Through their eyes: a breast cancer survivor-led art workshop for undergraduate medical students
Original Article | Teamwork and Education in Palliative Medicine and Palliative Care

Through their eyes: a breast cancer survivor-led art workshop for undergraduate medical students

Muna Alkhaifi1 ORCID logo, Rebecca Starkman2, Elwyn Zhang3, Malika Peera4, Preet Ahluwalia3, Ellen Paonessa3, Sylvia Langlois5,6, Sarah Kim7, Joyce Nyhof-Young8,9

1Department of Surgery, Mount Sinai Hospital, Toronto, Canada; 2Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; 3Breast Cancer Survivorship Program, Odette Cancer Centre, Department of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; 4Faculty of Health Sciences, Queen’s University, Kingston, Canada; 5Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; 6Centre for Advancing Collaborative Healthcare and Education, University Health Network and University of Toronto, Toronto, Canada; 7Department of Family & Community Medicine, St. Joseph’s Health Centre, Toronto, Canada; 8Office of Education Scholarship, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; 9Academics Program, Women’s College Hospital, Toronto, Canada

Contributions: (I) Conception and design: M Alkhaifi, P Ahluwalia, E Paonessa, E Zhang, J Nyhof-Young, S Kim, S Langlois; (II) Administrative support: M Alkhaifi, R Starkman, E Zhang; (III) Provision of study materials or patients: M Alkhaifi, S Langlois; (IV) Collection and assembly of data: R Starkman, E Zhang; (V) Data analysis and interpretation: R Starkman, M Peera, M Alkhaifi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Dr. Muna Alkhaifi, MD, MPH. Department of Surgery, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada. Email: muna.alkhaifi@sinaihealth.ca.

Background: As breast cancer survivorship increases, medical education must better prepare students to provide patient-centred care. Traditional didactic methods often fall short in fostering the requisite empathy and understanding. Integrating arts-based learning with patient storytelling may offer an effective approach to support affective and reflective learning outcomes. The objective of this study was to explore the potential of a novel arts-based educational approach aimed at enhancing medical students’ understanding of breast cancer survivor patients’ experiences and empathy through mindful engagement and collaborative creation.

Methods: We conducted a two-hour experiential workshop with 23 first- and second-year medical students at the University of Toronto. Participants heard directly from breast cancer survivors and engaged in a facilitated, clay-based art-making session to reflect on patient experiences. Data were collected via non-participant observers, post-workshop questionnaires focus groups with students, and interviews with patient participants. Quantitative data were analyzed descriptively, and qualitative data were examined using reflexive thematic analysis.

Results: The 23 student participants (100% response rate) described the workshop as impactful, citing deeper emotional engagement, increased empathy, and stronger understanding of cancer survivorship. Key themes included meaningful learning, high-impact educational value, and the workshop’s role as a valuable curricular addition. Patient participants reported feelings of empowerment and affirmation.

Conclusions: Arts-informed, patient-centred education has the potential to enhance empathy and reflective practice among medical students. Future research should explore longitudinal impacts, curricular integration, and interdisciplinary scalability to further evaluate its potential in medical education.

Keywords: Breast neoplasms; humanism; cancer survivors; medicine in the arts; program evaluation

Submitted Sep 16, 2025. Accepted for publication Jan 26, 2026. Published online Jan 28, 2026.

doi: 10.21037/apm-25-110

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Key findings

• Twenty-three participants (100% response rate) reported that the workshop was a positive learning experience and that they would recommend it to other medical students.

• All participants (100% response rate) reported feeling comfortable with the collaborative creation activities, and indicated that the workshop fostered deeper understanding and empathy towards the experiences of breast cancer survivors.

• Key themes from the qualitative analysis included meaningful learning, high-impact educational value, and the workshop’s role as a valuable curricular addition. Participants also provided suggestions for improvement.

What is known and what is new?

• Empathy training remains limited in medical education, leaving many healthcare professionals underprepared to provide survivorship care. Prior research indicates hearing directly from patients enhances medical education. Initiatives featuring patient experiences most commonly rely on narrative approaches. Emerging art-based programs show added value by enhancing students’ self-awareness, their understanding of patients, and supporting emotional awareness and expression among patients.

• This study provides valuable insights for health professionals and educators seeking to enrich medical curricula with pedagogical approaches centered on patient narratives that aim to foster empathy and reflection.

What is the implication, and what should change now?

• The results demonstrate that arts-based learning enhances medical education by fostering empathy, reflection, and a deeper understanding of patient experiences while empowering patient participants.

• Future research should investigate the long-term impacts of arts-based education on clinical behavior.

Introduction

Breast cancer is the most common cause of cancer and the second leading cause of cancer-related death in women in Canada and the United States (1,2). According to the National Cancer Institute, an individual is considered a cancer survivor from the time of diagnosis through the balance of life (3). Breast cancer survivors commonly experience persistent medical and psychosocial issues that continue after treatment completion (4). Patients often report reduced quality of life due to physical and mental symptoms including chronic pain, depression, or fear of recurrence (5,6). As breast cancer survival rates rise, these long-term experiences of those who survive breast cancer warrant significant attention (7,8).

Furthermore, to care for the increasing number of breast cancer survivors, there is an increasing demand for medical professionals who are not only dedicated to practicing empathy mindfully but also possess a comprehensive understanding of breast cancer survivor-patients’ perspectives. Intentional training in empathy remains limited in medical education (9), despite this competency being fundamental to medical practice and essential to delivering high-quality care (10). Meeting the diverse needs of cancer survivors requires meaningful institutional change in survivorship care, starting with embedding survivorship training into medical education curricula and continuing medical education (CME) (11). Research has shown that many medical residents lack the necessary experience and confidence to provide survivorship care (12), highlighting the importance of addressing these educational gaps in the training of future physicians. Empathy focused educational approaches are needed to engage trainees in learning meaningfully about breast cancer survivorship needs.

