Commentary by Maureen Rappaport MD, FCCFP, Assistant Professor of Medicine, St Mary’s Hospital Center, and McGill University, Montreal, Canada
I am trained as a family physician but one third of my practice is as a clinical supervisor and teacher of residents in a family medicine teaching unit. I am based at St. Mary’s Hospital, a small community hospital in the heart of urban Montreal. Our residents have to do a "research" project as part of their training. Like most of our clinicians, I am not a trained researcher but I have had extra training as an educator (McGill Scholar in Medical Education 2004). A research project was a requirement of that program and through the courses I took in the Department of Education I discovered academic researchers were exploring different theories of knowledge and research (Barone and Eisner, Clandinin and Connelly, Cole and Knowles, and Patton)): i.e. Qualitative Inquiry, Interdisciplinary Artistic Inquiry, and Reflexive Inquiry. I used these methods in my own research project and although I initially met with skepticism, in the end my project was well received.
Past resident projects at St. Mary’s Hospital were mostly literature reviews and chart audits and, though interesting, the topics tended to repeat themselves year after year. My experiences in the Scholar’s program gave me the idea to propose an "Interdisciplinary Art Project" stream to my colleagues. I was excited about this new development, other staff members became inspired to develop other projects, and best of all, the residents engaged wholeheartedly with this new project paradigm.
I developed the guidelines for the Interdisciplinary Art Project based on work done by Dr. Ruth Martin, at University of British Columbia Family Medicine, who was generous enough to send me her documents. (Draft guidelines for Interdisciplinary Art Resident Project,Version #7, September 2005).
Interdisciplinary Art Project Stream Guidelines
To integrate an artistic activity that includes photography, painting, sculpture, music, poetry, drama, film, or creative writing in a project that contributes to the existing knowledge base of Family Medicine
- To increase clinician self-understanding and/or understanding about the physician patient relationship
- To produce an oral/visual/audio/performance presentation which consists of the work of art itself AND
- To produce an abstract and a report written in a format similar to scientific research, however, you may write this report in the first person like a personal diary or field notes
- Demonstrate an academic understanding of the integration of the chosen artistic discipline with the discipline of family medicine
- To produce a scholarly work that attempts to understand, explain, and/or interpret a clinical question or enigma and to explain your motivation for choosing an artistic medium
- To include a historical and contemporary overview citing past examples of interdisciplinary work
- To explain how your project relates existing interdisciplinary knowledge or published literature
- To outline the ethical considerations encountered. ( Physician artistic activity can lead to ethical conflicts between what is research, art, or journalism, or when artistic activity interfaces with clinical care)
- To fully explain your methods ie. why, when and what materials/medium were used and if other participants were involved what consent process was used and did they have input in editing
- To present your results (the work of art) and a summary of the written report on resident day
- To have a full discussion about the impact and limitations of your project
- To demonstrate how the process of completing an interdisciplinary art project resulted in your personal growth or increased understanding
Preliminary Project Excerpts for Research Day June 16, 2010
Four projects are in the Interdisciplinary Arts Project stream this year:
1. The Exploration of a Patient’s Experience with Injury, Illness and Healthcare in Montreal -A short documentary film (Dr. Isaac Berman)
2. Poetry Therapy (Dr. Anne-Marie Leblanc)
3. Narrative Medicine, A Reflection (Dr. Tara McCarty)
4. Life-casting Project of Pregnant Woman and Her Partner (Dr. Tim Lussier)
Below are excerpts of three projects in their preliminary form:
Poetry Therapy: Anne-Marie LeBlanc
"As [Arthur] Lerner [is reputed to have] said, ‘poetry has the potential to help you be your best possible self… it brings us back to our own humanity’. I think I could say this is exactly what poetry brings me: humanity."
Outline of Project
- History of Poetry Therapy
- Poetry and humanity
- Presentation of poems
- Research Method
- Four beneficial effects
- "Finding the Words to Say It"
- "It Takes a Whole Doctor to Treat a Whole Patient"
- "Paying Witness to the Unfolding Occurence of Life Itself"
- "Becoming a Better Professional"
"The poem named ‘Une Femme Morte’ was written during my palliative care rotation."
Une femme. Morte.
Et moi qui entre
Un regard, en fait deux
L’un eteint et l’autre en peine
Qui ont aime… et cesseAd’aimer.
Trop difficile cette vie
La-haut ce sera plus calme…
Et la musique quiAla transporte
Je souffle sur son ame
Et reviens sur Terre
Lui ouvre les yeux…
Que du vide. Que du vitreux
De l’ordinaire extraordinaire
Le rideau derriere moi
Je le saisis. Un dernier regard
Je la laisse
Et je marche hors de moi.
