A few years after becoming a doctor, Ray Barfield faced a crisis.
He could handle the long hours and difficult decisions facing a pediatric oncologist. He felt confident in his mastery of biology and his growing diagnostic skills. Yet none of that helped when he sat down with a young mother to tell her the terrible news: There was nothing more he could do to save her 8-year-old daughter’s life.
“At that moment, I broke,” Barfield says. “I wasn’t sure I could keep on practicing medicine.”
Doctors’ days brim with such heartbreaking moments. But Barfield’s training hadn’t prepared him for the emotional demands of doctoring – for the human side of medicine.
So he started over, reinventing the way he approached his patients and his practice.
“I had to learn all these lessons the hard way,” says Barfield, who teaches pediatrics at Duke Medical School and Christian philosophy at Duke Divinity School. “I had very little instruction or mentorship around these kinds of topics and issues in my own training. I learned largely from failing and not being sure what happened.”
I had to learn all these lessons the hard way . . .I learned largely from failing and not being sure what happened.
- Ray Barfield
Now Barfield is sharing some of those lessons with Duke undergraduates who aspire to be doctors. His new pilot program, “Reimagining Medicine,” launched this summer with eight weeks of classes for 14 rising juniors and seniors. Barfield hopes it’s the start of a long-term effort to change how students prepare to be doctors.
The curriculum wasn’t standard pre-med fare. No chemistry, biology or anatomy classes. Instead, students delved deeply into the arts and humanities through courses in topics such as improvisation, expressive writing, music and puppetry.
Ali Sloan, a junior neuroscience major, had doubts about some of the less traditional subjects at first.
“It challenged all of us to get out of our comfort zones,” Sloan said. “But in the end, it was an incredible opportunity for introspection and growth.”
Barfield and his colleagues think character is at the heart of good doctoring. In particular, they aim to nurture students’ empathy and imagination. Those, Barfield says, are precisely the tools doctors need – and often lack -- when they walk into a patient’s room and begin to listen to their stories.
“In medicine, conversations often go wrong because real communication and real listening isn’t happening,” Barfield says.
To strengthen their listening abilities, students worked with musicians and with actors skilled in improvisation. In improv, a student listens closely to a prompt from a partner and builds upon it. The conversation might go in any direction, which gives students practice in preparing for unpredictable situations – something they will face again and again as doctors.
Doctors rely on many tools to diagnose. But none is more important than the ability to observe.
To nurture that talent, Reimagining Medicine took advantage of the visual arts. Duke dermatologist Lynn McKinley-Grant has found that visual art can sharpen doctors’ perceptive abilities, including helping them to see past the surface in dealing with patients. McKinley-Grant led students in observation exercises at the Nasher Museum of Art. Students also used drawing exercises to refine their powers of observation.