Medical Teacher

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/imte20

Creativity: A viable and valuable competency in

medicine? A qualitative exploratory study

Annabel ten Haven, Elien Pragt, Scheltus Jan van Luijk, Diana H. J. M.
Dolmans & Walther N. K. A van Mook

To cite this article: Annabel ten Haven, Elien Pragt, Scheltus Jan van Luijk, Diana H.
J. M. Dolmans & Walther N. K. A van Mook (2022): Creativity: A viable and valuable
competency in medicine? A qualitative exploratory study, Medical Teacher, DOI:
10.1080/0142159X.2022.2072278

To link to this article: https://doi.org/10.1080/0142159X.2022.2072278

© 2022 The Author(s). Published by Informa

UK Limited, trading as Taylor & Francis
Group.

View supplementary material

Published online: 23 May 2022.

Submit your article to this journal

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=imte20
MEDICAL TEACHER
https://doi.org/10.1080/0142159X.2022.2072278

Creativity: A viable and valuable competency in medicine? A qualitative

exploratory study
Annabel ten Havena
, Elien Pragtb
, Scheltus Jan van Luijkc , Diana H. J. M. Dolmansd and
Walther N. K. A van Mookb,c,d
a
Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; bDepartment of Intensive Care
Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; cAcademy for Postgraduate Medical Training, Maastricht
University Medical Centre, Maastricht, The Netherlands; dSchool of Health Professions Education, Faculty of Health, Medicine and Life
Sciences, Maastricht University, Maastricht, The Netherlands

ABSTRACT KEYWORDS
Purpose: To explore and describe medical students, postgraduate medical trainees, and medical Medical education research;
specialists’ perceptions of creativity, the importance they attach to creativity in contemporary clinical skills;
healthcare, and, by extension, how they feel creativity can be taught in medical education. general; medicine
Methods: The authors conducted seven semi-structured focus groups with medical students
(n ¼ 10), postgraduate medical trainees (n ¼ 11) and medical specialists (n ¼ 13).
Results: Participants had a trifurcated perception of creativity, which they described as a form of
art that involves thinking and action processes. Facing complex patients in a rapidly changing
healthcare landscape, doctors needed such a multifaceted perspective to be able to adapt and
react to new and often complex situations that require creativity. Furthermore, participants identi-
fied conditions that were perceived to stimulate and inhibit creativity in healthcare and suggested
several techniques to learn creativity.
Conclusion: Participants perceived creativity as a form of art that involves thinking and action
processes. Creativity is important to tackle the challenges of current and future workplaces,
because it stimulates the search for original solutions which are needed in a rapidly changing
healthcare landscape. Participants proposed different methods and techniques to promote creativ-
ity learning. However, we need further research to design and implement creativity in med-
ical curricula.

1. Introduction
Society, and especially business and healthcare worldwide,
have emphasised a need for creativity (Rometty 2012; Koh
2013; Lecher 2017; Turabian 2017; Eurelings 2018; Leopold
et al. 2018). To successfully cope with the challenges of
today’s workplaces, educational researchers have concluded
that we need new skills such as flexibility and adaptability
(Mylopoulos and Regehr 2009; Carbonell et al. 2014). As
our healthcare systems are becoming increasingly complex,
changing rapidly and largely unpredictable, scholars have
also argued that we must learn to be creative so that we
can adapt accordingly and continue to perform adequately
(Koh 2013; Liou et al. 2016; Lith et al. 2016; Baruch 2017;
Lecher 2017; Turabian 2017). In this, medical professionals
are no exception, as they are increasingly faced with major
challenges. To name one that almost every country is fac-
ing at this very moment is how to deal with the COVID-19
pandemic. This pandemic poses challenges at all levels of
the organisation, including doctors in clinical care who
have suddenly lost many fellow doctors and nurses to
infection or burnout, are confronted with hospital bed
Practice points
 Participants had a trifurcated perception of creativ-
ity. They described creativity as a form of art that
involves thinking as well as action processes.
 Creativity is an important quality in a rapidly
changing healthcare landscape that requires a
multifaceted, flexible perspective to deal with
increasingly complex patients.
 This study reveals the importance of creativity to
medical curricula and identifies various conditions
for learning and enhancing creativity and associ-
ated educational techniques.
shortages, while also needing to set up large-scale
vaccination programmes.
The aim of critical thinking is to deal with precisely these
kinds of problems. Creative Problem Solving (CPS) techni-
ques could support such thinking, for they encourage stu-
dents to be open-minded and curious, think out of the box,