Prior studies indicate that hearing directly from patients living with chronic conditions (akin to the physical and psychosocial issues facing breast cancer survivors) provides important insights for enhancing health professions education, as the patients possess unique expertise about how a condition and its care affect their daily lives (13-15). This patient-as-teacher model is an effective approach for enhancing students’ capacity to understand and connect with patients (8). By integrating humanistic, patient-centered approaches, this model emphasizes patients’ lived experiences (16) and positions patients as “experts-by-experience”. It enhances student understanding and improves the quality-of-care trainees provide as healthcare professionals (16). Active patient participation fosters the development of key skills in students such as communication, empathy, listening and respect (17,18).

While most initiatives using the patient-as-teacher approach have primarily focused on narrative-based approaches to convey patient experiences, increasing efforts aim to integrate art into medical education. Research indicates that integrating art into care and education benefits both patients and students. Art-based interventions have enhanced emotional access, awareness, and expression in women with breast cancer, while medical students who engaged in poetry and artwork creation programs reported deeper self-awareness and patient understanding (19-21). Art has gained significant attention for connecting students with patient experiences, with various forms supporting learning and enhancing engagement (9,22). For instance, art literacy programs outperform traditional curricula in developing medical students’ cognitive empathy and skills (23,24). Initiatives where students create art reflecting patient experiences after mutual conversation and reflection, help trainees internalize and understand patients’ perspectives (25). The potential benefits extend beyond improved understanding of patients; art therapy-based approaches are effective in improving teamwork and communication skills among health professionals, as well as fostering team building in non-acute healthcare settings (26,27).

This study presents a novel art-based educational approach designed to enhance medical students’ understanding of breast-cancer survivor patients’ perspectives and empathy towards that experience through mindful engagement and collaborative creation. This study explored its potential to benefit both patients and students, while fostering lasting impacts on students’ outlook and perspective—impacts that cannot be achieved solely through traditional teaching methods or patient storytelling.

Methods

Study design

A two-hour workshop for first- and second-year medical students encouraged active participation, collaborative creation, and engagement with the experiences of breast cancer survivors (see Appendix 1 and Appendix 2). In the Canadian medical school involved in this research, the four-year curriculum is organized such that the first two years consist of academic coursework, while the third and fourth years are devoted to clinical rotations. First- and second-year students were recruited for this study to maximize the logistical feasibility of their participation due to the relative flexibility and consistency of their schedules during this period, whereas third- and fourth-year students were less available due to clinical rotations. Participants were divided into two groups, each completing the same activities, but hearing different patients share their story. The workshop began with a 10-minute introduction outlining the session goals, followed by a guided reflection on participants’ motivations for attending (S.L.). Subsequently, participants engaged in a 10-minute introductory exercise to enhance their comfort sharing their emotions and prepare them mentally for art making (P.A., E.P.). A 20-minute open discussion was then facilitated by breast cancer survivors who shared their stories and engaged with student questions. Next, participants individually engaged in a 45-minute clay-based art-making session led by a registered art therapist (P.A., E.P.), aimed at expressing emotions and insights into the patient experience through the medium of clay. Emphasis was on the creative process rather than final products, thereby encouraging mindful participation and reduced anxiety about artistic evaluation. The workshop ended with an opportunity to share reflections on the creation process and a 10-minute experience debrief (S.L.). An outline of the workshop is shown in Table 1.

Table 1

Outline of workshop

Time Duration Activity Objective
9:00–9:10 10 min Welcome & why Introduce workshop goals and activities, mindful reflection on reasons why students came today
9:10–9:20 10 min Group introductions & establishment of space Introductory exercise and mindfulness practice to get participants comfortable with sharing their emotions and in the correct mindset for later activities
9:20–9:40 20 min Patient story & discussion Patient participant shared survivorship story, followed by open discussion and exploration of patients’ experience and feeling, student reactions and questions, and facilitated dialogue
9:40–10:25 45 min Collaborative art Facilitated collaborative creation, encouraging participants to express their emotions and understanding of patient experience. Student art creations are joined together onto a single board in the last 5 minutes
10:25–10:35 10 min Debrief & reflection Open discussion of experience of hearing patient story and reflecting and art creation, followed by a debrief

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by institutional ethics board of Sunnybrook Health Sciences Centre (No. SUN-6407). Appendix 2 outlines study ethical considerations and measures that addressed them. Informed consent was obtained (R.S.) from all participants.

Participant recruitment

The principal investigator (M.A.) recruited two breast cancer survivors and community patient advocates, who met with facilitators prior to the workshop to discuss project goals. Medical students were recruited via email by the research assistant (R.S.), primarily through student interest groups.

Evaluation

Students completed a paper-based post-workshop questionnaire on program impact, accessibility, and delivery and participated in a post-workshop focus group (R.S., E.Z.). Two focus groups were held simultaneously to accommodate participant numbers. Patient participants were interviewed individually virtually (R.S.) post-workshop to assess impact and solicit suggestions for improvement.

Statistical analysis

Quantitative data (demographics and survey responses) were analyzed using descriptive statistics. Qualitative data (transcripts from the focus groups) were analyzed using a reflexive thematic approach (28). Transcripts were coded inductively by two independent reviewers (R.S., M.P.) in parallel. Coding was then reviewed and discussed by the reviewers and themes and subthemes generated through a broader consensus process (R.S., M.P., M.A.).

