Below is the transcript of the following Academic Medicine Podcast episode:
The Arts and Humanities in Medicine
May 3, 2021
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Toni:
Hi everyone. I’m Toni Gallo. I’m a staff editor with the journal and host of the Academic Medicine podcast. On today’s episode, I’m joined by the journal’s Editor-in-Chief, Dr. Laura Roberts and our new assistant editor for Medicine and the Arts, Dr. Arno Kumagai. We’ll be discussing the role of the arts and humanities in medicine and medical education, Arno’s vision for his new role and some of the special features in the journal that incorporate the arts and humanities. Thank you both for joining me today. Arno, could you start by just introducing yourself to our listeners?
Arno:
Absolutely. So thanks Toni and thanks Laura for inviting me. I’m Arno Kumagai. I’m professor and Vice-Chair in education for the Department of Medicine at the University of Toronto. I’m actually originally from the states and came up to Toronto about five years ago. I’ve had a longstanding interest, not only in medical education, but specifically in the engagement of creative arts in education. I have a background also in humanities. I also hold the F.M. Hill Chair of Humanism Education at Women’s College Hospital and University of Toronto. This kind of interest, this space in terms of humanities, humanism, teaching for social justice is all part of what I’ve done for quite a while now and absolutely delighted. I’ve been an editorial board member for a fair amount of time and this is a new position in the journal, which I’m absolutely delighted to accept. Thanks.
Laura:
Yeah, well, sometimes everything is just perfect. When you have someone with the extraordinary ability and talent and eye and sophistication to bring forward our journal in the area of humanities and medicine and medical education, it was just clear that Arno, you were just the right person. I really am very grateful that you’ve taken this on because I value it so much. I thought if maybe I could just comment, I see the features that we have in the journal, Teaching and Learning Moments, Medicine and the Arts, the cover art, and from time to time, we’ve had scholarly perspectives and research reports and even other special features that we’ve done in collaboration with other partners throughout medicine, really focusing on the arts and humanities. I just think it’s wonderful. It reinforces creativity. It obviously reinforces joy, our ability to express complex abstract experiences in very immediate sorts of ways.
Laura:
So it has so many compelling parts of it but I also think it helps us be more precise and reflecting on very difficult aspects of medicine, human suffering. It gives us insight into the experiences of others. It’s a kind of fluency that we have that we don’t have in other ways. So I really, really treasure this and I treasure you Arno and I’m very, very pleased that you’ve taken this on.
Laura:
We have tried to do a few things differently. I hope everybody’s seen the amazing covers. If you haven’t seen, the listeners haven’t seen our amazing covers because in our virtual world, it’s not the same as when you get that print copy. But go look them up or… We’re really trying to celebrate visual work by people in medicine and the health professions. But there’s also some meta-communication. I’m sure people will pick up on the meta-communication that some of this art is meant to convey in the spirit of social justice as Arno mentioned. I guess the last thing is, I think in addition to communicating the richness of our experience and emphasizing that we’re a profession and not technicians, it’s a values-laden effort. We’re bringing those values to the journal and I’m super excited about it.
Arno:
So, Laura, I completely agree with you. I think that the one thing that the humanities and in art in particular capture is a different way of knowing about medicine and about human beings and their moments of vulnerability and suffering that aren’t captured in other ways, like in biomedical sciences, clinical sciences. It’s a very different approach. It allows us to expand the way we look at ourselves and in the work that we do, in our patients and the world and what happens to human beings because, ultimately medicine is a human endeavor, a deeply social humanistic endeavor. I think art really captures that and captures it in ways really that raised a lot of very interesting questions and a lot of very interesting dialogues. I’m absolutely delighted at this opportunity. This is-
Laura:
Yeah, that’s great. We haven’t talked too much yet about narrative but the storytelling is so powerful and maybe we can talk about that. But also, I’m in neuroscience and there’s this explosion in understanding really how art and different elements of the humanities help our brain stay healthy, expanding these neuro capacities for thinking that I think will enrich our talents in medicine as well. But narrative, if you could talk a little bit about storytelling, and then anything that we’re learning about cognition and art and humanities would be great.
Arno:
Yeah. I think that… In some ways at the root of humanities in general and art in particular is a story. Everything tells a story. Everything poses a question that begs an answer, that comes from people’s individual ways of interpreting it and seeing it based on their own history and based on their own experience. The stories that we have are ways… they’re powerful ways of connecting ourselves with each other as human beings and really understanding who we are, who each other is and what the world is like. I think that aspect of narrative is really important. That’s not to say though that it’s not without risk because it also depends on who actually tells the story and the role that that story plays. Sometimes stories can be appropriated for the wrong reasons. We can assume that we understand what some of these experiences are based on, our appropriation of a story.
