Health education for classical musicians

Could compulsory health education at UK conservatoires improve the health and wellbeing of classical musicians? Dr Raluca Matei of Birkbeck’s Centre for Sustainable Working Life shares the findings of a recent study conducted with Jane Ginsborg, Juliet Goldbart, and Stephen Broad.

Picture of classical musicians

Despite rating job satisfaction very highly, many classical musicians also suffer for their art. In the largest survey to date (Fishbein et al., 1988), 76% of players reported a medical problem severe enough to impair performance. The most prevalent were musculoskeletal, affecting the shoulder, neck and back, however, they also reported acute anxiety, depression, and sleep disturbances.

More recent research shows that musicians experience hearing loss (O’Brien et al., 2014), visual problems (Beckers et al., 2016), and eating disorders (Kapsetaki and Easmon, 2017). There is a higher prevalence of insomnia and psychological distress among musicians than in the general population and they may be more likely to use psychotherapy and psychotropic drugs such as sedatives, antidepressants, hypnotics and/or medication for attention deficit hyperactivity disorder (ADHD) (Vaag et al., 2016a,b,c).

Compulsory health education for music students

Our study sought to find out if we could empower musicians to improve their health through a conservatoire-based health education course. The course was delivered to first-year undergraduate music students at a UK music conservatoire. The aims of the study were:

  • To explore students’ hearing and use of hearing protection
  • To design an evidence-based health education course
  • To assess the effects of the course on primary outcomes (perceived knowledge of course content and knowledge and awareness of potential risks to health) and secondary outcomes (including general health, health-related quality of life, health-promoting behaviors, self-efficacy, emotional state, perceived stress, frequency and severity of playing related musculoskeletal disorders (PRMDs), and perceived exertion)
  • To identify the topics within the course that were most salient to students

Unlike previous studies, which provide little information as to how curricula were designed and whether formative methodologies were used, the course curriculum was informed by findings of research on music performance anxiety (MPA) and PRMDs; the findings of evaluations of other courses designed to improve musicians’ health; theories and models deriving from health psychology (Taylor, 2012); discussions with the Acting Head of Undergraduate Studies at the institution where some of the authors are based; and members of the Healthy Conservatoires Network.

The course formed the major component of a module entitled Artist Development 1, compulsory for all first-year students at a tertiary-level music conservatoire in the UK. The module took place over the first and second terms of the academic year and consisted of ten weekly 1-hour lectures delivered to the whole cohort (104 students) and eight weekly 1-hour seminars delivered to ten small groups of 10–15 students. The course covered not only physical and mental health, but also effective strategies for practicing, memorizing and rehearsing, and life skills and behavior-change tools inspired by health psychology.

Students were required to submit a portfolio of assessments including a 1,000-word essay in response to both the following questions: (1) Looking back on the Health and Wellbeing component of Artist Development 1, what new information, useful for your own music-making, have you learned from one lecture or one workshop/seminar?; (2) How have you been able to put this information into practice when making music (e.g., practicing, rehearsing, performing or studying more generally)?

Course evaluation

A mixed-methods approach to evaluation was adopted: quantitative analyses of data gathered at baseline and post-intervention, and between-group data (intervention vs. controls); and qualitative, semi-structured interviews (unpublished).

In terms of hearing, tinnitus and hyperacusis were reported by both groups of respondents, with a higher incidence in the (third-year) control group than in the (first-year) intervention group. Ten percent of the intervention group had been diagnosed with hearing loss, although minorities of respondents in both groups reported having had hearing tests in the previous ten years.

Although respondents were more likely to use hearing protection when rehearsing with others and attending concerts, comparatively few members of either group used hearing protection, or, if appropriate, the mute on their instrument, while practicing alone. This could affect hearing, since private practice can cause over-exposure to risky levels of sound.

