 is a pleasure for me to introduce Joel Howell. Joel is professor at the University of Michigan in the Department of Internal Medicine, Health Management and Policy, History, and the Victor C. Vaughn Professor of the History of Medicine. He's the director of the University of Michigan, Robert Wood Johnson, Clinical Scholars Program, director of the University of Michigan Program in Society and Medicine. I do have to disclose that he told me that he still has a copy of my PhD dissertation, which I gave him during my year in Michigan. So I do question his judgment on that, that he kept it, but he has written widely in the use of medical technology examining social and contextual factors relevant to clinical application and diffusion of knowledge, analyzing why American medicine has become obsessed with the use of medical technology. He'll speak today on the medical arts. Joel. Okay, a couple of things. First of all, not only do I have Peter's PhD dissertation, but I read it every night. And I'm only up to about page 12 and I have no trouble going to sleep. It's a great honor to be here, especially, as I think this is correct, Mark, is your first fellow. Yes, very, so everything I do has been, and that's not actually not hyperbole. Mark taught me a number of lessons, one of which is if you think it's important, do it, and wait for the rest of the world to figure out but don't spend your time trying to track what other people want, and that's certainly how I've lived my profession. We go to work every day trying to teach our medical students and residents how to be good doctors. How are we doing? There's a lot of studies similar to this one, but basically 78% of physicians think that they're providing compassionate care to their patients, only 54% of our patients agree with us. If we ask patients if we are comfortable discussing sensitive emotional or psychological needs, considering the effect of illness on them or their family, or striving to understand their emotional needs, it's about half. These are not good numbers. Furthermore, the way in which we relate to our patients has an influence not only on how they feel, but also on physiological parameters of their treatment. There is a lot of literature on this, but here's one that shows that provider empathy correlates with diabetic and cholesterol control. How can we address this problem? There are a lot of useful ways we could do it, but what we've chosen to do is something called the Medical Arts Program, about which I'll speak for the next few minutes. Now, what does art have to do with or for healthcare? There are a number of ways that art might be useful. For one thing, it's potentially valuable for training in terms of studying visual arts and helping people to become more careful observers. This is a type of program that has gone on at many medical schools around the country and there's a bit of evidence, although not well controlled, suggesting that it works. I'd also argue that art has other virtues. It can teach people how to be more tolerant of ambiguity, how to learn to revel in ambiguity and not find ourselves forced to choose between seemingly dichotomous choices, often at the risk of ripping the guts out of the essence of what is essentially a very complicated decision. It can teach us about life, what do I mean by life? At this very moment, we have house staff and medical students at the University of Chicago hospitals and at the hospitals of others in the audience who are taking care of people who are dying. So we have people who are 25 years old taking care of people who know that they're going to die. Now, when you're 25, you don't think that you will ever die. How do we teach them what it feels like? How do we teach them how to relate? The arts are one way to go. How do we teach them how to understand what it means to be in pain? What it means to experience disability and death and to grieve? The arts are one way of doing it. I don't claim they're the only way of doing it, but they're certainly one way of doing it. And we've taken a collaborative approach to partner with our presenting arts organization, the University Musical Society, the Museum of Art and the Gifts of Art program to try to study whether or not the arts can be useful in this educational endeavor. So what do we do? We take students and we do what I described before. Here we see students at the University of Michigan Museum of Art, discussing some visual arts. Here we see them on the upper right with Wayne McGregor. Wayne McGregor is the director of Random Dance, a modern dance company, and he's talking to them about physicality and about the physicality of the doctor-patient relationship and the dances that we all do when we enter into patients' rooms. We don't often think about that, but our patients certainly do. And on the bottom left you see Andras Fayer, who's a cellist in the Takash Quartet. And they're talking about teamwork in medicine and they're talking about how you go from a career in which you're trained to be a soloist and then are asked to work with lots of other people. We take them to art museums. This is the Detroit Institute of Art. Here they are in the Garden Court. It's a fresco done by the great Mexican muralist Diego Rivera. And we explore how artists can help us think about ambiguity. I'll briefly point out here, this is one wall of what is a four-wall complex. And if we look very briefly at these two panels in the upper right and the upper left, this is a mural done by Diego Rivera in the 1930s. What he's done in those two murals is to give us a sense of science being used for good and science being used for evil. In this case, it's science used for good. Here we see a child getting immunized with probably diphtheria antitoxin. Diphtheria antitoxin was a truly life-saving innovation. The animals in the front represent the animals from which the vaccine was made. This was, this fresco itself is not far from Park Davis facility farm in those days where they made that. Back you see the scientists making the vaccine. The child himself is modeled on the child of Lindbergh. Lindbergh was the first person to fly across the Atlantic while Diego Rivera was making these frescoes. Lindbergh's child was kidnapped and later found dead. And the child looks a bit angelic. There's some controversy here. People were not happy with this. But the point is this is science used for good. And it shows science is a very positive force. In the upper column, on the other side, we see science being used for evil. Here we see scientists making poison gas. It had just been used in the First World War. They didn't know it was the First World War. They called it just the Great War. And of course, one of the great ironies is that this gas that we're using, mustard gas, soon became one of the first effective cancer chemotherapeutic agents. So here we have art