“Apart From What I Encounter in Clinics” – Medical Students’ Reflective Engagement with Museum Queer Arts

Goal of Innovation

Recognizing the growing potential of museum arts for humanity training and critical reflection [13], a program integrating reflective engagement with queer art exhibits was developed. The “Queer Art” program (representation of queer communities through paintings, photographs and other visual media) aimed to help medical students confront and overcome their internal biases, understand multiple perspectives, and improve their confidence in discussing gender inequalities and advocating for inclusivity to address their specific needs.

Steps Taken for Development and Implementation of Innovation

In this mixed-method evaluation, 24 final-year medical students were randomly selected from the full class of 150 at Panimalar Medical College Hospital & Research Institute, India. Final-year medical students were chosen because of their relatively increased exposure to marginalized and minoritized patients during their clinical rotations.

Program Implementation

The “Queer Art” program used a 4-week flipped classroom approach across three phases (Figure 1). In phase 1, all students were oriented to the “Visual Thinking Strategies” (VTS), which is a research-oriented and constructivist grounded pedagogical approach used to enhance visual literacy, communication, and critical thinking skills [14].

Figure 1

In phase 2, students in small groups of four were prompted to visit museums or select online museum arts. With facilitator-mediated discussions, students engaged in dialogue, initially adopting a pessimistic lens to explore the artwork. A pessimistic lens in this context refers to analyzing the artwork by focusing on themes of marginalization, oppression, and discrimination faced by the queer community [15]. As an example, while analyzing a historical androgynous painting, students started discussions on how this representation is often erased, ridiculed, or forced into rigid gender norms due to societal stigma. These discussions culminated in the creation of narrative reports by each group, crafted from a queer perspective (as mentioned before the reciprocal point-of-view).

In the third phase, students engaged with the same queer art but from an optimistic point of view. An optimistic lens in this context refers to analyzing the artwork by focusing on themes of resilience, empowerment, acceptance, and progress for the queer community [15]. As an example, on revisiting the historical androgynous painting students now viewed it optimistically discussing how societies must embrace gender diversity, implement inclusive policies, and foster acceptance. Such views were depicted from the physician perspective (a perspective transformation), and synthesized into reports of how they will work to promote inclusivity in their clinical practice.

Data Collection

For quantitative data, students’ confidence level before and after the program was measured using a 9-item validated questionnaire on a 5-point Likert scale across key aspects such as visual literacy, gender diversity, and gender inequality. The overall effectiveness of the program was evaluated using a 10-item validated questionnaire on a 5-point Likert scale. Both questionnaires were shared online as anonymous surveys.

For qualitative data, in-depth one-on-one semi-structured interviews of 40–45 minutes were conducted after the program to gauge the experience of each student and explore their thoughts and feelings about the art and its implications on their personal and professional perceptions, seeking to understand whether and how this program was effective. Consent was obtained and all interviews were audio recorded. Interpretative Description (ID) was used as a guiding method to analyse the qualitative data [16].

Reflexivity

To enhance study transparency and credibility, the author engaged in peer debriefings and maintained a reflexive journal to manage personal biases, challenging the initial interpretations and ensuring that the conclusions drawn were rooted in the participants’ actual experiences rather than the author’s preconceptions and hierarchical bias.

Data Analysis

Both descriptive statistics and paired t-tests were used to compare the confidence level before and after the program. p value of less than 0.05 was deemed statistically significant. Based on these findings, qualitative data were then analyzed to provide deeper insights and context to explain the observed outcomes regarding confidence. This approach allowed the qualitative analysis to focus on specific areas highlighted by the quantitative data, ensuring a more integrated and comprehensive understanding of the results.

ID was employed to systematically analyze the data from a clinical and educational perspective. This approach facilitated the identification of practical implications that could be applied in medical training based on perceptions and experiences of medical students. The first few interviews were open coded to identify initial themes. The codebook was refined and expanded as more data were collected and analyzed. Constant comparative analysis was applied to all transcripts to continuously refine and redefine codes and themes. Analytical memos were written throughout, contributing to the depth of understanding.

Ethical Approval Statement

This research study received approval from the Institutional Human Ethics Committee at Panimalar Medical College Hospital & Research Institute (PMCHRI-IHEC) (PMCH&RI/IHEC/116; dated 16.02.2024).

Outcomes of Innovation

A total of 24 final year medical students participated in this training program that included 6 male students and 18 female students. The mean age of the students was 22 ± 1.3.