Reassuringly, respondents reported increased knowledge of the topics covered in the course, including the sound intensity levels associated with hearing loss and how to deal with the health and safety issues associated with learning and playing a musical instrument. They also reported increased awareness of performance factors related to potential musculoskeletal injuries. The ratings of students who had taken the course and those who had not did not differ significantly, perhaps because the control group had had informal exposure to the other topics covered in the course, with the possible exception of life skills and behavior change techniques.

Students who had taken the course also rated their ability to deal with relevant health and safety issues significantly higher than controls.

In contrast, the only desired secondary outcome to increase significantly from baseline to post-intervention was self-efficacy, which may or may not have been the result of the course. Other significant increases were in the wrong direction: sleep problems, distress and lack of vitality all increased significantly from baseline to post-intervention, and controls experienced more severe depression, distress and lack of vitality.

We attribute these negative findings to the cumulative pressure on students over time. The first time the intervention group completed the questionnaire, they were in their second week at the conservatoire; post-intervention, they were facing deadlines for assignments to be submitted and recitals to be given. They may, however, have fared better than the control group simply by virtue of being a year younger. What we cannot know is the extent to which the health education course may have mitigated the demands perceived by the students in the intervention group.

Finally, from the topics covered in student assignments, it appears that managing MPA and behavior change techniques are of most interest or relevance to them at this point in their studies.

Conclusions

In the absence of a national curriculum for health, all institutions of higher education must develop their own approaches to health education, as do many university music departments and music conservatoires. The questions posed by Ralph Manchester in 2006 remain pertinent: “Who will develop this course? What topics will be included in the syllabus? Who will teach it? Will it be offered to freshmen or seniors, or can it be taken during any year? Can one course meet the needs of performance majors, music education majors, and others? Should we develop some minimal national requirements?” (Manchester, 2006, pp. 95–96).

Further questions could be asked, such as: When can a course be considered successful? What are its desired outcomes? How should they be measured? Once the content and delivery of a course have been evaluated, how should they be adjusted, if necessary? To what extent should students’ requirements and feedback be taken into consideration, given the available evidence and the need, on occasion, to challenge their beliefs? Very few health courses have been formally evaluated to date, and reports of those that have been evaluated do not say how the course was improved as a result.

Although it has been argued for the last 25 years that health education for musicians should be evidence-based (Zaza, 1993), the declarations and recommendations fail to mention the importance of evidence-based teaching. There is now a wealth of research on musicians’ playing-related health problems, and their management, but unless this is disseminated effectively to senior managers and educators, instrumental and vocal tutors, and students, there is a risk that conservatoires will maintain traditional practices rather than responding systematically to the best evidence available.

The topic of how music students, too, can be convinced that health education is a vital part of their training remains largely unexplored. Framing the objectives of health education courses as “performance-enhancing” rather than “preventative” is likely to be more attractive to students.

Although the course described in the present study did not have the hoped-for impact on secondary outcomes including reported health-related behaviors, reduced PRMDs and stress, it was associated with improvements in primary outcomes relevant to health education, namely the perceived knowledge of topics covered in the course and awareness of health risks.

Furthermore, the study itself is the first evaluation of a health education course for musicians that documents the process of designing the course on the basis of a rigorous assessment of the available evidence, and its incorporation in the “real world” context of a music conservatoire.

Further Information

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Examining the class system in British museum employment

Sam Evans, a PhD researcher at the Department for Organizational Psychology, is leading a series of focus groups which will ask participants to reveal what it takes to get in and get on in the museum sector, and how social class shapes career chances and experiences.

I’m interested in how inequality is reinforced in the workplace. Class, until recently, has been surprisingly absent from the debate. Research into diversity or equality, often overlooks class, as does occupational psychology in general. Part of the reason for this absence is that class is not a legally protected characteristic, like age or gender, but also it is argued that there has been a more fundamental ‘individualisation’ of Western culture.

Class identities have become more difficult to see or express in the workplace. Our careers are thus seen as our responsibility, and we don’t often think or talk about the structural inequalities that might frame this. However, there is research suggesting inequality at work is increasing, professions are becoming more not less exclusive, and social mobility is declining.