Results

Quantitative

A total of 23 students (nstudents =23) took part in the art workshop, and all completed the post-study questionnaire and focus group. Eleven (47%) were first-year medical students, and 12 (52%) were second-year students. The majority were female, with 21 female participants (91%) and 2 males (8%). The majority of participants were 21 to 24 years old (n=21, 91%); 2 were 30 years old (8%). Seven participants identified as East or Southeast Asian (30%), 11 as South Asian (47%), and the remaining five as Middle Eastern, White, and Black. Fourteen participants were born in Canada (60%), the remaining 9 in Asia and the Middle East.

Regarding previous experiences, 3 participants (13%) had previously attended an art therapy and/or arts-based education workshop. Two (8%) had attended a workshop on breast cancer survivorship, and 2 others (8%) had attended a workshop on another cancer survivorship. Six participants (26%) had attended a workshop on survivorship of other conditions; 12 (52%) had attended a workshop featuring patients sharing in person stories, and 15 (65%) had attended a workshop where they asked patients questions directly.

Table 2 presents the students’ responses to the post-study questionnaire, which addressed the workshop’s structure, environment, and effects. Overall, participants rated the workshop highly, with all participants (100%) reporting that it was a positive learning experience and that they would recommend it to other medical students. All participants (100%) reported feeling comfortable with the collaborative creation activities and indicated that the workshop fostered deeper understanding and empathy toward experiences of breast cancer survivors. While participants rated aspects like the physical space, incentive influence, and clarity of objectives slightly lower, each still received over 74% agreement.

Table 2

Participants’ responses to questions about the workshop structure/environment and effects of the workshop

Question Strongly agree, agree, % [n] Neutral, disagree, strongly disagree, % [n]
The workshop was a positive learning experience 100% [23] 0% [0]
The workshop contributed to a greater understanding of breast cancer survivors’ experiences 100% [23] 0% [0]
The workshop enhanced my ability to empathize with patients’ perspectives 100% [23] 0% [0]
Overall, the process of collaborative creation contributed positively to my learning experience 100% [23] 0% [0]
I felt comfortable participating in collaborative creation activities 100% [23] 0% [0]
The novelty of the workshop was a factor in my decision to participate 100% [23] 0% [0]
The opportunity to learn from a breast cancer survivor was a factor in my decision to participate 100% [23] 0% [0]
Overall, the facilitators were effective at guiding the workshop and supported my learning 100% [23] 0% [0]
The project team communicated relevant information clearly and effectively 100% [23] 0% [0]
I would recommend this workshop to other medical students 100% [23] 0% [0]
I felt that the workshop was a safe and non-judgmental environment 96% [22] 4% [1]
The size of the group was appropriate and was conducive to my learning experience 96% [22] 4% [1]
The length (duration) of the workshop was appropriate 96% [22] 4% [1]
The workshop’s learning experience could not be replicated through patient narrative storytelling alone 91% [21] 9% [2]
The workshop improved my ability to observe the emotions and feelings of others 91% [21] 9% [2]
I would like this workshop or a similar experience to be incorporated into a formal curriculum 91% [21] 9% [2]
I had a clear understanding of the program’s objectives at the start of the workshop 87% [20] 13% [3]
Registration for the workshop was convenient 87% [20] 13% [3]
The medium and materials used for collaborative creation activities were easy to work with 83% [19] 17% [4]
The physical space of the workshop was conducive to my learning experience 74% [17] 26% [6]

Qualitative

Focus group data (student participants only, [nstudents =23]) and interview data (survivor participants only) were analyzed qualitatively. Two breast cancer survivors participated (sharing their stories and engaging in the artmaking) in the workshop (nsurvivors =2). Both were female identifying, white, and aged between 40–65 years. The cancer survivors had completed cancer treatment within the last 5–10 years.

Four major themes were developed (Table 3). The workshop provided (I) meaningful learning opportunities; (II) high-impact educational approaches; and was (III) a valuable addition to medical education; (IV) Suggestions for improvement were offered.

