‘Creative Enquiry helps us have safety nets for our own emotions and situations, which directly improves how we care for patients. Everyone I know in foundation training goes through all sorts of difficult experiences that we have next to no time to recover from – both physically and emotionally. [Creative Enquiry] supports us to stay human and trust our gut, rather than feeling like we’re just filling rota gaps.’ (Mashael Ishaque, FY2)

As Clinical leaders we recognise the need to unlearn and relearn some new skills to enable us to lead colleagues in the Human Dimension. As senior clinicians our autonomy, attention to detail, perfectionist traits and desire to ‘fix’ can be seen as strengths. As leaders of teams, we need to develop a different set of skills that lean more heavily on the more human dimension. As we move from caring for patients and their families to a more system wide leadership approach, we need to flex to enable us to delegate, decide where we focus our energies and how we create space for wider discussion and shared decision making. This learning should enable us as leaders to appreciate the challenge of balancing the Clinical and Human Dimension that many of us face in our clinical roles with more clarity.

The Human Dimension is everything to do with the ‘humans’ we work with. Those who have symptoms or illnesses (patients) and the humans that care for them (relatives, friends as well as healthcare professionals) and the humans that are learning in the healthcare professions (students). The Human Dimension includes the spaces where those relationships, meanings and experiences unfold.

One way of conceptualising it is through an image of the double stranded DNA of the medical consultation or of medical education itself, where one strand represents the Clinical Dimension.¹ Students go up the spiral growing in Clinical prowess and the ability to name diseases and apply treatments. It is the world of right and wrong answers. We represent the Clinical Dimension with the question ‘What is your diagnosis?’ or ‘what is the matter with you?

For the Human Dimension, clinicians need to travel down the spiral to explore the question ‘How can I help you?’ or ‘what matters to you?’ This is a different kind of question where the doctor needs to understand something of the patient in order to begin to explore how they can be of help. It may involve diagnostic capability, but may also involve writing a letter, listening or advocating. Clinicians learning about the Human Dimension are invited to grow their curiosity, epistemic humility (understanding the importance of patient lived experience for example and valuing this as a way of knowing or expertise)¹ and ‘negative capability’ – that is, being able to be present in uncertainty and not knowing, drawing on the medic become poet, Keats.²

If we were to agree that the Human Dimension is important potentially to both clinician and patient (and there is growing evidence base for the value of relational care, the importance of connection, alongside recognition of growing bureaucracy meaninglessness and burnout),^3,4 how might we then create space in educational or clinical spaces for this Human Dimension?

In fact, our clinical practice and education culture is rapidly moving in the opposite dimension of valuing the human. Clinical practice faces neoliberal and economic forces, the increasing complexity of medical knowledge, the rise of AI, growing disconnection across colleagues, reduction in trust in the doctor-patient relationship and a surge in patient complaints and litigation. In the field of clinical education students have increasingly complex lives, financial constraints, their own health issues, alongside growth in learning from technology which in the UK at least involves ANKI cards (a whole set of knowledge-based learning can be passed from one year to the next, mitigating the need for attending lectures), Geeky Medics OSCE practice (mitigating need to meet patients) and PassMed questions to prepare for the Medical Licensing Assessment (mitigating the need to be on the wards). Engagement decreases, students become disconnected from each other and their educators and in particular from the lived experience of being in the complex and messy system that healthcare is.

So how might we emerge the Human Dimension curriculum in education and the Human Dimension space in clinical practice? This is a design question, which requires co-creation including understanding the frontline experience whether student, patient or clinician, alongside system constraints and potential spaces for this work. One methodology that we have found that profoundly supports access to the Human Dimension is through creative enquiry – that is exploring lived experience through the arts.⁵ Here we propose extending reflection and how we think about practice from patient, student, clinical perspectives through encounter with the arts. Evidence for the transformative nature of such engagement is drawn personally from years of enabling these kinds of spaces in medical education^6,7 and in the wider literature.^8-10 Students describe ‘life changing impact’,¹¹ ‘being astounded at the support and warmth which my peers approached my contribution’¹¹, learning to ‘see beyond clubbing and splinter haemorrhages to the story behind [a patient’s] withered hands to the person and all their history.¹²

What if we started as medical students engaging in spaces where we could explore what it is to be human in our complex systems and threaded this through to our first years as resident doctors and beyond? What if we built our future doctors with a deeper understanding of what makes us human intertwined with, rather than subsumed by the clinical dimension? In the light of opposing forces, can we reclaim the human dimension of healthcare that we are uniquely designed for and take for granted at our peril. In turn would nurturing the human dimension (understanding ourselves, others and our systems) equip us better towards more compassionate leadership?

