Engaging the Brain: Art and The Science of Dentistry

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National Portrait Gallery (London, England, UK), Purchased with help from The Art Fund, the Henry Moore .... Hans Hofmann, Fiat Lux, 1963, oil on canvas, The.
Engaging the Brain: Art and The Science of Dentistry Catherine Flaitz, Karen Novak, and Jay Heuman UTHealth School of Dentistry, UTHealth McGovern Center for Humanities and Ethics and Museum of Fine Arts - Houston

Personal Interest as a Dental Educator • Clinic consults: – – – – –

Focus on the EHR Minimal eye contact Multitasking Time constraints Struggle with disease description

• Didactic oral pathology: – All lesions look the same – Antiquated terminology – No physical or emotional connection to PowerPoint – Sound bite descriptions

Dental students at the MFAH

With a Sweeping Brush Stroke … Goals: • Enhance 3 skill sets: • Close observation • Unbiased analysis • Clear, empathetic communication Objectives: • To briefly describe the role of humanities in teaching art and the science of dentistry • To discuss humanities in the clinical arts of communication and diagnosis • To discuss the need for engaging the “right side” of the brain in a highly technical, instant messaging and reactive learning environment

Humanities in Medical Education • Popular addition in curriculum • Includes art, theatre, poetry, literature, narrative essays, music • Emphasis on patient - not disease Goals: F • Awareness of the art of medicine • Increase compassion and empathy • Increase tolerance for ambiguity • Recognize biases in interpretation • Encourage reflection •

Grant VJ. J Med Ethics 2002;28:45

Sir William Osler, Father of Modern Medicine. Retrieved from http://www.mattdippl.com/257/ ambition-and-vitality/.

Arts and Improved Visual Skills • Art-based learning in 50% of medical schools for teaching observational skills (Rodenhauser P. Teach Learn Med 2004)

• Improved visual diagnostic skills in medical students who participated in art workshop (Dolev J. JAMA 2001; Bardes C. Med Educ 2001; Bell L. Anat Sci Ed 2014)

• Improved assessment scores in standardized patients (Lunstroth R. UT Innovations, 2006 )

George Bellows, A Stag at Sharkey's, 1917, lithograph, The Museum of Fine Arts, Houston, Museum purchase funded by "One Great Night in November, 1989", 89.252.

Art in Science: Enhancing Observational Skills  “Is she about to place the flower in the vase or is she extracting it?”  Visual literacy: the process of deriving meaning from a visual object.  Finding a variety of meanings in an observation by being open to the unfamiliar. 

Friedlaender GE, et al. Clin Orthop Relat Res 2013;471:2065. Frederic Leighton, Mrs. James Guthrie, 1864-65, oil on canvas, Yale Center for British Art, Paul Mellon Collection, B1978.43.10.

STEM to STEAM – Nationwide Trend Rhode Island School of Design From STEM to STEAM: Science and Art Go Hand-in-Hand By Steven Ross Pomeroy August 22, 2012 7:56 AM

Art is needed for creativity and critical thinking – presently, we are creating a group of robots.

Arts, Neuroscience and Learning • Pictorial Superiority Affect: Visual imagery is the most powerful tool for learning • Improved learning with more senses, including emotions • Richer encoding = richer memory and recall • Boost learning and retention: Prior experience, Pictures, Practice (Jeter C, et al. ADEA Workshop 2014)

David Alfaro Siqueiros, Concentration (Head of a Boy) [Cara de niño (Concentración)], 1939, Piroxylene on Masonite, The Museum of Fine Arts, Houston, Museum purchase funded by Agnes Cullen Arnold Accessions Endowment Fund, 2010.9. © 2014 Estate of David Alfaro Siqueiros/SOMAAP, Mexico/Licensed by Artists Rights Society (ARS), New York

The Art of Observation at UTHealth History of the Program • In 2003, medical school partnered with the Museum of Fine Arts – Houston for elective • 2005 – present: activity for Summer Medical and Dental Education Program, RWJ grant • 2011 – present: medical and dental students participate in this interprofessional elective • 2013 – dental faculty development activity • Funds through the MFAH and UTHealth McGovern Center for Humanities and Ethics

