Promoting well-being through creativity: a mixed-methods study on integrating studio art into education for students in medical fields in Japan.

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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Med Educ . 2026 Mar 9;26:621. doi: 10.1186/s12909-026-08964-8 Search in PMC Search in PubMed View in NLM Catalog Add to search Promoting well-being through creativity: a mixed-methods study on integrating studio art into education for students in medical fields in Japan Yuko Taniguchi Yuko Taniguchi 1 Center for Learning Innovation, University of Minnesota Rochester, 111 South Broadway, Suite 300, Rochester, MN 55904 USA Find articles by Yuko Taniguchi 1, ✉ , Moto Kitayama Moto Kitayama 2 Advanced Medical Education Center, Department of Gastroenterology and Hepatology, Nagasaki University, 1-12-4 Sakamoto, Nagasaki city, Nagasaki, 852-8523 Japan Find articles by Moto Kitayama 2 , Yuko Akazawa Yuko Akazawa 3 Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki City, Nagasaki 852-8523 Japan Find articles by Yuko Akazawa 3 , Hisatoshi Kawano Hisatoshi Kawano 4 Faculty of Education, University of Yamanashi, 4-4-37 Takeda, Kofu City, Yamanashi 400-8510 Japan Find articles by Hisatoshi Kawano 4 , Yasuhiro Nagata Yasuhiro Nagata 5 Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki City, Nagasaki 852-8523 Japan Find articles by Yasuhiro Nagata 5 , Sanjana Molleti Sanjana Molleti 6 Medical School, University of Minnesota Twin Cities, 420 Delaware St SE, Minneapolis, MN 55455 USA Find articles by Sanjana Molleti 6 , Sophie Gorham Sophie Gorham 7 Hennepin County Medical Center, 730 South 8th Street, Minneapolis, MN 55415 USA Find articles by Sophie Gorham 7 , Olivia Costa Olivia Costa 6 Medical School, University of Minnesota Twin Cities, 420 Delaware St SE, Minneapolis, MN 55455 USA Find articles by Olivia Costa 6 , Puja Chhetri Puja Chhetri 1 Center for Learning Innovation, University of Minnesota Rochester, 111 South Broadway, Suite 300, Rochester, MN 55904 USA Find articles by Puja Chhetri 1 , Josie Friedman Josie Friedman 8 School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA Find articles by Josie Friedman 8 , Shanze Hayee Shanze Hayee 9 Department of Psychiatry and Behavioral Sciences, University of Minnesota, Twin Cities, 606 24th Ave S, Minneapolis, MN 55454 USA 10 Masonic Institute for the Developing Brain, UMN, 2025 East River Parkway, Minneapolis, MN 55414 USA Find articles by Shanze Hayee 9, 10 , Robert Erdmann Robert Erdmann 1 Center for Learning Innovation, University of Minnesota Rochester, 111 South Broadway, Suite 300, Rochester, MN 55904 USA Find articles by Robert Erdmann 1 , Kathryn R Cullen Kathryn R Cullen 9 Department of Psychiatry and Behavioral Sciences, University of Minnesota, Twin Cities, 606 24th Ave S, Minneapolis, MN 55454 USA 10 Masonic Institute for the Developing Brain, UMN, 2025 East River Parkway, Minneapolis, MN 55414 USA Find articles by Kathryn R Cullen 9, 10 Author information Article notes Copyright and License information 1 Center for Learning Innovation, University of Minnesota Rochester, 111 South Broadway, Suite 300, Rochester, MN 55904 USA 2 Advanced Medical Education Center, Department of Gastroenterology and Hepatology, Nagasaki University, 1-12-4 Sakamoto, Nagasaki city, Nagasaki, 852-8523 Japan 3 Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki City, Nagasaki 852-8523 Japan 4 Faculty of Education, University of Yamanashi, 4-4-37 Takeda, Kofu City, Yamanashi 400-8510 Japan 5 Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki City, Nagasaki 852-8523 Japan 6 Medical School, University of Minnesota Twin Cities, 420 Delaware St SE, Minneapolis, MN 55455 USA 7 Hennepin County Medical Center, 730 South 8th Street, Minneapolis, MN 55415 USA 8 School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA 9 Department of Psychiatry and Behavioral Sciences, University of Minnesota, Twin Cities, 606 24th Ave S, Minneapolis, MN 55454 USA 10 Masonic Institute for the Developing Brain, UMN, 2025 East River Parkway, Minneapolis, MN 55414 USA ✉ Corresponding author. Received 2025 Sep 22; Accepted 2026 Mar 3; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13085415  PMID: 41803863 Abstract Background Mental health challenges are a significant concern among students and trainees in medical fields worldwide, including Japan, where high psychological distress is prevalent. This pilot study examined the feasibility and impact of a 6-day creative arts program designed for Japanese medical and international graduate students. Method A total of 14 students provided informed consent to participate in the study. Employing a convergent mixed-methods design, quantitative and qualitative data were collected and analyzed independently. Students completed the Comprehensive Inventory of Thriving (CIT) before and after the program to assess changes in psychological well-being. Pre-post differences were examined using paired t-tests. Qualitative data collection included post-program surveys, semi-structured interviews, and six-month follow-up interviews. We conducted thematic analysis to identify key patterns in student experiences. We then examined whether changes in CIT scores correlated with the frequency of qualitative codes to identify potential points of convergence between the two datasets. Results Thirteen students completed all major components of the study, with an average attendance of 5.2 out of 6 sessions. CIT scores significantly increased from before ( M = 198.0, SD = 29.9) to after completing the program ( M = 217.3, SD = 20.2), t (12) = -4.89, p = .0004, indicating a significant increase in thriving. Thematic analysis yielded three core themes: (1) Discovery through the underexplored parts of self and surroundings, (2) Rapid community bonding through inspiration, and (3) Creativity as a disruption to stress. Six-month follow-up interviews revealed additional themes related to enduring impact from the intervention: Applying creative insights into everyday life and mindsets. Through the convergent mixed-methods analysis, one pairing reached statistical significance: the change over time in the CIT subscore ‘Meaning’ was strongly correlated with the qualitative code “Out of the ordinary” (r = + 0.868), suggesting that increases in participants’ sense of meaning were strongly associated with the frequency of experiences that felt “Out of the ordinary” during the creativity program. Conclusion The findings suggest that a creative arts program for medical students is both feasible and effective in promoting well-being, enhancing stress management skills, and deepening self-awareness. The program shows promise for integration into medical education to support students’ holistic development and mental health. Supplementary Information The online version contains supplementary material available at 10.1186/s12909-026-08964-8. Keywords: Mental health, Creativity, Arts, Medical education, Student well-being Introduction Mental health challenges among medical trainees (both undergraduate and graduate students in the medical field) represent a serious, widespread, and persistent problem across the globe [ 1 – 7 ]. Despite increasing rates of depression, anxiety, stress, sleep disorders, and suicidal thoughts, among students in the medical field across the globe [ 8 – 15 ], relatively few medical students seek or receive treatment [ 4 ]. Obstacles to seeking mental health care include the stigma attached to mental illness and treatment, concerns about potential consequences, financial burden, lack of available time to engage in treatment, and limited access to services [ 16 ]. In Japan, high prevalence rates of mental health challenges among students in the medical field have been reported [ 17 ]. Recent studies on the impact of the COVID-19 pandemic indicate that it has posed substantial mental health challenges for Japanese medical students [ 18 , 19 ] and that, compared to non-medical students, medical students were less physically active, spent more time being sedentary, and had higher depression scores [ 20 ]. In addition to the intense academic, psychological, and emotional demands of medical training, students in these fields may face additional stressors such as harassment in the context of hierarchical professional relationships, as respect for hierarchy is deeply ingrained in Japanese culture [ 21 ]. As a result, there has been a call for greater attention to the mental well-being of Japanese medical students at an organizational level [ 22 , 23 ]. In Japan, barriers to addressing the needs of students in medical fields include limitations in awareness and understanding of mental health issues and stigmatized attitudes towards those who face mental health problems. Although Japanese medical students generally have higher mental health literacy (35.2% among second-year students [ N = 301] and 81.3% among fourth-year students [ N = 130] [ 24 , 25 ]), the students report that they are more likely to advise others to seek out a mental health professional for their depression than seek one out for themselves [ 24 ]. Other work has showcased how fears of judgment prevent open discussions about mental health in this population [ 26 ]. These barriers further underscore the need for systemic change to support students’ mental health in medical fields in Japan. Arts participation is a promising strategy for supporting mental health in medical education in Japan, given that it may bypass stigma. A substantial body of research in the field of Arts in Health has consistently documented mental health