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The Arts and Medicine
August 14, 2018

Deck the Halls With Diverse Portraits

Author Affiliations
  • 1Georgetown University Medical Center, Washington, DC
  • 2Georgetown University School of Medicine, Washington, DC
JAMA. 2018;320(6):528-530. doi:10.1001/jama.2018.11013

In the halls of many medical schools are oil portraits of white gentlemen wearing compassionate expressions and dignified robes or white coats, professors and scientists who by and large look the same and are no longer reflective of the diversity of today’s medical school classes and faculty. Now, more women than men are entering medical school; women of minority groups surpass minority men in their rates of graduation; and students of Asian descent are present in greater numbers.1 Perhaps inevitably, wall portraiture has not kept pace with these changes and is a reminder of where the demographics still lag: the percentages of Hispanic and black enrollees at medical schools have remained stagnant in the same period.2 It is no surprise then that some medical school groups are seeking to add new faces to the walls, those of successful women and of minorities and persons of color in medicine whose images serve the same inspirational and aspirational purposes the older images served. Until a diverse leadership becomes the norm as women and minority students, house officers, and rising faculty achieve later-career advancement, portraits of earlier-career role models can serve as signs pointing the way to real-life advancement. In representing successful women and men, as well as minorities and persons of color, an inclusive portraiture signals that professional possibilities are open to all.

At Georgetown University Medical Center Kristi Graves, PhD, president of Georgetown Women in Medicine, created the Women on the Walls initiative, which has placed photographic portraits of medical students of various backgrounds, ethnicities, and races on the walls while it awaits completion of the campaign’s first commissioned painted portrait of a black female dean and nominations for additional women faculty leaders who should be portrayed. The Women on the Walls campaign is “one way to open up conversations about how we depict leadership and the impact of seeing (or not seeing) someone 'like you' displayed on the walls as an indication of respect and honoring valued contributions,” Dr Graves shared in a recent conversation.

At Harvard Medical School, Julie Silver, MD, associate professor in the Department of Physical Medicine and Rehabilitation and the associate chair for strategic initiatives at Harvard Medical School, created a #WallsDoTalk contest in 2017 that asked medical students from across the country to look around, note typical “recognition or honor walls,” and design alternative images promoting 1 or more of the themes of education, wellness, healing, innovation, or diversity and inclusion. The initiative was geared toward creating a learning environment with “inclusive art” that “everyone can feel comfortable in,” Silver says; a perspective echoed by Harvard Medical School Dean George Daley, MD, PhD, when he said, “The art we display on our walls should make everyone feel like they belong there.” The 2 winning entries were Unique and Unified: Same, Same but Different by Navya Talluri, a grid of (mostly female minority) eyes, faces, body parts, and radiographic images (“The dichotomy between [our] uniqueness and unification…provides a pathway for learning, yet also a need for future medical innovations”); and Glass by Laura Flores, a self-portrait in scrubs, where the artist is shown sitting next to glass windows (“I desperately want this [glass] wall to come down to reveal a strong, independent, Hispanic woman…But for now, it reflects loneliness, a feeling minority medical students experience too often.”).

It makes sense that portraits should reflect changes in institutional culture and practice. Compare conventional medical portraiture with Blaise Smith’s group portrait of women scientists at the Royal Irish Academy, which not only celebrates the achievements of each through the use of whimsical icons but daringly suggests that science is a collective enterprise that rests on teamwork and, even more important, solidarity.3

Eight Scientists by Blaise Smith, oil on gesso panel, 200 × 100 cm, 2016. Commissioned for the Royal Irish Academy for Accenture Ireland’s Women on the Walls.

Image courtesy of Blaise Smith. Reproduced with permission.

Georgetown University, Harvard University, and the Royal Irish Academy may be at the forefront of this cultural movement, but some medical professionals who are artists have expressed identical themes in private paintings that offer innovative approaches to traditional medical portraiture. Suliman El-Amin, a psychiatry resident at Mayo Clinic, has been painting portraits motivated in part by a desire to open the lens on racial diversity in medical institutions. In Graduation (2017), El-Amin presents his personal interpretation of the American dream, riffing on Grant Wood’s famous American Gothic with an image of an African American medical school graduate standing alongside a relative, a farmer in the Deep South. By pairing the doctor and the farmer in front of a field, El-Amin explained in an email, he wished to portray their common ground, the “hard work and dedication” that made his own successes possible, and the enormous challenges some students overcome to achieve their standing within the medical community. In an earlier painting, The Cloaking (2012), El-Amin depicts a White Coat Ceremony with 3 figures of different ethnicities: a black dean, a white student, and a female faculty of undefined origin.

Top: Graduation by Suliman El-Amin, acrylic on canvas, 38 × 42 in, 2017; Bottom: Millennial Madonna, or Estell, Finally by Andrea Gahl, oil on canvas, 30 × 48 in, 2018.

Images courtesy of Suliman El-Amin (top) and Andrea Gahl (bottom). Both reproduced with permission.

