A pilot cluster randomized, controlled trial of a clerkship-based visual arts curriculum to combat bias and promote well-being

Needs and Objectives: Retrospective analyses have shown associations between arts exposure and protective personality traits (e.g., empathy, tolerance of ambiguity), suggesting that facilitating arts exposure may help learners gain these traits. Unfortunately, most visual arts‐based curricular interventions lack rigorous assessment and are rarely performed in the clinical setting. We conducted a pilot randomized, controlled trial to assess impacts of incorporating a visual arts curriculum into a clinical clerkship. Setting and Participants: Study participants were University of Michigan (UM) medical students on VA Ann Arbor Healthcare System (VA) inpatient internal medicine teams. Museum arts (MA) interventions occurred at the UM Museum of Art whereas hospital arts (HA) interventions and case‐based conferences (CBC) were at the VA. Description: After participants provided written informed consent and completed a baseline survey, we randomized teams to three weekly one‐hour sessions: MA (n = 14), HA (n = 14), or CBC (n = 15). Developed by an expert arts educator, MA and HA used active, guided discussion of artwork to explore themes of compassion, suffering, and ambiguity. The HA curriculum was identical to MA except for the use of digital representations of artwork and facilitation by non‐experts. CBC served as contact time and environmental control arm. Evaluation: Psychometric surveys were repeated after curriculum completion, using validated scales of empathy, mindfulness, tolerance of ambiguity, and grit. We also compared NBME shelf exam performance. No statistically significant Results were identified within quantitative outcome measures, including shelf exam performance between the arms. Focus groups with formal qualitative analysis, however, suggested that the arts curriculum provided a fulfilling escape from clinical medicine, increased cognizance of implicit bias, and promoted differentiation between observation and interpretation. Discussion/Reflection/Lessons Learned: In our pilot study, students were willing to participate in art‐based interventions while on clinical duties. No statistically significant quantitative Results emerged, but absence of difference in NBME shelf exam scores was reassuring. Focus group discussions identified benefits of the arts intervention not otherwise captured by quantitative measures. Despite being shelf exam neutral, students felt stress while away from clinical duties. Study strengths include randomization of an unbiased study sample and use of outcome measures relevant to curricular stakeholders. Inclusion of the HA group also supports the feasibility of implementing arts interventions at other centers.