Faculty Bibliography

PURPOSE:Medical student burnout is becoming increasingly common. The Art of Seeing is a visual arts elective at one US medical school. The purpose of this study was to determine the effect of this course on attributes that are foundational to wellbeing: mindfulness, self-awareness, and stress. METHODS:A total of 40 students participated in this study from 2019 through 2021. Fifteen students participated in the pre-pandemic, in-person course, and 25 students participated in the post-pandemic, virtual course. Pre and post-tests included open-ended responses to works of art, which were coded for themes, and standardized scales: mindful attention awareness scale (MAAS), situational self-awareness scale (SSAS), and perceived stress questionnaire (PSQ). RESULTS: = 0.046). Improvements in the MAAS and the SSAS did not depend on class format. Students also demonstrated increased focus on the present moment, emotional awareness, and creative expression in the post test free responses. CONCLUSIONS:This course significantly improved mindfulness, self-awareness, and stress levels in medical students, and can be used to help enhance wellbeing and mitigate burnout in this population, both in-person and virtually.

In comparison to other art forms, dance remains underrepresented in the medical humanities, especially within the academic medical setting. Several factors, including perceived lack of applicability to patient care, contribute to this pattern. This paper contends that, to the contrary, learners across the medical education spectrum stand to gain much from engaging with the movement arts, including improvement of clinically-relevant skills such as physical self-awareness, observation, communication, and mindfulness. This paper makes the case for the nascent subdiscipline of Movement and Medicine, developed by the authors and piloted for inclusion in medical humanities curricula within a medical education context. Movement and Medicine employs a dance-inspired pedagogy to a) promote awareness of personal movement and embodiment tendencies and b) harness that awareness to gain more profound, sensory insight into the embodied experiences of others-experiences of health, illness, or otherwise. This work outlines the research, rationale, and philosophy behind Movement and Medicine; concretely defines the subdiscipline and situates it within the medical humanities landscape; proposes practical approaches to engaging with and applying this material; and describes a Movement and Medicine course developed for one American medical school.

Background: To bolster medical student wellbeing and combat burnout, the NYU School of Medicine (NYUSOM) implemented a longitudinal resiliency curriculum coupled with a wellbeing self-assessment tool. We qualitatively studied the impact of this curriculum on knowledge, self-awareness, and behaviors related to wellbeing and resiliency.
Method(s): The MD AWARE curriculum was launched in August 2017 for the NYUSOM class of 2020. Six sessions were implemented at critical junctions of their training. Each session includes a short lecture, followed by a small group activity led by trained facilitators. At the start of each session, students complete an anonymous online self-assessment adapted from three validated assessment tools measuring different aspects of wellbeing and burnout. Students immediately receive scores with explanations and benchmarks of each and then debrief in their small group. After each MD AWARE session, students completed a retrospective pre/post evaluation survey. Focus Groups (FG) were held in December 2017 (after Sessions 1& 2) to gain richer insight into the impact of the curriculum and self-assessment tool. A purposeful sampling strategy with maximal variation was employed to recruit participants; 10 students participated in each FG. Qualitative data was gathered through the surveys and the FG. The FG were recorded and transcribed. Each FG had 2 project staff members and post-session debriefing. Member-checking was also used. Responses were subsequently coded and analyzed by two experienced faculty members (a third colleague assisted in theme triangulation). An iterative data analysis strategy was applied. Throughout the analysis, an audit trail, frequent memo writing and a reflexivity journal was maintained.
Result(s): Themes: Community Building: Connecting with another student it was helpful for my wellbeing Skill and Knowledge Acquisition and Application: The main sort of takeaway is you need to be aware of (Burnout) and if you need help there are resources Importance of Faculty Development: I think that a prep session between those who designed the curriculum and those who facilitate the small-groups could go a long way towards creating the environment I imagine was originally intended Value of Refection: The score didn't add much It was more about the act of answering the questions than the number that came out of it NYU Administration Values Medical Student Wellbeing: Just the fact that NYU has this program and is making it part of orientation already speaks volumes about its priorities: that we matter
Conclusion(s): Thematic analysis of the impact of MD AWARE indicated that it provides concrete information on resources available to the students. Additionally, the students value both protected time with their peers and for self-refection. Lastly, although care must to be taken in selecting faculty to facilitate the small groups, the mere existence of the longitudinal curriculum signaled that the NYUSOM administration values medical student wellbeing

