Like most physicians who supervise a team of medical students and residents on an inpatient internal medicine clinical teaching unit, I have a routine. In March 2020, the COVID-19 pandemic demanded changes. First, we put on masks that prevented us from seeing faces of other team members. Second, we limited the number of team members visiting the bedside of patients to reduce exposure of healthcare personnel to COVID-19. Third, we moved in-person large group meetings, such as Grand Rounds, to Zoom, where most participants turned off their cameras. These changes led to the loss of an important aspect of humanity—face-to-face interaction. In response, I looked for a way to reintroduce humanity into our time together. I stumbled on something from my background in musical theatre production,an activity that I soon called “The Music Video”.

Every day, our team takes 4-6 minutes to watch a video that contains music. At first, I used the videos as a diversion to lift our spirits, with no other purpose than entertaining the team. But over time, our reactions motivated me to pursue more specific objectives. These include setting a mood for the day (upbeat, fun, mellow, introspective, sad), improving our powers of observation, displaying my passion for this form of art to role model broadening one’s horizons, and teaching something about musical theater. As a general theme, these viewings show the power of vocal performance to bring us out of ourselves and into contact with others. We can’t see each other’s faces—something we dearly miss—but we can all see the facial expressions of the artists.

I have developed a list of favorites. The accompanying table provides a sample playlist with URL links to each of these videos. I always start with upbeat videos, usually either Joshua Lee Turner’s Band on the Bus version of “Baby Driver” or the 2018 Tony presentation of Once On This Island. The former shows a group of five musicians on their tour bus happily covering the Simon and Garfunkel hit song. It is impossible not to smile while viewing it; it’s a toe tapper. The latter is, in my opinion, the best example of a performance on a Tony Award program because it motivates viewers to see the show. Matthew Thomas Grant’s “Thank Me Now” from the Los Angeles production of Emojiland: The Musical evokes the emotions of first-year residents in the middle of a night on call, complete with the anger and intensity of circumstances when asked to simultaneously handle 10 urgent clinical tasks. I point out Grant’s remarkable use of his eyes and hands to convey the song’s message. Chilina Kennedy’s “Omar Sharif” from the Tony-winning musical The Band’s Visit is sublime and soothing, with an embracing Middle Eastern mood. I show that one when the team needs to relax.

Sometimes, I show them different versions of the same song. A great example is “I Say a Little Prayer”—a Burt Bacharach and Hal David classic covered by many people. My favorite covers are Kenton Chen with the Scary Pockets and the karaoke-style performance by the cast of the film My Best Friend’s Wedding. This exercise shows the group how the same stem of material (the music and lyrics) can evoke very different reactions with different interpretations resulting from the cultural context of the artists (see Aretha Franklin’s acclaimed pop-R&B cover).

On some occasions, team members bring their own videos. While working over Christmas, a resident from the United Kingdom showed us and excerpt from The Snowman; a cartoon about a little boy that people in the United Kingdom watch over the holiday season. While watching the video, I could see both pride and homesickness on the English resident’s face, reflecting the capacity of music to evoke powerful memories.

On my last day with one team, I showed them a cover of “Vincent,” the haunting song by Don McLean about Vincent van Gogh’s mental illness, sung brilliantly by Voces8, a London-based a cappella group. The intertwined beauty and sadness left us speechless. All I could say was, “that was beautiful but we can’t end on that note”. So we watched a second video that day: Cynthia Erivo’s uplifting performance of “Stand Up,” the theme song from the movie Harriet, the story of Harriet Tubman’s role in the Underground Railroad. As we left the room to see our patients, I could hear the team singing behind me. I smiled; mission accomplished that day.

To hone their powers of observation, I ask them specific questions; sometimes before the viewing, sometimes afterwards. Christine Hudman’s performance of “Welcome Home” from the musical Bandstand is perfect for this exercise. What is this show about? (A returning World War II soldier). What is the message of that song? (Welcome home, I have missed you). What musical or dramatic techniques did they use to engage the audience? (Key change, drum roll, riffing notes.) These exercises complement the way I teach them to use inspection of patients2—to really look at them—as a foundational clinical skill. But most importantly, the music video sets a mood for the day and brings the team together.

When I first started doing this, I worried that the residents would resent using their valuable time in a way that seemed tangential to the task of the day. I knew that I had to set the tone to get them to disconnect with the pressing issues on their to do lists. Before showing the first video to a new group, I explain the purpose, ask them to put their phones, lists, and pagers on the table in front of them, and just relax, watch, and listen. Because I sit at the end of the table farthest from the screen, I can tell who is absorbed (they sit very still, eyes glued to the screen) and who is not (they fidget and look at something else). Some of them nod their heads or sway rhythmically; some tap their feet or hands. At the end, they often clap. And while I have not done a formal evaluation, some of them spontaneously tell me it was their favorite part of the day.

This teaching method is not unique. Moniz et al published a scoping review of 769 records of the use of arts in medical education including literature, narrative writing, theatre, film, comedy, and graphic novels.The same authors proposed a theoretical framework for doing so.4 But I had no such formal structure or evaluation strategy. I was simply looking for something to counterbalance all the sadness we see in our patients—a sadness that was exacerbated during the COVID-19 pandemic. Over time, this activity has grown into something more: a chance to integrate thought processing and skills I learned in my “second career” in theatre into my day job. It occurs to me that many clinicians who teach medicine can do likewise; either by using the “playlist” I have provided or creating a new curriculum that taps into their own interests outside medicine. Doing so requires a teacher to be brave and take risks—the students may not like what we have to offer. But maybe they will.

I look forward to the day we take our masks off in our clinical settings and see each other again. But I am pretty sure that even when that happens, the Music Video will remain an important part of my routine.

References

  1. Detsky AS. From academic medicine to Broadway. J Gen Intern Med. 2020 Sep;35(9):2776-2777. doi:10.1007/s11606-020-05851-w. Epub 2020 Apr 20.
  2. Gupta S, Saint S, Detsky AS. Hiding in plain sight—resurrecting the power of inspecting the patient. JAMA Intern Med. 2017 Jun 1;177(6):757-758. doi:10.1001/jamainternmed.2017.0634.
  3. Moniz T, Golafshani M, Gaspar CM, et al. How are the arts and humanities used in medical education? Results of a scoping review. Acad Med. 2021 Aug 1;96(8):1213-1222. doi:10.1097/ACM.0000000000004118. Epub 2021 Apr 6.
  4. Moniz, T., Golafshani, M., Gaspar, C. M., et al. (2021b). The prism model: Advancing a theory of practice for arts and humanities in medical education. Perspect Med Educ. 2021 Aug;10(4):207-214. doi:10.1007/s40037-021-00661-0. Epub 2021 Apr 29.

Issue

Topic

Medical Education, SGIM

Author Descriptions

Dr. Detsky (allan.detsky@sinaihealth.ca) is Professor of Health Policy, Management and Evaluation (IHPME) and Medicine at the University of Toronto, Canada. He has also produced musical theatre on Broadway and the West End, earning two Tony Nominations and one Olivier Award.

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