Formal Art Observation Training Improves Medical Students’ Visual Diagnostic Skills

Harvard Medical School, Medicine Education Office, Brigham and Women's Hospital, Boston, MA, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 07/2008; 23(7):991-7. DOI: 10.1007/s11606-008-0667-0
Source: PubMed

ABSTRACT Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation.
To improve students' visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care.
Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis.
Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training.
Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session.
The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation.
Following the course, class participants increased their total mean number of observations compared to controls (5.41 +/- 0.63 vs. 0.36 +/- 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A 'dose-response' was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03).
This interdisciplinary course improved participants' capacity to make accurate observations of art and physical findings.

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Available from: Maria A Blanco, Dec 08, 2014
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    • "Indeed a subset of these students reported that the sessions increased their empathy by creating an opportunity to consider others' points of view, and reconsider their own preconceived notions; a useful skill that supports patient-centred care, and particularly so when dealing with patients whose clinical problems do not fit easily into a diagnosis. Naghshineh et al. (2008) provided medical students with 8 weeks of didactic sessions held in an art gallery that integrated physical diagnosis with art topics and life drawing. Students exhibited enhanced " visual literacy, " a term from a text edited by Flood and Lapp (1997), as illustrated in their sophisticated description of artistic and clinical imagery. "
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    ABSTRACT: Background: There is strong evidence supporting the personal and professional benefits for medical students of exposure to art. There is limited information on art-making in relation to medical education. Methods: We explored art-making within medical education by analysing 76 artist statements submitted with visual artwork by students, residents and practitioners to the 2010 and 2011 White Coat Warm Art exhibitions. We analysed the data using grounded theory strategies to identify how medical students and practitioners describe their engagement in artistic creation and how it impacts their personal and professional lives. Results: Our analysis yielded eight themes that illustrated instrumental, humanistic and advocacy-oriented implications of art-making: enhancing learning, escaping constraints, balancing life and work, surviving, expressing self-identity and discovering professional identity, bearing witness, healing self and others, and advocating change. Conclusions: Art-making can play a valuable role in medical education by providing a means of making sense of, and learning foundational information and concepts in medicine. Creative expression through artistic means also provides learners and practitioners a means of exploring their emerging sense of professional identity and clarifying their value commitments. In addition, the experience of art-making fosters well-being, empathy and commitment towards a better future for medicine.
    Arts & Health 05/2015; DOI:10.1080/17533015.2015.1037318
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    • "The researchers found that students who were exposed to the training had significant improvement in identifying heart, lung and bowel sounds. Many researchers have demonstrated the use of visual art, such as paintings and photographs, as a way to improve physical diagnostic skills in the form of observing, identifying, discriminating and clustering data (Dolev, Friedlaender, & Braverman, 2001; Kirklin, Duncan, McBride, Hunt, & Griffin, 2007; Naghshineh et al., 2008; Pellico et al., 2012; Pellico, Friedlaender, & Fennie, 2009). This research has primarily been conducted using visual arts education techniques used originally to critique paintings and sculpture , often in collaboration with an art museum or gallery, to improve objective observational skills through visual stimuli (Braverman, 2001; Frei, Alvarez, & Alexander, 2010). "
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    ABSTRACT: Abstract Noise overload within the clinical environment has been found to interfere with the healing process for patients, as well as nurses ability to effectively assess patients. Awareness and responsibility for noise production begins during initial nursing training and consequently a program to enhance aural awareness skills was designed for graduate entry nursing students in an Australian university. The program utilised an innovative combination of music education activities to develop the students' ability to distinguishing individual sounds (hearing), appreciate patient's experience of sounds (listening) and improve their auscultation skills and reduce the negative effects of noise on patients (action). Using a mixed methods approach, students' reported heightened auscultation skills and greater recognition of both patients' and clinicians' aural overload. Results of this pilot suggest that music education activities can assist nursing students to develop their aural awareness and to action changes within the clinical environment to improve the patient's experience of noise.
    Contemporary nurse: a journal for the Australian nursing profession 03/2014; 47(1-2). DOI:10.5172/conu.2014.4737 · 0.65 Impact Factor
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    • "It has been suggested that programs using visual arts to improve observation skills of medical students must consider both the manner of instruction and the types of images used for such instruction (Dolev et al. 2001; Reilly et al. 2005; Shapiro et al. 2006; Naghshineh et al. 2008). For this exercise, both representational and non-representational art were selected to stimulate discussion and engage students. "
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    ABSTRACT: Background: Clinical observation is fundamental in practicing medicine, but these skills are rarely taught. Currently no evidence-based exercises/courses exist for medical student training in observation skills. Aim: The goal was to develop and teach a visual arts-based exercise for medical students, and to evaluate its usefulness in enhancing observation skills in clinical diagnosis. Methods: A pre- and posttest and evaluation survey were developed for a three-hour exercise presented to medical students just before starting clerkships. Students were provided with questions to guide discussion of both representational and non-representational works of art. Results: Quantitative analysis revealed that the mean number of observations between pre- and posttests was not significantly different (n = 70: 8.63 vs. 9.13, p = 0.22). Qualitative analysis of written responses identified four themes: (1) use of subjective terminology, (2) scope of interpretations, (3) speculative thinking, and (4) use of visual analogies. Evaluative comments indicated that students felt the exercise enhanced both mindfulness and skills. Conclusion: Using visual art images with guided questions can train medical students in observation skills. This exercise can be replicated without specially trained personnel or art museum partnerships.
    Medical Teacher 05/2013; 35(7). DOI:10.3109/0142159X.2013.770131 · 1.68 Impact Factor
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