However, several medical schools and internal medicine programs are bucking that trend by offering trainees some novel teaching formats. Some have built simulation centers that can help teach critical procedures. For example, this technology can be useful in teaching medical residents how to perform arthrocentesis procedures. Most medical schools incorporate the objective structured clinical exam (OSCE) into their clinical examination curricula. The OSCE relies on using standardized patients and actors to simulate the patient clinician encounter. This exercise is good up to a point; simulation is great, but there is a tendency for participants to see it as being a practice drill and most prefer seeing real patients instead. What is really needed is a way to teach the art of “learning to look,” a term coined by Charles Bardes MD, professor of clinical medicine at Weill-Cornell Medical College in New York. Dr. Bardes and others have developed educational collaborations with local art museums for the purpose of developing student skills in clinical observation, description, and interpretation. As he noted: “Courses in physical diagnosis teach the students to recognize normal and abnormal findings, especially the cardinal signs and symptoms of disease, but do not emphasize the actual skill of careful looking in itself. Looking is often assumed. In the visual arts, on the other hand, the act of looking carefully is made explicit. In art education, major emphasis is placed on meticulous observation and description of visual information.”1 Can art appreciation enhance our skills as medical detectives?
Visual Thinking Strategies
A recent study done at Harvard Medical School in Boston set out to answer this question by creating a course for first- and second-year medical and dental students consisting of eight paired sessions of art-observation exercises (20 hours) coupled with didactic lectures that integrated fine-arts concepts with physical diagnosis topics.2
The frequency of accurate observations on a one-hour visual-skills examination was used to evaluate pre- and postcourse descriptions of patient photographs and art imagery. Students were given eight minutes to report their free-text observations and interpretations of five slides depicting three patients with a variety of clinical disorders and two artworks in different genres, none of which were shown or discussed during the course. The clinical images included physical findings associated with upper-extremity deep-vein thrombosis, stroke, and (yes) relapsing polychondritis.
Class participants increased their total mean number of observations by nearly 40% compared to control students who had not participated, and they showed an increased sophistication in their descriptions of artistic and clinical imagery. There appeared to be a ‘dose response’ to learning since those who attended eight or more sessions scored significantly better than participants who attended seven or fewer sessions. It appears that this type of intervention promotes strategies for students to confront and decipher visual information. They achieve this by exercising visual problem solving in art and medical imagery using the repeated practice of observing and describing. By exploring a wide range of artistic concepts, art genres, and medical conditions, course faculty were able to challenge students to see beyond specific content areas.