benefits over time, demonstrating a wide range of mental health outcomes, including reduced stress and anxiety [ 27 – 30 ], reduced depression symptoms [ 31 ], improved emotional regulation [ 32 ], and enhanced self-concept and self-efficacy [ 32 – 34 ]. Experts in Arts in Health fields have developed multiple theoretical frameworks conceptualizing the relationship between the arts and positive health outcomes. For example, the INNATE Framework (the INgredients iN ArTs in hEalth) conceptualizes art as an experience composed of active ingredients, whose interactions generate multiple mechanisms (biological, psychological, social, and behavioral) contributing to health benefits [ 35 ]. Another theory-building study, the Arts and Culture in Public Health Framework, synthesized data from an interdisciplinary mixed-methods research initiative and identified seven broad domains by which arts and culture influence health: “self-efficacy, personal and cultural resonance, aesthetic experience, emotional engagement and empathy, expression and being heard, meaning-making, and self-transcendence” [ 36 ]. Both frameworks recognize the complexity of how arts engagement impacts a human being, rather than focusing on singular mechanistic explanations for how the arts promote health. We recently proposed the Artist Mindset framework [ 37 ] as a way to understand the value of engaging in creative activities for young people with depression. Developed through collaborative autoethnography by a poet and a psychiatrist, the framework examines how strategies that artists use to navigate their creative process may be applicable to navigating mental health challenges. In this work, six core strategies – protect curiosity, be bold, go to discomfort, require play, suspend forming an opinion, and share – were identified as contributing to the Artist Mindset. Although originally developed for adolescents with depression, the Artist Mindset strategies are transferable and relevant to college students in medical training. The framing of mental health support through creativity rather than a clinical approach offers an opportunity to circumvent stigma-related barriers. Despite growing evidence of the effectiveness of the arts for well-being, arts and humanities in medical education settings have generally focused on professional development, such as fostering empathy, enhancing observational skills, and supporting professional identity formation [ 38 , 39 ]. However, information about the impact of the arts on well-being has emerged indirectly through qualitative findings. For example, a study engaged students in exploring five mental states through visual arts, film, and literature, revealing the potential of narrative-based approaches to elicit empathy, resilience, and reflective insight [ 40 ]. A second study reported that a nine-month Art as Self-Care course for medical students provided a calming experience and suggested a protective effect on burnout, with fewer students in the intervention group showing a worsening in psychological distress over time [ 41 ]. Nevertheless, we did not find any peer-reviewed studies in Japan examining the well-being of students in the medical field as the primary outcome of an art-based approach. The aim of the current pilot study was to explore the feasibility and preliminary impact of a six-day creative arts intervention for students enrolled in graduate medical programs at Nagasaki University School of Medicine (NUSM). The collaborative study was co-led by a team from the University of Minnesota (UMN), who had previously led a creative arts intervention for adolescents with depression [ 42 , 43 ], and a team of NUSM professors. The creative arts intervention was tailored to fit the specific context and needs of NUSM students. Our mixed-methods approach was informed by best practices in replicating arts-based interventions, which emphasize integrating prior evidence with local knowledge shaped by participants’ environments. Feasibility, practical constraints, stakeholder relevance, and institutional factors influencing implementation and sustainability were also carefully considered [ 44 , 45 ]. The following research questions are posed in this work: (1) Is it feasible for students enrolled in undergraduate and graduate medical programs to participate in a research study, and to complete study procedures such as consent, arts activities, and repeated assessment? (2) Will completing the creative arts program be associated with improvements in well-being? (3) What did the students experience as particularly meaningful in the program, and what processes appeared to be important? For the first research question, we expected that some students in the medical field would be willing to enter the study and complete the study activities, but also anticipated a small sample size, as the concept of well-being through creativity is relatively unfamiliar in Japan. This small group was expected to inform how this concept could be made more accessible with appropriate adjustments. For the second research question, we hypothesized that, consistent with our prior work [ 42 , 46 ], students would demonstrate improvements in well-being. Since the final research question was exploratory, using qualitative methods to discover meaning in the participants’ experiences, we did not articulate a specific hypothesis; however, we applied the Artist Mindset framework to understand these experiences as shared by the students. Method The study was approved by the UMN Institutional Review Board (IRB) and the NUSM Ethics Committee in 2023. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Participants were recruited through campus flyers, class announcements, and emails. Students Fourteen students (mean age 26.8 years; 13 female) provided informed consent to participate in the study. Four participants were undergraduate medical students and were from Japan. The remaining ten were international students enrolled in graduate programs. Among them, eight were pursuing MD/PhD degrees in Advanced Preventive Medical Science, one was pursuing a Master’s degree in Disaster and Radiation Medical Sciences, and one was pursuing a Master’s degree in Life and Radiation Research. In terms of nationality, six of the international students were from Kazakhstan, and the remaining four were from China, India, Myanmar, and Vietnam, respectively. Given the high demands on time that students in medical fields experience, which interferes with self-care and obtaining needed mental health services [ 16 ], it was unclear if students would be willing to enroll in a research study that involved an extra-curricular activity. Thus, feasibility was assessed through recruitment (whether participants enrolled in the program), retention (whether participants remained engaged and completed the program), and acceptability (whether participants perceived the program as relevant and meaningful to their well-being). Setting Nagasaki University School of Medicine, located in Nagasaki, Japan, is a nationally recognized institution known for its contributions to medical education, public health, and global health research. The university is situated in an urban campus environment. Its diverse student population includes domestic and international students, supported by programs that promote global health education and exchange. Study design For this pilot study, we conducted a single-cohort, prospective, longitudinal study to assess the impact of the intervention on thriving and mindset in students in the medical field in Japan. Given the pilot nature of this study, a power analysis was not carried out in its planning. Rather, the results of this study will be used to plan future, larger studies that also incorporate a control condition. Research team The creative arts intervention was led by an interdisciplinary team including two physicians and medical educators from Nagasaki University (MK, YA); a physician (KC), an Arts-in-Health scholar (YT), two medical students from UMN (SM, SG); and a music educator and composer (HK) from the University of Yamanashi. An additional physician from Nagasaki University provided consultation (YN). The data analysis was conducted by an interdisciplinary team at UMN: two post-baccalaureate scholars participated in the qualitative analysis; a Bioinformatics and Data Science Teaching & Learning scholar (RE) led the mixed-methods statistical analysis. Curriculum Drawing from creative arts curricula the research team had previously developed and successfully implemented in youth with depression [ 42 , 43 ], the program for this study was adapted to fit the specific population and available community resources. This program embodied the essence of an artist retreat by offering students a focused, distraction-free environment to nurture creativity, explore new materials, and connect with a supportive artistic community. It emphasized cultivating an artist-like experience through self-reflection, art activities, open studio time, and collaborative guidance from a professional teaching artist. Designed to create a sense of entering a new space, even though it takes place within the same building where students in medical fields attend classes, the program allowed autonomy by empowering participants to identify their own creative directions, while the facilitator remained available to provide consultation and support. This approach of creating artist-like experiences provides a unique space for medical trainees to engage in artistic exploration and nurtures authentic, free expression. Even while they are actively enrolled in