We would love to open a discussion around how promoting and nurturing reflection through creative enquiry could feed into rehumanising healthcare.

References

1. Younie, L. Flourishing spaces: purpose, qualities, theoretical roots and implications. Journal of Holistic Healthcare 22, 3-6 (2025).
2. Keats, J. in The Letters of John Keats, 1814–1821 (Vol. 1, pp. 193–194)   (ed H. E. Rollins)  (Harvard University Press, 1958).
3. Scott, J. G. et al. Understanding Healing Relationships in Primary Care. Ann Fam Med 6, 315-322, doi:10.1370/afm.860 (2008).
4. Sinskey, J. L., Margolis, R. D. & Vinson, A. E. The Wicked Problem of Physician Well-Being. Anesthesiol Clin 40, 213-223, doi:10.1016/j.anclin.2022.01.001 (2022).
5. Younie, L. & Swinglehurst, D. Creative enquiry and reflective general practice. Br J Gen Pract 69, 446-447, doi:10.3399/bjgp19X704969 (2019).
6. Younie, L. A qualitative study of the contribution medical humanities can bring to medical education MSc thesis, University of Bristol, (2006).
7. Launer, J. & Younie, L. in Finding meaning in healthcare: Looking through the hermeneutic window   (eds R. Shah & R.  Clarke)  100 – 120 (Routledge, 2025).
8. Haidet, P. et al. A guiding framework to maximise the power of the arts in medical education: a systematic review and metasynthesis. Med Educ 50, 320-331, doi:10.1111/medu.12925 (2016).
9. van Woezik, T. E. T., Stap, T. B., van der Wilt, G. J., Reuzel, R. P. B. & Koksma, J. J. Seeing the Other: How Residents Expand Their Perspective by Learning With the Arts. J Grad Med Educ 15, 50-58, doi:10.4300/jgme-d-22-00140.1 (2023).
10. Moula, Z. et al. A Scoping Review of Programs of Active Arts Engagement in International Medical Curricula. Perspect Med Educ 14, 296-308, doi:10.5334/pme.1506 (2025).
11. Younie, L. & Adachi, C. Nurturing the Human Dimension in Digital and Medical Spaces Through Pedagogy of Care – a Case of Creative Enquiry. Perspect Med Educ 13, 307-312, doi:10.5334/pme.1147 (2024).
12. Younie, L. in Creative Arts in Humane Medicine   (ed C.L.McLean)  163-180 (Brush Education Inc., 2014).
13. O’Carroll, A. The Triple F**k Syndrome: How medicine contributes to the systemic oppression of people born into poverty. BJGP Life (2022). <https://bjgplife.com/the-triple-fk-syndrome-how-medicine-contributes-to-the-systemic-oppression-of-people-born-into-poverty/>.
14. Sointu, E. Challenges and a Super Power: How Medical Students Understand and Would Improve Health in Neoliberal Times. Critical Sociology 46, 851-865, doi:10.1177/0896920519880242 (2020).

Authors

Louise Younie

Louise Younie is a GP and Professor at the University of Oxford and at Queen Mary University of London, developing Creative Enquiry Methodologies for introducing the Human Dimension and facilitation of Flourishing Spaces in medical education.

Anna Baverstock

Anna Baverstock is a consultant community paediatrician looking after children and young people with complex neuro-disability and their families. She also has a leadership role as associate medical director looking at medical leadership and wellbeing. A member of civility saves lives group, a senior consultant at Doctors training and a passionate advocate of kindness in healthcare.

Declaration of Interests
Louise Younie: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Funding bid from the Della Fish Foundation for work in the field of the Human Dimension of Medical Education, Chair of the Royal College of General Practitioners Creative Health Special Interest Group, Editorial team for the Journal of Holistic Healthcare, Lead for Flourishing Spaces Website, Newsletter and Team.
Anna Baverstock: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Senior consultant at doctors training, speaker with civility saves lives