Medical Students Transfer Observation Skills from Painting to Patient

What is unusual about a group of students huddled around a painting at Boston’s Museum of Fine Arts, debating the deeper meaning behind a canvas of ambiguous brushstrokes? Nothing – except that the group comprises Harvard medical students engaging with the artwork to improve their diagnostic skills.
The students are part of an elective course called Training the Eye, which teaches students basic art observation skills they can transfer to physical exams and clinical diagnosis. Students taking the course commit to an intensive 10 weeks of art museum visits, a drawing workshop, clinical didactics, and bedside rounds led by Brigham and Women’s Hospital course co-founders Joel T. Katz, MD and Shahram Khoshbin, MD.  With arts advisor Alexa Miller and museum educator Michelle Grohe, they have continually evolved it to integrate arts education with clinical training.
“Young doctors need the chance to develop skills and understanding around what it really means to see a patient,” says Miller. “Part of this is practice. Part of this is having the opportunity to examine one’s own biases and judgments.”
Harvard isn’t the only school using the arts as part of their medical training — Miller is currently working with Boston University School of Medicine, the University of South Florida, the Carolinas Health System, and other teaching hospitals to integrate arts education into clinical training programs.
The faculty have seen students apply these new observation skills in various teaching hospitals with great results. In 2008, Sheila Naghshineh, MD and the team published ​a study about the course in the Journal of General Internal Medicine. They found that students who participated in seven or more arts-based sessions made 38% more observations than their peers, in response to both clinical and art imagery. Participating students further provided significantly more evidence for their interpretations than their peers.
“The arts present a space where we can be in ambiguity in a safe and positive way where nobody is dying and nobody is suffering,” says Miller. “Uncertainty is a very authentic part of life and of problem solving. Uncertainty is welcome, helpful, and interesting in arts situations.”

Photo Courtesy the Rose Art Museum, Brandeis
Above: Alexa Miller facilitates an arts discussion with medical students 
Jeffrey Campbell, a Harvard medical student who took Training the Eye in the spring of 2012, says the program teaches a skill set that is virtually impossible to learn in a classroom.
“Learning how to communicate what we see is extraordinarily helpful when we then have to describe x-ray images or MRIs,” says Campbell. “The connection between looking at medical images and looking at art is never really made explicit in our normal coursework, but the parallels are clear.”
Stepping away from normal coursework, Training the Eye allows students to master critical observation skills that aren’t always readily available in a traditional medical curriculum. They transfer those skills from painting to patient, such as looking objectively without jumping to conclusions, discussing different opinions without judgment, and articulating ambiguity. Students also learn how to:
  • Communicate collaboratively
  • Disagree respectfully
  • Observe objectively
  • Navigate uncertainty
  • Use teamwork to find a collective truth
  • Problem solve and problem find
Campbell says struggling to describe and understand the ambiguity of a painting is similar to the uncertainty of diagnosing a patient in the hospital.
“In both cases, we need to be able to make very detailed observations but then zoom out to look at the painting or the patient as a whole,” Campbell said. “If we miss the details, then we won’t get the diagnosis. But if we don’t zoom out, we miss fundamental aspects of who the patient is as a person.”
Miller describes how, at first, students are often frustrated with the process because it is so different from a schooling situation where the “right answer” is immediately available.
“They are highly successful at mastering content as quickly as possible, so as to move on to the next problem,” says Miller. “The arts experiences are by design a more open-ended situation, requiring time, skills, peers, and comfort with ambiguity to progress.”
Through her organization Arts Practica, Miller hopes to help fill a gap in medical training by integrating arts education tools with clinical skill development. Combining her background in the arts with expertise from top medical leaders and faculty, she provides a model for learning observation in the context of art museums to improve quality in the clinic.
“With the right methods, we can deal with familiar problems in new ways,” says Miller. “Even though great science requires keen observation, navigation of ambiguities, and competent communication, training lacks a consistent model to practice these skills. The arts have everything to do with the solution to this problem.”
Editor’s Note: For more information about Arts Practica, listen to this American RadioWorks podcast and check out these interviews with students and faculty from Harvard Medical School about Training the Eye.
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