The News:

Students who took a course in art observation significantly improved clinical observation and professional development skills, researchers found.

Interest in integrating the arts and humanities into Medical education is not new, Medscape points out. Several programs around the country now either offer or require medical students to take classes in the arts or humanities to help foster skills that are essential to good clinical care, including observation, critical thinking, and empathy. To date, however, few studies have formally assessed the effect of such training on specific clinical skills.

Now, a randomized controlled study published in the January issue of Ophthalmology does just that. Jaclyn Gurwin, MD, an ophthalmology resident at the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues found a significant improvement in observational skills among students who underwent formal observation training in art compared with students who did not.

“The paper is important because it demonstrates that a structured program in art observation improved first year medical students’ observational skills on clinical images,” said Barry S. Coller, MD, vice president for medical affairs, physician-in-chief, and David Rockefeller Professor of Medicine, Rockefeller University, New York City.

Dr. Coller helps teach the Pulse of Art Course at the Icahn School of Medicine at Mount Sinai, which is designed to improve observational skills through the study of art and the history of medicine.

Observation skills are an essential component of any medical education, aiding doctors during patient exams and in making medical diagnoses, yet several studies have indicated inadequacies in this area among medical trainees and practicing physicians.

In an effort to explore ways to improve these skills among medical students, researchers from the Perelman School and Children’s Hospital of Philadelphia, in collaboration with educators at the Philadelphia Museum of Art, turned to the field of visual arts to examine if training in art observation, description, and interpretation could be applied to medical training.

In the current study, researchers randomly assigned 36 first-year medical students to an Art Training group or control group. Students in the art training group participated in 6 custom-designed art observation sessions over the course of 3 months.

Each art session lasted 1.5 hours and was taught by professional art educators at the museum, using an approach called “Artful Thinking,” which begins with approaching a piece of art with introspection and observation before interpretation. The sessions included information on teaching the principles of art, the vocabulary used in artistic descriptions, observation description, comparing, and interpreting. Students in the control group did not receive any formal art training.

To assess the effect of art observation training, all students in the study completed pre- and postintervention tests. The tests required students to describe in writing their observations of three different types of images: art images, retinal images, and external eye/face images involving ocular or periocular disease.

Using predetermined criteria specific to each type of image, the tests were graded by two ophthalmologists and a fourth-year medical student (retinal and external eye images) or art educators (art images). Grading consisted of awarding points for identifying specific observations included in the grading guideline for each imaging type.

For example, the rubric for retinal images included points for correctly describing specific observations of retinal hemorrhages with central hemorrhagic cyst, ocular histoplasmosis, chorioretinitis, and Stargardt’s Disease. All the graders were masked so that they did not know which medical student they were evaluating, nor whether it was a pre- or postintervention test.

Students who participated in art training had a significant improvement in overall observational skills compared with the control group, with a mean change from pre- to posttest scores of +19.1 and −13.5, respectively. The improvement was also seen when restricted to descriptions of retinal images (+6.1 vs −2.8), external eye images (+6.7 vs −3.1), and art images (+6.2 vs −7.6).

Senior author Gil Binenbaum, MD, Richard Shafritz Endowed Chair in Pediatric Ophthalmology Research, The Children’s Hospital of Philadelphia, University of Pennsylvania, told Medscape Medical News he is cautiously optimistic that these findings indicate that improving observational skills through art study can improve clinical skills.

“Although further studies are needed to know how these findings relate to clinical practice and whether they improve patient care, he notes that observational skills are fundamental to the practice of medicine, and yet medical students are not taught how to make observations,” Binenbaum noted.

“One reason we partnered with art educators is that we thought observation is important to medicine and we’re not explicitly teaching observation in medical school,” he continued. Given the importance of observation in medicine, Dr. Binenbaum thinks the study’s findings can be applied to all areas of medicine, not just ophthalmology training.

In addition, he emphasized that improving observation through art training may have other beneficial effects on medical students beyond what the study revealed. For example, follow-up conversations with some of the study participants revealed that many felt the art training had helped them be more open to multiple interpretations or ways of observing a specific thing, which in turn helped them, for example, on the wards and in working with a team to figure out a clinical situation.

Steve’s Take:

In his best sellers “The Tipping Point,” “Blink” and “Out­liers,” journalist/author Malcolm Gladwell writes about the unexpected implications of scientific research, urging readers to employ unusual, uncommon thinking.

Earlier this month in Ophthalmology, the journal of the American Academy of Ophthalmology, Gladwell offers another example of his profession’s observations and advises: To make medical students better doctors, send them to art school. As a lawyer, I can strongly endorse the same for law students.

In either case, the basis of Gladwell’s opinion is the aforementioned study involving medical students who completed observation skills testing before and after art training to see if training improved students’ observational skills and empathy.

Well, it turns out it did; appreciably. As Gladwell explains: “Taking would-be physicians out of the hospital and into a museum–taking them out of their own world and into a different one–made them better physicians.”

Bottom Line:

The implications of this study are broad, Gladwell writes. The trend in medicine has been toward greater specialization as physicians are required to master greater amounts of information in their complex field. Medicine in the modern age demands great focus. But intense preparation doesn’t need to take place exclusively in medical school, Gladwell contends.

Steve's Take: Many other professions beyond #medical could enjoy the benefits of #arttraining such as #lawyers, #journalists, and even #accountants to name a few
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Interestingly, the study found that the observation skills of the students who didn’t get art training were worse at the end of the study, raising the possibility that the initial medical school curriculum, with its intense focus on memorization, may have the effect of eroding the skills of the future physicians.

The idea of the importance of different kinds of training is not new. But, Gladwell writes that this study should prompt a larger push in exploring the benefits of cross-disciplinary preparation. He says this study reminds us that “the best expert is the one who also belongs to the wider world.”

Although nominally directed at the medical profession, I believe the conclusions of the study authors and observers like Gladwell almost certainly apply to other professions which are “people”-oriented. Law comes to mind, but also teacher/university lecturer, journalist, media, marketing, public relations and even accounting. I’m bound to be leaving some out, so please let me know what other not-so-obvious careers might resonate with art training.