This past spring, my palliative care colleagues and I sat down in front of Kara Walker’s artwork titled The Jubilant Martyrs of Obsolescence and Ruin at the High Museum of Art in Atlanta, Georgia. For thirty minutes, we slowed down, turned off our cell phones and pagers, and looked slowly and intently at this 58-foot massive cut-paper work. Like the other works of art we studied in the museum, our docent facilitator began the conversation by asking us the following question: What is going on in this artwork? Some saw a scene of incredible violence. Others saw a satiric commentary on the American Civil War. One remarked on figures representing different races and identities. Another commented on gender and sexuality portrayed in the work. With each comment, the facilitator asked: What do you see that makes you say that? Our eyes sharpened and our language became more precise with each passing comment. For example, when a participant was asked to clarify her remark on different eras of American history portrayed in this image, she honed in on the figure in the upper right of the artwork who appears to be wearing a suit. To her, he represented an African American figure from the Civil Rights era more than from the Civil War. The facilitator acknowledged and paraphrased her comment, and then continued: What more can we find?
This artwork was one of many evocative drawings, paintings, and sculptures we viewed over eight months in a course titled “The Art of Palliative Care.” My colleagues and I designed this art museum-based curriculum to promote observation skills, self-reflection, tolerance for uncertainty, and flatten the perceived medical hierarchy. With the support and guidance of the Harvard Macy Institute Art Museum-based Health Professions Education Fellowship, my colleagues and I created a six-part curriculum for palliative care practitioners (including attending and trainee physicians, social work, nursing, and spiritual health) to support the non-technical aspects of palliative care; that is, the self-reflective, introspective, and metacognitive domains that guide and mediate our interpersonal relationships with others.
Much of medical education is taught using the “see one, do one, teach one” model. This model might work to teach providers to titrate opioids or change ventilator settings, but it cannot train you to walk into the room of a person who has just been told he has weeks to live, surrounded by family who is in shock, and navigate the physical, emotional, and spiritual suffering of a vulnerable patient and his loved ones. Palliative care providers typically enter a patient’s life during a time of crisis, and we bear witness to tragedies often rife with injustice. When we approach these both delicate and gut-wrenching situations, we need to read the suffering of a patient and his family. We need to look deeply at a complex crisis, investigate the nature of the patient’s suffering, and promptly establish trusting relationships with patients and their families. I realized early as an attending that I cannot teach this with a textbook or a clinical exam.
I also did not learn these skills in my clinical fellowship in palliative medicine. In my first years as an attending, facing early burnout, I found my own personal time in museums looking deeply at art, reading the emotions conveyed by artists, and reflecting on myself through my interpretations and reactions to art (i.e., using art as a mirror to understand myself) to be instrumental in my adaptation to life as an attending. I believe the meta-awareness of how I create meaning in the face of suffering has made me a more resilient physician. Given the alarmingly high rate of burnout among palliative care practitioners at 62%, I wanted to share these art-based experiences with my interdisciplinary team.
My decision to enroll in the Harvard Macy Institute Art Museum-based Health Professions Education Fellowship and design this course was to understand the theoretical basis of art museum-based pedagogy and strategies to implement it in my home institution. Upon completion of the course, we conducted a focus group and qualitative analysis that identified four themes: 1) using art as a “proxy” in a neutral setting to safely access emotions and work through difficult situations; 2) experiential immersion in clinical development; 3) discovering the power of the multidisciplinary palliative care team; and 4) modeling work-life balance. We also learned that our participants desired more time debriefing during class time to connect their experience with art with their experience as palliative care clinicians.
Our team at Emory has recently received a grant to expand museum-based education at Emory University for this academic year to include more learners from the health professions beyond members of our palliative care team. The Harvard Macy Institute has given me access to an extraordinary family of fellow educators who have become my collaborators and colleagues as we continue to study, develop, and implement museum-based pedagogies in the health professions.
Cover Photo Attribution: "Museum" by Dorset Photographic is licensed under CC BY-NC 2.0.
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Author BIO
Ali John Zarrabi, MD (Art Museum Fellowship ’19) is a physician and Assistant Professor of Family and Preventive Medicine and Internal Medicine at Emory University School of Medicine. His clinical, education, and research pursuits are devoted to investigating and promoting the healthy adaptation of adults who live with serious illness. His areas of professional interest include arts-based pedagogy and nonpharmacologic strategies for treating chronic pain in seriously ill patients. Ali John can be followed on Twitter or contacted via email.
Ali John Zarrabi
Ali John Zarrabi, MD (Art Museum Fellowship ’19) is a physician and Assistant Professor of Family and Preventive Medicine and Internal Medicine at Emory University School of Medicine. His clinical, education, and research pursuits are devoted to investigating and promoting the healthy adaptation of adults who live with serious illness. His areas of professional interest include arts-based pedagogy and nonpharmacologic strategies for treating chronic pain in seriously ill patients. Ali John can be followed on Twitter or contacted via email.