From the 1/29/2021 newsletter
Perspective/Opinion
Can the Observation of Art Make us Better Clinicians?
By Stephen Humphrey, MD, Valerie Carlberg, MD, Alexandria Bear, MD, and Arthur Derse, MD, JD
Drs. Humphrey, Carlberg, Bear, and Derse describe how teaching Visual Thinking Strategies can improve perspective, communication, and empathy …
When people think of medical education, they envision the sciences – biology, pharmacology, physiology, and anatomy – among others. Artistry, or the consideration of art, is typically not deemed relevant to the skills a physician must acquire. Despite this, many trainees have heard the adage “medicine is an art.” This phrase typically arises after a nuanced physical exam finding, an innocuous but relevant comment in a patient history, or the success of a forgotten treatment modality for a recalcitrant condition. The term “art” in that context means the application of knowledge, skills, and judgment. The Oxford Dictionary also defines, “art,” however, as “the expression or application of human creative skill and imagination, typically in a visual form such as painting or sculpture.” If we agree that medicine is both a science and an art, can observation of art make us better physicians?
In fact, research shows the study of art in medical education improves visual literacy, diagnostic accuracy, communication, self-reflection, tolerance for ambiguity, and builds empathy. Visual Thinking Strategies (VTS) is a teaching method based on the research of psychologist, Abigail Housen, and museum educator, Philip Yenawine, that has been effectively integrated into the curriculum at several medical schools.
Visual Thinking Strategies – Questions
VTS is a method of art observation in which students are presented with a piece of art and VTS facilitators utilize three sequential, open-ended questions:
“What’s going on in this picture?”
“What do you see that makes you say that?”
“What more can we find?”
The questions guide students’ critical thinking. Skills derived from VTS can be applied to diverse scenarios, including the physical examination as well as discussions with patients or colleagues. At institutions utilizing VTS, it is incorporated into elective or mandatory courses for medical students in all phases of training. Usually, the VTS curriculum is a longitudinal experience over the course of a month or months. Though less common, some studies show benefit from a solitary experience or the ability to integrate VTS over several years.
A collaboration between MCW and the Milwaukee Art Museum
During the 2019-2020 academic year, Drs. Valerie Carlberg, Alexandria Bear, and Stephen Humphrey introduced VTS at the Medical College of Wisconsin. Their project, entitled “The Art of Observation,” was supported by the Kern Institute’s Transformational Ideas Initiative (TI2) grant mentored by Dr. Arthur Derse, in a collaboration with the Milwaukee Art Museum.
The first session was implemented as part of the “Art of Medicine Through the Humanities” elective directed by Dr. Derse. Fifteen fourth-year medical students participated. Students observed art and clinical images and recorded their observations. Pre- and post-session surveys were distributed and the quality and quantity of their responses was evaluated in a blinded fashion. Not surprisingly, the session led to a substantial increase in the number of observations and descriptors. Students reported that the session was valuable, citing that it enhanced their ability to analyze images critically, articulate observations, and understand multiple perspectives. We look forward to hosting more sessions post-COVID-19.
Opportunities
Within the last year, VTS has been described and celebrated in the AAMC’s Report on The Fundamental Role of the Arts and Humanities in Medical Education (FRAHME) (AAMC, 2020). In the future, we envision The Art of Observation taking place over three to six sessions with roughly ten to thirty students each. This would include an introduction to VTS followed by sessions evaluating portraits, landscapes, and abstract art. Expanded techniques would include the evaluation of medical photographs, “back-to-back” drawing, and asking students to serve as facilitators. We might later include residents, fellows, and faculty members, advancing the Kern Institute’s goals of character, competence, and caring.
The carryover into clinical medicine
By sharing observations aloud, participants will build confidence in diagnostic reasoning. Through listening and paraphrasing others’ observations, students will develop appreciation for diverse perspectives and increased tolerance for situations where there is no clear answer. Additionally, students will self-reflect and evaluate their assumptions, values, bias, and stigma, thereby building cultural competency, social intelligence, and caring.
At a time of great challenge throughout the world, The Art of Observation and VTS can empower physicians-in-training at MCW to embrace whatever situations arise with improved perspective, communication, and empathy.
Drs. Humphrey and Carlberg are Assistant Professors of Dermatology (Pediatrics) at MCW.
Dr. Bear is Assistant Professor of Medicine (Hospice and Palliative Medicine) at MCW.
Dr. Derse is Professor and Director of the Center for Bioethics and Medical Humanities (Institute for Health and Equity), and a faculty member of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.