Promoting creativity in medical education

The practice of medicine is based on a solid fund of knowledge and a physician’s ability to quickly assimilate and organize information during a patient encounter.  However, the process of making a diagnosis and formulating a treatment plan is not always straightforward.  Often, what separates the truly exceptional physicians from the rest is the ability to attack problems from alternative angles–more simply put, creativity.

Traditionally, medical education is centered around science.  Creativity has little role in modern western medical schools–it is not taught or encouraged.  Overwhelming amounts of fact must be committed to memory during medical school–leaving little time for creative experiences such as art, music, and drama.

Recently in the journal Academic Medicine, Dr. Niamh Kelly published an editorial addressing the concept of creativity in medicine.  Inspired by Ted Robinson, a speaker at the TED conference, Dr. Kelly champions the idea of promoting more creativity in medicine–not only in the clinical practice of medicine but in the delivery of care to the patients who need it.  Promoting creativity in medical education and in the everyday practice of medicine may open up a whole host of new possibilities and, as Dr. Kelly argues, allow healthcare providers to reach new levels of collaboration and productivity in the treatment patients and disease.  Science is central to medicine, but promoting a culture of creativity may allow physicians to reach their full potential.  Medical

schools and medical professionals must actively promote creativity by utilizing conference times, rounds and other gatherings to discuss creative thinking and pursuits.  In addition, medical education must foster experiences in the arts and music–group events for exploration.  By exploring new things and having new experiences while learning medicine, the creative side of student’s brain remains stimulated and creative thinking is cultivated even in the midst of gross anatomy, physiology and pharmacology lectures.  These creative experiences may very well produce physicians that are able to think and approach patient problems in new and unique ways.  New approaches often result in new therapies and new solutions to tough problems.

In an essay in the New York Times, Dr. Danielle Ofri further examines the issue of creativity in medicine.  Her comments are quite sobering as she makes the point that medicine has now become more algorithmic and more standardized. Healthcare reform and prevention of medicare fraud has made this standardization even more regimented.  Creativity has been given little room to flourish.  As providers of healthcare, we must work to reclaim some of this “creative space” in order to provide the best possible care to our patients.  Science and the thorough approach to patient care remains central to success–however, the complex social situations, personalities and individual characteristics of our patients make creative approaches to care essential.  As healthcare delivery in the US continues to be redefined creative thinking and fresh ideas may make the difference in access to care and patient outcomes.

As a profession, physicians must possess a sound fund of knowledge and be able to readily assimilate large amounts of data rather quickly.  Our ability to perform under pressure is due to repetition during years of training.  However, as medicine and healthcare systems become more complex we must be able to apply our knowledge in creative ways in order to provide the most effective care.  Although traditional medical education has not relied heavily on creativity or creative thinking we must begin to consider changes in the way in which we train medical students and residents to think.  We must foster creativity–through music, art, writing and drama.  All of these experiences will serve to make us better equipped to serve the patients of the future.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

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  • morebuzzkills

    I would argue that medical schools are not doing a good enough job of fostering this core fund of knowledge you speak of. Every attending over the age of 50 that I have spoken with has told me that they feel like the overall caliber of medical students is declining. Sure, they say medical students seem smarter…but they are less capable, can’t think on their feet, and don’t know solutions to common problems. Let’s get these first order problems out of the way before we start focusing on second and third order issues. Constantly introducing new items into the curriculum and never “trimming the fat” results in a dilution effect for all other experiences. The end result is that many medical students are mediocre in a bunch of different categories.

    Anecdotally, creativity is alive and well in medical school (see the following YouTube video – if you’ve been to medical school, you can relate):

    http://www.youtube.com/watch?v=Amq8VHutZPo

    As far as injecting it into the curriculum…not gonna work. The last thing medical students need is another “supplementary curricular requirement” that ultimately ends up fostering burnout, apathy, and indifference. Art cannot be mandated. It should be spontaneous and from the heart for it to be truly meaningful. I’m not arguing that creativity and art do not have a place in medicine, quite the contrary. However, once the become a requirement, they degenerate into a check box rather than something meaningful.

    • Shalena Garza

      Creativity could be demonstrated by figuring out the core reason why a patient is or was non compliant and working with the patient, case manager, social worker, nurses, family etc to come up with a plan that works for the patient even if it is not ideal in the eyes of the physician.

