Art may be a key component of education in Medicine and Internal Medicine
Department of Internal Medicine, Universidad Del Norte, Barranquilla, Colombia
Gimnasio Campestre alumnus (2013)
- Faculty of Creation and Communication, Visual Arts Program, Universidad El Bosque, Bogotá, Colombia
Correspondencia para los autores: santiagogomezjordan@me.com
Recibido: 25 de octubre de 2024
Aceptado: 8 de noviembre de 2024
Tabla de contenido
ABSTRACT
Introduction: Art has historically intertwined with human development, reflecting essential aspects of society such as politics, religion, and science. This review examines the integration of art into medical education. Methods: A literature review was conducted using MEDLINE, Google Scholar, and LILACS in July 2024. The search terms used were “((Medicine) OR (Internal Medicine)) AND ((Art) OR (Art Education))”. Discussion: Art education enhances cultural, emotional, and observational skills in medical students. Visual Thinking Strategies (VTS) and historical art analysis demonstrate the value of art in improving diagnostic and empathetic abilities. Studies indicate that art-based programs lead to better communication and a deeper understanding of patients. Most interventions involve museum visits, discussions, and artwork creation. Academic journals and university programs are increasingly integrating art into medical education. Conclusion: Art curricula should be tailored to cultural contexts, enhancing students’ empathy and comprehension of patients. Colombia and other countries should incorporate art education into medical programs, promoting collaboration among physicians, educators, and artists.
RESUMEN
Introducción: El arte se ha entrelazado históricamente con el desarrollo humano, reflejando aspectos esenciales de la sociedad como la política, la religión y la ciencia. Esta revisión examina la integración del arte en la educación médica. Métodos: Se realizó una revisión de la literatura utilizando MEDLINE, Google Scholar y LILACS en julio de 2024. Los términos de búsqueda utilizados fueron “((Medicina) OR (Medicina Interna) AND ((Arte) OR (Educación Artística))”. Discusión: La educación artística mejora las habilidades culturales, emocionales y de observación en los estudiantes de medicina. Las estrategias de pensamiento visual y el análisis histórico del arte demuestran su valor para mejorar las habilidades diagnósticas y empáticas. Los estudios indican que los programas basados en el arte conducen a una mejor comunicación y comprensión del paciente. La mayoría de las intervenciones implican visitas a museos, debates y creación de obras de arte. Las revistas académicas y los programas universitarios están integrando cada vez más el arte en la educación médica. Conclusión: Los planes de estudio de arte deben adaptarse a los contextos culturales, mejorando la empatía y la comprensión de los pacientes por parte de los estudiantes. Colombia y otros países deben incorporar la educación artística en los programas médicos, promoviendo la colaboración entre médicos, educadores y artistas.
Art has never ceased to play a role in history, becoming fundamental to human education and development
INTRODUCTION
From ancient times, visual and plastic arts have represented an essential element in human life. Since their beginnings, they have been more than just a combination of lines and colors; they serve as pictorial representations of the pillars that compose society—politics, religion, economics, occupation, emotion, social structures, science, family, and more. Art has developed alongside humanity, from ancient Egypt to the Renaissance, Impressionism, Cubism, and Modernism. Art has never ceased to play a role in history, becoming fundamental to human education and development. But can art be integrated into medical education, and more importantly, into postgraduate studies in internal medicine? This review outlines and describes the findings in the literature, with a particular emphasis on Colombia.
METHODS
This review was conducted using electronic databases: MEDLINE (via PubMed), Google Scholar, and LILACS (via the Virtual Health Library) in July 2024. A Boolean search was performed using the following terms: “((Medicine) OR (Internal Medicine)) AND ((Art) OR (Art Education))”. Relevant studies were screened and included in the final analysis to develop this review.
