The impact of an arts-based programme on the affective and cognitive components of empathic development Joyce Zazulak, 1 Camilla Halgren, 2 Megan Tan, 2 Lawrence E M Grierson 1,2,3 1 Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada 2 Michael G DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada 3 Program for Educational Research and Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada Correspondence to Dr Lawrence Grierson, Department of Family Medicine, McMaster University, McMaster Innovation Park, 175 Longwood Rd. S., Suite 201A, Hamilton, Ontario, Canada L8P 0A1; lawrencegrierson@gmail.com Accepted 5 January 2015 Published Online First 5 February 2015 To cite: Zazulak J, Halgren C, Tan M, et al. Med Humanit 2015;41: 69–74. ABSTRACT Medical education research demonstrates that empathic behaviour is amenable to positive change when targeted through educational programmes. This study evaluates the impact of an arts-based intervention designed to nurture learner empathy through the provision of facilitated visual literacy activities. Health Sciences students (N=19) were assigned to two learning groups: a group that participated in a visual literacy programme at the McMaster Museum of Art and a control group that participated in the normal Health Sciences curriculum. All participants completed an inter-reactivity index, which measures empathy on affective and cognitive levels, prior to and following the programme. Those individuals assigned to the visual literacy programme also completed open-ended questions concerning the programme’s impact on their empathic development. The index scores were subjected to independent within-group, between-test analyses. There was no significant impact of the programme on the participants’ overall empathic response. However, sub- component analyses revealed that the programme had a significant positive effect on cognitive aspects of empathy. This finding was substantiated by the narrative reports. The study concludes that the affective focus of humanities-based education needs to be enhanced and recommends that learners are educated on the different components that comprise the overall empathic response. INTRODUCTION Empathy refers to one’s ability to experience vicari- ously the feelings, thoughts, viewpoints and values of another. It is a complex construct underpinned by the interaction of cognition and affect. The cog- nitive aspect of empathy reflects one’s ability to identify and understand the experience of others via his/her intellect. This is sometimes referred to as ‘perspective-taking’, and may be open and responsive to nurturing. The affective aspect refers to the passive response of an individual to the emo- tions of another person and, as such, are often con- sidered a personal trait, which may be less amenable to teaching and learning. 12 In the case of the physician, empathy is a critical determinant of the overall quality of care that she/he provides to her/his patients. The physician who is able to understand the perspective of another is afforded an enriched framework for understanding a patient, which can contribute to accurate deci- sions, 3 reduce patient anxiety 4 and encourage adherence. 5 Yet, a number of recent research studies have shown that medical trainees’ empathy declines during training, 2 6–10 reaching its lowest levels during residency. 189 It is hypothesised that this decline is a result of cynicism that develops due to a hidden focus on detachment and clinical neutrality during medical education. 7 Accordingly, the medical education community has responded by introducing a number of educa- tional interventions designed to offset this discour- aging trend and foster the development of empathic ability. 79 There are communication skills workshops, which use lecture, video and audio recordings to highlight the behavioural manifesta- tions of empathy 7 ; experiential learning activities in which students assume the role of the patient in simulated clinical scenarios 7 ; narrative interven- tions, which use literary and theatrical media to immerse trainees within the contexts of illness and care 11 12 ; and new approaches that engage students in the facilitated observation of art. 13–17 In each case, the implication is that the learning experience modifies the way learners process cognitive and/or affective information in a way that fosters the development of empathy. Art appreciation techniques, which include guided observation and facilitated discussion, were first introduced to the medical education commu- nity by Dolev et al 18 in a training programme designed to teach students how to reason physi- ology and pathophysiology from careful observa- tion—an attribute they referred to as visual literacy . In Dolev’s programme, and in several similar pro- grammes, 15 17 19 student participants visit the museum, observe paintings and discuss their per- ceptions in a facilitated group session. This educa- tional approach is based on the results of qualitative, stream-of-consciousness interview research that describes how individuals’ observa- tional ability changes with experience along a con- tinuum ranging from simple observer to re-creative reflector. 20 The basic idea is that exposure to art appreciation techniques equips learners with visual literacy strategies that increase the attention that is paid to the details that constitute an image, which in turn improves the quality of the perceptions that are formed through observation. In this regard, visual literacy exercises purport to have a positive impact on learners’ cognitive processing. Thus, in the context of patient interactions, this improved cognitive ability to recognise and process visual details may also ultimately improve a learner’s ability to empathise. 16 17 Along with colleagues from the Department of Family Medicine and throughout the Michael G DeGroote School of Medicine at McMaster Zazulak J, et al. Med Humanit 2015;41:69–74. doi:10.1136/medhum-2014-010584 69 Original article on May 26, 2020 by guest. Protected by copyright. http://mh.bmj.com/ Med Humanities: first published as 10.1136/medhum-2014-010584 on 5 February 2015. Downloaded from