February 2018 | Issue 34

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Bringing art into medicine

Editor mug shot.jpgBy Nicole Lim, Senior Assistant Director, Communications & External Relations


The medical students gathered for their timetabled activity in the auditorium. The lights dim. On the large screens, a bespectacled face appears, stark against the soft focus of a room. "You have cancer," the face declares.

It was a Friday morning medical humanities lesson and the movie was Wit. Originally a Broadway play, it charts the medical journey of a highly accomplished, but socially aloof professor of English literature. After being diagnosed with advanced ovarian cancer, we see her identity slowly whittled away by the disease and treatment, and her increasingly desperate search for a human touch from her care team. The film ends, as it must, in her death.

Examining medicine and its impact on society through different forms of art is often an optional and even neglected part of medical curricula. But without medical humanities, proponents argue, doctors cannot truly become patient-centred in their care.

"Suffering cannot be understood [merely] by chemical analysis or a bar chart," said LKCMedicine Lead for Medical Humanities Assistant Professor Michael Stanley-Baker. "It is experienced and lived, and you need to engage with it in a much more complex and human way than is addressable through clinical science alone."

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Created by Lucy Davis, Together Again is an ongoing inquiry into material, genetic, historic and poetic stories of wood from Southeast Asia

In essence, medical humanities, which are a compulsory part of the LKCMedicine timetable for Years 1 and 2, are about how "you feel, they are about subjective experience, and how that is structured through social, institutional, technical, political forces, that are just as present in medicine as elsewhere in society", he added.


Embracing the shades of grey through the looking glass

Being open to and comfortable with seeing things from different perspectives is a hallmark of a good physician. Accepting the shades of grey and inherent uncertainties of medical practice is a skill, one that medical students, who come from a science-focused background, need to hone over the course of their studies.

"While we think we're dealing with diseases, we're treating the people who are carrying the diseases and each person is a human being with his own history, experiences, aspirations and emotions," said Assistant Dean for Integrated Care Associate Professor Chin Jing Jih, who co-leads the Professionalism, Ethics, Leadership, Law and Patient Safety course at LKCMedicine.

While the humanities encourage medical students to see encounters from different perspectives, they also teach them observational skills. When performing a physical examination, for example of a patient's respiratory or cardiovascular system, students are taught to start by standing at the foot of the bed and observing the patient. They are taught to observe how the patient looks and lies in bed, and also what's around them; can they see family photos, a walking stick, or any other clues that will give them more information about this patient.

"Viewing art develops those kind of observational skills," said Dr Tanya Tierney, Assistant Dean for Clinical Communication Training & Student Welfare, who has been closely involved in the teaching of medical humanities lessons.

​And evidence backs this up. Observational skills learned through medical education have been honed by a supplement of arts-based observation interventions in many medical schools, Caroline Wellberry and Rebecca McAteer noted in their work.​
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​This stack of books is one of four sculptures by Cultural Medallion Winner and Master Sculptor Han Sai Por​ made from felled trees that had to make way for campus​ development
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​Creating an inspiring campus experience

LKCMedicine backs up its mission to train patient-centred physicians by deliberately creating physical spaces around both campuses, which encourage students, staff, faculty and passers-by to take a moment out of their hectic lives to reflect on a thought provoking piece of art or beautiful landscaping.

"By providing a beautiful environment and sufficient space to rest, reflect and refresh, I hope we can add to their well-being and enhance their performance," said Mrs Kwee Wai Phin, LKCMedicine Governing Board and Campus Development & Infrastructure Committee member, who, together with her husband, has been closely involved in the development of the School's campuses. In particular, she trains her keen eye on the aesthetics around the campus.

Artworks for the medical school are carefully selected. Criteria for selection include the artwork's ability to provoke interesting conversations, debate, reflections on history and artistic concepts. For example, the stainless steel sculpture by Turner Prize-winning sculptor Tony Cragg that stands tall at the entrance lobby of the Clinical Sciences Building (CSB) showcases the evolving relationship between the stainless steel, ambient light and the reflection of its surroundings in the CSB's mirrored ceiling.

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   Untitled, which is part of the 'Points of View' series by Turner Prize-winning sculptor Tony Cragg, stands tall at
the CSB driveway​

"My husband and I hope that this installation will draw students, faculty, clinicians, scientists and all visitors to congregate in the space to exchange ideas, learn and listen to each other's point of view to enrich your life and be the beginning of a journey into the world of art and creativity," said Mrs Kwee, whose husband generously loaned the three-metre-tall sculpture to the School.

Seemingly in a constant dialogue with the viewer, the sculpture questions every movement, yet resists definition. Amidst the ever-changing landscape of medical education and practice, the dynamics of LKCMedicine are challenged by changing patient care and demographics, driving innovation and the exploration of new points of view.

Overall, the School's dual campus is home to 30 publicly displayed artworks, the majority of which come from the NTU Museum's collection. Among the artworks from the Museum is Cultural Medallion Award for Visual Arts 2012 winner Milenko Prvacki's painting Group Portrait with Table. At first glance, it is a picture of a table, but upon closer observation viewers see that to the artist the table where people gather to make important decision and share important family moments.

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Milenko Prvacki's Group Portrait with Table encourages viewers to see everyday items in a new light

Arguably, art encourages acceptance of different perspectives and priorities that each patient encounter brings with it. "Art is a human expression and gives us another perspective of what others are thinking, broadening our horizons. This gives us a greater awareness of ourselves and others, and helps us understand and reconcile differences," said Ms Faith Teh, NTU Museum Deputy Director. And this, in turn, helps physicians to be more empathetic, and higher levels of empathy have been shown to result in better clinical outcomes.

