Formal art observation training improves medical students’ visual diagnostic skills

Naghshineh, S., Hafler, J.P., Miller, A.R., Blanco, M.A., Lipsitz, S.R., Dubroff, R.P., … Katz, J.T. (2008) Formal art observation training improves medical students’ visual diagnostic skills. Journal of General Internal Medicine 23(7) 991-7.

Abstract:

This quasi-experimental study examines the effect of visual arts training on the physical examination skills of a group of medical students. In the spring semester of 2005, 24 first-year medical students from the Harvard Medical and Dental School were randomly selected to go through a course of eight weekly two and a half hour classes titled Training the Eye: Improving the Art of Physical Diagnosis. In the course, professional art educators taught the students visual literacy (“the ability to find meaning in imagery” (p. 991)). Thirty-four students participated in a separate control group, 19 of whom were selected randomly and 15 of whom were recruited. Before and after the course both groups completed a demographic text and a one-hour visual skills examination where they were shown two slides of art they had not seen and three slides of patients with clinical disorders and were then asked to report on and interpret them. The images were different in the pre- and post-test. These visual examinations were evaluated by a group of senior art educators and physicians based on the frequency of accurate responses. The students who participated in the course completed more accurate visual observations compared to a group of students who did not take the course, suggesting that education in visual literacy can be productive in the medical field by strengthening physical examinations.

Key Findings:

The frequency of accurate visual observations from the participants in the Training the Eye course increased 38% from pre-test to post-test. Students who attended all of the sessions increased the frequency of accurate visual observations more than students who attended seven or fewer of the sessions. These improvements happened for both art and clinical imagery slides. In addition to the quantitative analysis of the examinations, a qualitative analysis of the responses showed that students in the intervention course used more fine arts concepts when describing the content of medical images during the post-test than they did during the pre-test.

Significance of the Findings:

The Training the Eye course demonstrated that studying fine art and clinical imagery can improve observational skills used to practice clinical medicine. The level of improvement was linked to the amount of practice, with students who came to all the sessions increasing the number of accurate observations more than students who didn’t. With physical examination evaluation skills decreasing in the medical field, courses teaching visual literacy could help to reverse the trend.

Methodology:

The participants of this study were first year medical students at the Harvard Medical and Dental School from the spring semester of 2004-2005. Twenty-four of the students participated in the Training the Eye course while 34 comprised the control group. The students in the intervention group were selected the randomly as were the students in the control group. However, after 32 students were selected for the control group only 19 agreed to participate. An additional 15 students were recruited for the control group. There were no statistically significant differences in demographic characteristic or pre-course visual skills examination between the randomized and the recruited control group participants. All of the students completed a demographic test in order to match the demographic characteristics between the intervention and control groups. The students also completed a one-hour visual skills examination at the beginning and the end of the course that measured the frequency of their accurate visual observations when looking at new artistic and clinical images.

Students in the intervention group participated in eight weekly two and a half hour sessions where they went to the Boston Museum of Fine Arts (MFA). At the MFA, professional art educators put the students through a 75-minute observation exercise followed by a one-hour lecture which linked visual arts concepts with physical diagnosis. There were also weekly reading assignments. All of the visual examinations were evaluated by a group of senior art educators and physicians based on the frequency of accurate responses. A select outside group of educational researchers, arts educators, and independent researchers also coded and categorized the data for reliability and validity.

Limitations of the Research:

True randomization was compromised when, in order to even the numbers between the control group and the intervention group, additional students were selected for the control group. However, demographics were matched to make sure that the groups were still equivalent. Because the examination was given at the end of the semester, there was no follow up to see if the participants retained and used the knowledge over a longer period of time. Similarly, because the students were only evaluated based on their interpretations of clinical imagery rather than on their observations of real patients, the direct relationship between the course and medical practice were not measured. Therefore it is difficult to determine whether the learning was applied after the course.

Questions to Guide New Research:

Could this program be replicated without the use of the Museum of Fine Arts or another museum? How would the Training the Eye course influence currently practicing doctors? How would medical researchers react to the training course?