CONTACT E. Pragt e.pragt@mumc.nl Department of Intensive Care Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX,
Maastricht, The Netherlands

These authors contributed equally to the research described in this article.
Supplementary data for this article can be accessed online at https://doi.org/10.1080/0142159X.2022.2072278.
ß 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-
nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or
built upon in any way.
2 A. TENHAVEN ET AL.
conceptualise and reflect, allowing them to take a multi-per-
spective approach that is conducive to original and new
insights. In this process, students also learn to improve their
intuition and associative power and to use metaphors to
solve problems. Students who are familiar with these techni-
ques will contribute original, new and practical ideas. A pre-
liminary survey by Jackson et al. (Jackson 2005) suggested
that medical students need creativity to understand complex
patients, make clinical decisions, solve problems, use tech-
nical or craft skills, and communicate thoughtfully and
empathetically with each patient.
If we embrace this perspective that we need more cre-
ativity in healthcare, the first question that arises is: how
do different stakeholders – medical students, postgraduate
trainees and clinicians –, perceive creativity in medical edu-
cation? As a term widely used, creativity is generally con-
sidered to be multifaceted, although its definition differs
depending on the context (Csikszentmihalyi 1996; Amabile
1997; Lubart and Sternberg 1998; Treffinger et al. 2002;
Robinson 2013; Min and Gruszka 2017). The question of
how creativity is perceived by different groups of health-
care professionals (in training or otherwise), however, has
hitherto not been explored.
In terms of learning, there is a consensus that it is possible
to teach and stimulate creativity. Two meta-analytic studies,
for instance, have showed that creativity training is effective.
Also Rose and Lin (1984) showed in their study that creativity
training positively affected creativity in school settings. Scott
et al. (2004), in their turn, confirmed that creativity training
indeed induced creativity in different organisations and aca-
demic settings (Rose and Lin 1984; Scott et al. 2004; Tsai
2013). Likewise, Amabile (1998) argued that creativity, rather
than being an innate trait, can be learnt. In her research, the
author identified three different components of creative
behaviour that can be influenced, which were: domain
expertise, creative-thinking skills and motivation. She con-
cluded that a conducive work environment can stimulate
creativity (Amabile 1998; Amabile and Pillemer 2015).
Nevertheless, the said studies did not explore how creativ-
ity can be taught. After reviewing 156 creativity training pro-
grammes, Scott et al. (2004) concluded that a creativity
training programme has the most significant positive effect
on creative outcomes when it is based on the cognitive
capacities of problem finding, conceptual combination and
idea generation. The CPS model (Isaksen and Treffinger 2004;
Scott et al. 2004; Treffinger et al. 2006; Valgeirsdottir and
Onarheim 2017) is one such training programme that focuses
on the cognitive process. The existing literature, however,
offers hardly any guidance on how to learn creativity through
training programmes that focus on such processes in medical
education. An exception is the scoping literature review by
Lake et al. (2015) who showed that students in medical edu-
cation can boost their creativity by practising certain aspects
of creativity, for example in theatre, dance, writing, poetry, lit-
erature, music, painting and the visual arts.
In light of the above, the present study seeks to address
the following three research questions involving different
groups of healthcare professionals (in training or otherwise):
1. What are medical students, postgraduate trainees and
clinicians’ perspectives on creativity in the context of
medical practice?
2. How do they perceive the importance of creativity in
healthcare in general and in doctors’ daily clinical prac-
tice in particular?
3. How do they perceive creativity teaching and learning
in medical education?
2. Methods
2.1. Setting
We conducted this study at Maastricht University Medical
Centreþ (MUMCþ) and the Faculty of Health, Medicine and
Life Sciences (FHML), Maastricht University, the Netherlands.
At the time of the study, these institutions were home to
437 medical specialists, 373 postgraduate medical trainees
and 2067 medical students.
2.2. Design
Consistent with the exploratory nature of our research, we
held semi-structured focus-group interviews. Such inter-
views are particularly instrumental in facilitating detailed
descriptions of the understanding and experience around
an unclear topic (Kitzinger 1995; Stalmeijer et al. 2014). We
used the guideline by Assema et al. (1992) to semi-structure
the focus-group interviews around the three research ques-
tions (see Supplementary Appendix 1).
2.3. Sampling and participants
In the period spanning September to December 2018, we
held seven focus-group interviews with three separate par-
ticipant groups, specifically: medical students from the
FHML of all years of study, postgraduate trainees from dif-
ferent disciplines and across all years of MUMC þ and
medical specialists from various MUMC þ disciplines (see
Figure 1 for more details about the specific group composi-
tions). As our research focused on learning in medical
undergraduate and postgraduate training, we chose these
participants because they were the main groups of learners
we could identify in this particular context.
We invited participants by email, newsletter and
through the faculty’s social media page. Additionally, we
used our personal networks to recruit participants. Thirty-
four participants took part in the study. Of the seven inter-
views, we held two sessions with students (n ¼ 6, n ¼ 4),
two with trainees (n ¼ 5, n ¼ 6) and three sessions with
medical specialists (n ¼ 4, n ¼ 4, n ¼ 5) (see Figure 1).
2.4. Procedure
The focus-group interviews were facilitated by a trained
and experienced moderator (SJvL). An observer (AtH) was
also present to take extensive notes of the discussion and
nonverbal communication. Their rationales were probed
whenever deemed necessary. We concluded that saturation
was reached when no new topics emerged during the
interviews. For all but one group this was the case after
two interview rounds. With participants’ written informed
consent, all focus-group interviews were audio-recorded
and transcribed verbatim. Each participant received a

