Art Class Improves Medical Students' Observation Skills

Mary Beth Nierengarten

January 23, 2018

Interest in integrating the arts and humanities into medical education is not new. 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.

In the current study, researchers randomly assigned 36 first-year medical students to an art training group (n = 18) or control group (n = 18). Students in the art training group participated in 6 custom-designed art observation sessions held at the Philadelphia Museum of Art 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 (P = .001). The improvement was also seen when restricted to descriptions of retinal images (+6.1 vs −2.8; P = .001), external eye images (+6.7 vs −3.1; P < .001), and art images (+6.2 vs −7.6; P = .047).

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.

"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.

Dr Coller also noted this benefit among the participants. "Of note, the discussions among the students about the images also had a positive impact on at least some of the students' openness to others' interpretations," he told Medscape Medical News.

This openness may be a fundamental benefit of bringing the arts into medical education. In an accompanying editorial, two journalists, David Epstein and Malcolm Gladwell, lauded the study for showing the potential benefits of what they call "cross-disciplinary preparation." Calling up the likes of Nobel-prize winning biologist Howard Temin and Galileo before him, the journalists point to the breadth and depth of the knowledge that informed these men from outside their primary fields of study.

Epstein and Gladwell "would argue that doing other things outside your discipline that fosters other parts of your brain, your attention and awareness, and your thinking helps make you better at your primary job," Dr Binenbaum told Medscape Medical News.

"I've always believed the virtues of a 'well-rounded' education was real but unquantifiable," said Gladwell, a staff writer for the New Yorker and international best-selling author of multiple books told Medscape Medical News in an email. "But [Gurwin et al] managed to actually identify a clear benefit! I hope other researchers follow suit."

The authors and editorialist have reported no relevant financial conflicts.

Ophthalmology. 2018;125(1):2-3, 8-14. Article full text, Editorial full text

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