intense medical and medical-science programs, the curriculum encourages students to take on the artist mindset [ 37 ]. The curriculum emphasizes self-reflection and intentionally frames cultural differences as opportunities for authenticity. This aspect especially lends itself to a diverse body of students, such as the one included here. The curriculum prioritizes personal expression by employing artistic media that are accessible without specialized art techniques. Further curriculum details are available in Table S1 of the Supplementary Materials. Study design This study employed a convergent mixed-methods design [ 47 , 48 ], collecting both quantitative and qualitative data to examine how a six-day creative arts program may influence students’ well-being and mindset. Quantitative data Before and after completing the creative arts program, students completed the Comprehensive Inventory of Thriving (CIT), a 54-item assessment that measures a broad range of psychological well-being constructs and represents a holistic view of positive functioning [ 49 ]. The CIT was validated in five samples of a total of 3,191 diverse participants from the United States, has been shown to have excellent psychometric properties, and to have convergent validity with other existing measures of well-being, as well as discriminant validity with existing measures of ill-being [ 49 ]. The CIT assesses seven domains of functioning that encompass 18 subdomains: Relationship (subdomains: Support, Community, Trust, Respect, Loneliness, Belonging); Engagement (subdomain: Engagement); Mastery (subdomains: Skills, Learning, Accomplishment, Self-Efficacy, Self-Worth); Autonomy (subdomain: Loss of Control); Meaning (subdomain: Meaning and Purpose); Optimism (subdomain: Optimism); and Subjective Well-Being (subdomains: Life Satisfaction, Positive Feelings, Negative Feelings). Each subdomain is assessed using three questions that probe this aspect of functioning using a 5-point Likert scale. Three subdomains are reverse-scored: Loneliness, Loss of Control, and Negative Feelings. CIT Total scores (the primary outcome) were calculated by summing all of the subdomain scores. Higher values mean greater well-being / thriving. The CIT was selected as it was designed for implementation in school and medical settings, along with the suitability of its broad approach, which combines wide-ranging domains of thriving into a single summary measure [ 49 ]. We also explored changes in CIT subdomains to facilitate the mixed-methods analysis described below. The CIT was administered in English for international students and in Japanese for undergraduate Japanese medical students. Statistical analysis of the quantitative data To assess change in thriving over time, paired t-tests were conducted to compare CIT scores from pre-intervention to post-intervention. To explore whether individual differences in thriving at baseline might help predict response to the intervention, we conducted a Pearson correlation analysis to examine the relationship between baseline CIT scores and change in CIT scores. Qualitative data Data collection Students completed surveys to provide their perspectives on the last day of the program. We also conducted semi-structured interviews immediately after the study and six months after the program. The first author (YT) conducted interviews in Japanese with four Japanese medical students. The remaining nine participants were interviewed in English by the sixth and seventh authors, who were also medical students (SG and SM). All three interviewers either facilitated a creative session or participated in the program as engaged researchers working alongside the students. Surveys and interview questions in English and Japanese are shown in the Supplementary Materials (S3-S5). Qualitative data analysis We employed reflexive thematic analysis (TA) [ 50 , 51 ] to inductively examine the interview responses and responses to the open-ended questions. TA is theoretically flexible, allowing meaning to emerge through coding at the semantic, or surface level, while also supporting the exploration of deeper, latent meanings within the data [ 51 ]. Because creative arts interventions have been little studied among students in the medical field in Japan, this method’s flexibility was fitting, as it allowed us to be open to various insights to emerge while maintaining a clear, systematic approach to data analysis. We followed the recommended six steps, described in Table 1 . Table 1. Theme analysis process Stage 1. Initial review The team (YT, PC, OC) familiarized themselves with the data through multiple reviews. Stage 2. Coding scheme development The lead researcher (YT) generated the initial coding schemes. Through a back-and-forth conversation within the team, the coding schemes were refined, and the team used the split coding process to systematically review the data. Stage 3. Coding The team members (YT, PC, OC) reviewed interview responses and open-ended responses from the post-surveys for coding while taking analysis memos. Specific coded data from each presentation were organized within a shared spreadsheet to facilitate transparent tracking and comparison. The lead researcher (YT) served as the gold standard coder [ 52 ], meeting regularly with each team member to review their coded notes and corresponding spreadsheet entries. The team resolved disagreements of codes by using the open discussion strategy [ 53 ]. Stage 4. Theme construction The team worked collaboratively to review each theme, analyzing its significance and how groups of coded excerpts illustrated and supported it. Themes were assessed for their relevance and alignment with the research questions. This iterative process continued until the subgroup reached consensus on the initial thematic drafts. Stage 5. Theme refinement To refine the themes, the team members returned to the original data, from which they extracted specific details to ensure that the emerging themes captured what the data demonstrated. Thematic maps were employed to help organize and visualize the relationships between themes. Stage 6. Report construction The final stage of reporting included synthesizing all the findings to capture a coherent report. Open in a new tab Reflexivity statement of the qualitative data analysis team The first author (YT), who identifies as a woman, is a scholar in Arts in Health with a strong background in qualitative research and guided the qualitative analysis, including oversight of the initial codebook development and active involvement in coding during the thematic analysis. Holding an MFA, she is also a novelist, poet, multimedia artist, and educator. Her perspective is informed by her artistic training, her lived experience as a 1.5-generation Japanese immigrant, and over 20 years of facilitating creativity-based workshops in medical settings. The eighth author (OC), who identifies as a woman and holds a B.S. in Psychology, participated in the initial coding and theme development. Her perspective is informed by her academic training in psychology and her involvement in multiple creativity-based studies with adolescents experiencing depression and anxiety, both as a participating researcher and qualitative data analyst. The ninth author (PC), who identifies as a woman and holds a Bachelor of Science degree in Health Sciences, also contributed to the initial coding and theme development. Her perspective is informed by her training in qualitative research, with a focus on creativity and well-being among at-risk youth, as well as her lived experience as a 1.5-generation Bhutanese-Nepali American navigating multiple cultural identities and the stigma surrounding mental health in her community. Convergent mixed-methods analysis To integrate the quantitative and qualitative data, we examined correlations between the CIT scores (total score and subscores) and the frequency of qualitative codes. Upon identifying correlations, we applied meta-inferences (Fetters, 2019), which involves comparing, contrasting, and synthesizing insights from both sets of data to produce a comprehensive understanding of the research questions. Meta-inferences help identify points of agreement (convergence), disagreement (divergence), complementarity (non-conflicting but different insights), and expansion (overlapping findings requiring further exploration). Figure 1 provides an overview of the study analysis process. Fig. 1. Open in a new tab Overview of study analyses Results Feasibility Of the 14 students who consented to participate in the study, 13 completed all major components, including the pre- and post-CIT, the program itself, the post-program survey, and the final interview. Average attendance during the program was 5.23 out of 6 sessions. Five students attended all six sessions, seven students completed five sessions, and one student attended three sessions. Twelve students completed the six-month follow-up interviews. Thriving Total CIT scores increased significantly from pre ( M = 198.0, SD = 29.9) to post program ( M = 217.3, SD = 20.2), t (12) = -4.89, p = .0004, showing a significant increase in thriving (Fig. 2 ). When compared with published norms [ 49 ] this magnitude of increase is equivalent to a shift from approximately the 75th percentile to the mid-to-high 90th percentile for thriving scores. Fig. 2. Open in a new tab Average CIT total scores at each time point Figure 3 displays total scores over time for each participant. Participants with lower baseline scores demonstrated greater improvement, evidenced by a strong negative correlation between baseline