summary of the session and was invited to make correc-
tions and comments.
2.5. Analysis
The researchers conducted the qualitative data analysis
using ATLAS.ti, version 8.0 (Scientific Software Development
GmbH, Berlin), to manage the data including the focus-
group transcripts. In doing so, they applied the generally
accepted principles of primary, secondary and tertiary cod-
ing and constant comparison (Watling and Lingard 2012).
This meant that codes were grouped into categories, which,
in turn, were systematically checked against new data and
arranged into broader, overarching themes (Strauss and
Corbin 1990; Boeije 2009). Whereas AtH analysed all the
transcripts, SJvL cross-checked the codes. Both researchers
compared and discussed the codes until they reached con-
sensus and overarching themes emerged. All co-authors dis-
cussed and agreed on these themes.
2.6. Ethical approval
The study was approved by the Ethical Review Board of
the Netherlands Association for Medical Education (NVMO)
(file no. 2018.5.2). The moderator and observer had no pro-
fessional relationship with participants of any kind. Nor did
participants receive any financial compensation.
3. Results
In the following, we will present the results pertaining to
each of the three research questions. In addition to this,
we will provide schematic overviews of the results relative
Figure 1. Composition of the three participant groups.
Figure 2. Participants’ trifurcated perception of creativity.
MEDICAL TEACHER 3
to questions 1 and 3 (Figures 2 and 3, respectively). Each
question will be further illustrated with representative
quotes (listed in Tables 1–3, respectively).
Research question 1: What are medical students, postgraduate
medical trainees and clinicians’ perspectives on creativity in the
context of medical practice?
In this theme, we discussed participants’ perceptions.
The majority of participants found it difficult to define cre-
ativity in the medical setting. They reported many different
perceptions of creativity and commented that these per-
ceptions, indeed, differed across individuals and contexts.
Nevertheless, we were able to discern three main percep-
tions of the construct. First, many participants associated
creativity with various forms of art, such as playing an
instrument, painting and writing. Second, they held the
view that creativity involved a process of thinking that
takes place ‘out of the box’. Such process required dynamic
adaptability and was enabled by the mechanisms of
freethinking and seeing or making connections. Moreover,
participants regarded creative thinking as a way to
approach an issue from various angles and perspectives.
Third, they added that there was more to creativity than
this thinking process, as the ideas resulting from it had yet
to be translated into real products or solutions. Hence, cre-
ativity was also perceived to encompass an action process.
The said perceptions of ’thinking’ and ’acting’ were the
expressions of creativity that were most frequently men-
tioned. Figure 2 gives a precise overview of each of the
three main participant perceptions. Quotes to illustrate
these perceptions are included in Table 1.
Research question 2: What importance do participants attach to
creativity in healthcare in general and in doctors’ daily clinical
practice in particular?
4 A. TENHAVEN ET AL.

Brainstorm

Role model - observing others Gain practical experience, role-play

New places and people Ask to think ‘out of the box’

Questioning : ask
Trough arts and
exploring questions &
expression of art
‘why' questions
Learning
Stimulating conditions Inhibiting conditions
creativity
1. Freedom in time and space 1. Limited Freedom, time and space
2. Safe educational climate 2. High workload
3. Domain-specific knowledge, skills and 3. Administrative burden
experience 4. Strict framework & rules
4. Courage to make mistakes and trying
5. Discipline and motivation
6. Open-minded

Figure 3. Conditions and techniques perceived to enable creativity learning.

