Article In Brief
A small but growing number of neurology residency programs are developing formal or informal neuro-humanities initiatives, offering clinicians a chance to indulge their artistic interests through museum exhibits, book discussions, and more. The goal is to promote a sense of wellness and well-being.
When the department of neurology at the Medical University of South Carolina (MUSC) began to renovate its clinical space early in 2023, it was tasked with finding new art to line the department's hallways. Instead of bringing in a consultant or designer, Jonathan Edwards, MD, chair of neurology there, turned to residents Mattia Rosso, MD, and Charlie Palmer, MD, co-leaders of the department's new initiative in neuro-humanities.
“Dr. Edwards wanted to celebrate the diversity and creativity of our department, and we thought that photography might be one of the best ways to do that,” said Dr. Rosso, a third-year resident. So Dr. Rosso and Dr. Palmer, working with their mentor, Parneet Grewal, MD, assistant professor of neurology and the faculty director of wellness programs for the department, announced a photography competition open to all departmental residents, fellows, staff, and faculty.
The contest garnered more than 50 submissions from more than 15 contestants in five categories: people, landscape and seascape, the city of Charleston, wildlife, and medicine. Two judges—one from a photojournalism background and the other a “magical realist” photographer—judged the competition, and the winners were announced at a departmental gathering.
“When I told people about the competition, they were all extremely happy to have an excuse to take pictures,” Dr. Rosso said. One contestant, internationally known movement disorders specialist and neurology professor Mark Stacy, MD, told Dr. Rosso about a patient who introduced him to photography years ago.
“It gave them the opportunity to go back to their own passions,” Dr. Rosso said. “It seems like many of us have had some kind of interest in the world of the arts, like photography and literature and music, but have had to put that aside for clinical and family duties.”
The photography contest is just one of many events the fledgling neuro-humanities group organized in less than a year. The best attended to date was “A Day at the Museum,” a December 2022 tour of Charleston's Gibbes Museum guided by vascular surgeon Jeb Hallett, MD, who combined his passion for medicine and his love of art to explore art collections through the lens of a physician.
“We took stock of multiple paintings, and each of us would take turns observing and describing something in the painting,” Dr. Palmer said. “We've also had a movie night, viewing the 2012 film ‘Amour’ by Michael Haneke, followed by a discussion on film language and ethics in dementia, and an event with Warda Faridi, who gave a talk on Ian Curtis, the lead singer of Joy Division, who famously had poorly controlled epilepsy and severe depression, and how his disease informed his music.”
Future events will include a talk on the neuropsychology of comic books with Javier Suarez, MD, a PGY-4 resident at Massachusetts General Hospital who recently blogged for Neurology on how the brain processes comics, and an exploration of the neuroscience of coffee through tasting.
MUSC is not alone in its focus on the connection between neurology and the arts and humanities. A small but growing number of neurology residency programs are developing formal or informal neuro-humanities initiatives. Most of these have their events and discussions during the residents' “off hours,” but at least one, The Art of Neurology at the UT Southwestern Medical Center in Dallas, takes advantage of the protected time allotted to residents purely for learning outside their clinical responsibilities.
The Art of Neurology
Alexander Frolov, MD, an assistant professor of neurology and clinician educator who focuses on behavioral and cognitive neurology, noted that many residents shared his interest in neuro-humanities, but no forum existed within the department for exploring that interest.
“Many of us come into neurology with the understanding that, although we can help our patients, we are not necessarily able to cure them to the same extent that might be possible in other specialties,” said chief resident Rumyar Ardakani, MD. “But we are there with our patients through the disease process and go through that journey with them. When we first started down this path of becoming a doctor, we all had this drive to help people, to learn about them and experience joy and suffering with them, but as we get into residency, with how busy things can be, it's easy to forget that. Both for our own wellness and for our ability to be better neurologists, it's important to have a space where we can focus on and discuss the humanistic aspects of what it means to be a neurologist.”
The Art of Neurology, launched in early 2002, is a monthly lecture and discussion series carved out of the residents' protected learning time. “People really enjoy that there is dedicated time reserved for this, where we can disconnect and all be together and give our full attention to these discussions,” Dr. Ardakani said.
One of the most popular programs so far was a lecture on the art of observation, with Bonnie Pittman, distinguished scholar in residence for the Edith O'Donnell Institute of Art History and director of Art-Brain Innovations in the Center for BrainHealth at the University of Texas at Dallas. “She taught us about observation, and then we all went to the Dallas Museum of Art and practiced what we've learned,” Dr. Ardakani said.
Entry into Educational Discussions
Michael Stanley, MD, a behavioral neurology fellow at Brigham and Women's Hospital, has served as an informal adviser to several neuro-humanities programs in neurology residencies. An avid writer who has been published in the Wall Street Journal, National Review, Christian Science Monitor, and other outlets on subjects where neurology and neuroscience intersect with public-interest topics, he also serves as director of outreach and engagement for the Boston Society of Neurology, Neurosurgery, and Psychiatry, for which he recently launched a popular blog that features book reviews, scripts, screenplays, poems, and interviews contributed by clinicians at all levels, from residents to fellows to attendings.