scores and change scores ( r = –.81, p < .001, N = 13). Fig. 3. Open in a new tab Change in CIT total scores over time Theme analysis The qualitative data analysis team constructed five subthemes from the codes listed in Table 2 of the Supplementary Materials (S6). These include: (1) flow– a state of deep immersion and focused engagement in creative activity; (2) connecting with their creative self– participants’ recognition and exploration of their creative attributes, or affirmation of themselves as creative beings; (3) mixed emotions– the experience of holding multiple and sometimes contradictory emotions; (4) community connection– feelings of belonging, shared experience, or relational closeness with others; and (5) well-being– participants’ awareness of the factors that contribute to their emotional and psychological health. The interaction and integration of these subcategories resulted in the development of three overarching themes: (1) Discovery through the underexplored parts of self and surroundings, (2) Rapid community bonding through novelty, and (3) Creativity as a disruption to stress. From the six-month follow-up interviews, we constructed an additional theme, applying creative insights into everyday life and mindsets. Figure 4 illustrates the construction process, from coding to subtheme construction, and then to the three themes that represent what the students experienced during the creative program. Fig. 4. Open in a new tab Development of codes and thematic categories In the following sections, we demonstrate how each theme was constructed using representative quotations from post-program interviews (I) and open-ended questions from the post-program surveys (PS). To maintain student confidentiality, all example quotes have been modified to include non-gendered (“they/them”) pronouns. Theme 1: discovery through the underexplored parts of self and surroundings This theme was constructed through the interplay of three subthemes: “Connecting with their creative self,” “Mixed emotions,” and “Well-being.” This theme captures how the creative program prompted self-inquiry, reflection, and imagination, guiding students to explore previously unnoticed aspects of themselves and uncover self-discoveries that had always been present but remained outside their awareness. Many students expressed that they had been unaware of certain aspects of themselves. Others found that their previous self-beliefs were challenged. The following comments capture the insights students gained through creative exploration. “I didn’t think of myself as someone with a strong, standout personality. But through this program, I realized that individuality is simply about bringing out what’s inside me, organizing it, and looking at it from an objective perspective. For me, just expressing what’s inside was a major task in itself.” (I) “I discovered that I feel safe when I don’t seek precision.” (S) “ Now, when I’m looking up at the sky, I find myself saying things like, ‘Wow, the sky’s face looks great today.’ It’s like I’ve become more conscious of voicing my feelings. Over these six days, we worked on externalizing what was inside us. I realized that expressing my emotions freely is really good for my mental well-being.” (I) These comments reflect students’ internal discoveries, showing that engaging in creative activities beyond their field enabled them to reconnect with often-overlooked aspects of themselves, leading to greater self-awareness. Additionally, students became aware of previously unexplored spaces in their physical surroundings. For instance, one student shared: “There’s a forest and air raid shelters from wartime behind the university, but I had never explored them before.” (I) Many students associated their academic campus with education and research and most students reported being unaware of the forest or historical landmarks on campus. The idea of exploring their own surroundings had simply never occurred to them. The discovery of our surroundings requires exploration, and the creative activities in this program provided an opportunity to explore. Theme 2: rapid community bonding through novelty This theme consists of the subthemes “Flow,” “Community Connection,” and “Well-being,” illustrating how quickly students formed meaningful connections with one another in a short period of time through shared creative experiences. By collaboratively making art and exchanging ideas with each other, the interaction naturally becomes personalized. The exchange of creative insights during the project also served as a way for the group to get to know each other more deeply, since collaboration requires individuals to discuss their ideas. In this reciprocal exchange of inspiration, attention gathered around what felt novel, fresh, and unique. The creative process moved to the center, holding the group in a shared, focused act of making. The following example shows how students inspired and influenced one another to explore directions and try concepts they might not have considered if working alone; this occurred during the Collaborative Community Garden project (Fig. 5 ), in which participants were invited to decorate a shared panel designed to be connected by a single flowing river. Fig. 5. Open in a new tab Collaborative community garden collage created by study participants “I consider myself a bit of a conservative person. I like something with a similar color and very stable music that is not that sharp, not that bright. But when I interacted with people, I say, ‘Wow, it’s also interesting to express yourself in a different way.’ When we were making the community forest, I was more into the details of making trees, making a 3D–like forest, and they [other students] were bringing a lot of colors. It has really become so beautiful in the end, but I could never have imagined it. I was like, ‘Wow, if you mix all these things, it can become like that?’ Working with different people, they have different inspirations, different thoughts, different views, but we can create something together.” (I) The accumulation of these daily interactions supports a deeper sense of connection and community, as demonstrated in the following example: “We’re like, wow, we can do something together like walking, talking, and sharing. It was really nice. You don’t know what others’ passions are like, so it made us more connected and brought us closer. Every day during the workshop, there was a time to share our artwork and a part of our souls with others.” (I) Getting to know different creative styles became a meaningful way for many students to connect with each other on a deeper level quickly, since creative choices tend to reflect one’s lived experiences, lifestyle, preferences, and sense of purpose. While conversations naturally emerged during the creative process, they were often focused on personal and unique details, further contributing to connection, focus, and bonding among students. Overall, this theme captures the students’ experience of rapid bonding with one another through shared creative experiences. Theme 3: creativity as a disruption to stressful life This theme consists of the subthemes “Flow,” “Community Connection,” and “Well-being,” synthesizing students’ reflections on their renewed understanding of creativity as a tool for breaking the cycles of a stressful life. Students described how engaging in creative practices allowed them to step outside routine patterns of thinking and perceiving. This theme frames creativity not merely as an act of making, but as a means of cognitive and emotional disruption. To truly take a break from the pressures of academic life, one needs an equally powerful tool to override its ingrained patterns. For the students, consistently spending two hours each afternoon thinking about creative topics and engaging with art materials became a calming and relaxing space, even amidst the activity of creating. Many students articulated how creative practices offered a meaningful shift away from academic work, describing them as both powerful and essential for their well-being. The following statements illustrate this shift into a flow-like focus. “Making arts, feelings [emotions], and concentrating on something can bring you control and peace.” (PS) “My takeaways about stress and well-being is that doing creative activities, particularly drawing or coloring, can help create space in my mind and not focus so much on stressful things. My daughter likes to color and I now realize that I can color with her, too. It’s not just for her.” (I) “When I was drawing, I didn’t think about anything. [I have] so many thoughts every time I’m stressed, but when I was drawing or doing something [creative], I noticed that I was relaxed. It’s joyful for me.” (I) “It’s easier to express my current psychological state through drawing. When I’m stressed or anxious, creative activities like drawing help me refresh myself.” (I) “I noticed that I was happier after that week, especially during the week when we were doing (the program). I tried to come earlier every time just to spend time there, and I found myself feeling much lighter.” (I) Students discovered that the creative process is an effective mental break from the academic obligations that often dominate their thoughts. In addition to the calmness, relaxation, and enjoyment, students described the creative activities as a useful container to process difficult emotions. Engaging in creative expression allowed them to process, rather than avoid, these feelings, serving as a form of emotional regulation. The following comments demonstrate the