Table 1. Representative quotes illustrating participants’ trifurcated perception of creativity in daily healthcare.
Quotes from participants
Art as an expression of creativity ‘In art, you create something new, something that did not exist, and that is what I associate with creativity’
(medical specialist).
‘I think you have to be creative to make art. It takes creativity to generate something, to make something. And
I think art, by definition, means to make something’ (trainee).
‘I particularly associate creativity with art, all forms of art, such as writing, cabaret, painting’ (student).
Thinking process ‘Creativity means to look at problems from a different perspective and coming up with amazing new “out-of-
the-box” solutions to existing problems in the world when I did not even consider it a problem’ (medical
specialist).
‘Creativity, to me, is looking at things from different angles. Like, when you have a problem, that you do not
use the most standard solution, but that you think of different things and then apply the solution that is
best’ (trainee).
‘Creativity is thinking outside the box and coming up with solutions. That you can think beyond the standard
rule, beyond the list of symptoms that you’ve learnt’ (student).
Action process ‘Creativity requires that you can contribute something, in my opinion. That’s being creative. You have to be
able to think and make something’ (medical specialist).
‘If you do nothing with a creative idea, it remains in your brain, and then it doesn’t bring you any further. You
must be able to do something with creativity; it must be usable to a certain extent’ (trainee).
‘Creativity is making something new that didn’t exist yet’ (student).

Table 2. Representative quotes illustrating how creativity is manifested in healthcare in general and in daily care in particular.
Multifaceted perspective facilitating the
design of original and workable
personalised care solutions
The changing complex healthcare
environment
Quotes from participants
‘A diagnosis or plan must be tailored to each patient. You need to be able to integrate the objective data, the
interests and the context of the patient into individual therapy. And be able to respond and adjust yourself
to the patient’ (medical specialist).
‘There are unexpected and acute situations where no standard solution or protocol can be followed, you need
to improvise, and therefore you need to be creative’ (trainee).
‘You have to be able to think beyond the checklist of symptoms so as not to miss any diagnoses. Because
diseases and symptoms often differ from the norm’ (student).
‘Everything is changing around us. To keep pace with these changes, we need to innovate and develop new
solutions for research, medicines etc. And innovation starts with creativity. Besides, if we do not innovate,
the level of care will remain the same and will not improve’ (medical specialist).
’In my view, there is no progress without creativity. It is the creative things that cause change and that create
new things. If everyone sticks to the protocol, healthcare will get nowhere’ (trainee).
‘Things change around us. And if you don’t go along and renew, things will end. To change and renew, you
need creativity’ (student).

In this theme, participants explored how creativity
emerged in healthcare in general and in doctors’ clinical
practice in particular. They also discussed the perceived
importance of creativity in healthcare. First, participants felt
that patients with complex problems require doctors who
are able to provide original, workable and personalised sol-
utions. To be able to do so, they needed a multidimen-
sional perspective, as many clinical presentations, contexts
and care processes may deviate from standard protocols.
Likewise, evidence-based medicine is often not seamlessly
transferable or applicable to practice. In participants’ view,
a doctor must therefore be able to think ‘outside the box’
or ‘think creatively’ to integrate the available, most suitable
and applicable evidence with the clinical experience, per-
sonal preferences, values and contextual aspects of each
individual patient. Second, participants felt that the rapidly
changing healthcare environment also called for creativity,
as it required doctors to adapt and react flexibly and
dynamically to new and often complex situations. In this
changing and unpredictable landscape, complex problems
constantly arose that according to participants could only
be solved if doctors, in addition to generating novel ideas,
created and applied new, alternative solutions.
Many participants considered creativity important to a
doctor’s performance and felt it helped raise the
quality of healthcare delivery. A majority held the view that
 MEDICAL TEACHER 5

Table 3. Representative quotes about creativity-enhancing techniques.