I want to explore these issues in-depth in my research project, The Museum of Them and Us; I am interested not just in how people are classed, but also occupations, roles and organisations. I am particularly interested in why some careers and types of work favour some groups of people and not others. We assume anyone can get in and get on, no matter how tough, given they have the right personal qualities. But what is this really like for people from different backgrounds? I have chosen to look at museums, partly because I am familiar with the field, but also because visiting and working in museums is described as middle class. But why is this, does this account for all types of work, and what does this mean for people who might not be from middle-class backgrounds.

I don’t have a fixed definition of the term ‘class’ (this is a subject that has been debated for 150 years and most researchers recognise there is no one single definition), but am using Pierre Bourdieu’s concept of capital of class. This involves looking at the types of economic, social or cultural capital that are valued within different types of museum work and how this relates to the type of capital people actually have, or are able to acquire. Cultural capital is particularly important as this relates to accent, dress, education and knowledge of particular types of culture, and is often highly valued in cultural work.

I have already conducted interviews with representative bodies, trade unions and membership bodies as well as analysing reports and websites to look at how ‘getting and getting on is described’. I have found that, as with other research, museum work has become less secure and more competitive. The onus seems to be on the person to develop themselves as specialist and professional, and yet also flexible and versatile. This potentially makes it riskier and less beneficial for anyone entering the field. Class was talked about but was often described as difficult to see or measure, and most diversity initiatives were aimed at developing the individual to fit the required ways of working, rather than look more closely at how ways of working might be creating inequalities.

With the focus groups and interviews, on the one hand, I am asking people to talk about their work – what it takes to get in and on, how this might have changed, how this might be different for different roles, are some roles held in higher esteem than others and why. On the other hand, I want to talk about social class – what does it mean to people, do they think class matters and if so, how? I am also asking people to contribute images or photos that they think represent their work.

Take part in the focus groups:

If you have worked or volunteered for a museum you can take part in a focus group or an interview. If people think that class has mattered to them in particular, I am also conducting private interviews.

Taking part is confidential, enjoyable and you will be helping the sector. To take part in a focus group or an interview and for further information, please contact me or visit my website.

Thursday 5 April
6PM – 7.30PM, Birkbeck Main Building, Room MAL 420, Malet Street, WC1E 7HZ  

Wednesday 11 April
6.30PM – 8PM, Birkbeck Main Building, Room MAL 420, Malet Street, WC1E 7HZ.

Thursday 26 April
6PM – 7.30PM, Museums Association Offices, 42 Clerkenwell Close, London, EC1R 0AZ

Friday 18 May
2.30PM – 4PM, Birmingham Museum and Art Gallery, Chamberlain Square, Birmingham B3 3DH

Wednesday 23 May
6PM – 7.30PM, Museums Association Offices, 42 Clerkenwell Close, London, EC1R 0AZ

Thursday 7 June
4PM – 5.30PM, Whitworth Gallery, The University of Manchester, Oxford Road, Manchester, M15 6ER

Thursday 14 June
5.30PM – 7PM, M Shed, Princes Wharf, Wapping Road, Bristol, BS1 4RN

Or schedule an interview:
If you think social class has mattered to you personally in your work or career then you can take in part in an individual interview, by email, Skype or face to face (depending on your location).

If you are interested in finding out more, please contact Sam directly.

About Sam:

I studied History originally, and then spent about 25 years working in marketing in the museum, cultural and public sectors. A lot of my work was really about understanding people and organisational cultures as much as ‘doing’ marketing, hence my interest in studying organisational psychology.  I started studying part time about 8 years ago, first obtaining a degree in psychology at OU, then moving on to the MSc in Organisational Psychology at Birkbeck.

About the same time as graduating, I was made redundant, which forced a decision – stick to the marketing “battleship” I knew, or jump onto the less stable “raft” of psychology. I had already met some PhD students and Dr Rebecca Whiting who became my supervisor, and thought I would really like to study for a PhD here. So when I was offered a studentship, I took the leap. It’s been one of the best decisions I’ve ever made!

