The Mental Health and Wellbeing of Healthcare Practitioners. Группа авторов

CHAPTER 2 What Does Creative Enquiry Have to Contribute to Flourishing in Medical Education?

       Louise Younie

       Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

       … to articulate subjective experience—if even privately, if only momentarily—constitutes a radical act that defies … depersonalization [1]

CONTEXT

      As a young GP new to the blood, sweat and tears of being alongside patients in the community, my image of the good doctor, knowledgeable about the body, its diseases and treatments, began to crumble. Patients attended with interwoven suffering of experience, emotions, trauma and disease, variously expressing themselves through body and mind. I was not prepared for the interpersonal work demanded from my consultations and at times, was lost in how I might transcend the chasm of meaning between my understanding and that of the patient. Seeking to engage future doctors with the complex interpersonal nature of practice, I began to explore Creative Enquiry, an approach which involves reflecting on lived experience through the arts. This work is counter‐cultural, honouring practice, lived experience and subjectivity alongside the more traditional acquisition of facts and skills. Situating creative enquiry for flourishing in medical education requires consideration of the hidden curriculum, what creative enquiry might have to offer and what is meant by flourishing.

Medical education is a key transformative time in the life of our future clinicians, where they move from lay person to possessing the tools and skills of the doctor. The journey immerses students in a powerful cultural medium of competition, perfectionism and heroism [2]. These are features of the hidden curriculum, a concept described by Hafferty relating to what students learn through the medical school culture, structures and processes, rather than what they are taught as part of the formal curriculum [3]. The direction of travel tends towards negation of the human, intersubjective dimension, first for the patient and then for the doctor too. Proponents of patient or person‐centred medicine call for greater attention to patients and their needs as human beings and collaborators in their own health, beyond that which a traditional biomedical approach to disease affords. At the other side of the ‘patient–physician diad’ [4], the doctor, trained as objective diagnostician can lose not just the personhood of the patient but also themselves in the process. Students describe being ‘swallowed up’ by medicine, losing their personal lives to their growing professional selves and ‘the medical machine’ [5].

      Whilst the hidden curriculum potentially distances future doctors from their patients and their own humanity and suffering, creative enquiry can be a humanising force, connecting us with each other, ourselves and our emotions in meaningful ways [6, 7]. The arts connect through for example, slowing down perception, facilitating emotional expression, reframing experiences, inviting multiple perspectives and offering participatory and improvisational engagement with materials [8–11]. This chapter is a case study grounding some of these ideas within the context of medical education and showing what kinds of thinking and sharing are possible. I am not claiming that arts offer the only way of fostering connection (other examples include Schwartz rounds and Balint groups [12]), nor that it is easy to introduce arts for health and flourishing in the medical culture – there will be both resistance against creative enquiry approaches and a reckoning of the time and cost of facilitating such work [13].

      Flourishing has been variously defined but in my work I draw on the concept of Eudaimonia, an Aristotolean concept relating not so much to pleasure and enjoyment (hedonia) although these make us happy in the short term, and more to authentic and meaningful engagement as well as personal growth [14–16]. Bringing the arts and flourishing together within medical education is a timely intervention. The rise in stress, burnout, anxiety and depression amongst medical students has raised concern [17, 18] and prompted both General Medical Council ( GMC ) and British Medical Association (BMA ) further enquiry into the stressors that are negatively affecting students and doctors [19], carrying out surveys into doctor and student mental health [20]. On the arts front, there is a growing evidence base regarding arts for health in our patient populations documented in the recent All Party Parliamentary Group report [21], and in the largest evidence report to date, by the World Health Organisation [22]. The arts have been found to improve psychological and biological markers of stress as well as enhance wellbeing and mental health [23]. In the field of medical education, the literature evidences medical humanities penetrating the medical curriculum [11], however arts for health and flourishing of medical students rarely features.

DESCRIPTION

      As a medical educator as well as a practicing GP my original focus when engaging students in creative enquiry, was around practice or practitioner development, seeking to expand the knowledges, processes and philosophies students have available to draw on in practice. These include personal as well as propositional ways of knowing, our subjective, intuitive and reflexive understandings alongside the facts and skills we can be tested on [24, 25]. However, I discovered that the creative enquiry process opened the door not just to practitioner development but also led to group and individual flourishing. One student captured this with a clay pot she formed with a small