DISCUSSION
Art, art education, and education through art are vital components of the globalized world. Cultural patrimony is an integral part of every country and society, with its intangible relationships playing a crucial role in educational curricula and conservation (Chen, 2024). In countries such as Colombia, art became a compulsory and fundamental area of the national school system in 1994 (De Jesús, Franco, Valencia, Marylin, & Sanchez, 2022). Education and art have evolved significantly over the last century, and this pedagogy must continue to contribute to the transformation, reflection, and growth of students across various disciplines.
Integrating art from primary school through postgraduate education can enhance the capacity for expression and understanding. It also fosters cultural and emotional appreciation of the self and the world. UNESCO has established several aims for art education, including the right to education, cultural participation, the development of individual capabilities, improvement in the quality of education, and the promotion of cultural diversity (UNESCO, 2006). Art and education merit reflection, communicative production, critical investigation, and integration into society (García Vélez, 2012).
One approach to implementing art education is called Visual Thinking Strategies (VTS), first introduced in 1991 by fifth-grade teachers in New York and later successfully adapted for the Museum of Modern Art (MoMA) education program for adults. VTS may be used to explore students’ conceptions of art through observation. It focuses on three key questions: What is going on in this picture? What do you see that makes you say that? and, What more can we find? (Philip Yenaw, 2013).
Art and medicine have intersected throughout history, with anatomy being the most prominent area of convergence in medical education. From the classical works of Andreas Vesalius and Leonardo da Vinci to modern anatomical texts like the Atlas of Human Anatomy (Netter’s Anatomy), Gray’s Anatomy, and Moore’s Clinically Oriented Anatomy, drawing and painting remain pivotal elements.
Since 1989, there have been descriptions of art analysis through the lens of medical professionals. In New York, six of Frida Kahlo’s paintings were examined by physicians (Lomas & Howell, 1989). Another example is the study “Ocular Pathology in the Paintings of… Prado Museum (Madrid),” which analyzed works by artists such as El Greco, Goya, Diego Velázquez, Rafael Sanzio, and Bruegel the Elder, among others (Santos-Bueso, Vico- Ruiz, Vinuesa-Silva, & García-Sánchez, 2016).
In addition, various studies have analyzed signs of disease in artworks across the world. In 2004, the National Portrait Gallery in London, England, included 18 works in their study (Strauss, Marzo-Ortega, & Goulden, 2004). In 2019, a study at the Finnish National Gallery in Helsinki, Finland, examined 283 paintings, primarily identifying redness of the cheeks and sun-induced skin lesions (Kluger, 2020). Most recently, in 2022, researchers at El Prado Museum in Madrid, Spain, selected 5,490 out of 16,568 works and identified 145 images depicting signs of disease (Santos-Bueso, Vico-Ruiz, Vinuesa-Silva, & García-Sánchez, 2016). These studies have established a significant precedent for further connections between art observation and medicine.
The integration of art into medical education offers a multifaceted approach that helps bridge the gap between scientific rigor and humanistic understanding. Using art to approach medicine may enhance observational and diagnostic skills, improve comprehension of patients’ perspectives, increase empathy, and foster an appreciation for multiple perspectives (Bell & Evans, 2014).
Proposals and projects for implementing curricular activities that integrate art and education have gained attention. One of the earliest studies assessing this approach was published in 2001. In this study, students in the intervention group, guided by an art curator, described preselected paintings. The results demonstrated improved observational skills when interpreting clinical photographs compared to a control group without exposure to fine art (p < 0.05) (Dolev, Friedlaender, & Braverman, 2001).
Another study found that introducing an art-based program led to remarkable improvements in skills such as narrative awareness, emotional recognition, empathy cultivation, and the ability to reason with multiple perspectives. These outcomes were significantly better than those from traditional clinical case studies using photographs (Shapiro, Rucker, & Beck, 2006).
