Spreading a new form of medical education through the power fostered by "interactive appreciation

◆Many medical students are not good at "language" and "observation".

-Please tell us about your current activities.

I am currently serving as the director of a home-visit clinic and teaching at a university once a week as a part-time lecturer at Dokkyo Medical University. In my classes, I use a method called "interactive appreciation.

In this interactive viewing, participants view paintings under the guidance of a facilitator and share their findings in words to deepen and expand their understanding. By setting aside information about the artist and the background of the work, everyone can share their findings openly and focus on the process of exploring the interpretation of the work while gathering a variety of materials for judgment. What we want participants to acquire here are mainly "Japanese language skills" and "interest in observation.

-Why do you teach classes to develop language skills and an interest in observation?

Because the issues that I felt in my dealings with medical students were precisely those that stemmed from "The Japanese language" and "observation.

Medical students today are severe and very eager to learn new diseases and diagnostic criteria. On the other hand, there are conversations with words, presentations that are not in writing, and medical record entries that have no basis. They have specialized knowledge, but they lack the language to organically link it all together, which I thought was a waste of time.

Also, when I went out for hands-on training, I found that some of the students were not looking at the patients, but were instead engaged with the notepad, chart, or computer in their hands. The textual information of the patient's speech is of course important, but if you add information such as facial expressions and body gestures that appear at the same time the patient speaks, it becomes even more useful information for medical treatment. I felt frustrated that missing out on such information would be a shame.

On the other hand, I also felt that telling them to "read books" and "look more closely" to develop an interest in the language and observation would not solve the problem in essence. While searching for a better way, I saw the potential in the perspective of art and its characteristics as a subject matter.

-Why did you see the potential in art?

I am ashamed to say that the main reason was that I frankly thought it was fashionable and fun (laughs). (Laughs.) This is also my policy, but I cannot convey the essence of something that I, as a teacher, do not think is good, and if I am not truly rewarding and enjoyable, I cannot continue teaching in the first place. In the process of researching a practical way to incorporate art into medical practice and education, I came across the concept of interactive art appreciation.

Interactive art appreciation is communication-based. Therefore, when the subject matter is ambiguous, when the basis of a statement is not mentioned, or when facts and interpretations are mixed up in a student's statement, we can promptly point out the problem on the spot and encourage awareness. To deepen awareness, students are encouraged to pay attention to what others say and compare it with their own, which naturally fosters an attitude of acceptance of diverse viewpoints.

In addition, there is no one-size-fits-all interpretation of art. This makes the atmosphere psychologically safe and lowers the hurdle of speaking up. This is why even children who normally don't speak up with a sparkle in their eyes speak up, and the participation rate in class is much higher than in other group work.

This kind of communication is difficult to achieve in discussions on patient cases or in teaching in a clinical setting. For example, when a patient is in front of you, it is difficult to speak up as you would like to because your concern for the patient takes precedence over your own. Even in group discussions on case studies, it is not uncommon to find that only the same person always speaks up.

I thought that interactive art appreciation could be a breakthrough to solve the problems I had been feeling because it allows us to focus on the process of "seeing" and "thinking" toward the correct answer, which is never reached.

How does interactive appreciation apply to the medical field?

-How exactly do you proceed with the interactive appreciation classes?

We do not just conduct interactive appreciation in each of the seven classes, but we set themes (goals) that we want the students to learn in each class and throughout the entire class. In particular, the first half of the class focuses on language skills, and the content is designed to help students acquire "Japanese language skills. Originally, interactive art appreciation does not require the setting of specific themes in this way. However, I believe that simply viewing art every week is not enough to solve the issues I consider, so I have organized my classes based on themes that I feel are necessary for medical professionals in my own unique way.

To be more specific, for example, when the theme of a class is "facts and interpretations," in order to have the students clearly separate facts from interpretations, I present a rule in advance: "When you are about to speak, be sure to declare 'This is a fact, but...' or 'This is my interpretation, but...' as a pillow phrase before speaking out your findings. If there is a mixture of facts and interpretations in a statement, it is not acceptable. If there is a mixture of facts and interpretations in a statement, I gently ask the student to redo his/her statement.

Another theme throughout the class is to "clarify the subject" of the statements. For better or worse, the Japanese language can be understood without a subject. However, it is not uncommon for confusion to arise in communication due to ambiguity in the subject. In order to avoid such confusion in the medical field, students learn to speak with a clear subject.

-How is learning interactive appreciation useful in the medical field?

As a concrete example, let me explain how "distinguishing fact from interpretation" and "making the subject matter clear," which I just mentioned, are useful in the medical field.