From Dr Rebecca Whiting, a lecturer in the Department of Organisational Psychology and Sam’s PhD supervisor:

Sam brings a wealth of experience to her research from working in this sector and an intellectual rigour from her academic training. Class is a challenging concept to research because of the many and sometimes conflicting ways in which its conceptualised and measured.

Many definitions reflect the relationship between class and socio-economic and cultural status. However, since class is not a ‘protected characteristic’ under the Equality Act 2010, it doesn’t always appear as an aspect of diversity in organizations, so is ripe for critical investigation. Museums are key locations of our socio-cultural heritage but are an under-researched context in organizational and occupational research.

This highlights the importance of Sam’s research which brings together this topic and context to explore how class impacts on museum work.

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Animating medieval manuscripts

Professor of Medieval Studies Anthony Bale discusses his work with Birkbeck’s artist in residence, animator Shay Hamias. Together, they are developing a new interface between contemporary digital animation and medieval studies.

This year Birkbeck received one of only 19 prestigious Leverhulme Trust Artist-in-Residence awards. The residency is supporting animation artist Shay Hamias to work with me in Birkbeck’s School of Arts. Hamias is an animation director, with experience working on short and feature films, advertisements, and the museum and heritage sectors. Hamias’ work creatively explores the visual possibilities of design, motion and narrative, seeking new ways to interpret the medium. Hamias had long been fascinated by the artistry of medieval manuscripts, their combination of the written word and visual effects, and their engagement with religious belief. So the Leverhulme Artist-in-Residence award provided a superb opportunity to develop a completely new interface between contemporary digital animation and medieval studies.

Hamias and I share an interest in the meanings of images and symbolism, in particular, the religious symbolism in Christianity and Judaism. Our project has sought to put modern design in conversation with medieval artefacts in a bold new way. We have tried to test that idea, proposed by many scholars of medieval culture, that the pages of medieval books are ‘alive’ and animate, full of ‘active’ visual and mnemonic effects for the reader. Can contemporary animation engage in a fruitful and stimulating encounter with the often perplexing but beautiful images we find in medieval manuscripts? In medieval manuscripts, design and illustration are provided as tools for the viewer/reader to enable them to decode biblical narratives, using a visual language that would resonate with them and locate them mentally.

In the creative process, the artist looks at a subject from a personal point of engagement with it, combined with established ways of seeing.  Animation lends itself to translating inner thought and inner states, in a creative process based on lateral approaches to thinking and the use of associative emotions and imagination. Hamias and I have been thinking about how parallels might be drawn between modern visual language and medieval visuals. Might traditional techniques be applied to modern narratives, in a creative anachronism?

Formally, medieval manuscripts have much in common with modern animation: both condense time and space, through discontinuous visual and verbal narrative; both can rapidly illustrate change over a long period and produce memorable narrative through a ‘familiar’ iconography and media in service of popularly-held or generally-endorsed views; both can reveal metamorphosis and sudden change, sudden effects which are accepted by audiences because of their familiarity with the world created by the medium.

The emphasis of the residency is on Hamias’ artistic and creative freedom to respond to medieval sources in his own distinctive way. Hamias and I have met at least weekly during the residency, sometimes in libraries and archives with medieval manuscripts in front of us. The first animation project we have produced focusses on pilgrimage and visual movement. We have taken the idea of ‘visual storytelling’ and given it a contemporary take. We feel that our methodology remains ‘medieval’: our project is constructed entirely from things we have read in medieval texts or found in medieval visual culture. Moreover, Hamias put himself in a similar position to the medieval artist, who was imagining things based largely on received stories and depictions. Our first short animated film is called ‘The Matter of Jerusalem’, after William Wey’s 1460s manuscript book which describes the journey from Venice to Jerusalem.

We now have plans to develop this film and to collaborate on an exhibition about Birkbeck’s own medieval books in summer 2018.

You can follow Anthony and Shay’s project on their Instagram page @animatedpage

 

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