Narrative Medicine, A Reflection: Tara McCarty
"This is a little piece I wrote in the call room last week after a particularly difficult night. Small reflections such as these are known as narrative medicine. AThe doctors, nurses and staff who care for the ill are exploding with stories of beauty, sadness, and unique information that they are privileged to know about their patients’ lives. Narrative medicine, as described by Rita Charon, internist and writer, is a way of practicing medicine that enables the physician to practice it with empathy, reflection, professionalism and trustworthiness. It can be conceived as a model for a new way to practice medicine, a way that perhaps is a form of reincarnation from the old."
It’s late in the evening and I’ve been paged by the attending who asked me to see Mr McDonald. He hadn’t been doing well and the attending wanted me to check on him and re evaluate his pain control later on tonight. Actually, I knew this patient from a couple months ago when I was on call- a sweet 91 year old man who still had all his mental capacities and a great photo of his nine grandchildren by his bedside. He came with pancreatic cancer and a CVA, and when I saw him, he was desatting and short of breath from a likely aspiration pneumonia. On top of that, he had gone into fast a fib at around 160, and at 4 am, alone on the eighth floor, I put him on a monitor and pushed some IV metoprolol until he slowed down.
Once my heart rate and his were both down to the double digits, he smiled at me, amused. "It’s Ok, my dear", he said, "You don’t have to look so worried anymore". When I left later that morning he was satting well, had a heart rate of 70-90 and he patted my hand gently when I left.
Tonight, I go in to check on him. Much has changed. He has had two more CVAs, and he is now Level 5 care, existing on that lovely trifecta of nasal prong O2, morphine and scopo. I walk into his room, introduce myself, explaining that we have met before. He is breathing at about six during the minute that I count but seems to be focusing on my eyes. I realize the sound that is coming from his throat is what we doctors so eloquently call "the death rattle". I am holding his hand and with my free one press the call bell to ask the nurse to phone his family, but once she answers, the only one left breathing in the room is me. Mr McDonald, the sweet man who only a couple months ago had told me to "stop being worried", had just died, here in front of me, his hand in mine.
In a haze, I did the usual, the exam needed to pronounce, the papers, the signatures, the call to the family, helped the nurses clean him up, take out the IVs, take out the foley, take off the EKG stickers. I left his peaceful body in his room, waiting for his family. But his spirit stayed with me for a while. I left his room and walked down the dark hall, Mr McDonald’s ghost floating beside me, calm. And so he walked beside me, holding my hand, all the way from 5 main to 5 south, and then he let me off at the elevators. I pushed the down button for me, and the up button for him. His elevator came first, and he waved softly and smiled as the doors closed, his eyes once again telling me that everything was OK.
Life Casting of a Pregnant Woman’s and Her Partner’s Hands
Resting on Her Belly: Timothy Lussier
Introduction: The bond between a family and the unborn fetus is not very well discussed in the medical profession as the pregnancy is quickly reduced to a checklist of symptoms and signs. Art can help to capture this relationship in a way that is informative and powerful for the observer whether it be a patient, passerby or the responsible physician. Objective: Use sculpture to help capture the bond between the mother, partner, and the unborn fetus. Design/Method: Research aspect-to explore what is known concerning the bond between the mother/family and the developing fetus; Creative arts aspect-life-casting project of a pregnant woman and her partner symbolically representing the connected union. This will be followed by a survey of observers to verify the art assists in the intended purpose. Results: 1) Written report 2) Sculpture 3) SurveyADiscussion: Art can be a transforming experience and has shaped minds and history through time. It is our way of expressing complex ideas or emotions and communicating this to others. The nine months of pregnancy is a powerful experience for the family not formally recognized by the mother’s interaction with the medical profession. A life-cast sculpture of this bond may help us to better understand this experience and promote this experience within the family.
The above excerpts are just tastes of what these projects hold. I can’t wait for research day, to hear my residents present these works to their peers and my colleagues, to see poetry, stories, and art next to evidence- based searches. Medical Humanities has taken yet another place in the Academy.
Note: Although the projects are in various stages of development the residents have generously agreed to share their work so far.
Barone, T.E. & Eisner, E. (1997). Arts-based educational research. In R.M. Jaegar (Ed), Complementary methods for research in education. (2nd Ed.) (pp.73-116). Washington, D.C.: AERA.
Clandinin, D.J. & Connelly, F.M. (2000). Narrative inquiry: Experience and story in qualitative research. San Francisco: Jossey-Bass.
Coles, A. & Knowles, G.J. (2000). Researching teaching: Exploring teacher development through reflexive inquiry. Boston: Allyn and Bacon.
Lerner, Arthur. Cited by McARDLE, S. and BYRT, R., in Journal of Psychiatric & Mental Health Nursing. 8(6):517-524, December 2001. p. 521.
Patton, M.Q. (2002) Qualitative research and evaluation methods. Sage Publications: California