Evaluation of Confidence Levels

On comparing the confidence levels of participants before and after the training with the t-test, there was a highly significant improvement with p-value < 0.0001 across all nine aspects as depicted in Figure 2. Initially, confidence levels were notably lower, particularly in areas such as using gender-inclusive language, educating peers about inclusivity, and analyzing artwork to explore gender diversity. However, after the program, there was a marked improvement across all measured aspects, demonstrating a positive impact on students’ understanding and engagement. Notable changes were observed in fostering respect for gender diversity, recognizing patient diversity needs, and committing to inclusive clinical practices.

Figure 2

Qualitative Analysis

The subsequent ID analysis explored how the confidence levels of participants were influenced by their perceptions and ideologies prior to the program, compared to the shifts in perspective and confidence observed afterward. This analysis examines how engagement with queer art and reflective activities challenged pre-existing assumptions, fostering a deeper understanding of diversity and inclusion.

Evaluation of Program

The evaluation of the program, as shown in Table 1 (appendix), indicates high satisfaction among participants across various dimensions. Notably, the program was particularly effective in helping participants understand the needs of the queer community, reduce personal biases, and change perceptions positively. Overall, the integration of arts into the curriculum was well-received, highlighting its potential to enrich traditional medical training by fostering critical thinking and visual literacy skills.

Critical Reflection on Your Process

This study aligns with the United Nations Sustainable Development Goals (SGD) 5 (gender equality) and 10, (reducing inequalities), a set of 17 global goals designed to address social, economic, and environmental challenges, aiming for a more just, sustainable, and inclusive world by 2030 [17]. The integration of arts into medical training represents a new yet impactful approach, offering students a unique opportunity for reflective engagement and critical dialogue [18]. Art addresses not just seeing, but also the combination of observation, interpretation, appreciation, exploration, advocation, promotion, communication, and reflection [19]. A growing body of literature highlights the effectiveness of arts-based interventions in enhancing key clinical skills, particularly in observation, communication, and empathy [20, 21].

From the analysis of confidence ratings, coupled with qualitative data, initial hesitations in areas such as gender discussion and patient encounters were rooted in fear of judgment, limited exposure, and a lack of structured opportunities to engage with sensitive topics. For many students, societal stigma and internalized apprehension created a sense of passivity or an unwillingness to act, even when they were aware of inequities. These patterns underscore that low confidence was less about ignorance and more about the absence of an environment that encouraged open, reflective dialogue and active engagement with diverse perspectives [22].

A key success to the program was the transformation observed post-program which demonstrates a shift that stemmed not merely from external activities but from deep internal reflection and perspective change. The qualitative responses reveal how students began to question their biases and move beyond surface-level understanding of gender diversity. As they engaged more deeply, they reported a growing ability to empathize, interpret, and navigate complexities related to inclusivity. This shift was not instantaneous but occurred as students reflected on their own discomfort, recognized the limitations of their prior views, and allowed themselves to experience the emotional weight of the narratives they encountered. This process of internal transformation helped students bridge the gap between knowing and understanding, enabling them to see inclusivity as a shared responsibility rather than an abstract concept [23, 24].

Arts-based interventions have long enhanced observation and clinical reasoning in medical education, yet this program takes a different approach that ultimately contributes to best clinical practice [25, 26]. By engaging with queer art, students moved beyond passive learning to actively confronting issues of inclusivity and social justice. This transformation highlights how confidence, when rooted in reflection and empathy, drives both personal growth and the advancement of more inclusive clinical practice.

The evaluation of the program also highlights its success in fostering meaningful shifts in participants’ perceptions and attitudes toward inclusivity. However, it is important to acknowledge the limitations of this study, including the small sample size and the potential for bias with self-reported confidence levels. Future research could benefit from larger sample sizes and longitudinal follow-up to assess the long-term impact of arts-based interventions on students’ attitudes and behaviors.

The strength of this approach lies in effectively facilitating the discussion among students. A notable challenge faced was initial reluctance among students in openly discussing their personal experiences, even in one-on-one interviews. Further application of this approach may require shifts in educational structures, faculty attitudes, and institutional support systems to create a safe and supportive environment where students feel comfortable sharing their thoughts and feelings without fear of judgment or reprisal [27]. Also, it is important that students recognize and effectively reflect on concrete and detailed aspects of inclusivity rather than broadly discussing stigma and discrimination.