To add to these uncertainties, the concept of science as a culture. This is the expression, expectation and experience of science by different communities. In culturally diverse Singapore, this is especially evident. Asst Prof Stanley-Baker recounts the memory of one Singaporean of Malay descent, a-self identified Peranakan, describing her Hokkien grandmother when she was given a series of treatment options in the face of a terminal illness. "Her grandmother said, 'Why don't I just go to China.' The doctor thought she'd meant a holiday, not realising that is a colloquial expression of resignation, that she would die, thereby returning to her ancestors who'd come from China."


Not just looking but seeing art

That's why the School looks out in particular for artwork that can offer its future doctors a broader outlook on the complex and diverse society that we live in. Balancing the focus on disease of the scientific curriculum, "we hope that being surrounded by beauty brings life and hope, and gives them the balance required to maintain their feelings of empathy towards those they are tasked to take care of" said Mrs Kwee.

This kind of reflection is something the students practise actively during their Medical Humanities sessions too. For example, the first lesson in Year 1 is tied closely to the concurrent teaching block focusing on cardiovascular system, so students are asked to reflect on the heart.

"In anatomy, it is a pump. In physiology, it supplies oxygen. But how is the heart perceived? What does it symbolise?" said Dr Tierney.

Improved observational skills and self-reflection can also help to protect students from the stresses of the medical world. Such self-care has the potential not only to minimise burnout, compassion fatigue and moral distress, but to promote well-being and increase resilience in the face of challenges, reported a team of US researchers who looked at clinicians caring for seriously ill cancer patients.

But the art on campus is not just selected for its ability to stimulate thought and reflection. Many projects are the result of collaboration between the wider campus community. "The museum makes a conscious effort to give an opportunity to the rest of the campus community to be part of the creation of art, such as through projects like Apollo's Dream," said Ms Teh.

IF 11 (Custom) 2.JPG IF 10 (Custom).JPGLeading ceramicists Suriani Suratman and Hiroko Mita worked with LKCMedicine's inaugural cohort to create Apollo's Dream, conveying the young doctors-in-training's aspirations for the future 

Trees Upcycled and Bloom at LKCMedicine as well as artworks displayed at Media Art Nexus, Fern and Dandelion on NTU's main campus are key examples of collaborative artworks involving the wider student and faculty community. And nurturing creativity in physicians, whether that's through visual arts or narrative forms, is associated with better patient outcomes.


Take a moment, it is worth it

Each artwork offers passers-by an opportunity to step back and reflect, even if just for a moment. For example, the painting of 11 Mandalay Road by Wong Chor Yee displayed at the CSB foyer ​encourages people to enjoy a now lost perspective of the heritage Headquarters Building. LKCMedicine Class of 2021 student Aaron Goh said, "This piece is a reminder of the rich history that LKCMedicine has inherited, and beckons us to create the future of healthcare."

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    On display at the CSB foyer, 11 Mandalay Road shows the viewers a lost perspective of the heritage Headquarters Building

LKCMedicine Class of 2022 student Cheong Nian Kai's favourite artwork is Celoteh Di Balik Meja (Chattering Behind the Table) by Indonesian artist I Wayan Legianta. "The vast array of colours and hand gestures signify the different viewpoints and backgrounds of every individual in the discussion. This artwork is especially fitting at LKCMedicine, with its team-based learning pedagogy, centred on lively discussions, achieving a fruitful and meaningful learning experience," said Nian Kai, of the painting on display at the Medical Library.

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   In Celoteh Di Balik Meja (Chattering Behind the Table), I Wayan Legianta portrays different viewpoints and backgrounds of individuals participating in a discussion, very much like a lively classroom

​Unlike any other science, medicine is inherently human. The increasingly computerised, compartmentalised and standardised approach to medicine runs the risk of blinding physicians to solutions that creativity and innovation could provide. As Columbia University Medical Centre Associate Professor of Medicine Deepu Gowda said, "Medical practice is about interpreting very complex and nuanced details—the same way you'd interpret a piece of art." 

LKCMedicine art features prominently in NTU Museum’s upcoming art trail

Come the next academic year, visitors to NTU's campuses will be able to navigate around the sprawling main campus and its satellite in Novena, following an art trail. While more than 98 per cent of the Museum's collection is on public display, the trail focuses on 35 of the Museum's biggest gems, including 15 works on display at LKCMedicine's Novena campus. As leader in smart campus development, NTU Museum will incorporate an augmented reality element in the trail as well as a map and special publication to celebrate the Museum's 10th anniversary year.

"We're a campus museum, and 98 per cent of our collection is on public display around campus and this trail launched to mark our 10th anniversary really celebrates this," said Ms Teh.​


SIDE STORY: Bloom

The delicately crafted petals of the honeysu​ckle flowers open gently, suffusing the café with hues of blue. The glow dims as the flowers close. The light fades from bright yellow to peaceful green, subtly changing the ambience with every transition, lulling you into a world of calmness and tranquillity.

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Called Bloom, this digital mural of 3D flowers is located in the Supply & Demand café at the Clinical Sciences Building. It is powered by solar panels and the colours change in response to the temperature outside – blue for a cool day and red for a warm day. "We wanted to use a common language," said Visiting Artist at NTU's School of Art, Design & Media (ADM) Fabrizio Galli, who supervised the production and installation of the art piece. Conceptualised by a group of ADM students, the art piece is modelled after Chinese honeysuckle flowers, which are associated with positivity, happiness and a renewed energy.

An emblem of the relationship between technology and nature, science and art, Bloom is a reminder to exercise our eyes and hearts.

Did you know: You can play with the lights at the click of a button, located at the front counter in Supply & Demand. There are six colours in total!

Additional reporting by Grace Ang​

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