Furthermore, similar studies involving three 90-minute interactive sessions led by museum educators showed significant improvements. Participants spent more time contemplating artworks, used more words in descriptions, and made a greater number of observations in both art and patient assessments. These sessions also enhanced tolerance for ambiguity and professional communication skills, with all improvements being statistically significant (p < 0.05) (Klugman, Peel, & Beckmann-Mendez, 2011).
Finally, some authors have categorized works of art into three themes: How is the teaching of medicine represented in paintings? How are diseases depicted in paintings? And how can we teach the practice of medicine through paintings? (Díaz Díaz, Giménez García, & Arránz Sánchez, 2021).
A scoping review comprising 729 records about the inclusion of art and humanities in medical education between 1991 and 2019 in North America found that literature led the distribution at 26%, followed by visual art at 11%, theater (9%), film and television (9%), music (3%), and comics and graphic novels (2%), among others. Regarding visual art, 48% of those records involved observation, 27% involved creation, 20% included both observation and creation, and 4% were unspecified (Moniz et al., 2021).
In 2020, a review analyzed 28 different curricular interventions in medical education across undergraduate and postgraduate programs. Most interventions consisted of just one session (42%); however, the longest reported intervention spanned 15 to 17 sessions. The demographic distribution of the participants revealed that 53% were medical students, 28% were residents from specialties such as family medicine, dermatology, radiology, gynecology, psychiatry, neurology, emergency medicine, and internal medicine, 7% were oncology fellows, and 14% were other health providers. The most common interventions were museum visits with discussion (53%), followed by classroom discussions (17%), drawing and artwork creation (10%), and Visual Thinking Strategies (VTS) analysis (3.5%). Interestingly, most of the reports originated from the United States (Dalia, Milam, & Rieder, 2020).
These approaches, like art itself, are versatile and can be incorporated within each program’s local context. Some interventions derived from VTS include guided sessions with silent observation, well-crafted guiding questions, pointing out observed details, paraphrasing student comments, linking ideas, and closing the conversation (Philip Yenaw, 2013).
Further supporting the idea that there is space for communicating art and medicine through investigations, commentaries, and works, the journal Academic Medicine features a section called Medicine and the Arts (MATA), which provides space for artwork and its relevance in medical education and practice (Academic Medicine, 2024). Similarly, Annals of Internal Medicine, the journal of the American College of Physicians, includes a section called Graphic Narrative/Comic, where authors can submit “original graphic narratives, comics, animations/videos, and other creative forms addressing medically relevant topics. We encourage work capturing the experiences of those who provide and receive care, whether poignant, thought-provoking, or just plain entertaining” (Annals of Internal Medicine, 2024). Additionally, the Autonomous University of Bucaramanga journal (MedUNAB) has dedicated a section called Science and Art, publishing paintings, including those created by physicians (Miguel Enrique Ochoa-Vera, 2023).
Some barriers to implementing an art curriculum may include a lack of awareness of its importance among health educators, physicians, students, and parents. Cases described in China regarding primary and secondary schools highlight issues such as parental attitudes, lack of social participation, school priorities, and student interest in traditional art (Chen, 2024).
CONCLUSION
Research on education, art, and medicine must converge to develop a robust, evidence-based curriculum. The study and analysis of art and painting can enhance medical students’ understanding at all stages of their education, helping them better comprehend their patients and themselves. This approach fosters a deeper understanding of patients’ social circumstances, hopes, and fears in relation to their diseases (Shapiro & Shallit, 2014).
A medical art curriculum should be adapted to our cultural heritage, social background, scientific strengths, and the capacity to express, identify, and be aware of our roles as human beings. It must include art observation, creation, exhibition, and discussion. Education systems around the world—particularly in Colombia—must take rapid action. Physicians, teachers, and artists must join forces to introduce art education and research into university medical programs, including internal medicine and its subspecialties.
Disclosures
Funding sources
The present work had no funding sources.
Competing interest
The authors declare no conflict of interest in the preparation of this document.
Availability of data
The data supporting the findings of this study are available within the article [and/or] its supplementary materials.
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