“Fifty years after Awakenings, we've come to realize just how right Oliver Sacks was about exploring neuroscience through narrative neurology. And what Monet did by showing that people read across brush strokes tells us an awful lot about how the brain works. I'll ask medical students, ‘How is it that we come to see this at all? How do we emotionally react to something we know isn't real?’ These are amazing entry points into educational questions,” Dr. Stanley said.
“It seems like many of us have had some kind of interest in the world of the arts, like photography and literature and music, but have had to put that aside for clinical and family duties.”
—DR. MATTIA ROSSO
“The neuro-humanities can be explored as an academic discipline by scholars, practiced as a pedagogical tool for educators, or approached as a therapy for both suffering patients as well as their burned-out doctors.”
The Power of Storytelling
Neuro-humanities programs are also getting a foothold at Weill Cornell Medicine and University of California, San Francisco. At Weill Cornell, fourth-year neurology resident Nara Michaelson, MD, has spearheaded the launch of an initiative that focuses on narrative medicine as a way to promote wellness and encourage discussion among residents about issues they face, such as difficult cases.
“At least once a month, we meet to discuss either a short story or a piece of poetry and use that to promote discussion and reflection on what it means to take care of patients,” Dr. Michaelson said. “It takes place during our ‘morning report’ session, when we usually discuss cases and do neurologic localization, diagnosis and management. We decided that we would devote one Thursday a month to more of a narrative focus, talking about the socioeconomic and psychosocial implications of neurologic conditions.”
One of their first sessions focused on a short story in the form of a letter that the husband of a patient with advanced dementia had written to thank a hairstylist who styled his wife's hair for the last time before she died.
“It appeared all over Twitter, and I remember seeing it and being so touched. There is just so much richness in the letter,” Dr. Michaelson said. “He talks about how it was just another day for the stylist, but it made his wife feel special and gave her a sense of self-worth. As doctors, we are so focused on doing more and more and more, and it's important to reflect on how even the small things we do, everything we do and say, leaves a lasting impact. We had a great discussion about that.”
As part of the resident and fellow section of the Neurology journal, Dr. Michaelson has worked with Galina Gheihman, MD, a fourth-year neurology resident at Mass General Brigham, and Roxanna Nahvi, PhD, a graduating medical student at New York Medical College and incoming neurology resident, to develop a new blog called SIGNposts.
They've called for essay submissions of less than 1,000 words from those involved in local Student Interest Group in Neurology (SIGN) chapters about topics relevant to medical students.
“Stories are very powerful, and inherently they are of great interest,” she says. “We tell stories all day long, but we don't often stop and focus on the psychosocial impact of those stories.”
Listening Parties: A Pandemic Initiative
At the University of California, San Francisco, the department of neurology has hosted various events related to the arts and humanities and medicine, but nothing specifically for residents until this past year. “During the pandemic, we felt very separate from one another and had less opportunity to reflect together, so with the support of faculty and funding from the wellness branch of our residency, this year we have been able to start a neuro-humanities initiative,” says fourth-year child neurology resident Greta Peng, MD.
Three events sponsored by the group so far have included a gathering to read short narrative medicine articles; a “listening party” where residents discussed a radio podcast about physician-assisted suicide in a patient with cognitive impairment; and a discussion of the “Ten Tensions Project,” an online art gallery that is a photographic exhibition of the physician's inner life, developed by a Nina Shevzov-Zebrun, MD, a pediatrics resident at Stanford University. In May, the group will gather to discuss One by One by One: Making a Small Difference Amid a Billion Problems with author Aaron Berkowitz, MD, PhD, FAAN, who recently joined UCSF as a professor of neurology.
Dr. Peng also started a “writing buddies” group with a cadre of 12 residents interested in creative writing. “I've paired people up, and they can meet at their own convenience, online or in person, and exchange writing pieces and get feedback,” she explained. “In June, those residents and other interested people will meet in a creative writing session led by writer and neurologist Dr. Alison Christy.” (Dr. Christy was recently profiled for Neurology Today's “Off the Clock” feature.)
Groups like these are looking to connect with one another through social media and in forums like the AAN's Annual Meeting. “We have been putting our heads together to discuss how our different groups started and what events they've had so far, and it's been so interesting to see the diversity of programming we've had across the groups,” Dr. Palmer said. “We're exploring the idea of shared resources, like a repository of some kind.”
“Neurology training sometimes just feels like you're riding a train and you don't have enough time to reflect fully on the significance of what we do, the care we provide, and the experiences our patients have,” Dr. Peng said. “Neuro-humanities gives us the opportunity to have these kinds of conversations, and I think it makes us better physicians.”