Arno:
There are a lot of authority issues involved as well but the fact that it does have this ability to set… You could say an empathic anchor between people. This empathic bridge, I think is really phenomenal. And how do we explore this as part of education, right? I mean, stories in some ways form the foundation for transformative experiences and how do we teach about this and how do we think and reflect on it. So this is all part of this venture.
Laura:
Anything on the cognition? What do you know about this cognitive neuroscience and humanities?
Arno:
Yeah. Obviously there’s a… in fact there was a paper looking at, I think it was in Science either last year or the year before, looking at the idea of how stories play a role in understanding the mind and how we can project ourselves into somebody else or have the person to enter our world in terms of theory of mind. I think it does actually play a role but what’s so interesting for me from a knowledge basis, is that what we learn from stories is very, very different than other forms of knowledge, right? It’s not just cognitive. It’s not just cognition. It’s deeply empathic. It’s deeply experiential. It’s even sensual in terms of our imagination of how we experience certain things. So, I think it actually brings… Stories have the ability to go even beyond. I mean, cognitive in this strictly rationalistic sense and capture us deeply as human beings.
Laura:
You know, as you were talking, I was thinking about another feature that we’ve tried to really expand is the trainee letters to the editor. Last year we did this thing where trainees were invited to tell stories about first experiences on their developmental journey. And then this past year we were looking at people, the trainees’ experiences around COVID and senses of courage and compassion and connection, community. I know you were involved with reviewing those letters but weren’t some of those narratives just so powerful and so beautiful?
Arno:
It’s really interesting Laura that you bring this up because I think… if you think about it, medical education is actually a story of transition, okay. It’s liminality. It’s how we change in these different roles and how our identities change. I think the thing that was so exciting about these letters to the editor is a capture of these moments along this path of transition, right? So some of them are just deeply, I mean, just poignant and eloquent in their poetic vision. I just was floored at how, the quality of the work. So it was… I mean we looked at, I don’t know, 500 something entries and it was just, right? The quality was just breathtaking.
Laura:
Yeah, no. I joked that there’s almost nothing where you sit there and you laugh out loud and you weep. When we read these letters, they’re just so, so beautiful. I do want to tell people that we have an upcoming call for this year’s trainee letter to the editor that Toni was going to maybe tell us a little bit about. Toni?
Toni:
Sure. As Laura mentioned, we’ll be… We just issued the call itself. You can find that on our blog, academicmedicineblog.org, but basically the topic for this year is trainees as agents of change in academic medicine. We’re looking for 400-word letters written by up to three authors, all of whom should be trainees. Really we want actionable ways to move the field forward. So you’re welcome to tell a story but there should be some recommendation or lesson as part of that. We don’t want pure narrative pieces for this. We really want you to think about what your experience meant, what you want others to get out of it. The process this year, we’ll have submissions open for just one week. You can submit those from May 24th to the 28th. It’s a Monday to Friday. Then we will have teams of editors and trainees looking at all of those, deciding which ones we’re able to publish this year. So again, academicmedicineblog.org. You can find all of this information. Laura, I don’t know, do you want to mention maybe why you chose this topic?
Laura:
About student trainees as agents-
Toni:
As agents of change.
Laura:
Yeah. Well, mostly because I’ve been so inspired by trainees as agents of change. I’ve been reflecting a great deal on how obviously trainees are our future but academic medicine has so many strengths and has so many good things, but we all must feel humbled by the experiences of this past year. There really are existential threats to humanity and certainly to academic medicine if we fail to change, to embrace change. So I have just been so singularly inspired by individual stories of trainees across the health professions at different stages. Pre-medical students who are… I mean I can think of one person who is a pre-med, who was an EMT who was going into urban neighborhoods in Milwaukee, taking care of elders who had COVID exposure and the fear and extraordinary sense of health disparities and inequity that exists in this country to residents who put on their PPE and were… Psychiatrists who went to serve in the ICUs or the backup medicine teams to try and help patients with COVID.
