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Notes

Thinking about Thinking: Pre-Medical Students in the Museum

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We hardly ever think about how we think. The rush of our day-to-day lives provides little time to reflect on our habits of mind—how they shape our perceptions, interpretations, and critical decisions. This is particularly true in the fast-paced clinical environment, where doctors are often forced to make diagnoses quickly.

As a part of its new Clinical Arts and Humanities Program, the Alpert Medical School partnered with the RISD Museum to create the workshop series “From Galleries to Wards.” This elective was designed specifically for students in Brown University’s Program in Liberal Medical Education (PLME), a combined baccalaureate-M.D. program spanning eight years of undergraduate and medical studies.

In bringing pre-med students to the Museum, our focus was not to teach medical facts and content but to foster different ways of solving problems and making meaning. For most of the Thursday evenings of their spring term, an enthusiastic group of PLME students engaged with works of art in the Museum through conversation, writing, and art-making. Facilitated by us—a medical student and an artist educator—these experiences gave students the opportunity to think about how they think. Building on the PLME’s emphasis on the liberal arts, we emphasized curiosity, encouraging students to take risks and ask questions. The prompts to most of the exercises were open-ended, without strict guidelines or pre-figured conclusions. This experience invited our students to step out of their comfort zones and cultivate creative, reflexive thinking.

Take, for example, our experience with this 1968 untitled painting by Cy Twombly.

We sat with this work for three hours. We began with open-ended discussion of what initially struck us about the piece, then we each picked a particular section of the painting and spent time sketching it. We focused on positive space—the marks of the artist’s hand, and then turned to the negative space—the areas around the marks. Simply by shifting our focus, we gained deeper insight into the painting, noticing details we did not see before. By the end of the exercise, each of us had different ideas about what Twombly was communicating in this painting, which led to a conversation about the possibilities and limitations of communication. How do we express ourselves? Which experiences are better communicated through pictures? Through words? Are there certain things that are unsayable, certain feelings that simply cannot be expressed? Why is it sometimes so difficult to grasp what others are trying say? Is it even possible to comprehend another person’s pain and suffering? What can doctors do to make sense of patients’ stories? All this was evoked by one work of art.

Our discussions inevitably led to more questions than answers, but these types of open-ended experiences are not unlike the scenarios these students will face as doctors. Once they leave the classroom, they will be confronted with clinical problems that have no clear answers. In the face of ambiguity and uncertainty, doctors who think broadly and leave space for multiple possibilities have a better chance of making the right diagnosis.

In his article “From Mindless to Mindful Practice—Cognitive Bias and Clinical Decision Making,” Pat Croskerry notes that “it’s not a lack of knowledge that leads to failure, but problems with the clinician’s thinking.” Because personal biases and cognitive shortcuts can lead to errors, Croskerry advocates the cultivation of critical thinking as a central part of medical education. By using works of art to teach pre-med students to think about how they think, we are equipping them with a practical set of skills for medical school and beyond. In evaluations at the end of the course, students consistently noted that the series helped them to develop a reflective mindset in all aspects of life, including how they think and communicate. One student commented that this was one of the most meaningful classes she had taken during her four years at Brown.

The RISD Museum and Alpert Medical School are further developing this type of coursework and collaboration. The series will be offered again next year, with some redesign to delve more deeply into the topics explored: communication, interpretation, empathy, and collaboration. As the participating students enter medical school and we follow up and assess the impact of this course on their clinical training, we hope to see that the series has eased their transition to medical school and prepared them for the unique challenges of clinical work.

Look out for Part Two of this series, in which students participating in From Galleries to Wards share their experiences.

S. Hollis Mickey
Assistant educator, Gallery Interpretation, RISD Museum

Kevin Liou
Fourth-year medical student, Alpert Medical School, Brown University