges and experiences of illness. Students are expected to produce a scholarly or creative product, and give a public presentation of their work.


2012-13 Fellows

Timothy Jolis MD’13
The Effect of an Emergency Department Trauma Patient Support Program on PTSD Rates

Trauma victims are often left unattended for hours in the Emergency Department after their primary and secondary surveys are completed.  Many are young, without family members present, and unable to move due to injuries or cervical collars.  Social workers are unable to spend extended periods of time with these patients, particularly during trauma heavy weekend hours.

Studies, such as one presented last month by investigators at Emory University at the Anxiety Disorders Association of America Annual Conference, showed that immediate psychiatric therapy for trauma victims reduces the likelihood of patient’s developing Post Traumatic Stress Disorder (PTSD).   Although this study showed that intervention can help patients avoid PTSD, its methodology has weaknesses which suggest a more streamlined approach might be more successful.  Firstly, although the intervention in the study was effective, it requires numerous visits to health care workers.  This is a luxury many trauma patients might not be able to afford.  Also, this study’s intervention has had inconsistent results in the past.  It used a form of trauma debriefing, which has patients talk through the events of the trauma with mental health care workers.  A 2002 meta-analysis in The Lancet found it to be ineffective.   This study showed that it is possible to help trauma patients avoid PTSD through immediate intervention, but a different approach is warranted.

Our study hopes to find out if the same beneficial effect can be achieved by using trained university students instead of professional health care workers. Brown University undergraduate volunteers will be trained to give emotional support to trauma patients for a significant amount of time during the patient’s stay in the emergency department. If this were found to be true, it could provide a low cost effective way to help trauma victims after a potentially devastating incident.

References:

  1. Johnson, Kate. “Emergency Therapy May Prevent PTSD in Trauma Victims.” Medscape Today News. 18 Apr. 2012.  http://www.medscape.com/viewarticle/762260?src=mp&spon=38>. 2 May 2012
  2. Emmerik AA, Kamphuis JH, Hulsbosch AM, et al. Single Session Debriefing After Psychological Trauma: A Meta-Analysis. The Lancet. 2002; 766:9335

Kevin Liou MD’14
From Gallery to Wards: An Integrated Clinical Arts Program

“The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”

- Marcel Proust

In the fall semester of 2011, we created Integrated Clinical Arts, a pilot curriculum for first-year medical students that explores the pragmatic value of the arts and humanities in medical education.  The purpose of this curriculum was to develop students’ thinking skills, nurture their creativity, and prepare them for the complexities of clinical work.  The curriculum included an interactive workshop at the RISD Museum of Art centered on an exercise called “Description, Deduction, and Speculation.”  In this exercise, students were first instructed to describe the object and create an inventory of what they could see, including the size, colors, materials, shapes and the content.  Then, they were instructed to interpret their observations, and draw from their prior knowledge and experiences to make sense of what they were seeing.  Finally, they were instructed to use their descriptions and deductions to frame a hypothesis about the work of art.  In this final step, students were encouraged to take a leap beyond the object itself and speculate about broader ideas, thinking about what the object says about its creator, or the values, beliefs, and ideas of its time period.

As we guided students to go step by step through description, deduction, and speculation, we were able to give students insight into their own habits of thinking and problem-solving.  Our approach was different than that of many other medical humanities programs, which typically feature art experts teaching medical students about highly acclaimed works of art.  These types of programs focused on strengthening observation skills, and using the artwork itself to spark discussion about medically-related subject matter, such as the doctor-patient relationship, cultural competency, and bioethics.  In contrast, we emphasized the process of thinking, not the art itself.  In recent years, collaborations between medical schools and museums have begun to adopt this process-oriented approach, featuring variations of the “Description, Deduction, and Speculation” gallery exercise.

Although this type of exercise is effective at fostering a particular way of thinking, it does not seem to tap into the full potential of the museum as a learning space.  In our feedback forms, a medical student commented, “Why couldn’t we just take a bunch of pictures and put them on a Powerpoint slide and do the exact same exercise?  Why do we have to make a trip to the museum?”  Other students added that the exercise was “reductionistic” and “too scripted” and “overly simplistic.”  These students have a valid point.  This type of exercise allows students to practice a fundamental cognitive skill in a guided environment, but it does not accurately reflect the realities of clinical work.  In the “real world” of medicine, we rarely analyze a patient’s medical problem in isolation.  Every patient’s medical problem is part of a complex web that includes other factors, such as human relationships, living conditions, and personal stories.  In other words, we don’t simply look at the single work of art.  We look at the whole gallery; we take in all the different pieces of artwork and reflect on how they complement each other.   This ability to both examine little details and appreciate the big picture is essential to clinical thinking and diagnosis. 