Questioning: asking exploring questions,
especially ‘why’ questions
Stimulating thinking ‘outside the box’
Brainstorming
Experimenting: gaining practical
experience and role play
Role modelling: observing others
New places and people
Using the arts and expressions of art
Quotes from participants
‘It is important that you do not give the answers right away, but that you ask in-depth questions. What are you
exactly doing and why are you doing this? With this, you stimulate students to be creative’
(medical specialist).
‘What I sometimes say to the students is, think of something crazy. Or, think in a different direction. I try to
challenge them to be creative’ (medical specialist).
‘It is important that you focus on the process instead of the results. For five minutes, everyone is free to say
anything that comes to mind. No answer is wrong’ (trainee).
‘By putting a person who normally thinks inside the boxes in a simulated situation, where he is completely out
of his comfort zone and can no longer fall back on his protocols, you create an environment where he can
safely make huge mistakes. And in this situation, he can also practise creativity’ (trainee).
‘A role model can show other people how to be creative. They can learn from observing the role
model’ (student).
‘A rotation at another hospital shows you how other hospitals solve problems. This can give you
inspiration’ (student).
‘If you get in touch with art, painting, poems, et cetera, your brain interacts in a different way than usual. New
roads are created in your brain, and these roads can also be used outside of art’ (medical specialist).