      • morebuzzkills

        Meh, I would call this medicine with an element of compromise (so really just medicine). You should be a dean or administrator if you can dress this up as creativity!

        • Shalena Garza

          ya. Encouraging participation in performance or quality improvement projects and hospital committees. Brainstorming for solutions in a non-judgmental environment. Perhaps a mock problem solving brainstorming exercise, using common hospital wide problems. Sometimes the beginners come up with great ideas too.

  • Fletch

    Morebuzzkills, I think you misunderstand what is meant by creativity in medicine. It isn’t craft or scrapbooking time. It is developing the skills to solve problems with imperfect information in imperfect circumstances. Creativity is essential. It also isn’t ever mentioned in medical school. When I interview residency applicants, I specifically ask creativity questions. When I ask something that should be easy, (tell me about a time that you did something creative) I get answers about owning a guitar in 8th grade. What I’m hoping to hear is how the applicant devised a call schedule that was fair for everyone even though one person was sick for a week. Creativity is not just about art.

    • morebuzzkills

      Let me clarify, I was specifically referring to the portion of the article where the author stated, “We must foster creativity–through music, art, writing and drama. All of these experiences will serve to make us better equipped to serve the patients of the future.” At my medical school, this would resemble the following:

      Objective: Creative awareness – The student shall attend three symphony performances each semester and write reflective essays on how the score correlates with the patient experience. In addition, the student will attend three art lessons (must include two of the following: water color, charcoal, or abstract). The student must also attend a ballet as well as a classic drama and write two reflections on the emotions these elicited.

      I totally agree that creativity, teamwork, and a culture of respect need to be fostered in all forms of medicine. However, using medical education, especially earl medical education, as a platform for this change is shortsighted. Education must provide a sound foundation and then, only then, can we begin to consider higher order items such as fostering creativity. Until medical education performs this fundamental goal to satisfaction, we must not tempt ourselves to use medical education as a “catch-all” for solving all of medicine’s problems. Acting in this manner results in the dilution effect I mentioned earlier.

      Furthermore, mandating art and creativity from the top down inherently destroys the very thing the mandate is trying to create. Art and creativity are some of the few things left in life that are actually spontaneous and from the heart. I am well aware that the governments as well as the suits in corporate medicine are trying to reduce everything to one giant algorithm. Let’s not try to inject creativity and art into medical education by standardizing it. If we want to foster the other side of the brain, why not cut out some of the fluff and allow medical students to actually live some semblance of a normal life? As mentioned in another post, most medical students are interesting people who would use at least some of this time to pursue the endeavors that make them interesting (excluding the robots of course).

      • Fletch

        I am about to make internet history…

        I agree with everything you just said.

        • morebuzzkills

          This is indeed historical! You appear to be in academic medicine, so this is not just historical but also very significant!

        • Suzi Q 38

          I agree with most of what morebuzzkills says, but sometimes h/she makes too much sense, so I forget to comment.

      • Dave

        As passionate as I am about finding a way to incorporate the creative arts into medical education and ultimately medical practice, my deepest fear is that a good idea would be implemented like you describe above, complete with the ubiquitous set of objectives. Sigh.
        An easy thing to try would be to “recommend” two years of some applied creative subject in undergrad as part of the med school admission process, or maybe even incorporate it into a requirement.
        As for the fluff and social engineering going on in the preclinical medical curriculum, my suggestion would be this: the week after spring break gets designated as Annual Bulls–t Week. Monday begins with your assigned papers and reflections and the week is packed with 8+ hours per day of all the fluff lectures, interprofessional activities, and anything that ends with “____-based learning.”
        The week after spring break is a lost week anyhow, so don’t schedule anything else scholastic and plow through the mandatory fluff all at once. Even empathetic people don’t want to write a reflective essay on showing empathy, especially while also trying to make sense of biochemistry or pharmacology.

  • Dave

    Buzz, you couldn’t be more right about not adding more fluff to the medical curriculum. That said, I come from an arts background and found many likeminded creative people in medical school. I’m convinced there must be a way to incorporate the creative arts, or at least some piece of them, into medical training, but I struggle to come up with specifics. Any ideas I do have run up against my inner scientist; I saw the video you posted and thought it was fantastic, but can’t shake the nagging question: could such a creative outlet for those who self-selected to do it be at all effective if forced upon the less willing?