Team-taught course at MFA-H 30 medical and dental students each semester for 3 evenings

Interactive classroom and gallery activities Focus: - Close observation - Unbiased analysis - Clear, empathetic communication Joan Miró, Painting (Circus) [Peinture (Cirque)], 1927, oil on canvas, The Museum of Fine Arts, Houston, Bequest of Caroline Wiess Law, 2004.45. © 2014 Successió Miró / Artists Rights Society (ARS), New York / ADAGP, Paris

Class 1 Interactive Lecture Close Observation & Accurate Description

Examining Clinical Photos Gallery Activity Impressionism Post-Impressionism Expressionism (Audrey Jones Beck Building, 2nd Floor)

The University of Texas School of Medicine and School of Dentistry students participating in The Art of Observation. Photo: Jay Heuman.

Elements of Art

Principles of Design

Line

Balance

Shape

Emphasis

Form

Movement

Space

Pattern

Texture

Repetition

Color

Proportion Rhythm Variety Unity

František Kupka, The Yellow Scale, c. 1907, oil on canvas, MFAH, gift of Audrey Jones Beck, 94.247. © 2014 Artists Rights Society (ARS), New York / ADAGP, Paris”

André Derain, The Turning Road, L'Estaque, 1906, oil on canvas, MFAH, gift of Audrey Jones Beck, 74.138. © 2014 Artists Rights Society (ARS), New York / ADAGP, Paris”

Elements of Art

Principles of Design

Line

Balance

Shape

Emphasis

Form

Movement

Space

Pattern

Texture

Repetition

Color

Proportion Rhythm Variety Unity

Roman, Portrait Figure of a Ruler, 200-225, Bronze, 82 x 49 3/4 x 17 1/2 inches, MFAH, Gift of D. and J. de Menil in memory of Conrad Schlumberger, 62.19.

Urhobo, Nigeria, Spirit Statue, Early 20th century, Wood, 57 x 17 1/2 x 13 inches, MFAH, Museum purchase with funds provided by the Caroline Wiess Law Accessions Endowment Fund, 2010.66.

Class 2

Interactive Lecture Acknowledging & Dealing with Bias

Gallery Activity African Mezoamerican South & Central American (Caroline Wiess Law Building, 2nd Floor)

Seated Figure, Olmec, 1500–300 BC, ceramic, The Museum of Fine Arts, Houston, Gift of Mrs. Ralph S. O'Connor in honor of her cousins, Louisa Stude Sarofim and Mike Stude, 86.409.

Class 3

Examining Clinical Photos Interactive Lecture Empathy and Clear, Concise Communication

Gallery Activity American Impressionism Regionalism Expressionism (Audrey Jones Beck Building, 1st Floor)

William Merritt Chase, The Apprentice (Boy with Apple), 1876, oil on canvas, The Museum of Fine Arts, Houston, Wintermann Collection of American Art, gift of Mr. and Mrs. David R. Wintermann, 84.444.

Marc Chagall, The Woman and the Roses, 1929, oil on canvas, The Museum of Fine Arts, Houston, gift of Audrey Jones Beck, 98.275. © 2014 Artists Rights Society (ARS), New York / ADAGP, Paris

Collection , NPG 6863. Marc Quinn, Self, 2006, blood (artist's), liquid silicone, stainless steel, glass, perspex and refrigeration equipment, National Portrait Gallery (London, England, UK), Purchased with help from The Art Fund, the Henry Moore Foundation, Terry and Jean de Gunzburg and ProjectB Contemporary Art, 2009, Primary Collection, NPG 6863.

Marc Quinn, Self, 2006, blood (artist's), liquid silicone, stainless steel, glass, perspex and refrigeration equipment, National Portrait Gallery (London, England, UK), Purchased with help from The Art Fund, the Henry Moore Foundation, Terry and Jean de Gunzburg and ProjectB Contemporary Art, 2009, Primary Collection, NPG 6863.

Mary Cassatt, Susan Comforting the Baby, c. 1881, oil on canvas, The Museum of Fine Arts, Houston, Gift of Audrey Jones Beck, 74.136.