high-complexity care required broad thinking beyond
guidelines and protocols, necessitating creativity in such
contexts. The level of creativity required was dependent on
the nature, content and context of a doctor’s activities.
Participants agreed that, although varying in frequency, sit-
uations that do not follow standard practice, guidelines or
protocols occur in all specialities and hence call for creativ-
ity. Yet, participants did not necessarily flag creativity as an
absolute requirement or a mandatory quality that all doc-
tors should possess. They believed that, in low-complexity,
standardised settings, a doctor would be able to deliver
high-quality care also without being creative. To illustrate
how creativity takes shape in healthcare, Table 2 lists
several representative quotes from participants.
Research question 3: How do participants perceive creativity
learning in medical education?
In this part of the study, participants discussed whether
they perceived creativity to be an innate trait or skill that
students could develop, what conditions they considered
conducive to creativity learning, and whether they knew of
any existing techniques to enhance this learning.
With respect to the first point of discussion, some partici-
pants felt that creativity was an innate trait (a specific tal-
ent, intuition or feeling inducing creativity), whereas others
considered it more like a skill that anyone could develop.
Despite this lack of consensus, participants did suggest con-
ditions and techniques they believed could help promote
creativity learning, as will be explained in the following.
In response to the second point under discussion, par-
ticipants mentioned several conditions that were perceived
to stimulate the process of learning creativity. Taking more
time and space to be creative, and a safe educational cli-
mate that allowed failures and gave proper guidance on
how to develop creativity were seen as important enabling
conditions. In addition to these, essential basic knowledge,
cognitive skills and experience were also perceived to pro-
mote creativity. Other vital prerequisites were being suffi-
ciently disciplined and motivated and learning to make
mistakes, as well as being open-minded to different per-
spectives. Some participants also identified several inhibit-
ing conditions. These included a lack of time and space to
plan and execute tasks appropriately, owing to a high
workload, administrative overload and an at times overly
strict framework of protocols, guidelines and regulations.
In terms of strategies that could enhance creativity
learning (the third discussion item), participants suggested
encouraging students to explore issues more in depth by
repeatedly asking them questions – especially ‘why’ ques-
tions. Also involving students in thinking ‘outside the box’
by brainstorming in an open-minded fashion, inviting them
to provide multiple solutions, were techniques considered
to boost creativity learning. Other ways to cultivate creativ-
ity were practical experience and role play involving clin-
ical-care-related scenarios, as well as using role models
who possess creativity-specific knowledge and skills and
expose students to new places and people. Finally, some
participants reported that creativity could be learnt
through the arts by looking at art, making art, or through
other forms of artistic expression.
Figure 3 below gives an overview of the conditions and
techniques that were perceived to enable creativity learn-
ing. To elucidate these findings, we have listed several illus-
trative quotes in Table 3.
4. Discussion
In this focus-group study, we explored medical students,
postgraduate medical trainees and medical specialists’ per-
spectives on creativity in the medical context. To the best
of our knowledge, this study was the first to address cre-
ativity within a medical setting so far. We concluded that
participants had a trifurcated perception of creativity,
which they described as a form of art (1) that involved a
thinking (2) as well as an action process (3). As the ‘creative
part’ of critical thinking, CPS techniques can optimise crit-
ical thinking in students, by encouraging them to be open-
minded and curious, think out of the box, conceptualise
and reflect. In this process, they learn to improve their intu-
ition and associative power as well as to use metaphors.
It follows that students who are familiar with these tech-
niques are better equipped to face challenges in health-
care. Although participants did not necessarily flag
creativity as an essential qualification any doctor should
have, we might consider it an important complementary
quality. Indeed, many situations in doctors’ daily practice
require some level of creativity because many problems
encountered do not follow standard practice, guidelines or
protocols. These findings agree with those by Jackson et al.
and other authors (Jackson 2005; Koh 2013; Liou et al.
2016; Lecher 2017; Turabian 2017) who suggested that
creativity is a fundamental aspect of the medical field
6 A. TENHAVEN ET AL.
because it provides adequate solutions to rapidly chang-
ing problems.
Many participants doubted whether creativity was a skill
anyone could develop, feeling that it was a characteristic a
person does or does not possess by nature. This finding is
contrary to previous study findings that creativity can be
learnt and enhanced (Rose and Lin 1984; Scott et al. 2004;
Tsai 2013). A plausible explanation for this might be that
many people do not consider themselves creative (Dyer
et al. 2012). Research has demonstrated that higher levels
of creative self-efficacy, defined by Tierney and Farmer
(2002) as ‘the belief one has the ability to produce creative
outcomes’, correspond with increased levels of creativity
(Tierney and Farmer 2002, 2011; Brockhus et al. 2014).
Hence, by changing an individual’s belief about their ability
to be creative, they can become more creative.
In this study, we identified a wide range of conditions
that stimulate and inhibit creativity. Participants expressed
concerns about conditions that inhibit creativity, such as a
lack of time owing to a high workload and administrative
overload, and an overly strict framework of protocols,
guidelines and regulations. This can be exemplary of the
internationally acknowledged high workload and the asso-
ciated increased risk of burnout among healthcare profes-
sionals (Boeke and Hoekstra 2018; van Esch and Soomers
2018). In a similar vein, these findings confirm Amabile’s
conclusion that managers can influence creativity in the
workplace (Amabile 1998; Amabile and Pillemer 2015).
They also echo a workplace survey conducted by Gallup
(2018) among a demographically representative sample of
the US adult population. As in our study, this agency iden-
tified several factors similar to our conditions that foster
creativity in the workplace, including sufficient time and
space to be creative and a safe educational or working cli-
mate (Wigert and Robinson 2018).
4.1. Practical implications for medical education
Overall, this study supports the idea that creativity is
important to help medical professionals overcome chal-
lenges in contemporary, complex healthcare. As outlined
previously, studies have confirmed that creativity can be
learnt and enhanced through creativity training pro-
grammes. Participants in this study also suggested several
techniques for teaching and learning creativity that can be
easily applied in medical curricula (see the Results section,
research question 3). Some of the creativity-learning techni-
ques our participants proposed, such as asking questions
and brainstorming, bear a similarity to the CPS approach
used by training programmes that focus on cognitive proc-
esses. CPS has already been applied successfully in various
settings, including elementary, middle and high schools,
colleges and universities, small and large businesses and
different organisations (Treffinger 1995). Although CPS has
evolved in the past 60 years to give rise to multiple ver-
sions of its model (Isaksen and Treffinger 2004), a few cen-
tral phases have remained constant (Isaksen and Treffinger
2004; Puccio et al. 2006; Treffinger et al. 2006). We there-
fore welcome a further study or pilot project to test which
of these CPS models suits the medical setting best.
4.2. Limitations of the study
The findings in this study are subject to at least three limi-
tations. First, our data may not represent the whole popu-
lation of medical students, postgraduate medical trainees
and medical specialists. Second, the convenience sampling
method we used of recruiting participants via personal
emails and non-personal group emails influenced the vari-
ous group compositions. Although some focus groups
were limited in size, their homogeneous composition war-
ranted the dynamics in the interviews. Third, in this study
we did not differentiate between the various participant
groups, the different medical specialities, the various levels
of experience, nor did we control for age or gender effects.
4.3. Suggestions for further research
We invite researchers to carry out a more in-depth explor-
ation of the role creativity plays within the different
groups, addressing the question of whether the groups dif-
fer in their degree of creativity and, if so, why. Additionally,
we welcome more work that aims to identify how best to
teach medical students creativity. Finally, insights gained
from the present and recommended future studies call for
the development of a valid instrument to measure creativ-
ity in the medical setting.
4.4. Conclusion
Participants had a trifurcated perception of creativity, which
they described as a form of art that involves thinking as well
as action processes. They considered creativity a vital quality
that was needed to tackle the challenges of modern-day
healthcare workplaces. To care for complex patients in a
healthcare system that is changing rapidly, doctors must be
able to come up with original solutions. To be able to do so,
they must learn to be creative and adopt a multidimensional
perspective. Additionally, participants proposed various con-
ditions and techniques to learn and enhance creativity.
However, we need further investigation to design, evaluate
and implement CPS skills training in medical curricula.
Acknowledgements
The authors wish to thank the participants for generously contributing
their time and expertise.
Disclosure statement
The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of the article.
Funding
The author(s) reported there is no funding associated with the work
featured in this article.
Glossary
Creativity: Creativity requires both originality and effectiveness.
Runco and Garrett (2012).