The personal stories these images represent are part of the changing dynamic of institutions as they adapt to diversity, and create an environment in which narrative elements, largely absent within the typically static, contextual sameness of “honor-wall” renditions, can make their way into contemporary medical portraiture. “Portraiture as an art form,” El-Amin explained, “provides an opportunity to display raw emotions with subtle changes in one’s face, body placement, and simple hand gestures that tell a story. It keeps the viewer focused on the characters of the narrative, encourages humanism, and forces the viewer to create an internal dialogue with the [picture’s] elements.”

Similarly, surgical nurse Andrea Gahl’s series of (diverse) portraits of surgeons includes a representation of a black female surgeon as Madonna with child (Millennial Madonna, or Estell, Finally), referring to the model’s multiple racial, familial, and professional identities. “To be a surgeon,” the physician sitter writes in a statement accompanying her portrait, “is to be positioned in close proximity to an apparatus of power my ancestors could not have imagined. But to rest my identity on that proximity to power and privilege would rip me from the historical struggle of justice that has defined my existence.” In these paintings, artists find new ways of representing leaders in science and medicine who are inhabiting different identities and have different stories to tell than their venerable white male predecessors.

This understanding of portraiture may be an answer to those who worry about the displacement of existing portraits as a dismissal of the historical contributions of researchers, scientists, and clinicians to medicine and their institutions. Rather than displace these figures, the perspectives the new images express enrich the historical record. “The act of making room for more images is not an erasure of the individuals that have contributed to the growth of the institution,” El-Amin says. Rather it widens the net, aligning institutional diversity goals with tangible representations of that diversity and recognizing social equity as an achievement as worthy of honor as traditional forms of academic medical leadership.

What actual changes the symbolic power of portraiture can harness are not yet clear. Diversity and inclusion rest on more than imagery of course, and institutional efforts to reinforce such messages through curricular design, faculty development activities, hiring practices, and admissions protocols are equally critical. Currently multiple medical schools are working to address implicit bias in the medical curriculum.4 Solutions include psychosocial interventions that increase awareness, foster an inclusive learning environment, and provide positive opportunities to engage and promote empathy.5 Commissioning and displaying diverse painted profiles of role models and honorees is one meaningful piece of this agenda. At the same time, we must recognize that symbolic gains ought to be facilitators of real gains. As students, residents, and faculty progress in their careers, leadership and character matter more than numerical gender and racial or ethnic advantage, and actionable interventions, such as changes in admission criteria, hiring practices, mentorship, and salary equity for faculty, matter more than what is on the walls. But decking the halls is a start.

Submissions: The Arts and Medicine editors welcome proposals for features in the section. Submit yours at artsandmedicine@jamanetwork.com.
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Article Information

Corresponding Author: Caroline Wellbery, MD, PhD, Georgetown University Medical Center, 3900 Reservoir Rd NW, Preclinical Science, Room GB-01B, Washington, DC 20007 (wellberc@georgetown.edu).

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

References
1.
Association of American Medical Colleges. Current trends in medical education. http://aamcdiversityfactsandfigures2016.org/report-section/section-3/#figure-4. Accessed July 18, 2018.
2.
Karani  R, Varpio  L, May  W,  et al.  Commentary: racism and bias in health professions education: how educators, faculty developers, and researchers can make a difference.  Acad Med. 2017;92(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions):S1-S6. doi:10.1097/ACM.0000000000001928PubMedGoogle ScholarCrossref
3.
Accenture.  Women on Walls: about. https://www.accenture.com/ie-en/women-on-walls. Accessed July 18, 2018.
4.
Sukhera  J, Watling  C.  A framework for integrating implicit bias recognition into health professions education.  Acad Med. 2018;93(1):35-40. doi:10.1097/ACM.0000000000001819PubMedGoogle ScholarCrossref
5.
Boscardin  CK.  Reducing implicit bias through curricular interventions.  J Gen Intern Med. 2015;30(12):1726-1728. doi:10.1007/s11606-015-3496-yPubMedGoogle ScholarCrossref
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    1 Comment for this article
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    Broadening Health Care Workforce
    Michael Berkwits, MD, MSCE | AMA
    JAMA has tried in its Arts and Medicine section to publish essays that reflect a range of art forms relevant to patients and the practice of medicine. This essay is a beautiful representation of hospitals and programs trying to use visual arts to make all colleagues -- and perhaps even patients -- feel welcome in our workplaces. The keystone to the essay, what moves it beyond identity politics, is El-Amin's quote and follow-up: " ' The act of making room for more images is not an erasure of the individuals that have contributed to the growth of the institution,” El-Amin says. Rather it widens the net, aligning institutional diversity goals with tangible representations of that diversity and recognizing social equity as an achievement as worthy of honor as traditional forms of academic medical leadership.' " We welcome comments from all readers on that point, and on the effort more generally.
    CONFLICT OF INTEREST: JAMA Editor
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