Table 3

Qualitative results

Name Description Student participants: quotes (all student quotes drawn from focus group data) Patient participants: quotes (all patient quotes drawn from interview data)
Theme 1: meaningful learning opportunities The workshop offered opportunities for students and patient participants to learn in concrete and impactful ways. Students learned about breast cancer survivorship and the importance of providing empathic care for those affected by breast cancer when they become doctors. Patients saw this learning occurring for students and also experienced their own meaningful educational moments – –
   Subtheme 1a: appreciating patient stories Students described learning about the lived experience of breast cancer, during acute treatment and following, in holistic and engaging ways they never had before. Patients described students engaging meaningfully with the stories they shared and understanding the diversity of experiences cancer survivorship “I think that it was very valuable to learn from patients firsthand. We don’t often get to encounter patients in a nonclinical setting, so hearing about their stories in a very honest way was really helpful.” (Student 7). “[The patient’s story] was making me just think about how the relationships and the support that people have outside of the doctor’s office have a big impact on how they come into the office. And I guess just the way that they’ll [patients will] process what’s going on in their health and their emotions alongside.” (S8). “One of the things that I think really stuck with me was that [the patient] mentioned that when she’s at those [oncology] visits alone, that people often think, ‘Oh my gosh, she’s so empower[ed]. She’s so strong for coming alone.’ But she was like, ‘deep down it was really isolating and lonely.’ I think something to keep in mind is to not make assumptions…that not everything is what it looks like on the surface.” (S1). “Honestly, I could have just heard [the patient] talk for an hour…I was really enjoying just hearing her uninterrupted, just laying out her full story.” (S13). “Thinking about our curriculum and how much we talk about empathy and really understanding patient stories and things like that, I think this was the closest interaction I’ve ever had that brought this actually into life in my head.” (S15). “The listening part was the most valuable for me because a lot of times when we listen to patients in other settings, it’s like we’ve just had a lecture on how to talk to a patient, for example, so we’re trying to think, oh, in the future when I’m talking to a patient, how do I apply this and this to their experience? But in a setting like this where it’s just people…and we’re really just trying to connect on a human level is a lot more valuable.” (S22) “When I was starting to talk a little bit about my ex-husband and how he had left me there [at the oncology clinic]…I could see their [the students] faces and I said, every patient has a story…I wasn’t going to the radiation by myself because I chose to go. It’s because I had a husband who just didn’t want to take me. So I was explaining that every patient has a story, and we can’t make assumptions. I think that was a real eyeopener to a lot of them.” (Patient 2). “Yeah, so I think I really do feel that there was a level of…understanding that there would be different emotions involved in breast cancer.” (P1). “I’m wondering if there’s a way of hearing from more than one person with breast cancer, more of a panel as opposed to just one story. And then that way the students have more exposure to the different perspectives.” (P1)
   Subtheme 1b: understanding the impact of healthcare professionals’ interactions with their patients Patients highlighted the lasting impact that the care team has during their cancer journey. Students recognized the impact that doctors and other members of the care team have on patients through their clinical interactions. Stories of positive and negative impacts were explored in patient participants’ narratives “It really stuck with me when she [patient participant] said that she liked how the nurse talked to her just like a friend…I feel like that’s one way just to make someone feel seen beyond just their diagnosis.” (S6). “I think it also really stuck with me when she [patient] was saying whatever interaction she has with healthcare professionals will be part of her story and something that she’ll remember forever when going through something like breast cancer. So that just made me reflect on the importance of our response to things as healthcare practitioners.” (S4). “Something that I really learned from interacting with [patient partner] was the importance of just listening and being there for the patient, which I think was a valuable aspect of having the patient share their experiences with us. Because sometimes we think all the benefit of medicine is just in the therapeutic, the actual medicine that we prescribe for them or physical things that we give to them. But a lot of it [the benefit] comes from just the empathy and the sense of being there for someone and that plays a huge role in the therapeutic relationship as well.” (S9). “When [the patient] was talking about how the healthcare providers, especially the nurse, saw that she didn’t have someone with her at those appointments and everyone else had their partners with them, I think she [the nurse] made the extra step to go sit beside her [the patient] and hold her hand. It really reminds me that as a healthcare provider in the future, if there’s something that you see that intrigues you or something that you want to learn more about, it isn’t hard to reach out to the patient, whatever that might look like.” (S11) “One of the things I really wanted to get across was that every time a doctor says something, as a patient, we remember it adds to our story. And I was explaining how now even though I am 15 years in remission, I have a story [of] little pieces that I’ve collected. That because of certain things doctors have said, when it comes up about having children, that is when I get very emotional because I had a doctor say something horrible, and that is now what stuck in my mind. So we were talking about every time you [students] say something, you tell a story, it creates adds more to the story.” (P2). “And I think that little piece really started making them think that it’s not the news and always how you deliver it. It’s how you make them feel when you’re giving a patient news and how you’re connecting. It’s the feelings in that moment that we [as patients] remember and we carry that with us.” (P2). “I guess you could say, I’m always meeting doctors that are farther along in their career, so I don’t know where they started from. But just being around these young, eager doctors or med students, I guess I just felt like I was learning things through their eyes.” (P2)
