Teaching Medical Students the Art of Uncertainty
Physicians often work without having a clear answer and must make decisions under the pressure of uncertainty, but medical school traditionally has not taught students how to develop that ability.
The ability to tolerate uncertainty can make a good physician great, says Deepthiman Gowda, MD, MPH, MS, associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons. “But in class, medical students are often presented with multiple choice tests or clinical cases that have a right or wrong answer. This can create a false sense of 'clinical reality' among students.”
A new study by Gowda suggests that training students to tolerate uncertainty could be done within the walls of a museum instead of a medical setting. “Art allows us to grapple with ambiguity,” Gowda says. “Paintings are dynamic, complex, and can continually be discovered. They act on the observer in emotional, social, and intellectual ways.”
In the study, Gowda studied the progress of 47 medical students enrolled in an art course from 2014 to 2017 as part of the VP&S narrative medicine selective requirement for all first-year students. During the six-week course, students visited the Metropolitan Museum of Art on a weekly basis.
One of the first objectives of the course was to train the students to slow down and appreciate details to help them develop the skill of close observation. In discussion groups, students shared their observations and listened to those of their peers, acknowledging the limits to what each of them can see. “Our perceptions and observations are affected by our own biases and histories,” Gowda says. “Just because you see something, doesn’t mean you’re looking closely. By asking our students ‘what else do you see?’ we can show them that observation is a tool to be harnessed.”
To assess the impact of the course, students were given the Groningen Reflection Ability Scale for reflective ability, the Tolerance for Ambiguity scale for ambiguity, and Best Intentions Questionnaire for personal bias awareness. In addition, the students participated in focus groups where they explored their experience with the course.
The data collected over four years suggest a notable improvement among the students who participated in the course, including a statistically significant improvement in GRAS scores. Through the process of looking at art and having conversations about their experience of viewing art, students became more reflective than they were before.
The students also noticed the change. In their evaluations of the course, students noted that the course improved their ability to perceive easily missed details, taught them how to describe elements that first seemed indescribable, heightened their curiosity, and encouraged them to be more aware of their surroundings. Students realized how their thoughts or emotional states can directly impact what they are perceiving.
Most students also included in their evaluations something Gowda did not anticipate: self-care. The students referred to the class as a place for restoration where they can deeply connect to their classmates, and one student described the course as a healing “sanctuary.” Given the rates of burnout in the medical field, these attributes can build resilience among students and create for them a healthy and flourishing training environment, Gowda says.
The art course taken by the students is one option within the narrative medicine track at Columbia University Vagelos College of Physicians and Surgeons. All first-year VP&S students take one course in the track, which infuses medical education with humanities. Other options include courses about narrative in film, fiction writing, philosophy, and dance to better understand how people express themselves through their bodies and movements.
“Bringing the humanities back into health care training helps to develop our students in a more holistic way as thinkers and observers,” Gowda says. “Humanities and science are not two separate worlds; creativity is a part of being a clinician.”
Deepthiman Gowda, MD, MPH, MS, is the course director of Foundations of Clinical Medicine Tutorials and director of clinical practice in the program of Narrative Medicine at the Columbia University Vagelos College of Physicians and Surgeons.