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Can Learning to Draw Make Duke Medical Students Better Doctors?

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A scalpel on skin is a rite of medical school. But this fall, medical students at Duke University's School of Medicine have the option to press pencil to paper.

That's not to say the hands-on cadaver dissections are being phased out. Instead, dead bodies enjoy new life as art subjects in the anatomical sketches of medical students.

The act of drawing demands focus. Artists must harness notions of light and shadow, proportion and texture, and translate them to a blank page. For individuals studying to be medical doctors, anatomical drawing fosters new observational skills. These "new" perspectives actually harken back to how anatomical studies were made before modern times.

"This is how people learned the human body centuries ago—they drew it," says student Winston Liu.

Liu, starting his third year of medical school at Duke this fall, cocreated the noncredit elective with Emma Fixsen last year. Fixsen, also starting her third year at Duke, earned her undergraduate degree in art from UNC-Chapel Hill. While interviewing at medical schools, she saw that New York University offered an anatomy-drawing class, and the concept stayed with her.

Fixsen and Liu worked together at a music therapy program and began talking about creating a class that combined art and medicine.

Liu, who laughs when describing his last art training as "finger painting in elementary school," served as a sounding board for the class details. Considering that most doctors-to-be at Duke lack the art education Fixsen has, and most likely come from a background on par with Liu's, the two balanced each other in the class's development.

They contacted the Trent Center's medical humanities director, Ray Barfield, and associate director Nikki Vangsnes with their concept. Duke's Trent Center for Bioethics, Humanities, and History of Medicine is based on the concept that the practice of medicine involves a multidisciplinary approach outside of science. The center helped connect the students with funding for the pilot program. Unlike other classes that meet weekly, the drawing class is limited to a handful of sessions.

"The hardest thing was deciding what to include with only four sessions," Liu says.

Each time the students met, they focused on organs, bones, or other parts.

Both Fixsen and Liu describe the initial anatomy experience with cadavers as "dehumanizing," for lack of a warmer term.

"Courses such as this one aim to rehumanize the vocation," says Barfield, adding, "This is part of an overall effort to use medical humanities to help medical students relearn how to see patients."

Drawing the body provides time to pause and reflect on who the person was.

"In clinical care, there is a big emphasis on talking about patient stories," Liu says. Since the cadavers can't discuss their stories, their bodies are left to do so.

Introducing art to those who lack experience in it is not formulaic.

"Instead of something starting from medicine, this is more of an independent exploration," says Ippy Patterson, a Hillsborough-based artist and graduate of the Rhode Island School of Design. Patterson led the inaugural drawing sessions last year. She credits her class approach to Betty Edwards's book Drawing on the Right Side of the Brain. The book covers how the brain builds new—and revises old—neuronal maps to strengthen skills.

Before each session, Patterson and the students met at a campus conference room in a separate building from the lab for conversation and dinner. After talking about drawing methods and challenges, it was time to fill the blank pages, and they went to the anatomy lab together. Students gathered and worked on drawing boards propped on stools, or their laps, while an organ was placed on a tray in front of them.

Patterson had never been in an anatomy lab before. "I couldn't help but see [the cadavers] as people who are missed," she says. She included several timed drawing exercises to help increase focus.

Time for reflection and observation is vital for this type of introduction to anatomical drawing. Emma Skurnick, a Chatham County artist who will teach the anatomy drawing elective this fall, stresses slowing down whenever she's giving creative guidance. Skurnick's bachelor of fine arts is in sculpture, but she was fascinated by medical illustration and later earned a certificate in science illustration.

The timing of when to introduce art to medical students is also key. The study of anatomy is naturally held during the first year of medical school, so the class is only open to first-year students. "Medical students in this part of training are in a good place to spend an hour observing the curve of a bone. They'll know that structure better than anyone who studied it in a textbook," says Skurnick.

Enrollment for this fall's class begins in late September, and the program expands this year with five more seats for students from the Duke Divinity School. The program could grow annually, as well.

"Over time, we will look for outside funding sources to make the program more sustainable," Fixsen says.

Would many time-strapped medical students voluntarily sign up for a noncredit course?

According to Liu, fifteen spots were available and approximately fifty students—out of more than a hundred medical school students—requested a seat last year. Students frequently made their way to the anatomy lab outside of class, during whatever "free time" medical students have.

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