University of Vermont

The College of Arts and Sciences

Unmasking the Art of Medicine

Theatre department challenges med students to look beyond the books

“I love the link between the arts and the sciences,” says theatre professor Sarah Carleton, whose students performed for the College of Medicine’s doctoring skills class, an exercise in observation and interpretation. In this vignette of a blind date, med students noted the backpack used, unconsciously or not, as a barrier between the couple. (Photo Sally McCay)

The science of becoming a doctor: formidable. A month in and first-year students are deep into human structure and function, understanding gross and microscopic anatomy, the embryological development of each organ system, how they work and interrelate. These are the building blocks of becoming a competent physician. But patients are more than their anatomical parts. How do doctors learn to treat the person?

The University of Vermont’s College of Medicine is taking a creative approach to helping students hold on to their humanity in a field that will become increasingly technical and competitive. That’s part of the aim of the doctoring skills course, to teach the art of empathy within an inherently, even theatrically unequal dynamic -- the white-coat power symbol versus the “crispy paper towels,” as medical professor Alan Rubin, M.D., calls the attire patients are often asked to cover themselves with.

One aspect is learning to observe without -- a challenge -- interpreting, at least at first. This year, inspired by a performance at the Fleming Museum in which student actors wore elaborate commedia dell'arte masks, Rubin initiated a collaboration with Sarah Carleton, associate professor of theatre, to have students perform a series of three skits for the doctoring skills class he co-teaches, asking them after each, “What did you notice? What did you see? What did you hear?”

The scenes were consciously nonmedical, circumstances new med students might easily relate to -- coming home for Thanksgiving the first year of college and interacting with a grandmother, a blind date, a man at an airport bar. “We wanted them to use their own vision and their own language in describing what they saw,” explains Rubin.

After each skit students broke into small groups to talk, then opened a class discussion. They mentioned body language, when the characters looked away, avoiding. The man in the bar, someone noted, was old, at which Rubin shot back, “you’re interpreting.” The man had white hair, wrinkles, walked with a cane. Observations.

Patient language 

That focus on observation was key according to student Andrew Jones. “It took people out of this zone that we often get in that’s focused on medicine and forced them to think about people and interpersonal interaction, humanizing that relationship,” he says. “As medical students we’re inclined to think about getting right answers. If the situation had been (to make) a diagnosis, I guarantee that most of my peers would have been thinking, ‘What’s wrong with this guy? How do we fix him? Look at the way he’s sitting, maybe he has back pain.’ Instead we were forced to look at this person, listen to this person and ask, ‘What are they feeling? What are they thinking?’” 

The reaction Jones heard outside of class backs that up. He says students enjoyed hearing other people’s observations and interpretations and how they differed from their own. The meaning behind the sound of a sigh or the tilt of a head is not a textbook case. One person, says Jones, felt uncomfortable during the grandmother-granddaughter interaction. Others did not.

The fact that tension was sensed there at all, fairly universal in the class discussions, surprised Carleton because she hadn’t intended that to be part of their relationship. That, she says, is the thing about the mask. “When you hide in a mask, it exposes other aspects of the (actor’s) psyche. It’s the natural power of the mask, and the audience can’t help but respond,” says Carleton.

“I think the masks encouraged people to look at nonverbal communications, to look at body language,” Jones says. “What the mask signified to me was that the face was unimportant in what we were doing. We’re going to look at the rest of their body, we’re going to use those other skills.”

In its holistic medical training program, UVM also requires students to take "Professionalism, Communication and Reflection" (PCR) throughout the first year. As Jones describes the difference between doctoring skills and PCR, the latter helps developing doctors to look inward and process the feelings that come up during difficult parts of the training, as well as to help consider and organize career goals. “I think the doctoring skills class is focused outward -- how are you perceived by other people? How do you want to be perceived by other people?

“You can approach it in a way that says I’m the physician and you’re the patient, and I have answers and you have problems -- or you can approach it in a way that says we’re having a conversation and we’re going to teach each other things….

“The skills (from doing these observations) are essential to good doctoring...especially in a situation where you’re invested with so much power and so much trust, you need to understand what people are saying when they’re not saying it -- you need to be able to read their body and their face. If you don’t -- I’ll just go out on a limb and say that you won’t be a good physician.”