importance of acknowledging and exploring different aspects of the self. “[This program] helped me realize that we can express ourselves…I used to cry sometimes when I was alone, when I felt stressed. Now, I will turn on the music, and I will get the paper and pen. I can describe what I feel. And it’s like a dialogue with myself. This is a new method of fighting stress […]. It [creativity] is not only an interesting, but also vital activity. It helped me to introduce me to myself.” (I) “We should not forget we are human beings. Like we should let ourselves feel, we should let ourselves talk, and we should let ourselves listen to nature and feel nature. This program gave me the reminder that we are human beings.” (I) In art, the self often becomes the central subject of the creative process. While stress and difficult emotions may hinder academic work, they can be valuable in creative expression, as authentic art draws directly from the artist’s inner thoughts and feelings. The students indicated this idea of “using emotions” offered a way to shift out of being stuck in stress, transforming it rather than avoiding it. In this context, creativity becomes a disruptive force, allowing individuals to move from automatic responses to intentional engagement; many students found that creativity can both interrupt and defuse stressful situations. The final quote above demonstrates how the disruption of creativity serves as a reminder for these students to fully experience their humanity. Long-term impact of the creative program The six-month follow-up interviews reveal that many students continued to recall the insights and sensations they experienced during the program, confirming the three themes discussed in the interviews, and leading to the construction of the theme, Applying creative insights into everyday life and mindsets. Students articulated a range of insights gained from the program, spanning from concrete discoveries, such as finding a specific art medium they came to love, to broader shifts in self-perception and worldview. These included recognizing themselves as creative (“I am creative”), redefining creativity as more inclusive than their prior conceptualizations (“Everyone is creative”), embracing a more inclusive attitude toward art (“Art is for everyone”), and valuing reflection (“It’s important to take time to reflect”). They also demonstrated the importance of curiosity (“Pay attention”), courage (“Step outside of your comfort zone”), and the simple joy found in the creative process. Students discussed how they integrate these insights into their current lives. For example: “I started drawing more seriously. It feels different, like I can express myself more. It’s very calming…Now, when I need a break or feel stressed, I draw. I wouldn’t have discovered this if I hadn’t taken part in the workshop. Sometimes, I find myself asking questions like, ‘How would I draw my name tag today?’ Drawing gives me peace, and I feel less anxious about my work.” (I) Each day as the students arrived, they were invited to design their name tags based on the day’s theme, which related to the workshop’s focus (for example: “nature” on the nature exploration day, “imagination” for the clay session). For this student, the daily activity of decorating their name tag was helpful to set the stage for a creative mindset. The student recalls how receiving a specific prompt helped them get started with drawing, providing both direction and inspiration in an approachable way. The student replicated the specific element from the creative program they experienced. Similar to the previous student, some people applied the concept that creativity can be found in our daily lives as they navigate their academic life. For example: “I now look up at the sky. This came out of this creativity workshop. When I’m walking, there is beauty around me, and at the same time, there are messy thoughts. I started to pay attention to all of these. I think I changed my values and priorities. I value small, simple things in everyday life, rather than chasing a large goal.” (I) Many students expressed an appreciative view of others as they described a growing recognition of what creativity means. With new insights and application of this wisdom, they live with a more inclusive way of considering what constitutes creative expression. For example: “I discovered that being yourself by just putting some part of you can be creative. I used to think art belonged to people who had this art technique. But I, too, can create this, and this [what I created] is great. This kind of attitude and knowledge at the workshop influenced me.“ (I) “I discovered that everyone, no matter their profession, can express their emotions. The workshops showed me how important it is to take time to be aware of what’s going on inside our minds and to release those feelings, whether through art, writing, or communication.” (I) This finding, applying creative insights into everyday life and mindsets , indicates a shift in how individuals perceive creativity, not as a fixed skill or talent limited to the arts, but as a flexible process that can be integrated into daily life for anyone. Through these concrete examples in the six-month interviews, students illustrate how they have recognized the importance of tapping into their creativity and the importance of doing so for their well-being. Convergent mixed-methods analysis Results from the correlations between CIT subdomains and theme frequencies are shown in Fig. 6 . Fig. 6. Open in a new tab Correlations between CIT subscores and theme frequencies. This correlation matrix shows the strength and directionality of correlations between CIT subscores (x axis) and frequency scores for each of the identified themes resulting from the qualitative analysis (y axis) The strongest relationship observed was between the CIT subscore “Meaning” and the qualitative code “Out of the ordinary” ( r = + 0.868, p = .043), suggesting that the extent to which participants’ sense of meaning increased after the intervention was strongly related to the frequency of “Out of the ordinary” experiences in their narratives. Although not statistically significant, several strong correlations between qualitative analysis codes (QC) and CIT subscores can be observed in the heatmap in Fig. 6 , with the most notable correlations shown in Table 2 . Table 2. Strong correlations between CIT scores and frequencies of qualitative codes Correlation Qualitative Code CIT subscore definition 0.751 Out of the ordinary: participants experienced concepts that might be seen as unusual or outside social norms. CIT total score 0.733 Community: participants talked about the value of community, meeting new people. Belonging: (1) I feel a sense of belonging in my community; (2) I feel a sense of belonging in my state or province; (3) I feel a sense of belonging in my country. 0.730 Share: participants shared their work and the ideas behind it with others. Meaning: 1. My life has a clear sense of purpose 2; I have found a satisfactory meaning in life 3; I know what gives meaning to my life. 0.712 Out of the ordinary: participants experienced concepts that might be seen as unusual or outside social norms. Mastery: Skills: (1) I use my skills a lot in my everyday life; (2) I frequently use my talents; (3) I get to do what I am good at every day. Learning: (1) I learned something new yesterday; (2) Learning new things is important to me; (3) I always learn something every day. Accomplishment: (1) I am achieving most of my goals; (2) I am fulfilling my ambitions; (3) I am on track to reach my dreams. Self-Efficacy: (1) I can succeed if I put my mind to it; (2) I am confident that I can deal with unexpected events; (3) I believe that I am capable in most things. Self-Worth: (1) What I do in life is valuable and worthwhile; (2) The things I do contribute to society; (3) The work I do is important for other people. 0.675 Authenticity: participants experienced learning about their own distinct and creative elements that were specific to their own style. CIT total score Open in a new tab To further explore the relationship between CIT subscore “Meaning” and the qualitative code “Out of the ordinary” ( r = + 0.868, p = .043), we applied the meta-inference approach (Fetters, 2019). This involves comparing, contrasting, and synthesizing insights from the qualitative data coded as “Out of the ordinary” alongside definitions and constructs of “Meaning” within the CIT subscore. Using the meta-inference labels, we organized this analysis using four categories of integration as demonstrated in Table 3 : convergence (points of agreement), divergence (points of disagreement), complementarity (non-conflicting but distinct insights), and expansion (findings that overlap but warrant deeper exploration). Table 3. The interface between the CIT subscore, “Meaning,” and qualitative data coded with “Out of the ordinary” Quantitative finding: CIT subscore, “Meaning” Qualitative findings: Participant comments coded as “Unordinary,” defined as “Participants experienced concepts that might be seen as unusual or outside social norms.” Meta inference and interpretation Meaning and Purpose 1. My life has a clear sense of purpose 2. I have found a satisfactory meaning in life 3. I know what gives meaning to my life “In the Self-Portrait Puzzle Project, creating 12 puzzle pieces, each representing a different part of myself, was quite challenging. I don’t usually analyze myself in detail, and I tend to see myself in a vague, general way. I also don’t often express myself through illustrations or artwork. In the end, I realized that truly looking at myself was unexpectedly difficult.” “On the first day when we made our self-portraits, it actually seemed easy. I had to just put something from my life. When we started this portrait, I thought I should really think about what the real me is, who I am, and what follows me as a shadow. I found out that, ‘Wow, I should really think. This isn’t like everyday thoughts.’ So on the first day, I took the time to think. Most of the time, [in my life], I just think about necessary logistical things. Reflective thinking was challenging, but at the end, I feel good because I now know that I really like these things. I spent some time thinking not just about everyday things. Then, when I started to put things [on the puzzle portrait], I noticed even more what I really like.” Areas of convergence. Participants described experiencing a reflective thought process, noting that such engagement with the self felt unusual and outside of their everyday routines. Through this process, new self-discoveries emerged, an experience captured in Qualitative Theme 1: Discovery through the underexplored parts of self and surroundings . New self-discoveries through unordinary experiences appeared to be particularly linked to CIT subscore question 2: “I have found a satisfactory meaning in life.” “Performing music in front of everyone and being in the spotlight made me nervous. It was an unusual experience. Before, I thought creating music would be difficult, but I realized it could actually be quite simple.” Areas of divergence. Some novel situations remained unusual and could have warranted deeper interpretation, but they were not always expressed through overtly reflective or introspective thought. “The prompt, ‘What always follows you?’ made a strong impression on me. I thought it was a great prompt. It immediately resonated because I always feel like I have to do this, I have to do that. I have endless to-do lists that seem to chase me. When I reflect on myself, I often think about what I need to do rather than what I enjoy doing. I don’t usually think about positive past memories. I tend to focus more on current responsibilities and the pressure that comes with them. In Japan, it’s easier to fit in and avoid standing out. Being unique often makes things harder.” Areas of complementarity. Participants expressed a sense of self-acceptance by acknowledging their individual differences as creative and unique. This may be linked to CIT subscore question 3: “I know what gives meaning to my life,” which requires participants to identify specific elements that shape their sense of purpose and meaning. “The very first activity was very challenging because, even though I think I know a lot about myself, when I start to think about it or when I start to paint or even describe myself with words, I need to search for it: what I am, who I am. I think that’s why I haven’t finished it. This activity stimulated my brain every day. I was thinking, ‘What can I add more? What can I add to my point to this puzzle?’” “The ‘What makes you weird?’ activity was difficult for me. I don’t really recognize my own uniqueness, and I don’t think of myself as someone with distinct characteristics, so I struggled to come up with anything.” Areas of expansion. The qualitative findings illustrate how participants navigated the creative process, often describing it as both challenging and insightful. Engaging in creative work, outside of their everyday routines, may play an important role in fostering a creative mindset and self-discovery. The challenges encountered during the creative process may themselves be meaningful, as they often serve as catalysts for growth. Open in a new tab Examining other strong correlations between specific CIT subscores and the frequency of corresponding qualitative codes, though not reaching statistical significance, reveals patterns that convergently support and reinforce the three themes identified through thematic analysis. Table 4 illustrates this alignment between the mixed-method findings and qualitative thematic insights. Table 4. Notable correlations and corresponding qualitative themes High correlations Qualitative theme Out of the ordinary (QC) and Mastery (CIT) [0.712] Explore (QC) and Learning (CIT) [0.607] Theme 1: Discovery through the underexplored parts of self and surroundings Share (QC) and Meaning (CIT) [0.730] Community (QC) and Belonging (CIT) [0.733] Theme 2: Rapid community bonding through novelty Out of the ordinary (QC) and Total score (CIT) [0.751] Authenticity (QC) and Total score (CIT) [0.675] Theme 3: Creativity as a disruption to stress Open in a new tab Discussion This study investigated the feasibility and potential value of a creative arts program designed to improve well-being in undergraduate medical students and graduate students in the medical field in Japan. Key findings were that (1) students willingly participated and completed study procedures, suggesting feasibility; (2) quantitative measures suggested improvements in well-being after the program; and (3) qualitative findings provide insights into the experiences that students found to be most meaningful and relevant to their well-being. Feasibility Based on student enrollment and completion rates in this small pilot study, our findings suggest the feasibility of implementing a creative program in a medical education setting in Japan. Out of fourteen students who consented to participate, thirteen students completed the study. Considering the demanding schedules of students in the medical field and the fact that this program was offered in the evening after a full day of work, research, or classes, consistent attendance may have posed a challenge. However, the high attendance rate (more than five out of six sessions on average) suggests that a program like this can be successfully integrated into students’ lives. Many students expressed interest in participating in similar programs in the future. Impact on well-being The improvements in the pre- and post-CIT scores suggest that there was a measurable positive shift in well-being following the program. These findings are consistent with the broader evidence base from research on the impact of creative interventions on mental health and well-being. Although systematic reviews specific to medical education are limited, reviews of creative interventions for children, adolescents, and young adults consistently demonstrate benefits for mental health and well-being, particularly with regard to anxiety, depression, self-confidence, resilience, empowerment, and social connection [ 54 – 57 ]. In a similar context, a study on arts-based self-care programs for medical students reports comparable outcomes, particularly the use of the arts as a calming distraction from academic stress [ 41 ]. Our qualitative themes, self-discovery, peer connection, and stress reduction, are consistent with these findings. In addition, a recent systematic review examining the mechanisms of creative interventions for youth mental health and well-being reported that facilitators often emphasized creating spaces characterized by freedom, safety, social connection, self-identification, and enjoyment [ 58 ]. Through the qualitative analysis, we identified three themes representing how this creative arts program may have contributed to an increase in well-being. Three themes were identified, (1) Discovery through the underexplored parts of self and surroundings , (2) Rapid community bonding through novelty , and (3) Creativity as a disruption to stress . Here, we discuss each theme in the context of the extant literature and the lens of the Artist Mindset. The first theme, Discovery through the underexplored parts of self and surroundings , shows how creative activities enabled students to explore their inner selves and their environment, leading to self-discovery, which often involves emotional activation. One participant reflected, “The first day, I didn’t know what I could do. But on the second day, I realized that we are free to use all the stuff that is in the room. So that’s how I was able to use all those colors.” This comment reflects the “require play” strategy of the Artist Mindset. Play involves freely exploring activities without expectations or predetermined goals [ 37 ]. Artists engage in play to preserve a childlike sense of wonder and the freedom to experiment. In this case, participants used available materials to explore how they felt as they created their piece. The participant navigated one step at a time, and later, reflected on the meaning and the purpose of their experience: “I felt like I wanted to purposely get out of the rules that were set,” while also acknowledging, “but I don’t usually behave that way.” This reflection suggests how the participant demonstrated incorporating the strategy of “require play” as a rule to follow that facilitated both their creative work and their well-being. The strategy from the Artist Mindset “go to discomfort” was also evident in this theme. For example, a participant mentioned, “Before this course, I hated to draw with acrylic paint […] But then I was like, wow, it’s so good just to paint this [galaxy painting]. And I don’t know, it’s a lot of emotions when I’m doing this and deciding how to draw. And it was amazing in my opinion.” Despite this participant’s previously-held negative associations with acrylic painting, they challenged themselves to “go to discomfort” by trying the medium anyway, and this led to a powerful and rewarding experience. A third principle from the Artist Mindset that resonates