Original Article

Exploring Bias in Health Care: Using Art to Facilitate a Narrative Medicine Approach among Third-Year Medical Students

Authors: Erij Elkamel, MS, Daniela Guerra, BS, Marquita Samuels, MBA, Sarah E. Stumbar, MD, MPH

Abstract

Objectives: Teaching medical students about biases in health care poses challenges due to the complexity of modifying preexisting beliefs and the possibility of triggering strong emotional reactions. Narrative medicine fosters reflection and discussion among healthcare providers, and visual thinking strategies (VTS) enable providers to improve diagnostic ability through close and methodical examination of art. This study investigated the effectiveness of a session integrating narrative medicine and VTS to enhance third-year medical students’ understanding of bias in health care.

Methods: A 90-minute “Narrative Medicine Rounds”session was implemented in the Family Medicine clerkship for all third-year medical students in the Florida International University Herbert Wertheim College of Medicine class of 2024. The session included a faculty-facilitated discussion of Robert Colescott’s painting Emergency Room, an overview of narrative medicine principles, and a sharing of student narratives related to bias experienced in the healthcare setting. After the session, students wrote and submitted their narrative essays. Students also completed an anonymous, optional, computer-based evaluation with Likert-type and free-response questions. Likert questions were analyzed using descriptive statistics. For the short-answer questions, teams of two researchers (D.G. and S.E.S., E.E. and M.S.) analyzed responses for themes and subthemes, met to reach consensus on a codebook through discussion, and recoded data as needed until frequencies of themes were mutually determined.

Results: Of 101 students, 87 (86%) provided responses to the Likert questions. Seventy percent of respondents agreed that Robert Colescott’s Emergency Room was a useful tool for discussing bias in medicine, whereas 25% were neutral. Fifty-one percent of respondents agreed that the session enhanced their understanding of bias in patient care, with 33% being neutral. Forty-seven percent of respondents agreed that the session made them more familiar with narrative medicine as a tool that they can use in patient care, with 28% being neutral. Students identified five themes for recognizing bias: empathy (16%), self-reflection (60%), active listening (17%), communication (13%), and education (7%). Whenaddressing bias, students outlined five strategies: drawing from personal experiences (1%), self-reflection (64%), communication (29%), education (15%), and advocacy (26%).

Conclusions: Combining narrative medicine and VTS in a single session offers a promising approach for discussing bias in healthcare education. Through reflective experiences and art interpretation, students demonstrated an awareness of often interconnected strategies to identify and mitigate bias while caring for patients. Future next steps for this study involve exploring longitudinal impacts and integrating narrative medicine strategies throughout the medical school curriculum.

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