    Can we teach someone to be creative? I wish I knew the answer! I don’t think there’s any system that can reliably turn a Bartleby into a Bellini, but I do believe certain creative qualities can be nurtured and encouraged. In the performing arts, we can teach people how to do improv. There are exercises you do together and games you play and even the stiffest, most uptight thespians can learn to think on their feet and live in the moment. They may not be Robin Williams, but certainly better than when they started. In some cases, the transformation can be truly astounding and hints that maybe some small piece of that could find its way to the wards. Obviously, the success of any such endeavor in a med school setting would hinge on the quality of the teacher.

    • morebuzzkills

      Exactly…variability in the quality of the teacher is exactly why TBL doesn’t work at every school. Solution: cut the already existing fluff out of the medical school curriculum, tell med students to take a couple of the free hours every week to enjoy the things they did before med school, 90% of the class (excluding the robots) will pursue these creative endeavors the author speaks of.

    • http://www.facebook.com/shirie.leng Shirie Leng

      Really Dave? I came from an arts background too and fond no common ground in general.

      • Dave

        Yeah, I was surprised myself at first! I had heard so many stories about what med students were like, but the reality was that many of my colleagues were also artists and even more still appreciated the arts. I’ve seen many of them out at the symphony or the theater or other venues. Granted, we probably don’t consititue a majority, but there have been enough musicians in the 4 classes at any given time to pull together an orchestra and/or choir of medical students. Even among those who came in with little background, I know at least 3 who took up piano lessons when they started M1, others singing, a group who started a band, a number of writers, a couple painters. Not surprisingly, most of these are the top students in each class. The valedictorian for a few years running has had a musical background and our AOA chapter has a strong artistic lean to it as well.

  • azmd

    In order to even gain admission to medical school, students have to spend their college years, and these days, some of their high school years manically pursuing activities that will allow them to robotically check off all the boxes on the “most desired applicant” type cv. To get into a residency they have to do the same thing all over again during four years of medical school.

    It did not always used to be this way. When I was applying to college, medical school and residency, and when I was a junior attending there was plenty of time to goof off, and still get into a decent school. These days an applicant has to have near-perfect grades and near perfect scores on an ever-proliferating number of standardized tests, not to mention the requisite number of extracurricular activities, community service activities and scientific research activities.

    As a parent, I see those of my children’s high school peers who are bound for the most selective colleges and universities engaged in a grueling round of ceaseless activity directed at building the all-important college application resume, I also notice that there is ample parental involvement in guiding these activities.

    In my opinion, by expecting such a robotic level of perfection and accomplishment from such a young age, we are selecting out those people who are more creative, more prone to thinking out of the box as opposed to jumping through a never-ending series of hoops. Also, by over-programming everyone’s day through college, medical school, residency and even into attending-ship, time for creative thinking is squeezed out.

    If we want to have more creative doctors, we need to give them more time to daydream. A day that is mandated to be filled with jumping through regulatory and coding hoops followed by an evening filled with jumping through more EMR hoops and MOC hoops is guaranteed to stifle what creativity is left in someone. Truly creative people will be miserable with this sort of schedule. Mandating that doctors participate in “creativity enhancing” activities is exactly the sort of over-programming that got us into this mess in the first place.

    Also, I think if we want more people who think outside the box in medicine, (although I am not sure that the powers that be really do in fact, want this) we should consider giving preference for medical school admission to applicants who have taken a few years off and worked in some other field where they have actually had to use problem-solving skills as opposed to robotically completing a long list of required academic accomplishments.

    • morebuzzkills

      A-freaking-men!!! If something isn’t going right, let’s just add another program to fix the other broken program (without removing the first broken program). It blows my mind that the same check boxes exist for residency. How can program directors not see that the applicant who was president of club A, treasurer of club B, member of club C, did research in department X, and volunteered at clinic Z had a series of progressively diluted experiences? What happened to dedicating yourself to something, becoming good at it, and helping people in the process? Oh naivety…I exhausted my check box reserves when I decided to apply to medical school.

  • http://www.facebook.com/shirie.leng Shirie Leng

    Medicine does not attract creative types. By the time you’ve shut down your life to ace physics and chemistry and memorized dermatomes and types of nephritis any creativity you have is usually buried deep. Then you get to practice medicine in an era of litigation and regulation that discourage anything creative you might try to do. If you’re the creative type, look elsewhere for work.

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