with this theme about discovering underexplored aspects of one’s self and environment is “Protect curiosity.” Curiosity is defined in psychology as “a positive emotional-motivational system associated with the recognition, pursuit, and self-regulation of novel and challenging opportunities” [ 59 ]. From an artist’s perspective, curiosity is similarly understood as an elusive sensation that offers entry into the creative process; its meaning or significance is not yet known, but the artist has the courage to take risks and explore it. The Artist Mindset emphasizes that artists “protect” this sensation of curiosity. This concept is discussed by the late Faith Fitzgerald, a physician and master medical educator, in her influential essay Curiosity where she defined curiosity as “the urge to investigate, to discover” [ 60 ]. When students participate in creative activities that prompt self-inquiry, they activate their curiosity to ask who else they might be, how else they might think, and how else they might relate to their surroundings beyond the patterns reinforced in typical academic settings. This emphasizes the importance of recognizing curiosity in medical students and encouraging it. Fitzgerald noticed that students often kept their artist identities separate from their medical identities: “They just did not think it wise to let anyone know because they had received a message from house staff, faculty, or peers that interest in anything other than purely biological medicine was inappropriate for a medical student. Medical education itself suppresses the expression of curiosity, emphasizing examinable facts rather than more ineffable thought processes in order to provide reproducible experiences for students.” ([ 60 ], p.71) Despite increasing integration of arts and humanities at the institutional level since this essay was published over twenty-five years ago [ 61 ], the separation between the identities of “medical trainee” and “artist” remains evident as participants in this study consistently described creative experiences as existing outside their academic world. A recent study on curiosity among medical students found that final-year students exhibited significantly lower levels of intellectual medical curiosity compared to first-year students [ 62 ]. Perhaps, encouraging students to retain their identities as artists could help reverse such trends, not only for their capabilities as professionals in the medical fields, but for the sake of their own development and well-being. As an important departure from training in medical fields, which often emphasizes external knowledge acquisition, the inward and environmental exploration that takes place in creative arts activities may help students develop a different dimension of curiosity, one that is reflective, experiential, and personally meaningful. Such curiosity has been linked to well-being and life satisfaction [ 63 – 65 ]. For instance, a recent study [ 63 ] found that physicians often associated curiosity with positive emotions and well-being, while its suppression, often due to limited autonomy and time, was linked to negative emotions. This study also revealed a two-way relationship between curiosity and stress: some physicians felt that stifling their curiosity caused stress, while high stress levels, in turn, diminished curiosity. These findings underscore the importance of creating space to protect and nurture curiosity. Another study on medical students found that their expected job satisfaction was strongly tied to how much they believed their curiosity would be nurtured in their future role as physicians [ 66 ]. The first theme, especially the act of exploring “the underexplored parts of self and surroundings,” relates to this point of interactive learning and engaging with challenges to investigate and discover. The second theme, Rapidly forming meaningful relationships , shows how engaging in creative experiences may contribute to forming rapid connections among peers through collective focus. The emphasis on “rapid” is significant, as building relationships typically takes time, yet students in the medical field often report having too little time. The act of engaging in creative activities together seems to accelerate the process of connection due to the cultivation of shared experiences. Previous studies on arts-based participation within communities have also recognized the power of shared creative arts experiences for driving increased social connection [ 67 – 72 ]. Shared creative experiences with community members help cultivate meaningful relationships, build connections, and develop collective fulfillment [ 73 – 75 ]. This stronger sense of thriving experienced at the interpersonal and community level can, in turn, positively influence various health outcomes of individuals and communities [ 68 , 76 ]. This theme resonates with the “share” strategy from the Artist Mindset framework, which emphasizes the importance of sharing our creativity with others: “Seeing the development of one’s peers’ work provides inspiration and an opportunity to express encouragement and wonder. Gaining insight into the hidden parts of one’s peers can foster deeper understanding and connection between collaborators in this kind of setting” [ 37 ]. Here we observed how sharing can also lead to new perspectives. For example, one participant noted, “Seeing different perspectives and ways of thinking from everyone made me realize that there are so many different ways to live,” demonstrating empathetic understanding alongside recognition and appreciation of differences. The third theme, Creativity as a disruption to stress , demonstrates students’ recognition of the therapeutic value of creative engagement. As this theme was constructed based on the subtheme, “flow,” the creative activities are presented as a powerful coping mechanism, allowing focus on the creative process, enjoyment, curiosity, and temporary detachment from their high-pressure identities as medical students or researchers. Flow is an experiential state characterized by deep immersion in the creative process, high engagement, and a balance between challenge and perceived control during the creative process [ 77 , 78 ]. Research suggests that a flow state is associated with intrinsic enjoyment, a sense of mastery, and reduced self-consciousness, and experiencing flow regularly can enhance life satisfaction, reduce stress, support emotional resilience, and encourage a sense of competence [ 79 , 80 ]. Participants’ comments, such as “making art, feelings [emotions], and concentrating on something can bring you control and peace,” and “When I was drawing, I didn’t think about anything,” suggest that they experienced a flow state. Through creative expression, people not only engage their skills and imagination but also access a restorative mental space that nurtures both personal fulfillment and overall well-being [ 81 ]. This theme directly speaks to maintaining well-being and managing a demanding lifestyle by creating space for emotional and cognitive pauses, allowing medical trainees to step back from the work that often consumes their thoughts. In addition, this theme demonstrates that a dedicated space for exploring the strategies used by artists, as outlined in the Artist Mindset, is an appealing and meaningful concept, as this theme reflects how participants began to recognize themselves as creative beings with the capacity and need for self-expression. One participant noted, “[This program] helped me realize that we can express ourselves.” Creative expression is not reserved for professional artists; rather, all people possess creativity and can engage in artistic practice in their own ways. The theme Disruption of Stress suggests that participants temporarily shifted their roles from medical students to artists. This shift was made possible through the program’s integration of daily creative sessions. As one participant shared, “I tried to come earlier every time just to spend time there, and I found myself feeling much lighter.” This theme indicates that providing a dedicated time to practice the Artist Mindset may help disrupt the intensity and stress of medical education. The findings from the six-month follow-up interviews, Applying creative insights into everyday life and mindsets , captured the lasting cognitive shifts students experienced, as they began noticing creativity in their surroundings and people around them, integrating creativity into their routines, and their overall view of and approaches to uncertainty. The subtheme, Flow , continues to be relevant as it functions as a space for students to take a break through a state of focus and calm not often encountered in their usual academic work. The subtheme Connection with creative self points to how students developed not only a deeper intimacy with themselves but also a stronger understanding of their own creativity. As one student reflected, “I discovered that being yourself by just putting some part of you can be creative. I used to think art belonged to people with art techniques. But I, too, can create this, and this [what I created] is great.” Many participants realized how inherently creative they already are. This understanding extended to others as well, as another participant commented, “I discovered that everyone, no matter their profession, can express their emotions.” Such reflections suggest that participants applied the Artist Mindset strategies, “Be bold” and “Go to discomfort,” as emotional expression is not typically part of the medical education curriculum. The subtheme indicates