   Subtheme 1c: enhancing practitioner empathy Student participants shared feelings of empathy and care that were acquired/felt through their processing of the patient partners’ stories “A lot of times in class we’re given a patient story but then we have to immediately come up with a response and we’re not really given the time to reflect on it. And I think being able to sit there and create our thinking about the patients really helps us to develop that sense of stronger empathy.” (S5). “I want to echo a lot of what [student name] said regarding our exposure to patient stories and our curriculum current. I feel like a lot of it is very much shallow empathy in the sense that even asking a patient about their life story or how they’re feeling about their thing, it’s just almost framed as a checklist that we should be learning about whenever we’re doing a clinical assessment. It’s literally like, oh, did you get points for asking them about their feelings? It’s really a very shallow, systematized and non-human way to actually ask a person about how something devastating might be affecting their lives. And I think the actual proximity to hearing the patient tell their full story, not interrupting them in any way, just giving them the floor entirely, I think really helps. It makes them the actual narrator of their story.” (S13). “Being sort of forced to think about [the patient’s story] and whatever comes up actually creates something from it, I think results in a much deeper engagement with the patient. Compared to just checking off a box and being like, oh, I’m sorry you’re going through that. How are you feeling? Oh, that sounds really tough. Next question. So ultimately this was a much deeper, and I’d say more true experience of what empathy actually looks like.” (S6) “I really do feel that there was a level of empathy there [from students]. A level of compassion and understanding that there would be different emotions involved in breast cancer. And I think that really came out when some of the students reflected that.” (P1). “They [the students] were definitely, I think, very quiet and very empathetic. I could tell they were really processing a lot of what I was saying. So I felt a lot of connection and a lot of support from the listeners in the room. They were all very attentive and I think they were feeling a little bit of empathy for me.” (P2)
Theme 2: high-impact educational approaches
   Subtheme 2a: encouraging student reflection Emphasis on reflection both in instruction and in time allotted to actively reflecting “I think we don’t get much practice with “presence” in usual classroom situations. And I feel like this [was] really a time that’s dedicated for us to sit down and not think about anything else. Especially with the grounding statements that were read out to us before we started the session, I found that really helpful because we usually have a lot of different things to keep up with and this was nice to just not think about anything else.” (S3). “The first thing [I liked] would be the grounding exercise because we all as a group took the time to meditate as one instead of oh, one person’s not doing it.” (S7). “Usually even when we hear patient stories in class, it’s like we move on to a lecture right afterwards and we don’t really get the time to sit with people’s stories. So it was nice to have dedicated time where we knew we couldn’t do anything else so we could just think about what we heard.” (S7). “I learned a different way to be reflective. I don’t think I’ve ever had to be reflective in such a creative way, especially when it’s tied to something like medical or related to medicine.” (S2). “I think that having the time to be thinking about her [the patient’s] story after you’ve heard it and having to quietly sit and ruminate on it is good to help you, I guess, think through it more instead of just having to try and say something immediately or that kind of thing.” (S8). “I liked how there wasn’t much direction given to us. It was just kind of use the clay and let yourself feel while you play with the clay because it was nice to use that time to reflect. How did that story make me feel? What does that look like to me?” (S1) “This [workshop] lets them [the students] reflect and kind of almost guide their own learning from you give them the story and then you let them take what they want from that story instead of telling them very prescriptive, this is what it’s like to be, to have breast cancer and giving them a list of things.” (P1). “I was nervous going into [the workshop] just because speaking in front of a group of people is never easy, at least not for me. But the funny thing was, is that grounding exercise where right before the patient spoke, I found that grounding exercise helpful for me. It is like, okay, I’m in the moment so that I let all the distractions of my life kind of go away and I was there to tell my story. So I think it really helped just kind of allay my fears and get me engaged as well.” (P1). “After just telling my story, it was nice to sort of sit and be a part of that process and just even for myself, just to take a minute to sit and just be in a quiet space and just sort of be in my own flow.” (P2)
   Subtheme 2b: freedom from evaluation If output or evaluation were not required as evidence of learning tied to participation, students experienced a freedom to engage with the patient story that was impactful and meaningful for them “We didn’t really have instructions for the work [and] that kind of provided a sense of safety, because we weren’t really being judged based on what they told us to do or what instructions would’ve been given out.” (S11). “I think just in the beginning knowing this [art] is just for your own reflection and there’s no assignment component. You’re not going to say, ‘She created that’; ‘I created this’ and I have to explain it. I like that [that] anonymity was kind of established from the beginning.” (S6). “Not being evaluated in any way… it made it much more conducive to a genuine empathy rather than something that you’re putting on maybe just so you could get a mark.” (S13). “I liked how there wasn’t much direction given to us. It was just kind of use the clay and let yourself feel while you play…Versus being like, okay, let me make this because they want to see this.” (S1). “The reason that this felt so different for me was not just the component of creation. It was the fact that unlike in our clinical skills, I wasn’t trying to collect information in any way. I wasn’t trying to take things that I would have to put in a case report…the fact that I didn’t have to write down what it should feel like, what are her ideas about where this is coming from? How is it affecting her function, whatever. Not having to gather any kind of clinical information, I think took a lot of the pressure off, and so I could just sit there and listen and receive.” (S16) “Having the students talk with each other and sharing their ideas gives them a sense of what it feels like to be in an open space, to speak freely, to say what their ideas are and be vulnerable with their ideas and not worry about someone saying, that’s not a good idea.” (P2)
   Subtheme 2c: patient stories are most powerful in person The experience of being in front of a live patient telling their survivorship story was significant “It’s different to be in a room… Actually listening to the patient, it’s different when you hear them talk and breathe and they’re there. You are forced to be present with whoever’s there in the room. You just don’t get the chance to wander off.” (S15). “The ability to ask [patient partner] questions directly. I think that is what separated this from just a zoom lecture of a patient talking. But actually getting to ask specific questions and hearing people ask her questions and seeing people engage more. I think I really valued that because it felt like she had ownership over her story, but then we also had ownership as participants to respectfully and truly be there.” (S17). “In clinical skills we learn a lot about empathy, and we watch videos sometimes, but it’s not the same as listening to a real patient come in and share their story.” (S5). “We’ve had patient stories that they post or sometimes they have in our Friday lectures, which a lot of people don’t attend. But I’ll be honest, I find myself skipping anything that’s not necessary to the exam. And I feel like in a smaller setting like this, especially paired with a hands-on activity, I was much, much more motivated to be present and really listen to the patient. And because we were a smaller group… proximity wise, I felt closer, and it felt like she was speaking to me directly.” (S19). “I think the actual proximity to hearing the patient tell their full story… I wanted to just hear her keep going, and honestly, we couldn’t because time constraints, but I was really enjoying just hearing her.” (S13). “We have had patients speak to us, but it’s always been over zoom or over a virtual setting or a virtual platform, and I think that having it be in person in small groups is a lot more conducive to practicing empathy.” (S12) “I was really, really impressed by the students’ questions after I had shared my story. I thought they were very thoughtful and they were curious, and what I was afraid of was the wall of silence after you speak. So I was pleasantly surprised about how engaged they were and just the meaningful questions they asked.” (P1). “Personally, I felt a little bit of a relief as I was sharing my story. There was release and release in a good way. Not that I was holding onto anything negative, but a release of being able to give back. I think that was a huge part for me. I like to give back, and I mentioned it when I was talking. I wanted to take what I’ve been through and give it back in some capacity, because the way I look at it, I might as well. I’ve been through this, and I’ve come out of it on the other side. So I always think to myself, what’s my purpose here? And I feel like my purpose was, it’s to give back and to share my story. And it was really sweet because one of the med students came up to me after and said, you’re a really good storyteller. And that made me feel really nice.” (P2)
