EP126: AI, Medicine, and the Human Touch: A Discussion with Dr. Gauri Agarwal

In this episode of SEE HEAR FEEL, Dr. Gauri Agarwal, an associate professor and associate dean of curriculum at the University of Miami's Miller School of Medicine, discusses the importance of integrating visual thinking strategies into medical education. Dr. Agarwal shares a touching anecdote about a hospital chaplain during the pandemic to explore the intersection of humanity and technology. She explains the origins and applications of visual thinking strategies in healthcare, highlighting the benefits in empathy, communication, and cognitive flexibility. Dr. Agarwal also reflects on what it means to be human in the age of artificial intelligence, emphasizing the irreplaceable role of love and true human connection in medicine.

00:00 Introduction to Dr. Gauri Agarwal

00:53 A Touching Pandemic Anecdote

02:12 The Intersection of Humanity and Technology

03:31 Visual Thinking Strategies in Medical Education

09:08 Integrating AI in Medical Training

11:55 The Role of Humanities in Medicine

12:41 Final Reflections on Humanity in Medicine

Dr. Gauri Agarwal, MD received her MD from the University of Miami in 2000 and trained in internal medicine at the University of Pittsburgh. She is currently an Associate Professor of Clinical Medicine and the Associate Dean of Curriculum at the Miller School of Medicine at the University of Miami. Her research interests include the impact of visual thinking strategies on medical education. She also has a passion for the medical humanities. In 2017, she received the Leonard Tow Humanism Award from the Gold Humanism Honor Society. The Gold Foundation also supported her recent work exploring the intersection of the humanities with artificial intelligence.

Show notes

Exploring the Intersection of Humanities and Technology in Medicine with Dr. Gauri Agarwal

In this episode of SEE HEAR FEEL, Dr. Gauri Agarwal discusses her background and current roles at the University of Miami, with a focus on the integration of visual thinking strategies in medical education. She shares a touching anecdote about a chaplain's dedication during the pandemic, highlighting the human elements that technology cannot replace. The discussion delves into the importance of empathy, communication, and the humanities in medicine, particularly in the context of artificial intelligence. Dr. Agarwal outlines the methodology of visual thinking strategies and their impact on medical students, stressing the need for human connection and reflection in healthcare.

00:00 Introduction to Dr. Gauri Agarwal

00:52 A Touching Pandemic Anecdote

02:11 The Intersection of Humanity and Technology

03:29 Visual Thinking Strategies in Medical Education

08:57 The Role of Humanities in Medicine

11:35 Final Reflections on Humanity in Medicine

Transcript

Christine Ko: [00:00:00] Welcome back to SEE HEAR FEEL. I'm with Dr. Gauri Agarwal. Dr. Gauri Agarwal, MD, received her medical degree from the University of Miami in 2000 and trained in internal medicine at the University of Pittsburgh. She is currently an associate professor of clinical medicine and the associate dean of curriculum at the Miller School of Medicine at the University of Miami. Her research interests include the impact of visual thinking strategies on medical education. She also has a passion for the medical humanities and in 2017 received the Leonard Tow Humanism Award from the Gold Humanism Honor Society. The Gold Foundation also supported her recent work exploring the intersection of the humanities with artificial intelligence. I will put links in the show notes to her recent work with visual training and artificial intelligence. Welcome to Gauri.

Gauri Agarwal: Thank you so much, Christine.

Christine Ko: Could you start off with sharing a personal anecdote?

Gauri Agarwal: Sure. This is fresh in my mind because I had written a [00:01:00] poem that was just published about this incident.

And it's actually about a good friend of mine, who's our hospital chaplain, and it was during the pandemic. And as you may remember, there were no visitors allowed in the hospital and when patients were dying, they were often left to die alone and many of our chaplains weren't able to even enter the room, but, our chaplain, who's a good friend, he would gown up with the mask on, cover his phone with the protective case, take it in and do the last rites. He was a, he's a Catholic priest and he would do the last rites for his patients and then zoom in the family. And they would sing hymns together at that moment of death and be there with the family and with the patient until that moment had passed. And it was just so incredibly touching to me that he would do that, that he would go into that room, first of all, at great personal risk when he didn't have to, and it wasn't part of his job [00:02:00] necessarily, but also to make sure that that patient didn't die alone and that he was also able to bring in the family via technology. That whole intersection of humanity and technology and everything else really struck me.

And so I had written this poem about it and I think it's relevant to our conversation today because as I've been thinking a lot about how AI is going to intersect into our future and what it means to be human, I was thinking about how AI doesn't really have a soul. It doesn't have a spirit. And one of the beautiful, wonderful things we do with families is be with them at those moments of death.

