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msJAMA
March 6, 2002

Art, Anatomy, Learning, and Living

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JAMA. 2002;287(9):1182. doi:10.1001/jama.287.9.1182-JMS0306-5-1

Artist Barbara Kerstetter first came into contact with medical students when she decided that spending time in an anatomy lab was an irreplaceable part of her education as a figural artist. To bring the learning experience full circle, she decided to teach an art class to medical students. This simple idea has become a six-week drawing course taught both with live models and in the sculpture section at the Metropolitan Museum of Art as part of our medical school's second-year requirement in the humanities. While the humanities are often used in the medical curriculum to inspire reflection and interpretation, a course in making art is rare.1 Both students and instructors have found that the activity of drawing is specifically relevant to the first year student's experience in the anatomy lab.

To accurately convey the human form, one has to know it through and through. Beneath the surface lie bone, muscle, guts, and—as any first-year medical student can tell you—lobular yellow fat, webby fascia, stringy flesh that gives, cords of the nervous system that do not, intestines that look as if they live at the bottom of the sea, and a brain that could not survive anywhere but in the skull. In a drawing class, the medical students relinquish the tactile access of the anatomy lab, and as in a Renaissance anatomy theater, place their collective visual attention on a single body in the center of the room. They begin to use their knowledge of anatomical depth as they will in the clinical setting, faced with the intact surface and presence of a live human being.

To draw the body—after having dismembered it—trains the medical student in disciplined acts of seeing and creating "expressive form" that, in the words of Suzanne Langer, "expresses . . . human feeling . . . meaning everything that can be felt, from physical sensation . . . to the most complex emotions . . . of a conscious human life."2 Kerstetter adds, "There is more to it than form and function; when drawing one must also capture the emotion of the model. How the model feels changes the entire pose and what poses the model will take."

We are struck with the earnestness with which nonmedical people—Ms Kerstetter, the tourists who stop to watch medical students sketching in the museum, the models who are themselves art students and actors funding their own education—agree to the value of cultivating a physician's ability to see what is beautiful and human. The urgency derives from each person's desire to have a physician who will see what is beautiful and human in him or her, and the fear of having one who does not.

Anatomy lab can be the beginning of a physician's training in how to isolate and restrict affect, or it can be the beginning of a training in the use of affective responses. The experience is a powerful engagement with life and death, raising fundamental questions about what it means to be made of flesh. If the study of anatomy implicitly challenges the medical student's powers of coherence, imagination, and sensitivity, the creative study of the human form—drawing the living, supple, flabby, stooped, or taut bodies—can provide students with access to the full continuum from science to art and cultivate a capacity for empathy.3 While sitting quietly and drawing living bodies, medical students have the time and the distance from routine to hang onto a wave of responses that are in continuity with their experiences in the anatomy lab. They experience a quickening of their consciousness of body, of aesthetic, of culture, of compassion, of shame. It is this vast and murky sea of human experience that an artful physician navigates.

Anatomy lab need not be a hazing necessary for entrance into medical culture, nor a purely functional exercise for learning the streets of the human body. It is an introduction to a medicine that is both visual and intimate and hints to the nature of future practice. Few of us can articulate this lesson in those early months of first year. Indeed, the solemnity of the first day in anatomy lab is succeeded by the long commonplace afternoons and jocular late-night study sessions. And in the second year, sensory experiences and visceral responses are exchanged for dense texts and exacting lectures. Frank Netter's careful drawings and our emotional reactions to what is to be learned—its very texture—begin to recede. Unless cultivated, the early quickening is lost, and we risk sacrificing our experiences of anatomy lab to the lore of what we suffered to become physicians.

We do not propose that adding an art class to the medical student's curriculum is a salve for time spent in the anatomy lab, nor that the anatomy lab is a trauma from which we need to be healed. We believe, instead, that anatomy lab is the initiation to an art of medicine, but one that requires disciplined training in the creative acts of seeing begun in the gaze at that first body in our care.

References
1.
Berg  G The Visual Arts and Medical Education.  Carbondale Southern Illinois University Press1983;
2.
Langer  SK Problems of Art.  London, England Routledge & Kegan Paul1957;15
3.
Bertman  SMarks  S The dissection experience as a laboratory for self-discovery about death and dying. Clin Anat. 1989;2103- 113Article
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