Table 3 (continued)
Table 3 (continued)
Name Description Student participants: quotes (all student quotes drawn from focus group data) Patient participants: quotes (all patient quotes drawn from interview data)
Theme 3: workshop is a valuable addition to medical education
   Subtheme 3a: novel Aspects of the workshop resulted in a novel experience compared to the usual curricular and learning opportunities “Oftentimes even if it’s a lecture or a speaker, just watching it online or even attending it in person, I just find myself zoning out because I just can’t keep that attention span for that long for some reason. But having something physical to handle and to think about it just really helped me to do both things. So very engaging.” (S10). “I think [this workshop] it’s a really different way of learning than what we’re used to.” (S8). “ I think that the reason that this felt so different for me was not just the component of creation. It was the fact that unlike in our clinical skills, I wasn’t trying to collect information in any way. I wasn’t trying to take things that I would have to put in a case report.” (S16). “Not to sound obvious, but it was the clay…I feel like literally having a fun aspect to it encouraged me to come…I think [the clay is] unique and fun.” (S19). “I think that it was very valuable to learn from patients firsthand. We don’t often times get to encounter patients in a nonclinical setting.” (S7) “When I first started teaching in medical school, it was very didactic. You told the students what they needed to learn…But this was more interactive and I thought it gave them much more chance to reflect. A lot of medical school teaching is very just, there’s no time to reflect. You have to learn X, Y, and Z, and there’s no time. I think that creative element gave them time to reflect with the clay. So I think it was quite different from other encounters I’ve had with medical students.” (P1). “[Clay] it’s about getting your hands dirty, and it’s about, if you don’t like it, it’s very easy to just manipulate it or mold it or take something out. Whereas if you draw oh, and you got to erase it and all that. So I found the clay has a lot of leeway to it, which is really nice. And you can really add, you can take away. And again, I don’t think clay is something a lot of people use often, which is nice. Not in their comfort.” (P2). “I love making art. I love that side of thing. It’s something I haven’t done for a while…I enjoyed creating and thinking about my own story and what I was going to create.” (P1)
   Subtheme 3b: this approach is desired Desire for this kind of opportunity to be more available, and part of the official medical school curriculum “I think it’s really important for this [workshop] to be somewhat incorporated into our medical curriculum. I think in clinical skills we learn a lot about empathy and we watch videos sometimes, but it’s not the same as listening to a real patient come in and share their story and then having a space to reflect on it.” (S5). “I would love to see them [study PI] keep advocating to incorporate this [workshop] in medical education somehow because I feel like we’re again told to kind of think very academically, but I think this kind of brings back the human aspect of medicine in a way.” (S6). “I think it [the workshop] would be a useful thing to incorporate into the curriculum because I think it’s a really different way of learning than what we’re used to.” (S8). “I think it would be amazing to have something like this [workshop] incorporated…we have times where we are doing reflections a lot of the times, but they are just verbally or written on our own time.” (S10). “We also do IPE electives, and I feel like that’s a really nice space for people to sign up for this kind of thing [the workshop] because they’re choosing to sign up for it based on their interest, and it’s not mandatory.” (S3). “I was thinking maybe incorporating [this workshop] into clinical skills because I think in our clinical skills groups we already feel fairly safe in those groups and we’ve built rapport with those students as well. And a lot of the times in our mandatory activities in med school, they rarely incorporate these types of art-based activities… But if it’s incorporated into something that we have to go to...I think that students would be more receptive to that. I do think that everyone should participate in something like this.” (S7). “Not having to gather any kind of clinical information, I think took a lot of the pressure off, and so I could just sit there and listen and receive… There was something that I really appreciated about that. I wish that we kind of got more opportunities to do that.” (S14) “And I think the students need to learn that there is art and science in medical school... I think it’s nice to bring that [the arts] in and to teach them at the younger years that there is an art to medicine as well.” (P1)
   Subtheme 3c: safe and comfortable intervention “We didn’t really have instructions for the work [and] that kind of provided a sense of safety because we weren’t really being judged based on what they told us to do or what instructions [were] given out. Instead, we were given the space to create a sculpture… reflect in how we felt about the patient’s experience and the words that we also wrote down prior. So I think just being able to combine all that in a way that feels right for us was a sense of safety.” (S11). “The first thing would be the grounding exercise… I think all of us were in that moment together, so that allowed for the space to feel a little bit safer. And then also I think the facilitators and the patients sharing their stories were all very open and very nice and it allowed us to feel safer and open sharing as well.” (S7) “I totally felt very safe and very comfortable…I think knowing everyone on the team, I think that really helped. And having those meetings beforehand to prepare. I think that really helped because it just felt like you were part of the team and you had the support, especially if there was something that went wrong.” (P1). “To be honest, I felt really safe, really welcomed in all the meetings. I think it was very kind of you to offer to go through my writeup. If you need any help with anything, you offered to give me assistance that was really kind. I felt very supported…my voice was definitely heard. Everyone was very kind and honouring, and it was a very safe place to just share.” (P2)
Theme 4: suggestions for improvement