Laura:
And then we were just reflecting together, Arno and I, about the need for public health change and much more awareness. So whether it’s personal risk, disparity, self-compassion, mental distress and the need to change our health system to serve all people. I have lots of examples from the trainees that I am encountering and they’re doing great work and they hold the key to the future. So I want to give them a platform for talking about that, reflecting. And as you said, Toni, not just sharing their experiences but sharing an experience that has meaning that helped move people, creates this behavioral intention toward change. We’re listening and I wanted to demonstrate that. So that was part of it. Arno, did you have some thoughts on that?
Arno:
I couldn’t agree with you more, Laura. In fact, the thing that really fascinates me is how we oftentimes get young people coming into medicine who are incredibly idealistic and unfortunately, the system tends to beat it out of them very effectively. Whereas what we need to do, and I think for me, this is actually a focus in education is how do we keep that compassion, that idealism, that vision alive. It’s oftentimes a lot of the work that’s been done up here in Toronto has… what’s driven this in terms of response to systemic racism issues, Indigenous health issues, in terms of poverty, disparities, has been driven actually by the trainees, by the residents and the fellows and the students. They’re the ones who are contacting us saying, “What are we going to do about this? And how can we be involved? And here’s what we’d like to do. Can we get some backing?” So it’s really actually very interesting. So capturing that. So I agree with you. I think the ways… Part of this is stepping out of the way and letting them go.
Laura:
Totally.
Arno:
Right?
Laura:
Yeah, no. I know from my day job. Honestly, if I just had my chief residents run my department, we’d all be better off, I’m sure. But let me… I wanted to turn to your vision for medicine and the arts, but let me first comment on cover art. We’re doing it differently. I mentioned the visual is meant to pop and communicate and affirm in lots of ways that I think are congruent with the past, but are just another step or two forward. But we’re going to select the cover art differently than in the past. We’re doing a call for people to submit their artwork and then putting together a panel. So again, maybe Toni I’ll turn to you to share with folks, kind of this next steps and the logistics and then our process.
Toni:
Actually we started featuring original artwork on the cover in 2008. So this feature has been around for a little while but now, as Laura mentioned, we’re changing it up. It used to be a rolling submission process but we are… we actually… Today, the call opens today, the day that this podcast comes out. From now until the end of July, we are accepting submissions of original artwork for our cover. Then we’re going to have a panel, including Arno, look at all of the submissions that we’ve gotten and selecting a few to feature on the cover basically through 2022.
Toni:
We are, like before, looking for… It can be any kind of art. Painting, visual arts, textiles, sculpture, anything like that. As part of your submission, we’re also asking for a brief personal statement about the art and its connection to you and your experiences in medicine. This is open to anybody. You can be a trainee, you can be a physician, you can be a patient. It just has to, in some way, connect back to your experience in medicine. And again, academicmedicineblog.org will have all of the details of how you go about submitting and everything like that.
Laura:
Yeah. We made a decision to… I don’t want to say de-emphasize the narrative but I noticed in reviewing the art and the narrative, that often they were a little bit disjointed or one was beautifully built and the other was not as strong. So we were always kind of struggling, how do we get these into parity? So we just thought we just changed the frame, which is to really emphasize the visual dimension for the cover art and then to invite the artists to submit a brief narrative that contextualizes and creates a little bit of narrative meaning around what the visual piece is. But I think it was a little intimidating for the field and often we struggled as editors to bring forward the work with the appropriate symmetry of strength between the two pieces. So now we’re really going to be emphasizing the visual. Okay. So I hope-
Toni:
Laura, that brief statement is no more than 250 words. So very short.
Laura:
Yeah. Don’t be intimidated is the core idea. Thank you. So let’s switch again. Arno is… very graciously taken on this new role, although we’ve had what? Medicine and the Arts did you… you said that you looked up when we started that?
Toni:
Medicine and the Arts has been around since 1991.
Laura:
Wow.
Toni:
And Teaching and Learning Moments since 2002.
Laura:
Amazing. You clicked. I could feel it. And it was… It really felt there was a readiness in both for you, but also readiness for the journal that you immediately saw. I just wanted to ask you about that. I don’t know.
Arno:
That’s great, Laura. I mean, you’re right. In many ways, a lot of the work that I’ve done, a lot of the work I’ve done with learners or work I’ve done in curriculum design, the work I’ve done in scholarship kind of led up to this. Because a big part of what I’m interested in is how we use creativity, and the arts and imagination to really bring out the human experience of not only being a physician or being a health care provider, but being a patient and how that different way of knowing things can be embodied in art and appreciated in art. There are a lot of different roles that art have. I mean, some people use it… For instance, they may look at pictures, paintings to sharpen their skills in observation and description or in interpretation. They may use it for collaboration.
