The art of medicine

UNIVERSITY PARK, Pa. — Imagine trying to paint a copy of one of Vincent van Gogh’s works — without being able to look at it. Instead you can ask a partner short, close-ended questions about the painting and do your best.

That was the challenge Ksenya Badashova, a fourth-year medical student, faced as part of the class “Impressionism and the Art of Communication.” For Badashova — like other students in the class — the painting changed shape and came to life when she was able to ask open-ended questions and listen as her partner described what he saw.

“As medical students, we learn to ask certain questions,” Badashova said. “As you grow as a physician, you learn to let the patient tell you about what is happening in their life. By letting them tell a story, you realize how much more information you can get out of it.”

That’s one of the ideas in the monthlong class, which Dr. Michael Flanagan taught for the first time in January and plans to offer again next year. For the students, the class was both a break from the structured environment of many of their courses and a chance to approach what they’re learning from a new direction.

“Our job is to elicit information from our patients. By communicating more effectively and establishing rapport with patients so they are more comfortable telling you about their symptoms, you are more likely to make the diagnosis and have higher patient satisfaction,” said Flanagan, professor and vice chair of Family and Community Medicine at the University Park Regional Campus of the Penn State College of Medicine.

Flanagan, who already had an interest in painting and communications in medicine, said he decided to combine the two into a class where impressionism was the platform to teach about communications.

“The impressionist artists of the late 19th century redefined the accepted approach to communication through the arts,” he said.

Students in the Penn State College of Medicine take a required humanities course in their fourth year. Often this occurs at the same time they are traveling the country for residency interviews. The courses help broaden students’ perspectives and encourage them to bring a humanistic approach to their work. While there are many of those courses at the Hershey campus, there weren’t any that originated at the University Park campus, which is only in its fourth year.

In 2014 and 2015, Dr. Paul Haidet, director of medical education research at the Penn State College of Medicine, drove from Hershey in January to offer a humanities course on jazz and medical communication to the fourth-year medical students at University Park. The number of medical students at the regional campus is quickly growing, and Flanagan said he initially thought that more College of Medicine faculty should make the trip up to offer the classes at University Park. Instead, he ending up sitting in on Haidet’s class and using that experience as a foundation to plan his own course.

“I became the seventh member of the class. I did all the homework — the reflective writing exercises, listening to jazz and thinking about how it applied to medicine,” Flanagan said. “Just as one jazz musician provides space to another to improvise, as physicians we need to provide space to our patients to communicate in their own style. It was a transformational experience, unlike anything I ever had in medical school myself, and I thought, ‘This is what I want to bring to the regional campus.’”

Dr. Michael Flanagan

Dr. Michael Flanagan, assistant dean for curriculum and student affairs at the University Park Regional Campus at Penn State's College of Medicine, developed Humanities 7970 to help his students improve their medical communication skills through a collaborative and hands-on study of impressionist art.

Image: Patrick Mansell

The approach is a change from when Flanagan was in medical school.

“We were too busy sitting in lectures,” he said. “There was very little on communication. You picked that up on the fly by modeling other health care professionals you admired, but there was no formal curriculum.”

In addition to completing painting exercises, the 22 students in Flanagan’s class studied famous — but challenging — artists like van Gogh, Paul Gaugin and Paul Cezanne to gain different perspectives on communication. Then in class, they took turns playing the role of a physician trying to diagnose a challenging patient while a classmate observed.

“Many of your patients will have some underlying mental health issue — even if it’s just anxiety about seeing you,” Flanagan explained. “Our students have to work on communicating with patients who present in that way.”

The situation in class — an anxious and frustrated 60-year old woman complaining of coughing spasms — gave the students a chance to practice not only asking open-ended questions, but listening and encouraging the patients to tell their story.

Michael Abendroth, the observer of one group, noted that the doctor, Scott Paradise, was persistent, demonstrated empathy and proposed a plan of action after spending time talking with the “patient,” Matthew Adams.

“I thought you did a very good job trying to draw information from him,” Abendroth said.

Paradise, who is going into family medicine, said that much as the impressionist artists broke out of the structure of their time, doctors can personalize their visits with their patients — doing more than following a checklist — while still not missing anything.

“We’re taught the algorithm to go through during the patient interview — it’s very formulaic to make sure we don’t miss anything,” Paradise said as he worked on his final painting for the class. “The more we learn about medicine, we can develop our own style to allow the patient to tell their own story and fill in the gaps.”

Flanagan said two other faculty members at the University Park regional campus are designing a humanities course for next year, this one on death and dying. 

“We are working hard to develop and expand our focus on the humanities at this campus,” he said, “and will hopefully create more humanistic and caring physicians in the process.”

Last Updated February 12, 2016