   Subtheme 4a: subgroup structure The workshop was delivered by splitting the students into two subgroups for the patient story, artmaking and reflection on joining the art pieces. The groups came together for the final reflection segment. Opinions were shared about the possibility that the large group was too large and challenges to using 2 groups that split and come back together “I feel like this [sub-group] was the perfect size. and maybe If there was a change, even smaller is nice too. But larger, then I feel like not everyone would be able to voice their experiences or opinions.” (S3). “Since we have a large group, it’s possible that some of us will have somewhat similar thoughts…for example, if somebody said something remotely close to what I was thinking, I would be like, ‘Okay, I don’t really feel the need to speak.’ So [I] figure if there was a smaller group, you’d get much more individual participation.” (S13). “Because we heard two different stories from two different patients, I was also worried that if I said something that referenced being very specific to the patient’s story, that perhaps that they wouldn’t be comfortable with that being brought up again, given that it’s a new group of individuals. So I think maybe if that was prefaced before bringing the two groups together, just from an ethics standpoint, that might make it easier for some people too.” (S14) “I liked at the end how everybody was kind of giving their one word of what they thought [in my small group]. … There were so many beautiful words in my room. I didn’t get to hear any of the words happening in the other room. So it would’ve been neat…just to hear maybe what was going on in the other room.” (P2)
   Subtheme 4b: pacing Regarding timing of different segments of the workshop “Maybe just a little more time in terms of bringing the [art] pieces together to see how they fit, just for a little bit more time to reflect and decide what goes where [on the combined board].” (S2). “I feel like the discussion [at the end of the whole workshop with both groups] kind of felt a little bit short to me.” (S17). “I’d extend the length of the second half of this project…by the time we had actually sat down to hear [patient partner’s] story, I feel a lot of time had passed...the introduction piece, the why are we doing this, what’s the study about? All of that stuff could have been a bit more condensed.” (S18). “I was tired towards the end of the day, so the timing [the length of the workshop] would’ve made a difference, especially when you think about being receptive to what people are telling you and also creativity. You need space after a day of class and labs and things like that.” (S15). “I think the length was good. That being said, though, I haven’t done much today. I haven’t had a busy schedule.” (S16) “I think it would be great to have more time [for my story], but realistically, I would also like to keep the time allowed for questions. I think that’s really important.” (P1). “I think time is the only barrier [to my ability to share my story] really… I think I went over by maybe two minutes, so I was probably about 12 minutes instead of 10.” (P1). “I think the only barrier would be nine minutes was pretty tight [to share my story]. It was pretty short, not impossible.” (P2)
   Subtheme 4c: changes to physical space Regarding the layout, type of seating, lighting, sound of the space used “I feel like the environment could potentially be a bit more relaxing. Like fluorescent light and sitting at a conference room table…creates a bit of a colder environment.” (S4). “I feel like maybe if it was a circular table or if there was more open space, maybe that would help. And then maybe, if there was some music that might’ve made it a little bit more relaxing.” (S3). “When we said about the music, I think when it was really silent in here. All you could hear is just the clock ticking. So just having some light sound in the background makes it feel comfortable and makes not an awkward silence or anything.” (S1). “I wouldn’t mind even sitting on the ground and just more casually crisscross, but obviously if there was a carpet put on the ground first. I feel like that could be a cozy kind of comfortable situation. Like maybe pillows or something.” (S6). “I think one thing to consider is if we were in a circle or if in a more conducive environment to sharing, that might help potentially, but I don’t understand there’s limitation to the room itself, so just a small one.” (S12). “I’m just thinking about what [Student 12] said earlier. I think even if it wasn’t possible, it’s a circle. Maybe just having [patient partner] be able to sit at the table with us maybe would’ve felt more intimate like a conversation was being had. I think sometimes when someone’s at the front of the room and just kind of seems like we’re entering a lecture again though, I think her story was very engaging.” (S14). “I find that in silence, my mind actually wanders because I’m thinking about other things. And also sometimes I think silence can be a little bit awkward… maybe having some sort of very soft music or something in the background that doesn’t take away from people’s thought process. But it’s just something there so you don’t feel as isolated or as a little bit awkward.” (S22). “I was kind of imagin[ing] jazz music or something. I almost wish there was something playing with people talking. Yeah. I think again, to prevent my mind from wandering.” (S18)
   Subtheme 4d: informal interaction with patients Desire for informal interaction with patient participant outside of the question and answer period following the patient story “It would’ve been nice if we had also been able to interact with them [patients] more informally while also doing the art portion of the workshop. I think it would’ve been more conversational and a lot of us would’ve been able to ask [questions].” (S7). “I also agree that it would’ve been nice to have a bit more, I guess informal interaction with [patient partner] because there was the question period at the end, but I didn’t really have a specific question to ask, but there were things I would have.” (S8). “I think there were thoughts that…I didn’t ask because the time constraints and it’s a bigger group of people or I didn’t know how to phrase things. I think it would’ve been nice to have a bit more time to informally interact with [patient partner]… Especially the opportunity to debrief with her after having a moment to reflect and I think it was mentioned before, some opportunities for more informal discussion with her would’ve been it.” (S4). “When me and [another student] came in at the end, [patient partner] was standing there and we were talking to her about how great it was and she was like, ‘Oh my gosh, thank you.’ Because I don’t think we got to tell her that when she was here formally, but that would’ve been nice at the very end because we would’ve had that rapport and felt comfortable talking to her about that.” (S1)
   Subtheme 4e: sharing about one’s artwork Students/patient did not share with the group about what they created and why, and how it connected to their reflections on the story. Desire was to do so “I like the idea of telling the patients how their story made us create what we created. Having the option, maybe not everybody wants to share that, but I think even they would’ve liked to hear how we interpreted that [their story].” (S6). “Instead of having that large group session at the very end…I think it would’ve been nice to have that in this room [where the small group had been] and then reflect on the same questions out loud with [the patient partner] and also go through explaining to her how our pieces were inspired by her.” (S1). “I feel like it might’ve been nice to know from the get-go that we wouldn’t have to share anything about our work if we didn’t want to, because as I was building, I was like, ‘Oh my gosh, this has to symbolize something’. And although it did to me, it wasn’t necessarily something that I wanted to share per se.” (S16) “The students seemed to really want to know about each person’s creation. They wanted to know what did you create and why did you create it?… I could tell even side conversations [between] some of the students, they were pointing out which piece was yours and why did you do this?” (P1)