Notes on contributors
A. ten Haven, MSc, is a 6th-year medical student at the Faculty of
Health, Medicine and Life Sciences, Maastricht University. Her scholarly
interests include creativity in the medical undergraduate and post-
graduate curriculum.
Elien Pragt, MD, is an anaesthesiologist-intensivist in the Department
of Intensive Care Medicine, and assistant professor at the School of
Health Professions Education, Maastricht University, and Maastricht
University Medical Centreþ.
Scheltus J. van Luijk, MD, PhD, is a physician educationalist at the
Maastricht University Medical Centre þ Academy who takes an interest
in the use and implementation of creative problem solving and design
thinking techniques in medical education.
Diana H.J.M. Dolmans, MSc, PhD, is a professor in the field of innova-
tive learning arrangements and a staff member of the School of
Health Professions Education, Maastricht University. Her research
focuses on key success factors of innovative curricula within
higher education.
Walther N.K.A. van Mook, MD, PhD, is an internist-intensivist in the
Department of Intensive Care Medicine, scientific director of the
Maastricht University Medical Centre þ Academy, and professor at the
School of Health Professions Education, Maastricht University.
ORCID
Elien Pragt http://orcid.org/0000-0001-5495-043X
Scheltus Jan van Luijk http://orcid.org/0000-0002-7696-5277
Diana H. J. M. Dolmans http://orcid.org/0000-0002-4802-1156
Walther N. K. A van Mook http://orcid.org/0000-0003-2398-8878
References
Amabile MT, Pillemer J. 2015. Creativity. Wiley Encyclopedia of
Management. Vol 11. DOI:10.1002/9781118785317.weom110105
Amabile T. 1997. Motivating creativity in organizations: on doing what
you love and loving what you do. Calif Manage Rev. 40(1):39–58.
Amabile T. 1998. How to kill creativity. Harv Bus Rev. 76:76–87.
https://hbr.org/1998/09/how-to-kill-creativity.
Assema P, Mesters I, Kok G. 1992. Het Focusgroep-interview: een stap-
penplan. T Soc Gezondheidszorg. 70(7):431–437.
Baruch JM. 2017. Jay Baruch, MD: design thinking inside out - creativ-
ity as clinical skill - a role for “not knowing”. Stanford Medicine X.
https://www.youtube.com/watch?v=Q4pPazFEL5s.
Boeije H. 2009. Analysis in qualitative research. London: Sage
Publications Ltd.
Boeke S, Hoekstra H. 2018. Meer tijd voor de patient. Enschede:
Landelijke huisartsen vereniging.
Brockhus S, van der Kolk TEC, Koeman B, Badke-Schaub PG. 2014. The
influence of creative self-efficacy on creative performance.
Proceeding of International Design Conference DESIGN 2014,
437–444.
Carbonell KB, Stalmeijer RE, Ko €nings KD, Segers M, Van Merri€ enboer J.
2014. How experts deal with novel situations: a review of adaptive
expertise. Educ Res Rev. 12:14–29.
Csikszentmihalyi M. 1996. Creativity - flow and the psychology of dis-
covery and invention. New York: HarperCollins Publishers.
Dyer J, Gregersen H, Clayton MC. 2012. Crush the “I’m not creative”
barrier. Canada: Harv Bus Rev. https://hbr.org/2012/05/crush-the-im-
not-creative-barr.
Eurelings LSM. 2018. Toys for the boys and pearls for the girls.
Nederlands Tijdschrijft Geneeskunde. 162(51/52):38–39.
Isaksen SG, Treffinger DJ. 2004. Celebrating 50 years of reflective practice:
versions of creative problem solving. J Creat Behav. 38(2):75–101.
Jackson M. 2005. Creativity in medicine and medical education. The
higher education acadamy. https://pdfs.semanticscholar.org/a329/
1bef5a0ebb7c69f0785035879e3ff167584a.pdf.
Kitzinger J. 1995. Qualitative research. Introducing focus groups. BMJ.
311(7000):299–302.
MEDICAL TEACHER 7
Koh DL. 2013. Creativity and innovation in medical education: it’s time
to let the trees grow freely. Ann Acad Med Singap. 42(11):557–558.
Lake J, Jackson L, Hardman C. 2015. A fresh perspective on medical
education: the lens of the arts. Med Educ. 49(8):759–772.