Upper-left: Charles W. Hawthorne, American Motherhood, 1922, oil on canvas, The Museum of Fine Arts, Houston, Museum purchase funded by the Houston Friends of Art, 27.8. Upper-right: Pierre-Auguste Renoir, Girl Reading, c. 1890, oil on canvas, The Museum of Fine Arts, Houston, Gift of Audrey Jones Beck, 98.297. Lower-leUpper-left: Charles W. Hawthorne, American Motherhood, 1922, oil on canvas, The Museum of Fine Arts, Houston, Museum purchase funded by the Houston Friends of Art, 27.8.

Upper-right: Pierre-Auguste Renoir, Girl Reading, c. 1890, oil on canvas, The Museum of Fine Arts, Houston, Gift of Audrey Jones Beck, 98.297. Lower-left: Mary Cassatt, Children in a Garden (The Nurse), 1878, oil on canvas, The Museum of Fine Arts, Houston, Gift of Mr. and Mrs. Meredith Long, 2001.471. Lower-right: Frederick Carl Frieseke, Girl in Blue Arranging Flowers, c. 1915, oil on canvas, The Museum of Fine Arts, Houston, Museum purchase funded by an anonymous donor, 99.181. ft: Mary Cassatt, Children in a Garden (The Nurse), 1878, oil on canvas, The Museum of Fine Arts, Houston, Gift of Mr. and Mrs. Meredith Long, 2001.471. Lower-right: Frederick Carl Frieseke, Girl in Blue Arranging Flowers, c. 1915, oil on canvas, The Museum of Fine Arts, Houston, Museum purchase funded by an anonymous donor, 99.181.

Description of Photographs • • • • • • • •

Physical characteristics Facial appearance/symmetry Body proportion Posture/stance Clothes and accessories F Attitude/personality Mental status Emotional overtones

John Biggers, The Cradle, 1950, conté crayon on paper, The Museum of Fine Arts, Houston, 25th Annual Houston Artists Exhibition, museum purchase prize, 1950, 50.1. © John T. Biggers Estate/Licensed by VAGA, New York, NY

Art and Disease Seal (Photo: Sam Ruttyn )

http://resources2.news.com.au/images/2012/04/18/12263 31/548110-seal.jpg

System CD Cover http://www.uulyrics.com

Patient Observation • What do you see? • Where is the photograph taken? • What about the level of alertness or mental status? • What does not belong?

Course Exercises and Assessment • Observations of individuals • Description of professional portraits • Description of patient photographs • Pre- and post-course oral lesion description • Reflective paper on artwork, clinical photographs and experience Mirror (one of a pair), Italian or American, early 19th century, red pine, paint, and gilding, The Museum of Fine Arts, Houston, The Rienzi Collection, gift of Mr. and Mrs. Harris Masterson III, 96.1355.1.

Assignment #1: Observing Someone Else • “The person I am observing is a man of … Asian descent and skin tone. His eyes are narrow and his hair is straight, hand length and jet black. The man is suspended three stories up and descending. I’m able to get a glance at his face as he reaches to his side to grab between his squeegee and sponge. He is a hard worker …. while suspended on a high-rise building. His shirt is blue with long sleeves and a collar and his pants are slate gray. He is also wearing F tan work boots and dirty gray gloves with holes cut out for his fingers. I must admit it is somewhat mesmerizing watching him swing back and forth across the windows sponging and wiping, meanwhile a fall of deadly proportions lies only a 2 x 8 plank of pealing green paint beneath him. Yet he doesn’t seem to notice anything, but what is right in front of him - the task at hand. The benefits of the job far outweigh the risk of an unfortunate accident. “ Dental Student

Describe Oral Lesion as Art Global and Specific Description • Visual language: swirls, curls, crevices, velvety, scalloped • Noted asymmetry • Tongue pattern, color • Age and gender • Skin color, complexion, makeup • Red patch on corner of mouth • White spot on lateral incisor • Tender to painful • Appeared healthy • Related to the condition

Benign migratory glossitis Assignment: Part of Reflective Essay

Describe Oral Lesion as Art Global and Specific Description • Visual language: sparkling saliva, filmy, bold color that pops, fragile, shimmering • Comparisons: “roll and tumble” of storm clouds or ruffled bed skirt • Surface texture , color • Location, size and shape • Tender to painful • Status of surrounding tissues • Appears serious, dangerous, alarming; evokes fear