Arno:
I’m really interested in knowing, kind of capturing this, the experiential part. What does it mean? What does the art say to me or does it say to somebody else, and how can we explore these human, these truly human aspects of being ill, suffering, of being in vulnerable places and of caring for people who are in those places? So what we’re seeing with these submissions, and you’re absolutely right, as soon as this came up as a possibility, I immediately said, “This is what I want to do,” because you see these submissions and you see this incredible artwork. Now with artwork, with Medicine and the Arts, it doesn’t have to be original but what’s really interesting is it allows you to present a piece and it can be poetry, an extract, an excerpt from a novel, a painting, a sculpture. And then you have a commentary, an essay where you probe the meaning of this.
Arno:
I think these things really open up the horizons for exploration and these really critically important aspects. What really makes me absolutely excited about this is that you take a journal as prestigious as Academic Medicine that actually opens the doors to say that this is an important part of learning how to be a physician or learning to be a health care provider. And we need to really engage the power of this particular area, this way of knowing, in order to do better for our patients. So it’s actually really exciting. I feel like I’m kind of at the beginning of a really interesting era. So thank you. Thank you for the opportunity.
Laura:
Yeah, no, that was so beautifully stated. Well, I think the listeners can tell that we’ve got just the right person at just the right time to move this forward. Let me thank you again Arno for all of this.
Arno:
No, thank you.
Laura:
Toni, back to you.
Toni:
Arno, I don’t know if there’s anything else about your new role. We’ve touched on some of the features in the journal but if there’s anything else in how you’re approaching this role or things you’d like to see from the community, types of submissions, areas you’d like people to explore. If there’s anything like that, that you want to mention.
Arno:
Thanks, Toni. Yes, I do. I mean, very much as Laura has stated, I’m very interested in how people can really engage with these submissions, as a way of expressing different ways of looking at medicine but particularly those who are in training, those who are in the process of becoming physicians or health care providers. How they can document the different, you could say the rites of passage as they go through this. So, that’s important. Also, the ability to use art and engage with art to comment on social issues in medicine, I think is very important. We’ve really made a major statement in some of the recent editorials and commentaries that we’ve made for the journal on the social role of medicine. I think that’s another way we can engage people. It’s also… one of the things that fascinates me is that I think a lot of people in academic medicine, a lot of trainees, and a lot of people who teach are really intimidated by the word. It’s the big R, research, right? And they feel that, that doesn’t really call to them.
Arno:
Whereas I think this is a way of using creativity in some ways as a vehicle for promotion, literal sense, as a way of gaining an understanding, as a way of gaining a reputation that is additive to what can happen in a traditional academic environment. So, it’s all of these things. My call-out is… we want to see things coming from people in training. We want to see commentary in terms of social aspects of medicine. We want to see how art can be used and beauty can be used to really reflect on what we do as physicians. That’s all part of it. So thanks for that. Thanks for the heads up. Yes, absolutely welcoming submissions.
Laura:
Really neat this year or year and a half, we’ve had submissions that have literally pieces of music. We’ve had poetry. We’ve had, right. We’ve had lyrics from songs. We’ve had really ancient pieces of art and then much more modern art. It’s clear that we’re tapping into greater breadth and I would love to see more. I’d love to see more of that. Really exciting.
Arno:
And the level of writing is really astonishing.
Toni:
We’ve mentioned the Medicine and the Arts feature cover. I wonder if we could talk a little bit about Teaching and Learning Moments, which is one of my favorite features and something I think that’s special about this is, it’s almost a way for people to see that they’re not alone, that they can read these essays and say, “Oh, I’ve had that experience too. I’m not the only one who’s felt this way.” I think that’s one of the special things about Teaching and Learning Moments. I wonder if Laura or Arno, you could maybe talk a little bit about that column.
Laura:
Oh yeah. I mean, I would say that I really love… I mean, when I have a day when I know that I’m going to be able to read a whole series of the Teaching and Learning Moments, that’s the definition of a really good day because the stories are always really powerful. There are times when we’re not able to accept some of the pieces and it’s because there will be a story but then it won’t have a synthesis of the… or the lesson that they hope someone will carry forward. So what we look for in this feature is, right, some poignant, some… It could be ordinary, actually. It could be a very ordinary interaction. There was one just recently that was just very simple but it spoke to the universality of the experience of becoming a physician. It was very nice. And then some very nice reflection and just like the Aesop’s fable. What’s the moral of the story?