Discussion

Mixed method analysis showed the workshop provided a powerful and novel learning experience for these medical students. Integrating in-person patient storytelling with creative, arts-based expression created an emotionally resonant format that students found more impactful than traditional didactic or narrative-only approaches. Hearing directly from a breast cancer survivor without interruption and asking questions were seen as especially meaningful. Students reported a deeper understanding of survivorship and highlighted the value of first-person narratives in enriching clinical knowledge and illustrating the diverse, individualized nature of the cancer journey (29,30). Patient participants felt empowered and affirmed by the storytelling experience, supporting evidence that co-creating survivorship narratives can be both educational and therapeutic (31,32). Our findings align with a broader shift in medical education toward incorporating real patients as teachers.

The integration of patient storytelling in medical education is valuable to consider alongside other educational approaches. Much of the existing medical education curriculum still relies heavily on standardized patients (SPs) (33-35). The use of SPs offers medical students and their evaluators important advantages that support consistent learning and equitable assessment across student cohorts (such as controlled interactions and standardization). These types of simulations are especially suited to clinical skill acquisition and evaluation during the early years of medical training (33). Yet, the same standardization that makes SPs valuable for assessment also limits the depth of emotional engagement and contextual richness they can provide. Unlike scripted SP interactions, authentic patient encounters carry the emotional complexity and nuance that students in our workshop identified as especially powerful. Exposure to patient narratives like those offered in our workshop, offers students meaningful insight into living through illness and navigating health systems (34), and significantly enhances students’ patient-centered clinical reasoning compared with more traditional or simulation-based materials (35).

The workshop’s focus on reflection and clay-based art making fostered authentic engagement. Students’ positive reactions to the use of clay as the creative reflective tool align with MacAskill et al.’s (36) systematic review identifying artistic creation as a key reflective learning method. Participants’ enjoyment of the clay medium illustrates that artistic creation can be an engaging vehicle for facilitating reflection and enhancing student empathy and patient-centred care (37). Consistent with prior studies (38-41), combining the patient-as-teacher model with art-based approaches enhanced medical students’ understanding and feelings of empathy toward breast cancer survivors.

Student and patient participant feedback indicated high satisfaction with the workshop’s structure, content and goals. It was described as a safe, meaningful, and valuable supplement to medical education, offering benefits not typically available in traditional curricula. Suggestions for improvement included smaller group sizes, adjusted pacing, enhanced physical space, and increased opportunities for informal interaction and art sharing.

Limitations

The research assistants who conducted the evaluation focus groups were present during the workshop (albeit not in a facilitator role), which may have influenced how openly participants shared critical perspectives or negative experiences and may have contributed to social desirability bias. Furthermore, as participation in the workshop was voluntary and not part of the medical school curriculum, it is likely that the students who chose to enroll had a pre-existing interest in arts-based learning. This may have contributed to more favorable evaluations of the workshop, introducing the potential for bias. Additionally, the study assessed only immediate, self-reported impacts without evaluating longer-term effects on students’ attitudes or clinical behaviors. Finally, the evaluation was conducted solely at Kirkpatrick Level 1, and therefore, it cannot be concluded that the intervention directly enhanced empathy and collective practice among medical students.

Implications, future directions

This study demonstrates that arts-informed, experiential learning enhances medical education by fostering empathy, reflection, and deeper understanding of patient experiences, while empowering patient participants. It offers valuable insights for health professions and educators seeking to enrich curricula with pedagogical approaches centred on patient narratives that foster empathy and reflection. Our findings suggest that experiential, arts-informed learning is a promising complementary strategy in undergraduate medical education. Future research should examine longitudinal impact on clinical behavior, most notably communication with patients, attitudes toward chronic illness and survivorship, as well as scalability, interdisciplinary application, and integration within existing curricula.

Conclusions

The study findings demonstrate that arts-informed, experiential learning, when combined with patient narratives, can enhance empathy, reflection, and a deeper understanding of patients’ experiences among medical students, while also empowering patient participants. The study findings can be used to support approaches aiming to incorporate arts-based learning into medical education. Both quantitative and qualitative findings indicate that the workshop was a positive learning experience, and participants valued the collaborative creation activities. Future research should focus on longitudinal effects, as well as the scalability, interdisciplinary application, and integration of arts-based approaches into medical education.

Acknowledgments

We extend our heartfelt gratitude to the patient participants, Jennifer Boyle and Sara Mody, for generously sharing their stories with us. Special thanks to Nicholas Bridi and Brittany Chang-Kit for their assistance with recruitment. We also sincerely thank the student participants for their enthusiasm and engagement in this study. During the preparation of this work, the authors used ChatGPT in order to assist with editing sections of the manuscript and reducing words where necessary. After using ChatGPT, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Footnote

Data Sharing Statement: Available at https://apm.amegroups.com/article/view/10.21037/apm-25-110/dss

Peer Review File: Available at https://apm.amegroups.com/article/view/10.21037/apm-25-110/prf

Funding: This research was funded by an Art of the Possible Grant from the Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto (No. AOP9-7).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-25-110/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by institutional ethics board of Sunnybrook Health Sciences Centre (No. SUN-6407). Appendix 2 outlines study ethical considerations and measures that addressed them. Informed consent was obtained from all participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Cite this article as: Alkhaifi M, Starkman R, Zhang E, Peera M, Ahluwalia P, Paonessa E, Langlois S, Kim S, Nyhof-Young J. Through their eyes: a breast cancer survivor-led art workshop for undergraduate medical students. Ann Palliat Med 2026;15(1):5. doi: 10.21037/apm-25-110

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