In the medical field, in principle, the name of the disease or condition is inferred or the severity of the disease is judged based on facts, and actions such as examination and treatment are decided. However, if you are not able to distinguish between facts and interpretations, you run the risk of performing unnecessary tests or procedures based on your own interpretations, even though no troubling facts have occurred to the patient. Also, when a medical treatment is not going well and you have to go back to the starting position and reexamine the direction, you may end up going in circles if your interpretation is included in the starting position.

It is also very important in the medical field to clarify who is the subject of the statement, whether the patient himself is saying "it hurts" or whether family members or others around him are guessing "it looks like it hurts. When a child is injured and goes to see a doctor, whether "the child (himself/herself) is in pain" or "the guardian thinks 'the child looks like he/she is in pain'" may change the subsequent medical examination. It is very important to clarify the subject matter in order to avoid communication confusion in the medical field and to perform appropriate medical treatment.

In most of the classes, we deal with art, which is not directly related to medical care, as a subject matter. Through this, you will learn how to deal with visual information and furthermore, be able to examine the information you have gathered, not only visual. In addition, by deriving interpretations from various sources of judgment, students will be able to approach the feelings and circumstances of essential people and come up with stories (narratives) that are not superficial. Needless to say, this is useful in the medical field. That is what we are trying to achieve in our interactive appreciation classes.

-Do you feel a positive response from the medical students who have taken the class?

Since this is our fifth year of incorporating this into our first-year classes, we have yet to see any students who have taken the interactive viewing class go out into the medical field. Therefore, I expect that we will find out in the future whether this class is really useful in the field.

However, by the time all seven classes are over, I can see a great deal of change in the students. Students who did not talk much at the beginning of the class are able to express their findings more and more as they become accustomed to the class. When I look at the final class reports, I see that the amount of information that can be extracted from a single picture has increased dramatically, and that each student is able to weave a story with rich sensitivity, with no two pictures being alike, as they are able to walk up to the person depicted in the picture and imagine his or her feelings based on a variety of criteria, We can sense various changes in the students.

◆Interactive appreciation incorporating Japanese culture to the world

-I understand that you are also involved in activities to promote interactive appreciation.

We offer it once a month to students who are undergoing practical training in hospital wards, in addition to the first-year students' classes. In addition to medical professionals, we also hold online interactive viewing experience sessions twice a month. I have been asked to give lectures at seminars and forums on an increasing number of occasions. I also held a workshop at the Japan Society for Medical Education. I think it was a unique theme, but the number of participants exceeded the capacity, and some participants have continued their relationship with us after the workshop, and it has served as an opening for new activities and initiatives.

In fact, if you look around the world, as of 2020, more than 120 medical universities are implementing programs in collaboration with museums (many of them using an interactive viewing method). Research has also shown that observation skills, which were once thought to be acquired only in clinical settings, can be trained through art education. Although it has not yet been adopted in Japan, I am convinced that medical professionals who possess the observation, language, and communication skills cultivated through interactive art appreciation can surely play an active role in the field, so I hope to expand my circle of sympathizers little by little at my own pace and without rushing.

-What do you envision for the future?

Art education for healthcare professionals has an overwhelming history and scale of practice overseas, but I would like to not only follow in its footsteps, but also create my own unique programs that reflect the unique subject matter, sensitivity, and aesthetic sense of Japanese culture, and eventually disseminate them to the world.

For example, manga is a well-known part of Japanese culture. Although there is the obvious caveat that manga is not suitable for beginners because it contains more information than paintings, I feel that it is an excellent educational subject because of its ability to integrate more information and weave a story together. Above all, it is fun for me to do. The students' response has been very positive (laughs). While it is good to learn about and incorporate foreign precedents and formats, I also believe that there is great potential for interactive appreciation that makes the most of Japanese culture.

In addition to manga, we collaborated with a local museum in the 2022 school year and used bamboo crafts, a traditional craft of Tochigi Prefecture, as the subject matter. The students' reactions were very different from those to seeing paintings projected on a screen, as they were able to get up close and personal to feel the texture and weight of these precious works, which are usually kept in acrylic panels and not touched.

As it relates to medical care, how to root medical professionals in the community is a pressing issue. Various initiatives are being implemented, such as scholarship programs and regional quotas, but I think that studying subjects such as traditional regional crafts can help students to become attracted to the region and fall in love with it. I think another essential approach is to encourage people to stay in the region.

It would be exciting just to think about it - to spotlight the people and things of the local area, and to see the bloom of educational initiatives that can only be done there bloom all over the country.