And we have sometimes a spiritual connection and sometimes they even ask us to pray and we may or may not feel comfortable doing that. But at least we can be present for that moment. But we have a soul and a spirit which machines do not. So it struck me as one of those very unique things that we offer as humans to the health care relationship with our patients. So I wanted to start with that. 

Christine Ko: I like it. What would you say to someone, though, you know, a doctor or scientist who says that we don't have a soul, though?

Gauri Agarwal: It's possible, but [00:03:00] it's one of those things that, if you do, it might bring some beauty to the relationship with the patient, right? You may not have that necessary belief, and you may not have that particular connection. You may have a different type of connection with your patients, but it's one of those things.

Things that make us human. And I think what I've been trying to reflect on is what are all of those myriad things that we bring as humans to the health care encounter that can be enhanced by technology, but also can never be replaced by technology. And this is just one of those things on that list. 

Christine Ko: Okay. Well, that's a good segue because, you know, you do integrate technology into your teaching and your writing and your research, and one of the things that you focus on our visual thinking strategies. Can you talk about that? 

Gauri Agarwal: Sure, this was something that's been developed decades ago by Abigail Housen and Philip Yenoween, and he's a cognitive psychologist and a museum educator, and it's been used for decades in K through 12 education. It's been used even by the FBI and the [00:04:00] police and, over the last several years in healthcare education, and basically what it is, it's very simple.

It's just three questions. And it begins by looking at something. So it's usually a piece of art, sculpture, whatever it may be. And you take about 30 seconds to just look at it and just absorb it. And then the first question is, what do you think is going on in this image, in this piece, whatever it is you're staring at?

And that question is really intentional because it's not, what do you see? It's, what do you think is going on? Which forces you to come up with a narrative, a story, some assumptions, something in your brain about what it is that you think is going on. And so we find that people's answers to that question are quite unique.

And so that's the first question. And as people are answering that question, there's a facilitator, and the facilitator is very important because what they do is, they have to carefully listen, they have to paraphrase to make sure that they're capturing what is being communicated to them, and they're usually [00:05:00] pointing to make sure that whatever it is that they are seeing in the image or the sculpture, that they're pointing to it to make sure that they're actually getting it right.

So there's a facilitator, there's this person answering that question, and it's often done in small groups. And the second question is, what do you see that makes you say that? So that you can really get the evidence behind it? I think this is a group of children playing in the park. You know, what is it that makes you say that this is a park?

Whatever it is. And then they bring the evidence. It's a critical thinking the reasoning behind it. And then the third question is even more simple. It's, what more can we find? And that question is also intentional. It's not, do you have anything else that you see? Because that's kind of shuts down a conversation.

The implication is there's always more to be found. What more can we find? And so when I was first introduced to this, it sounded really simple. I wasn't sure about the links to healthcare or medicine. And then I watched it play out in front of me with medical students. And it was just [00:06:00] incredibly touching, inspiring, energizing because what I was watching were these very clear links to medicine because when you're sitting down with a patient and you're looking at them, we often all of us make various snap judgments, right?

Sometimes we even teach students to make doorway diagnoses, right? When they come into the door, but we often recognize that those are mistaken or that our assumptions are proven wrong and that there are so many more details and layers of gray behind patients that we have to watch closely for and look for.

And so the art teaches that slow looking, that close observation, that picking up of detail the more you look at it. So that was incredibly powerful. And then the second piece was, as I said, everybody has a different perspective. So when you're listening to the person next to you say something radically different than what you were thinking in your own brain, completely shocks our cognitive bias.

And it says, huh, you know, I had no idea that that's how they were viewing it or that there's this whole background or context or culture or history behind this person that makes them see that that I don't see. So it really pushes them and it's a [00:07:00] neutral environment, right? Because it's art. It's not a patient, it's not a stressful environment, but just everybody can have their own opinion and they're free to express it.

So, by the way, this is great for interprofessional training, because we do it with medical students, nursing students, they're all free to jump in and give their viewpoint. So that perspective building was really great and really huge jumps, I think, in empathy, because they can understand the suffering sometimes, they understand the perspective, the person next to them and what brought them to that perspective and their background. So there's so many things. Tolerance of ambiguity is another big thing because, you know, as a medicine, we don't have black or white answers to things and looking at art, you don't get an final answer like a multiple choice question. So you're forced to reckon with that and be okay with that. And that teaches them that. So I could go on and on. But there are so many of these lessons. And I haven't even hit the communication pieces because we actually have our students facilitate conversation.