Blood-filled bulla from bleeding disorder Assignment: Part of Reflective Essay

Oral Lesion Description Pre- and Post- Course Description • Adapted from Aesthetic Development Interview, openended interview method describing art (Housen A, 2001-02) Relevant Findings (N = 11) • Increase in words: 49 (5-113) – 8 • Decrease in words: -32 (0-77) – 3 • Expression of feeling: Yes – 3; No - 8 • Global description: Yes - 8; No - 3 • More analytical (comparisons) Yes - 9; No - 2

Assignment: Describe the lesions on the tongue. Lymphangioma

Course Summary Course Participants • 6 different classes: F 2011, S/F 2012, S/F 2013, S 2014 • Total: 30-50 students/class (75 dental; 125 medical) • Dental: 1.8:1 :: Females:Males • Most were second-year students (DS, MS) Course Evaluation Summary • All agreed the elective was beneficial to their education • All were made more aware of the way they make observations • All learned a greater appreciation of art • Strong interest in visiting the art museum again

Learning Assessment Pre- and post- tests results • Improved ability to make accurate observations • Important to notice small or subtle details in patients • Confident in sharing ideas and opinions with others • Observations may be more helpful than reading a label or chart • Important to notice the environment, space or context of an object or individual • Opinions and attitudes regarding ambiguity and questioning their own ideas did not shift after the class (positive finding).

Reflective Essay Art of Observation Reflective Essay • Describe 3 pieces of art • Conversations with others • Emotional or ethical response • Appreciation, tolerance for conflicting interpretations • Correlation with patient care • Interprofessional learning Assessment • Essays were acceptable or Hans Hofmann, Fiat Lux, 1963, oil on canvas, The Museum of Fine Arts, Houston, Museum purchase outstanding, using a rubric. funded by Mrs. William Stamps Farish, Sr., by exchange, 2014 Renate, Hans and Maria Hofmann Trust / • 97.5% completed by due date. 81.30. © Artists Rights Society (ARS), New York

Dental Student Focus Group Summary Overall Impression of the Elective • Enjoyed beautiful off-campus setting • Class was nontraditional: no PowerPoint presentations, no tests, and not science • Expanded vocabulary in both art and medicine • Enjoyed being taught by an art expert • Enjoyed “learning for the sake of learning”

Gallery view, John A. and Audrey Jones Beck Collection, Audrey Jones Beck Building. © The Museum of Fine Arts, Houston

Focus Group Questions What about taking this course with medical students? • “It helped me understand their personalities better, and their culture – so intense and competitive.” • “It is helpful to be around them because we will have to work with them in the future.” In what ways will this course help you as a clinician? • Enjoyed thinking and observing beyond teeth • Time to look at “the whole person” • Liked the experiential format with peer feedback • Teaches the value of reassessment - not leaping to conclusions

Medical students studying art at MFAH Anthropomorphic Harp, Mangbetu (Democratic Republic of Congo, Africa), early 20th century, wood, hide, sinew, and string, The Museum of Fine Arts, Houston, Museum purchase funded by Frank Carroll, in memory of his parents, Frank and Eleanor Carroll, 2008.229.

Lessons Learned: 1. Visual images and emotions are powerful tools. 2. Clinical observation is enhanced with the integration of the arts. 3. Discussing art increases sensitivity, team building and collaboration. Special acknowledgement to Dean Valenza for the educational funds. Exterior, Audrey Jones Beck Building. © The Museum of Fine Arts, Houston

“I LOVE doing the type of analysis that we're doing … because it makes me realize how narrow-minded I am and how much I need to remove my blinders. I think we all get caught up in thinking that we have a certain level of depth with our reasoning, but obviously there's something missing.” T.D.A. Vincent van Gogh, The Rocks, 1888, oil on canvas, The Museum of Fine Arts, Houston, Gift of Audrey Jones Beck, 74.139.

Edward Robert Hughes, A First Visit to the Dentist, 1866, oil on canvas, private collection. Retrieved from http://directionsindentistry.net/dentistry -art-edward-hughes-first-visit-dentist/.

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