Laura:
That’s what we look for. We look for this unified message of a story, a reflection and then something to carry away. That’s super hard. That’s so hard to pull off but for me as the editor, getting a chance to read these things, I get to see the raw story. I get to see it, maybe sometimes fully formed, sometimes maybe a little bit less developed but always someone has had an experience that they want to share with someone. So it’s always a joy, always a joy to read them. As I say, I hope our authors will continue to submit these pieces, just understanding that they need these different elements to be successful in being published. But I also want to tell everyone that I love them. I love them. When I read them, I am always moved. They have been moved to write. I am always moved when I read them.
Laura:
It is heartache to not be able to work with the authors and help the work evolve more and accept more and all that, which is just a challenge with the volume that we get with our journal. But I have to say, I hope that our readers take a look at the TLMs. They’re really beautiful. I would just say as the editor, often on the receiving end of these, these submissions, they’re gifts. I feel like they’re gifts that our field is sharing with us. So I’d love to see more. I’d love to see more of them. Arno, I don’t know how much you’ve had a chance to look at those. I’ll be sure to send you some.
Arno:
Very much and I had published and reviewed with you. It’s interesting. So drawing actually from the humanities, there’s this notion that Virginia Woolf, the English novelist once used, which was called moments of being, and she says, you could pass through life, looking at the cotton wool of non-existence. And sometimes you could be walking along and at a completely unexpected moment, you have this clarity, this lucidity that touches you deep in your soul and connects with your values. We have these moments. So that, she calls that a moment of being. I think in medicine, particularly working in these spaces, we have these moments of being all the time but we have usually learned to ignore them. Whereas I think that these teaching and learning moments are our ways of distilling these moments of being down, as lessons for us in our development. So I agree with you. I mean, these are priceless and when they’re well done, I mean, they just blow you away. Yeah. So, that’s great.
Toni:
Many of the episodes of the podcast actually are the authors of these essays reading their stories for listeners so it’s great to get to hear not only about their experiences, but also to hear it in their own voice, which we don’t usually get to do when we’re just reading an essay. So listeners will recognize that from some of the other episodes. I don’t know if either of you have any kind of final thoughts you want to share either about work that’s happening at the journal or the larger role of the arts and humanities in medicine. But, Laura, if there’s anything, do you want to start?
Laura:
Sure.
Toni:
And then Arno?
Laura:
Sure. Well, I just want to say that I really, to reinforce what I said earlier, I really treasure the role of arts and humanities in medicine and medical education, the health professions for deepening our own experience as clinicians and carers, bringing greater clarity to our experience. As I say, this kind of fluency and connection with others. It’s also… I haven’t commented… I also think it’s incredibly efficient. I love… Poetry is so powerful. People will know if they’re reading the editorials, I often will include poetry or an excerpt from some poetry. It’s just so aesthetic but so efficient in communicating a complex idea or notion that I think has value and importance. So these are things that I will always elevate and try to affirm through the journal.
Laura:
I want to thank the staff actually. I want to thank my predecessors, my predecessor editors, who were wise enough to incorporate these different features in the journal because it makes it really, just a privilege as the editor to have these different elements. But I want to thank Arno for taking the journey with us. I know that you will make your imprint. You’ll make a difference with your expertise and your heart.
Arno:
Thanks, Laura. No, and I think this is a great opportunity that… It gives us room to have a discussion about really what it means to engage humanities and art and creativity and imagination in medicine. I mean the one word that we often don’t hear in medicine is a very ancient word, mystery. I think art allows us to really grasp and engage with mystery in its richest, most profound moment. So for me, this is a great adventure. I’m just going to have a blast. So I can’t thank you enough.
Laura:
That’s great, thanks.
Toni:
Thank you for joining us and listeners should remember to check out the cover art call and the call for trainee letters, which both are available now and some of the other features that we’ve talked about today. Academicmedicine.org is our website. You can find all of this stuff there. So thanks for listening.
Arno:
Thank you.
Laura:
Thanks Toni.
Toni:
Remember to visit academicmedicine.org for the latest articles from the journal, as well as all the special features that we talked about today. You can actually keep an eye out. There are a few papers that should be online now, related to the arts and humanities in medicine and they will all appear together in a summer issue. You can also access additional content on our website, including free eBooks and article collections. Make sure that you subscribe to Academic Medicine through the subscription services link under the Journal Info tab or visit shop.lww.com and enter Academic Medicine in the search bar. Institutional subscriptions are available through Ovid. Check with your librarian to be sure your institution subscribes.