So they have to listen, paraphrase, communicate back point, which I tell them in a code situation or a [00:08:00] team communication. It's really critical, right to check back and listen and make sure that there's closed loop communication. All of these lessons, and it's all done in this very safe, comfortable, beautiful environment of an art museum.

Christine Ko: So with your answer just now, which was nice and comprehensive. I know you couldn't touch on everything, but you did address a little bit, the role of visual thinking strategies in medical education. And you touched on that. There's empathy, there's communication work, et cetera. I've never heard it with those three questions that you said. So it's like, what is going on? What do you see that supports that? And what else is there? So that's great. Because actually it was Dr. Irwin Braverman, who is a Professor Emeritus in my department. He was actually A pioneer really in this. It's evolved now to this point, and I had never heard it called visual thinking strategies. When I first read your article, I wasn't sure exactly what the visual thinking strategy would be about.

Gauri Agarwal: The visual art piece, which I [00:09:00] do think teaches something really unique, happens twice in their first year of medical school. They get an exposure to it in their very first course of medical school. The second session is using it to understand AI, which we've been working on most recently, because as a curriculum dean, I was thinking about how can we teach medical students about artificial intelligence developmentally in a way that's not outdated by the time they graduate because it's just so rapidly evolving, right? I felt like those things needed to be merged. So they learn some basics about A. I., like what the terminology is, what are large language models? They play around with some image generation tools and large language models and generate differentials and all that kind of stuff. They play with V. R. They wear the headset. So they're, you know, playing with all of this advanced technology, but they're doing it in the art museum. And then once they're done, we actually do the VTS exercise. So they're using different parts of their brain, thinking, analyzing the art. And then we actually have them create [00:10:00] art.

And I think what's more important for medical students and for all of us really in health care is to grapple with these really deep questions of what it is that makes us human and how will our roles evolve as A. I., it's integrated into the practice of medicine? And so to me, that's the realm of the humanities, is that reflection, right? It's just incredible. The types of things that come up with what we talked about in the beginning, right? Being there at the bedside at the moment of death, communicating bad news, the physical warmth of touch that we often do in the course of the physical exam or in comforting. So many examples of things that they felt really only humans could do. That's sort of their reflection on where we are right now. 

Christine Ko: That's really cool. I love that last question. Like, what does it mean to be human? To be honest, for a large part of my career, I did obviously know I'm human, but I think maybe the expectation was not to be human, even though, I didn't really have that [00:11:00] consciously in my mind. To some degree, when I think about a really excellent doctor, a really excellent doctor is perfect and doesn't make any mistakes. That's just not my reality. 

Gauri Agarwal: Perfection is not the reality, right? We make mistakes. We say things wrong. We do things wrong. We're not always perfect. 

Christine Ko: Circling back to what we were talking about in the beginning with the spirit or soul. People are so complex and going back to your example with the visual thinking strategies and when you show someone a piece of art and say what's going on here, everyone has a different interpretation. No one has the same one. That just shows the reason I think being a doctor or being a patient is so hard is because there is not one perfect prescription, you know, whether medicine or just the communication piece.

You touched on a couple of times now the [00:12:00] humanities. How, because these situations and doctoring and being a patient are so complex, and can you talk about that a little bit more about how the humanities are important and relevant to us in medicine?

Gauri Agarwal: Really what makes us really excellent human physicians will be our communication skills, our empathy or reflection or ability to coordinate and communicate and adjust, and all of those things that I think that's what the humanities help us do. Whether it's art, whether it's poetry, whether it's writing, reflection, these are tools that help us build those skill sets. They're so critical and important in medical education, now more than ever. 

Christine Ko: I agree with you. Do you have any final ,thoughts?

Gauri Agarwal: I am really grappling with what makes me human and what I will bring to the future of medicine.

Christine Ko: Can I just ask you, when you've been thinking about what really makes you human, have you come to some answers?

Gauri Agarwal: Love. That's really what it boils down to for me. And [00:13:00] connection, at all levels of my life, right? With my family, with my patients, with my colleagues, with work. I truly love it, and I love the people that are in my life, and I'm connected to them in a meaningful way. It's intangible, right? That's the part that I cannot see ever feeling from a machine or being able to be generated from a machine. There might be simulations of love and connection, but not true love and connection. 

Christine Ko: Well, thank you so much for spending the time with me. I really appreciate it. 

Gauri Agarwal: Thank you, Christine, for the opportunity.