Teaching sensitive topics in the medical field has always been a challenge. Most healthcare students enter the profession with the desire to help people, but technology and bureaucracy often overwhelm their best intentions. In an attempt to remain professional, many students manufacture a protective distance, when in fact, reconnecting with their passion is what will best serve them. Truly understanding advocacy, communication, mindfulness, and presence with patients is challenging to grasp in an educational setting. Palliative care, end-of-life care, negotiating the health care system, racist interactions, and other difficult conversations are complicated for health care students to navigate.
At Ohio University, Merri Biechler, assistant director of the School of Theater in the College of Fine Arts, has collaborated with the Heritage College of Osteopathic Medicine (HCOM) and the College of Health Sciences and Professions (CHSP) to help students learn about these difficult situations by integrating theater into the conversation.
While pursuing her Master of Fine Arts in Playwriting at OHIO, Biechler began working with Tracy Shaub, D.O., to use live theater to teach end-of-life and palliative care to HCOM students. Since 2007, Biechler has led an annual reading of her thesis play, “Confessions of a Reluctant Caregiver,” which chronicles her experience serving as caregiver to her parents, both of whom died of cancer. The play has become part of the medical school’s curriculum, and is performed for second-year medical students during their “Addiction, Pain, and Palliative Care” teaching block.
“Beginning in early 2017, HCOM had some clinicians tell us that they were seeing outright racism in their clinics,” said Biechler. “There may be a medical student of color with the clinicians in the exam room, for example, and the clinicians don’t know how to respond in these situations. But the good news is theater does know how to respond.”
A rich history of Forum Theater began in the 1960s. During times of complex or controversial political issues, Augusto Boal of Brazil and his theater company took to the streets and presented scenarios. Spectators then discussed these scenarios, tried to figure out a better solution, and took the place of the performers to act the scene out. The spectators became “spect-actors.” Biechler uses this very technique with medical students in complex or controversial conversations.
In workshops with HCOM, Biechler presents real-life scenarios to students. Alongside Sharon Casapulla, director of the Rural & Urban Scholars Pathways Program in HCOM, Biechler creates scenes from authentic experiences the minority students and clinicians had with micro- and macroaggressions (with their permission). “These stories we use are real stories that people have experienced,” said Casapulla. “Because we can tell people ‘These are the real stories of the people you work with and study with every day,’ the experience is more powerful and meaningful, and impossible to dismiss.”
Professional actors perform these scenes, followed by students engaging in small-group discussions. Students and faculty then volunteer to replace the actors and carry out the scene in a way they think is more appropriate. “It’s one thing to sit and talk about what you would do, but to actually get it in your body is daunting and difficult,” Biechler said.
Physically acting out these scenarios instead of reading about them in a book gives people confidence they can practice in a safe environment. Biechler makes sure her workshops are established as a safe space—that participants can laugh or even cry about what they’re doing, but then it really becomes a brave space when students and faculty step up and try to change something.
“Working with Merri was one of the most creative learning opportunities I have had to this point at Ohio University,” said Tiffany Stainfield, a graduating HCOM medical student. “Her ability to bridge the gap between medicine and art, showing how abstract concepts of humanity affect something as concrete as medical care, was profound.”
One of the major benefits these theater workshops have on medical students is the development of a sense of community. “I believe that comes out of being open and vulnerable,” said Casapulla. “Learning about others’ personal experiences helps develop empathy, which is useful later on when working with patients who have different lived experiences.”
Biechler emphasized that standing up and getting these things in one’s body is important because many times, when it comes to microaggression, people freeze. “Thoughts of ‘Oh my gosh, I don’t know what to say, I don’t know if my friend needs support, I don’t know if my friend wants to handle it themselves or let it go,’ can race through our mind,” she said. “So the more we can practice, the more I think we’re moving toward disrupting racism and other issues.”
These practices are intended for all people. “It’s for white people, for allies, for people who not only want to be allies to their friends, but who also want to embrace anti-racism,” said Biechler. “It’s for people that have realized it’s not enough anymore to just be nice around issues of racism, but that we actually have to be anti-racist.”
“I experience microaggressions all too often in the midst of clinics or classrooms, and neither me nor my peers feel empowered to do or say anything. I am grateful for these tools to be an advocate for my patients, myself, and my colleagues” —past workshop participant
Another way Biechler and her colleagues give students tools to navigate difficult topics began in the fall of 2017, through the use of narrative medicine. Narrative medicine draws on the study of the arts, particularly literary arts, to help students be empathetic with their patients. An example could be presenting a painting to a class and having people write about it. Who are the people in the painting? What is their story?
“When you look at a painting or photograph and deconstruct what’s going on in it,” said Biechler, “you might initially think ‘oh, this is just a man who’s a drug abuser.’ But when you start to break down what the photo is really about, that’s when compassion and empathy start to happen.”
Biechler, alongside her colleague Samuel Dodd, visiting assistant professor of art history in the School of Art and Design and director of the Ohio Valley Center for Collaborative Arts, recently pitched an idea to CHSP called “The Healthy Village.” The project teaches patient communication and patient advocacy, and will be piloting in the fall of 2019. The proposal is for a longitudinal study of CHSP students who will take nine hours of theater classes over the course of four years using improvisation, long-form narrative, Visual Thinking Strategies, virtual reality, and Narrative Medicine techniques to learn patient advocacy, communication, mindfulness, and presence.
It can be difficult for undergraduate students to be present when having a difficult conversation with a patient. “We want to label these patients noncompliant—‘why can’t you just stop smoking?’—without understanding what is going on in their lives,” said Biechler. “But maybe smoking is the only way they can find any comfort in their life.”
Theatrical improvisation is another technique that Biechler uses. The training she received at the Alan Alda Center for Communicating Science focuses on teaching scientists how to become better communicators about their passion for science, and how to speak to laypeople about their research. Through theater games, scientists gain confidence in explaining complex research ideas and learn to distill their message through storytelling techniques. Many create an elevator pitch and a two- to three-minute video in a storytelling style so politicians and the public can understand why it’s so important to fund certain research.
Theater techniques can address an incredibly wide scope of topics—from the medical field to topics of consent, racism, gender, Resident Assistant or Teaching Assistant trainings, and more. “It’s not limited to one subject,” said Biechler. “It’s not limited to race or health care, it’s all just about getting people up and practicing responding to difficult situations in the moment.”
For anyone interested in getting involved with these techniques, reach out to Merri Biechler.
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