being used to exemplify ambiguity, tolerance for ambiguity, being happy with multiple mixed meanings. Now, how do students think about this? They love it. And why wouldn't they love it? I mean, we invite students to come and we give them tickets and they get to meet the artists. But does it really matter? So we decided, let's do a study. This is a study that's been funded by the Creative Campus Foundation and a joint grant to the Performing Arts Organization and the University, perhaps the first grant ever made by the Association of Performing Arts Presenters to a medical school. And we're continuing to be funded by the Doris Duke Charitable Foundation. We're very grateful for that. That's a joint grant between their art and their medical department. So how do we study the effect we're having on students? The experimental design is quantitative using some structured validated scales. I'll give you some examples in a second. Qualitative, textual analysis, analyzing how students respond to visual and auditory artistic stimuli. And I'll give you examples of that in a second. And finally, the third arm about which I won't talk very much is simulated patients. All of our students undergo interactions with simulated patients. They're graded by those simulated patients. And we can compare those who experience the arts and those who don't. The experimental design, there are three groups. First are those who are interested in participating. We said, who's interested in participating and a bunch of people raise their hand, that's one group. Those who are interested and actually participated in a lot of the events. There's another group of students who are interested but never did participate. They weren't that interested, they were busy, they've got scheduling issues. And finally, there's a third group of people who said they weren't at all interested in the arts. And that's where I think this study derives a little bit of analytic rigor. It is that instead of simply showing that people who are interested in the arts change, we're comparing them to people who are not interested in the arts and didn't participate. Of that third group, we took a stratified random sample. We asked them to participate in surveys, pre and post at the beginning, at the end of the academic year, and we bribed them with the traditional Amazon.com gift card. It's amazing what people will do for a $35 Amazon.com gift card. So what did we do? Let me just give you just a little flavor in the time that I've got. One of the things that we did is we took them to the art museum and we said, stand in front of a work of art that you don't understand or that you don't like. This one, for example. And that's the work of art we spent time spending time with. Now, the analogies, I could talk more about this if you want, but how often is physicians, do we see patients who we just don't understand or who we really don't like? And how do we relate to that? How do we approach them? We also took them to performance arts. This is a still from the absolutely amazing performance of Einstein on the beach. Einstein on the beach was the classic Wilson glass collaboration. It was remounted this year for the first time in 30 years. It started in Ann Arbor, it's since gone to the Brooklyn Academy, Toronto and other places around the world. And we asked students to reflect on their performance and what they learned from it. One student observed after watching this performance that, quote, a lot of what we do in medicine is very, very repetitive. It's very easy to lose focus and attention. When we take time and energy to be aware of what we're doing, medical practice becomes more refined, cost effective, safe and patient centered. The performance of Einstein on the beach required the artists to be ever present in their repetitive tasks and the end result is a testament to the power of such focused concentration. Another student noted how subtle details in a patient can lead to greater changes in their medical condition and how subtle changes were emphasized in Einstein on the beach. We've asked them as part of the survey to respond to visual and auditory stimuli and in the interest of time since I appear to have 27 seconds left. I will run slightly over. This is an example of one of the works of art that we asked them simply to reflect on. We said, what do you see? And we're studying the difference between what people who participated in the arts program wrote and what those who didn't wrote. The music which was might have played but didn't, that's okay. Priligin fugue number one by Shostakovich, a very angular piece of music. And we have some early results on the scales which I think are suggestive. The Jefferson scale of empathy showed more empathy among learners who attended arts events. Tolerance of ambiguity scale revealed greater tolerance for ambiguity among learners who attended arts events. The Maslak burnout inventory showed less emotional exhaustion among learners who attended arts events. This is as compared to learners who did not. Personal accomplishment subscale and the linear analog scale assessment were also positive. One of the scales, the depersonalization subscale, although the magnitude was lower, showed slightly more depersonalization among learners who attended arts events. None of these reached standard levels of statistical significance. However, I think it's interesting that five of our six measures moved, trended in the direction that we would hope they would after exposure to the arts. And we're continuing this study throughout this year again with help from the Dorstud Charitable Foundation. One of the interesting and powerful parts of this that I'd like to pass on was the importance of getting the right artists to become engaged. This show is Andrew Sturman. He's a saxophonist for the Philip Glass Ensemble. He is one of the artists who was able to come on rounds. We had him come on rounds in the inpatient setting who came to the outpatient clinic. And then when he talked to the medical students after the performance, we had a dinner and he related and they talked about the similarities and differences between performing art and practicing medicine and he was able to do so with some experience having dealt with our students actually on the wards. Here's the group gathered outside the Detroit Institute of Arts. We've also taken the most recently, we were in Chicago last year and went to the Chicago Art Institute. We plan to continue this program. We don't think that art is the only way of helping physicians to become better, but we do think that the great arts have a way of reaching some of the minds, some of the empathic, effective side of our mind that helps us to become better physicians. And we hope that in the near future we'll be able to present you some data showing that it actually does. Thank you very much. Thank you.