In addition, clinical work is often fragmented in nature, defined by various gaps in knowledge.  Medical information is never all present in one place, in one picture – it may be scattered throughout the entire “gallery.”  Many times, the bits and pieces do not even correspond directly.  Because there are so many moving parts, the people involved in a medical interaction – doctors and patients – often struggle to get on the same page.  One of the most challenging aspects of clinical care is figuring out how to communicate and work effectively as a team – how can we fill in the gaps, make information flow smoothly, and gather the full picture of the patient and the situation?

The “Description, Deduction, and Speculation” exercise helps students break down their thinking process, but it does not teach students how to think collectively as a team or how to engage in more holistic, complex ways of problem-solving.  For my project, I plan to build on our previous exercise and create a sequence of educational workshops that takes fuller advantage of what the museum gallery has to offer.  Rather than simply using individual works of art in the museum, I will be developing exercises that force students to analyze galleries as a whole, including the visitors’ experience and the overall layout and design of the museum.  In addition, I will also be incorporating the idea of teamwork and collaboration into these new exercises.  I believe this innovative approach will transform the museum from a simple storage place for art into a much more unique learning space. 

As a new third-year student, I have experienced first-hand the challenges of clinical work.  In many ways, the transition from classroom to wards is like traveling to a foreign place.  By giving students the opportunity to explore new landscapes and delve into the unfamiliar space of the museum, I believe these exercises will better prepare medical students for this crucial transition and make their time on the wards more rich and fulfilling. 

Joelle Karlik
Nina Karlsen-Ayala
The Adolescent Leadership Council (TALC) Gallery Project

Over the past 20 years, art therapy has emerged as an essential adjunctive treatment option in both adolescent and pediatric medical care as well as psychiatric care1. Art therapy has been proven to not only improve the psychological experience of chronically ill patients, but has also been an essential aspect of pain and symptom management in numerous chronic and palliative care situations2,3.  It allows participants to explore their own beliefs, emotions, and even misconceptions about their illnesses in a unique way, and presents these revelations in a manner that often transcends the traditional doctor-patient relationship. We hope that by presenting pieces of art created by local adolescents with chronic illnesses to the medical public at large, particularly medical trainees, we can afford medical students and practitioners a strikingly personal view of the pediatric/adolescent illness experience.

As part of The Adolescent Leadership Council (TALC) of Hasbro Children’s Hospital, we propose a month-long exhibit at Brown’s Hillel Gallery showcasing art created by adolescents with chronic illnesses.  TALC is an award-winning group mentoring program that places adolescents with chronic illness together with college mentors with chronic illness, medical students, residents, and attending physicians to discuss the human aspects of childhood illness. TALC’s five years of success are attributable to leadership and mentorship from trainees, residents, and attending physicians from the Departments of Pediatrics, Psychiatry, and Child Life.

To reach the greater medical community, we propose holding organized “Gallery Nights” where medical students, pediatric and psychiatry residents, and attending physicians can view the artwork, informally interact with the teens, and hopefully discover a unique human depth to the moving work.  We hope to provide small art projects and anonymous response sheets for visitors to actively respond to the presented work and to collect feedback for future programming.  

TALC already has a history of strong collaborations with toy designers from Hasbro Toy Company, local Providence artists, and New Urban Arts to support the adolescents in their creative endeavors.  Previous TALC exhibits have presented art of various mediums including painting, poetry, video, and sculpture paired with descriptive captions written by the teens themselves.  We hope to build off of the success of these past exhibitions, extend our reach to the community, and allow the installation to serve as much as a learning tool for clinicians as it does for the TALC adolescents.

Through an ongoing IRB-approved study, we also plan to retrospectively compare loneliness and attitude toward illness scores between TALC adolescents who choose to participate in art programming and those who do not.  Feedback from TALC adolescents, the greater public, and medical trainees and practitioners will direct future TALC programming and subsequent TALC outreach projects to the medical community. Through support from the Bray Student Fellowship, we hope to expand TALC’s art programming in both the academic and creative worlds. 

References:

  1. Hacking S, Secker J, Spandler H, Kent L, Shenton J. “Evaluating the impact of participatory art projects for people with mental health needs.” Health Soc Care Community. 2008 Dec;16(6):638-48. Epub 2008 May 13.
  2. Deane K, Fitch M, Carman M. “An innovative art therapy program for cancer patients.” Can Oncol Nurs J. 2000 Fall;10(4):147-51, 152-7.
  3. Trauger-Querry B, Haghighi KR. “Balancing the focus: art and music therapy for pain control and symptom management in hospice care.” Hosp J. 1999;14(1):25-38.