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From Canvas to Cystoscope: How Art Has Influenced My Medical Education in Urology

By: Yeonsoo Sara Lee, BS | Posted on: 01 Nov 2022

Hippocrates once called medicine the “practice of my art.” Through my journey in medicine, and currently as a third-year student on my clinical rotations, I have also found the reverse is true. Art has been both a crucial part of my medical education and a rejuvenating practice.

Over the past few years, much of my preclinical education was virtual. I realize now most of what I was taught catered to unilateral learning styles: for example, looking at pictures of anatomical relationships, listening to prerecorded or live video streams, or reading assigned literature. However, of the 4 main learning styles of the VARK model (visual, auditory, reading and writing, and kinesthetic), the majority of students find multimodal learning to be the most effective.1 So, perhaps subconsciously, I found I was turning to synthesizing much of this material in a way that was effective for me: in a multimodal manner, mostly by creating visual study guides by hand while referencing other study materials. I had always had an interest in the arts, so this felt like an opportunity to also exercise my “right brain” while engaging my “left brain.”

This practice started proving more useful during my anatomy course in my first year. In addition to dissections and studying in the anatomy lab, I turned to drawing out anatomical relationships to visualize structures and correlate clinical significances. On reflection, this makes sense: to draw something, one must understand it. I began sharing these illustrations with my friends and classmates, who suggested I post them on social media. When I began doing so, some told me they used the content I posted to review even more so than traditional study materials, which was a high compliment.

Creating medical illustrations and art has also become a tool for me to communicate scientific information and build community. As I explored more venues to incorporate my more creative tendencies with medicine, I began doing this primarily at my own institution. For example, I designed educational materials for preclinical courses with course directors, creating videos outlining things like the cranial nerves for my neurology course, or visual guides for cardiology concepts. I also contributed medical illustrations to posters and publications, both presenting my own original research endeavors and those of my colleagues.2 Additionally, I was given opportunities to share illustrations with my classmates in a more informal manner, including designing a class t-shirt. When asked by my course director to design a shirt to help raise morale for our hybrid virtual nephrology class, I helped start a tradition of creating t-shirts for the course (Figure 1), which has been continued in subsequent years. Getting to build relationships through an activity that brings me joy felt meaningful, as it could also be of use to others or brighten someone else’s day.

Figure 1. The design for the nephrology course t-shirts. The cactus is a nod to the Southwestern landscape of Mayo Clinic Arizona, where I spent my first 2 years of medical school.

Another important aspect of how art has helped in both my personal and professional growth is how I have had the opportunity to learn more about urology as I prepare to apply for residency next year. At AUA2022 in New Orleans, I was able to see various presentations of interest and was excited to see urologists with their own visual aids (including Dr. Lee Zhao of NYU Urology, who drew and animated his own graphics for a presentation on gender-affirming care). Speaking with experts in various fields, I was able to connect with urologists outside of my institution, leading to creating my own medical illustrations for a publication with Drs. Alex Xu, Kirtishri Mishra, and Lee Zhao (Figure 2).3

Figure 2. Figure of posterior urethroplasty with Tanagho flap published as part of collaboration with Drs. Xu, Mishra, and Zhao. 1, A simple prostatectomy is performed (if applicable) and the preexisting suprapubic tube removed. 2, The native bladder neck is closed (green arrows). If the preexisting suprapubic tube site is unable to reach the urethral stump to create a tension-free anastomosis, an anterior bladder flap is raised, incorporating the prior cystotomy (dashed blue line). 3 and 4, The flap is then tubularized and the cystotomy closed. 5, The urethral stump is then anastomosed to the tubularized flap over a catheter with running 3-0 Stratafix suture. 6, The finished product. This article was published in: Urol Clin North Am, Vol 49, Xu AJ, Mishra K, Lee YS, Zhao LC, Robotic-Assisted Lower Genitourinary Tract Reconstruction, 507-518, Copyright Elsevier (2022).3

Ultimately, I continue to recognize the value of physicians practicing visual communication. Medical concepts can be quite complex and difficult to understand, and medical illustration can harness both the provider’s precise scientific understanding and their ability to generate a spatial understanding of medicine. On my surgery clerkship, for example, I repeatedly watched my preceptors illustrate anatomical concepts, disease processes, and indicated surgical procedures in understandable ways for their patients.

Figure 3. One of the visual study guides before a nephrectomy procedure that was created during my week on urology clerkship.

Figure 4. Additional visual study guides that were created in preparation for a prostatectomy, cystectomy, and nephroureterectomy.

Following in their footsteps, I expanded my study guides to include the anatomy, disease process, and surgical steps that made the information more understandable for a trainee at my level. I found these useful to complete the night before each day in the operating room on my clerkship–it helped prepare me for didactic questions, and I had some semblance of understanding what the key steps of the procedure were. When I found myself spending more time on study guides during my rotation with the Department of Urology at Mayo Clinic Florida (Figures 3 and 4), this only further solidified my sense that I found the anatomy, clinical questions, and procedures of urology interesting to me, and it was a field I’d like to learn more about. The sentiment was reinforced when I found the residents and attendings I worked with during that week showed interest in some of the guides I had created and were truly invested in teaching me.

In full circle, I will be returning to the dissection lab in the fall to teach anatomy to first-year medical students. I am confident the skills I have accumulated in creating these illustrations and in surgery clerkship–attention to detail, understanding of visual relationships, intentional use of my hands to dissect or depict, and synthesis of information–will prove useful, and hopefully, I will be a more thoughtful teaching assistant. Beyond the classroom, however, I am looking forward to continuing this journey of using my art in medicine, and medicine in my art. In a lot of ways, a surgeon’s hands and an artist’s hands are not too different: the coordination, the precision, and the hours devoted to developing their craft. I look forward to developing in both of my crafts in my next steps as a trainee.

Acknowledgments

I thank Drs. Xu, Mishra, and Zhao for their support and involving me in their important and exciting work. I also thank Ms. Jennifer Regala for the invitation to write on my medical illustrations and journey involving art in medicine.

  1. Prithishkumar IJ, Michael SA. Understanding your student: using the VARK model. J Postgrad Med. 2014;60(2):183-186.
  2. Singh R, Lee YS, Kouloumberis PE, Noland SS. Right radial nerve decompression for refractory radial tunnel syndrome. Surg Neurol Int. 2021;12:507.
  3. Xu AJ, Mishra K, Lee YS, Zhao LC. Robotic-assisted lower genitourinary tract reconstruction. Urol Clin North Am. 2022;49(3):507-518.

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