title: Playing in the "Gutter": Cultivating Creativity in Medical Education and Practice.
abstract: In comics, "gutters" are the empty spaces between panels that readers must navigate to weave disjointed visual sequences into coherent narratives. A gutter, however, is more than a blank space--it represents a creative zone for making connections and for constructing meaning from disparate ideas, values, and experiences. Over the course of medical training, learners encounter various "gutters" created by the disconnected subject blocks and learning experiences within the curriculum, the ambiguity and uncertainty of medical practice, and the conflicts and tensions within clinical encounters. Navigating these gutters requires not only medical knowledge and skills but also creativity, defined as the ability to make connections between disparate fragments to create meaningful, new configurations. To cultivate medical students' creative capacity, the authors developed the Integrated Clinical Arts (ICA) program, a required component of the first-year curriculum at the Warren Alpert Medical School of Brown University. ICA workshops are designed to place students in a metaphorical gutter, wherein they can practice making connections between medicine and arts-based disciplines. By playing in the gutter, students have opportunities to broaden their perspectives, gain new insights into both medical practice and themselves, and explore different ways of making meaning. Student feedback on the ICA program highlights an important role for creativity and the arts in medicine: to transform gutters from potential learning barriers into opportunities for discovery, self-reflection, and personal growth.
authors.affiliation: K.T. Liou is a first-year resident, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York. D.S. Jamorabo is a second-year resident, Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey. R.H. Dollase is director, Office of Medical Education, Warren Alpert Medical School of Brown University, Providence, Rhode Island. L. Dumenco is director, Preclinical Curriculum, Office of Medical Education, Warren Alpert Medical School of Brown University, Providence, Rhode Island. F.J. Schiffman is Sigal Family Professor of Humanistic Medicine and vice chair, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island. J.M. Baruch is director, Program in Clinical Arts and Humanities, and associate professor, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Liou
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Jamorabo
authors.forename: Richard H
authors.initials: RH
authors.lastname: Dollase
authors.forename: Luba
authors.initials: L
authors.lastname: Dumenco
authors.forename: Fred J
authors.initials: FJ
authors.lastname: Schiffman
authors.forename: Jay M
authors.initials: JM
authors.lastname: Baruch
mesh_terms: D002983:Clinical Competence; D003210:Concept Formation; D003405:Creativity; D003479:Curriculum; D004501:Education, Medical; D006801:Humans; D008512:Medicine in the Arts