that the program allowed participants to practice being artists and to see and experience creativity in new ways. In the high-pressure environment of medical education, professional identity often overshadows other aspects of a person’s identity, narrowing self-concept. This program helped shift the view of creativity from a skill reserved for those with formal art training to one accessible to everyone. According to the Artist Mindset, the goal of an artist is simply to create. In this study, students learned that this goal is relevant for anyone. Moreover, practicing the Artist Mindset can support the development of skills relevant to mental health. This subtheme, therefore, suggests that participants practiced important skills that could help maintain their well-being. Overall, this theme suggests a reclaiming of the creative self, an important contribution to well-being [ 82 ]. Interpretation from a convergent mixed-methods approach In examining correlations between QC and CIT subscores, positive correlations were observed that were of medium to strong effect size (i.e., r values in the 0.4–0.8 range), most notably the relationship between “Out of the ordinary” and “Meaning.” As explored in depth through the meta-inference approach, this correlation indicates how, as an experience outside of their usual routine, creative activities provide an insightful space for medical trainees to wonder and explore. By pursuing this curiosity, they may make discoveries and construct meaning that they otherwise wouldn’t have encountered. This finding builds on previous studies [ 75 , 83 , 84 ] that have identified creative mediums such as creative writing, spoken word, music, performance art, and visual art as effective tools for meaning-making and supporting psychological well-being. Further, this point aligns with the Arts and Culture in Public Health Framework, which identifies “meaning-making” as one of the mechanisms through which arts participation contributes to health outcomes [ 36 ]. Further exploration of the connection between the “Out of the ordinary” code and “Meaning” revealed additional insights into what students perceived as out of the ordinary. One participant reflected, “I don’t usually analyze myself in detail,” echoing a common response that such in-depth self-reflection, combined with the responsibility to express insights through art, is not typically part of their academic life. This reflective and creative space nurtures a sense of wonder about identity, lived experiences, and the process of making meaning from who they are and how they understand their own experiences. Finally, the mixed-methods findings help explain why participants reported applying creative insights to their everyday lives and mindsets. The strong correlation between the “Out of the ordinary” code and total CIT scores may align with the theme of creativity as a disruption to stress. For example, one participant noted, “Stepping out of my daily routine made me feel better,” showing how the “Out of the ordinary” experience encouraged continued exploration beyond their comfort zones, and even created a coping strategy: “After the workshops, I started doing more things outside my usual routine.” Many participants emphasized the value of integrating creativity and the “Out of the ordinary” sensations arising from the creative process into their daily lives, identifying this as a key takeaway from the study. Strengths and limitations A strength of this study lies in its in-depth exploration of convergent data, which places the lived experiences of study participants at the center of the analysis. By employing a mixed-methods approach, the study was able to capture both quantitative patterns and rich qualitative insights, allowing for a nuanced understanding of how engaging in creativity impacts medical trainees. This integration made it possible to identify specific characteristics and correlations that were not only statistically meaningful but also deeply connected to the participants’ subjective experiences. Additionally, the focus on creative processes within medical education provides a novel contribution to the growing body of literature on well-being and professional development in healthcare training. However, the study is not without limitations. The small sample size and the lack of a control group limit the conclusions that can be made from the quantitative results. The fact that the sample was largely composed of female students limits the generalizability of the findings and calls for caution in extrapolating results to broader populations. Moreover, the degree of self-expression may have varied due to differing cultural expectations. Several participants indicated that not only creative expression, but personal expression itself, felt unfamiliar, as such self-expression is not typically encouraged in Japan. The six-month follow-up findings relied solely on interviews and did not include a quantitative measure, prohibiting the quantitative examination of the sustainability of post-intervention effects. Additionally, the themes identified from the six-month interviews could have been influenced by recall bias. Furthermore, as creative programming in medical schools has not been widely reported in Japan, it is challenging to compare these findings with similar studies in other contexts. The lack of existing benchmarks limits the ability to situate the results within a larger framework of medical education research. Future studies with larger, more diverse cohorts and cross-cultural comparisons are needed to further validate and expand upon these findings. While this study suggests that arts-in-health approaches are a promising direction for promoting well-being in medical education in Japan, further research is needed to identify the active ingredients, their combinations, and underlying mechanisms. These elements should be systematically assessed and tested to clarify which variables are most impactful for medical students. Additional research, ideally with larger samples and including randomized control study designs, will help articulate more focused findings regarding the most relevant and supportive components of arts-in-health interventions for medical students in Japan. Conclusion This pilot study demonstrates that implementing a creative arts program for Japanese medical students and international graduate students may be feasible and provides preliminary evidence of its potential impact on student well-being. The quantitative and qualitative results support the idea that creative engagement may contribute to enhancing psychological well-being, instilling self-discovery, and strengthening community bonds among medical trainees. The strong correlation between “Out of the ordinary” experiences and an increased sense of meaning suggests the potential for novel, creative activities in expanding perspectives and supporting mental health. These findings provide preliminary evidence for integrating creativity-based activities into medical education as a means to promote holistic development, resilience, and long-term well-being in future healthcare professionals. This study also contributes to identifying acceptable and culturally responsive approaches to supporting well-being and self-care among students in Japanese medical education. Providing opportunities for students to adopt an artist mindset through arts-based participation may offer a valuable model for institutions to adapt to their own contexts, resources, and learning environments, as well as for future studies to confirm and extend these findings. Supplementary Information Supplementary Material 1. (704.4KB, docx) Acknowledgements Not applicable. Clinical trial number Not applicable. Abbreviations CIT Comprehensive Inventory of Thriving TA Theme Analysis Authors’ contributions YT contributed to the design of the creative arts intervention, qualitative data collection and analysis, mixed-methods analysis, manuscript drafting, editing, and overall manuscript management. MK, YA, and YN contributed to the implementation of the study, quantitative and qualitative data collection, and manuscript writing, editing, and revision. HK contributed to the design of the intervention and manuscript revision. SM and SG contributed to qualitative data collection, interview transcription, and manuscript revision. OC and PC contributed to qualitative data analysis, manuscript writing, and editing. JF contributed to quantitative data analysis and manuscript revision. SH contributed to quantitative data analysis and manuscript revision. RE contributed to quantitative data analysis, mixed-methods analysis, manuscript writing and revision, and the creation of data visualizations. KC collaborated closely with the first author on the design of the quantitative assessment, qualitative data collection, quantitative and mixed-methods analyses, and manuscript writing, editing, and revision. Funding The study was funded by the University of Minnesota Global Health Seed Grant. Data availability The datasets analysed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate Approval was obtained from the Nagasaki University School of Medicine (23112401) and University of Minnesota (STUDY00017499). Written informed consents were obtained from the study participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Policy and Global Affairs, Board on Health Sciences Policy, Board on Higher Education and Workforce, Committee on Mental Health, Substance Use, and Wellbeing in STEMM Undergraduate and Graduate Education. 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