Lecher R. 2017. Diversity, creativity, and flexibility will be needed from
the next generation of medical scientists. Lancet. 389(Special
issue, S!). DOI:10.1016/S0140-6736(17)30199-X
Leopold TA, Ratcheva VS, Zaihidi S. 2018. The future of jobs report
2018. Switzerland: World Economic Forum.
Liou KT, Jamorabo DS, Dollase RH, Dumenco L, Schiffman FJ, Baruch
JM. 2016. Playing in the “gutter”: cultivating creativity in medical
education and practice. Acad Med. 91(3):322–327.
Lith J, Man R, Hoog M, Blaauwgeers H, Habets J. 2016. Opleiden is voor-
uitzien. Utrecht (the Netherlands): Federatie Medisch Specialisten.
Lubart TL, Sternberg RJ. 1998. Creativity across Time and Place: life
span and cross-cultural perspectives. High Ability Stud. 9(1):59–74.
Min T, Gruszka A. 2017. Handbook of the management of creativity
and innovation: theory and practice. Chapter: 3. In: Tang Min,
Christian H. Werner, editors. Singapore: World Scientific Press;
p. 51–71.
Mylopoulos M, Regehr G. 2009. How student models of expertise and
innovation impact the development of adaptive expertise in medi-
cine. Med Educ. 43(2):127–132.
Puccio GJ, Firestien RL, Coyle C, Masucci C. 2006. A review of the
effectiveness of CPS training: a focus on workplace issues. Creativity
Inn Man. 15(1):19–33.
Robinson K. 2013. To encourage creativity, Mr Gove, you must
first understand what it is. The Guardian. https://www.theguardian.
com/commentisfree/2013/may/17/to-encourage-creativity-mr-gove-
understand.
Rometty G. 2012. Leading trough connection. United States of
America: International Business Machines Corporation. https://www-
935.ibm.com/services/multimedia/anz_ceo_study_2012.pdf.
Rose L, Lin HT. 1984. A meta-analysis of long-term creativity training. J
Creative Behav. 18(1):11–22.
Runco MA, Jaeger GJ. 2012. The standard definition of creativity.
Creativity Res J. 24(1):92–96.
Scott G, Leritz LE, Mumford MD. 2004. The effectiveness of creativity
training: a quantitative review. Creativity Res J. 16(4):361–388.
Stalmeijer RE, McNaughton N, Van Mook WN. 2014. Using focus
groups in medical education research: AMEE Guide No. 91. Med
Teach. 36(11):923–939.
Strauss A, Corbin J. 1990. Basics of qualitative research: grounded the-
ory procedures and technique. Qual Sociol. 13(1):3–21.
Tierney P, Farmer SM. 2011. Creative self-efficacy development and
creative performance over time. J Appl Psychol. 96(2):277–293.
Tierney P, Farmer SM. 2002. Creative self-efficacy: its potential antece-
dents and relationship to creative performance. Acad Manag J. 45:
1137–1148.
Treffinger DJ. 1995. Creative problem solving: overview and educa-
tional implications. Educ Psychol Rev. 7(3):301–312.
Treffinger DJ, Isaksen SG, Dorval KB. 2006. Creative problem solving:
an introduction. Waco (TX): Prufrock Press Inc.
Treffinger DJ, Young GC, Selby EC, Shepardson C. 2002. Assessing cre-
ativity: a guide for educators. Storrs (CT): National Research Center
on the Gifted and Talented. http://www.gifted.uconn.edu/nrcgt.
html.
Tsai CK. 2013. A review of the effectiveness of creative training on
adult learners. JSSS. 1(1):17–30.
Turabian JL. 2017. Creativity in family medicine. Res Med Eng Sci. DOI:
10.31031/RMES.2017.01.000510 ISSN: 2576-8816.
Valgeirsdottir D, Onarheim B. 2017. Studying creativity training pro-
grams: a methodological analysis. Creat Innov Manag. 26(4):
430–439.
van Esch E, Soomers V. 2018. Nationale aios-enque^te 2018. Gezond en
veilig werken. Utrecht (the Netherlands): De jonge specialist.
Watling CJ, Lingard L. 2012. Grounded theory in medical education
research: AMEE Guide No. 70. Med Teach. 34(10):850–861.
Wigert B, Robinson J. 2018. Fostering creativity at work: do your man-
agers push or crush innovation? Gallup. https://www.gallup.com/
workplace/245498/fostering-creativity-work-managers-push-crush-
innovation.aspx.