Learning Objective #1: Recognize the therapeutic benefit of creative self-expression in the treatment of addiction CASE: Ms. D is a 37-year-old woman with history of opioid use disorder (using intravenous heroin), who presented to our hospital with severe neck pain. She was diagnosed with C-spine osteomyelitis and initiated on IV antibiotic therapy. Her course was complicated by cardiac arrest from heroin overdose (provided by a personal visitor). During her hospitaliza-tion, she was initiated on buprenorphine and met regularly with an art therapist. She created drawings and small sculptures that depicted her years-long struggle with heroin use, as well as emotional traumas that contributed to her use. Prior to discharge, she shared her artwork with her medical team, eloquently articulating how creating art helped her process her trauma and make a commitment to recovery. IMPACT/DISCUSSION: Addictions are an increasingly pressing national health concern. Many elements of Ms. D's case-her early childhood trauma, her life-threatening medical complications-will likely be familiar to internists who care for patients with substance use disorders. This presentation will focus on a promising and understudied aspect of addiction treatment: creative self-expression. Creative self-expression can be joyful, relaxing, and distracting from other difficulties. It also empowers patients to create their own narratives of self, recognizes patients' subjective experiences, and provides means of communicating difficult experiences with the clinical team and others. There is a strong theoretical foundation for the use of self-expression as a means for improved wellbeing in the medical setting and in trauma recovery (1,2). Current empirical data are encouraging but limited by small sample size, lack of objective metrics, and heterogeneity of art therapy modalities (3,4). This presentation will introduce conference participants to the robust theoretical basis of creative self-expression in healing and recovery. This theoretical basis will then be applied to a discussion of Ms. D's case. The presentation will include photographs of Ms. D's artwork, for which she has provided her consent. 1. Frank AW. Just Listening: Narrative and Deep Illness. Fam Syst Heal. 1998; 16(3): 197-212. 2. Larkin M and Griffiths M. Experiences of Addiction and Recovery: the Case for Subjective Accounts. Addiction Research & Theory. 2009; 10: 281-311. 3. Uttley L et al. The clinical and cost effectiveness of group art therapy for people with non-psychotic mental health disorders: a systematic review and cost-effectiveness analysis. BMC Psychiatry. 2015; 15: 151. 4. Schouten KA et al. The Effectiveness of Art Therapy in the Treatment of Traumatized Adults: A Systematic Review on Art Therapy and Trauma. Trauma Violence Abuse. 2015; 16(2): 220-228.
Conclusion(s): This case demonstrates the therapeutic potential of creative self-expression as part of a multi-modal treatment strategy for addiction

On Tuesday evenings at New York University School of Medicine (NYUSoM), the anatomy lab is transformed into an art studio. Medical students gather with a spirit of creative enterprise and a unique goal: to turn anatomy into art. They are participants in Art & Anatomy, an innovative drawing course within the Master Scholars Program in Humanistic Medicine (MSPHM)-a component of NYUSoM, which offers elective courses across a range of interdisciplinary topics in medical humanities. Art & Anatomy has had approximately four hundred fifty participants since its inception in 2009. The educational intention of the course is to use drawing as an active mode of learning that enhances visual-perceptual ability and three-dimensional (3D) spatial understanding of the body's interior; however, the course also opens a creative space for participants to process the emotional complexities of cadaver dissection and the anatomy lab experience. The anatomy lab can be the training ground for clinical detachment, but many U.S. medical schools are beginning to attend more closely to the emotional aspects of dissection. The authors maintain that the inherently expressive nature of drawing makes the Art & Anatomy course a novel and effective approach to this endeavor. Select student artwork and a curriculum overview are provided.

Background: In an effort to bolster medical student wellbeing and mitigate burnout, NYU School of Medicine (NYUSOM) launched a longitudinal resiliency curriculum, coupled with a wellbeing self-assessment tool. We aim to study its impact on the development of knowledge, self-awareness, and practices related to wellbeing and resiliency. Methods: MD AWARE (Medical Students Developing Awareness, Wellbeing, and Resilience) was launched in August 2017 for the incoming NYUSOM class. It involves six interactive sessions implemented at critical junctions over the first three years of medical school. Each session includes a short lecture, followed by a small group activity led by trained facilitators. At the start of each small group session, students are asked to complete an anonymous online survey (results only provided to student). The self-assessment includes 19 items adapted from three validated assessment tools measuring different aspects of wellbeing and burnout. Students immediately receive three scores with explanations of each and the opportunity to debrief in their small group. Thus far, the students have participated in the first two sessions. In the first, students were introduced to research on physician burnout, the protective effects of resilience, and practiced a gratitude exercise. In the second, students were introduced to mindful awareness to identifying cognitive distortions and practiced reframing negative inner dialogue. After each, students completed a retrospective pre/post survey, using a 4-point likert scale, assessing knowledge, self-awareness, and comfort/confidence in activities to promote wellbeing. Comparison between the survey results were calculated using pair t-test. Results: Survey results were available for 106/118 (90%) students participating in the first session and 55/114 (48%) participating in the second. Results of both pre/post surveys showed significant improvement (p=<.01) on every item. Notably, after the first session, students reported a substantial increase in their comfort acknowledging stressors (31.1% very comfortable pre-vs 61.1% post-) and seeking help when in need (18.1% very comfortable pre-vs 45.2% post-). After the second session, students reported increased comfort practicing mindful awareness (65.5% comfortable/very comfortable pre-vs 90.9% post-), increased confidence both identifying cognitive distortions (59.2% comfortable/very comfortable pre-vs 96.3% post-) and reframing negative responses (47.2% comfortable/very comfortable pre-vs 81.8% post-). Conclusions: While many schools have looked at ways to foster wellbeing in their medical students, our curriculum is unique in its longitudinal nature and use of repeated wellbeing self-assessments. Preliminary assessment demonstrates a positive impact on medical students' knowledge, self-awareness, and practices around wellbeing and resilience. Thus, our novel curriculum is a promising way to bolster resiliency skills and mitigate burnout in this vulnerable population