As part of the Advance HE Small Development Projects 2019 focusing on the metal health and wellbeing of students, Queen Mary University of London (QMUL) developed a platform for sharing what works for educators as well as evidencing student learning and engagement with creative enquiry and developing a community of practice. Dr Louise Younie, Clinical Senior Lecturer, details the project below.
As a clinician and educator, the rise in stress, burnout, anxiety and depression amongst medical students is concerning (Dyrbye et al., 2005; Dunn et al., 2008) not least because it is increasingly recognised that this poses a risk to future patient care and patient safety (Thomas et al., 2007; Shanafelt et al., 2010). Factors are multiple and complex but include a high pressure learning environment, competition and ranking, financial pressures and the encountering of suffering, all set within a culture of invulnerability which starts as a medical student (Spiers et al., 2016). Although medical student wellbeing is receiving increasing attention in medical schools across the UK little focus has been placed on the arts or creative enquiry despite the wealth of data from patient-focused studies considering the arts for health and wellbeing (APPG, 2017).
I have been engaging medical students with creative enquiry learning opportunities (using the arts and creative expression to explore lived experience) for over 15 years both at the University of Bristol and Queen Mary University of London (QMUL). Through running small group learning environments with self-selecting students where vulnerable leadership (Younie, 2016) is coupled with creative enquiry, it became evident that students were flourishing, sharing, building solidarity and exploring challenging parts of their lived experience as medical students. This Small Development Project (SDP) bid has allowed me to reformulate (through the website, writing, and images), consolidate and share with a wider audience the value of creative enquiry for student wellbeing.
Having worked in a predominantly grass roots way with creative enquiry in medical education practice and research (Younie, 2006; 2011), dissemination and engaging other educators and clinicians with findings has been challenging. I sought through this funding bid to find other ways of dissemination as well as making findings and key ideas more accessible. To address this, I have worked with animators and web designers to build a website. To develop more collaborative thinking and working, in order to take the field and ideas forward, I have been presenting ideas to various groups and inviting people to engage in a community of practice around creative enquiry.
Encountering and understanding ourselves better, reconnecting with our values, meaning and purpose, gaining self-acceptance, developing positive relationships and personal growth are features of human flourishing that have all been described by medical students engaging in creative enquiry. Five key ideas have emerged for which I have commissioned images for each one.
Creative enquiry invites human flourishing for a number of reasons.
1. Through creative expression we engage with our unique ways of seeing and making sense of situations
2. The imaginative work of creative enquiry can also invite us to look through different lenses, gaining new vistas and perspectives by writing, painting and exploring from other viewing points
3. The arts allow us to engage with the unsayable and indescribable. Through their different affordances they can be a catalyst to tease out the ineffable, emotional and intuitive dimensions of practice and experiencing
4. The arts enable us to inspect our own ideas, explore our own interior landscape at times surprising us by what emerges
5. Through metaphor, image, colour, rhythm and silence we evoke and engage others in our creative experiencing. Collaborative creative expression can nurture dialogue, meaning making and the sharing of our inner lives
Creative enquiry is a valuable process within higher education for the professions, which can both facilitate human flourishing for the future professional as well as developing their future practice.
Creative enquiry allows us to engage with the complexity and messiness of what it is to be human, to have viewing points, to learn from each other and share different ways of seeing and interpreting our lived experiences. Creative enquiry extends engagement beyond the biomedical disease-based realm to the biographical realm of fear, grief, loss and heartache experienced by the patient or the health care practitioner as they care for patients in their suffering.
Key learnings and challenges
• Importance of realistic appraisal of finance and time
• The practical challenges of organising and curating an art display
• The challenge of changing culture with new ideas, and how to share and embed alternative visions of practice and professional development
I started out with a very optimistic bid in terms of what was manageable with the time frame and with the money. I was prompted to submit a more realistic addendum which has still been exciting and challenging to deliver with my dual clinician and academic work commitments in such a short period of time. However, I have been supported by some fantastic people within QMUL with whom I had not previously worked (for example Karin Fernades who has tirelessly worked with me in developing the website or Maria D’amico who worked with me to create a logo image for the website and communications) as well as encountering key people to work with outside of the university (eg Josie Ford [www.studiojojo.co] who has contributed images which convey key concepts and is currently working on two animations). With team work, good relationships and institutional support, I have been able to achieve a surprising amount with the funding compared to if this work had been externally commissioned.
Curating an art display and prize nomination at the Mad Hearts conference was a joy but a great challenge. Time taken was much greater than what I had accounted for. Managing submissions, organising and creating the display would have benefitted from external support and I should have organised this, but due to time pressures and other commitments, I ran it myself. However, we had a good number of submissions, many of which are on the website now.
Introducing ideas around creative enquiry into higher education, and in particular medicine, remains an ongoing challenge as, philosophically, it heralds from a more constructivist rather than positivist position (upon which so much of the disease based research and learning is built in medicine). Production of the website and animations to facilitate narration and sharing of the purpose and value of creative enquiry is supportive.
Engagement, communication and impact
A community of practice is being built locally with students, educators, clinicians, artists, patients, some of whom can be found on the ‘about us’ section of the website. Further afield links are being made with others interested in exploring practice and flourishing who I am encountering through presentations and workshops.
Local impact – developing closer working with QMUL academics and clinicians across profession boundaries. Also greater introduction of creative enquiry into the Community Based Medical Education curriculum where I work, as well as within the broader medical curriculum.
National impact – Presenting at national conferences, sharing the website with educators across the UK. Invitations to present and run workshops at undergraduate and postgraduate events.
International impact – Online presence with website. Invitation to Sweden to facilitate creative enquiry with health professional educators. Writing for publication.
APPG. All-Party Parliamentary Group on Arts, Health and Wellbeing. ‘Creative health: the arts for health and wellbeing’, Inquiry Report. 2017
DUNN, L. B.; IGLEWICZ, A.; MOUTIER, C. A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry, v. 32, n. 1, p. 44-53, 2008 J https://www.ncbi.nlm.nih.gov/pubmed/18270280 .
DYRBYE, L. N.; THOMAS, M. R.; SHANAFELT, T. D. Medical Student Distress: Causes, Consequences, and Proposed Solutions. Mayo Clinic Proceedings, v. 80, n. 12, p. 1613-1622, December 2005 http://www.mayoclinicproceedings.com/content/80/12/1613.abstract .
SHANAFELT, T. D. et al. Burnout and medical errors among American surgeons. Ann Surg, v. 251, n. 6, p. 995-1000, Jun 2010. https://www.ncbi.nlm.nih.gov/pubmed/19934755.
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THOMAS, M. R. et al. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med, v. 22, n. 2, p. 177-83, Feb 2007. Ihttps://www.ncbi.nlm.nih.gov/pubmed/17356983 >.
YOUNIE, L. A qualitative study of the contribution medical humanities can bring to medical education. 2006. (MSc). Faculty of Medicine and Dentistry, University of Bristol, MSc dissertation, Bristol.
YOUNIE. A reflexive journey through arts-based inquiry in medical education. 2011. (Doctor of Education). Faculty of Social Science and Law, Graduate School of Education, University of Bristol, EdD Dissertation, Bristol.
YOUNIE. Vulnerable leadership. London J Prim Care (Abingdon), v. 8, n. 3, p. 37-38, 2016. https://www.ncbi.nlm.nih.gov/pubmed/28250830