The art of observation: a qualitative analysis of medical students’ experiences

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Abstract

Background

Although the inclusion of arts in medical school curricula has garnered attention, little is known about the effect of arts-based interventions on the behaviors, attitudes, and technical skills of students. The Art of Observation is an optional elective at the University of Texas Southwestern Medical Center (UTSW) in collaboration with educators from the Dallas Museum of Art (DMA). We utilized a qualitative approach to describe in-depth how engaging with art influences the development of medical students’ observation skills and empathy.

Methods

We analyzed evaluations from 65 medical students who completed the course between 2015 and 2017. Evaluations contained open-ended questions that asked students to reflect upon their experiences and describe their perceptions, thoughts, and feelings after guided museum visits. We used grounded theory to generate a thematic codebook, then employed axial coding to discover thematic relationships.

Results

We report three main findings and several subthemes: (1) Enhanced observation skills: by engaging with art and completing relevant activities, students developed the ability to synthesize a compelling narrative in addition to learning technical skills; (2) Improved physician socialization: students reported enhanced self-awareness, increased tolerance of ambiguity, and development of a humanistic view of medicine, key components of physician socialization; and (3) Reduction in burnout symptoms: students reported an enhanced sense of well-being after each session, which mitigates the process of burnout.

Conclusions

Fine arts can be used to teach technical skills, stimulate personal reflection, and prevent burnout. A meaningful engagement with the arts can play an important role in developing physicians who are observant, empathetic, and more well-rounded.

Electronic supplementary material

The online version of this article (10.1186/s12909-019-1671-2) contains supplementary material, which is available to authorized users.

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Most cited references 19

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Formal art observation training improves medical students' visual diagnostic skills.

Robert Miller, Shahram Khoshbin, Maria Blanco … (2008)

Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation. To improve students' visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care. Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis. Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training. Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session. The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation. Following the course, class participants increased their total mean number of observations compared to controls (5.41 +/- 0.63 vs. 0.36 +/- 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A 'dose-response' was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03). This interdisciplinary course improved participants' capacity to make accurate observations of art and physical findings.

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Training the clinical eye and mind: using the arts to develop medical students' observational and pattern recognition skills.

Lloyd Rucker, Brian J Beck, Johanna Shapiro (2006)

Observation, including identification of key pieces of data, pattern recognition, and interpretation of significance and meaning, is a key element in medical decision making. Clinical observation is taught primarily through preceptor modelling during the all-important clinical years. No single method exists for communicating these skills, and medical educators have periodically experimented with using arts-based training to hone observational acuity. The purpose of this qualitative study was to better understand the similarities and differences between arts-based and clinical teaching approaches to convey observation and pattern recognition skills. A total of 38 Year 3 students participated in either small group training with clinical photographs and paper cases (group 1), or small group training using art plus dance (group 2), both consisting of 3 2-hour sessions over a 6-month period. Students in both conditions found value in the training they received and, by both self- and instructor-report, appeared to hone observation skills and improve pattern recognition. The clinically based condition appeared to have been particularly successful in conveying pattern recognition concepts to students, probably because patterns presented in this condition had specific correspondence with actual clinical situations, whereas patterns in art could not be generalised so easily to patients. In the arts-based conditions, students also developed skills in emotional recognition, cultivation of empathy, identification of story and narrative, and awareness of multiple perspectives. The interventions studied were naturally complementary and, taken together, can bring greater texture to the process of teaching clinical medicine by helping us see a more complete 'picture' of the patient.

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Medical humanities and their discontents: definitions, critiques, and implications.

D Wear, M Montello, Jack Coulehan … (2009)

The humanities offer great potential for enhancing professional and humanistic development in medical education. Yet, although many students report benefit from exposure to the humanities in their medical education, they also offer consistent complaints and skepticism. The authors offer a pedagogical definition of the medical humanities, linking it to medicine as a practice profession. They then explore three student critiques of medical humanities curricula: (1) the content critique, examining issues of perceived relevance and intellectual bait-and-switch, (2) the teaching critique, which examines instructor trustworthiness and perceived personal intrusiveness, and (3) the structural/placement critique, or how and when medical humanities appear in the curriculum. Next, ways are suggested to tailor medical humanities to better acknowledge and reframe the needs of medical students. These include ongoing cross-disciplinary reflective practices in which intellectual tools of the humanities are incorporated into educational activities to help students examine and, at times, contest the process, values, and goals of medical practice. This systematic, pervasive reflection will organically lead to meaningful contributions from the medical humanities in three specific areas of great interest to medical educators: professionalism, "narrativity," and educational competencies. Regarding pedagogy, the implications of this approach are an integrated required curriculum and innovative concepts such as "applied humanities scholars." In turn, systematic integration of humanities perspectives and ways of thinking into clinical training will usefully expand the range of metaphors and narratives available to reflect on medical practice and offer possibilities for deepening and strengthening professional education.

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Author and article information

Contributors

Bowen He: Bowen.He@UTSouthwestern.edu

Smriti Prasad: Smriti.Prasad@UTSouthwestern.edu

Robin T. Higashi: Robin.Higashi@UTSouthwestern.edu

Heather Woodworth Goff:

ORCID: http://orcid.org/0000-0002-8496-3132

214-648-4227 , Heather.Goff@UTSouthwestern.edu

Journal

Journal ID (nlm-ta): BMC Med Educ

Journal ID (iso-abbrev): BMC Med Educ

Title: BMC Medical Education

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6920

Publication date (Electronic): 26 June 2019

Publication date PMC-release: 26 June 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 234

Affiliations

[1 ]ISNI 0000 0000 9482 7121, GRID grid.267313.2, University of Texas Southwestern Medical Center, ; 5939 Harry Hines Blvd, Dallas, TX 75390-8570 USA

[2 ]ISNI 0000 0000 9482 7121, GRID grid.267313.2, Department of Dermatology, , University of Texas Southwestern Medical Center, ; 5939 Harry Hines Blvd, Dallas, TX 75390-8570 USA

[3 ]ISNI 0000 0000 9482 7121, GRID grid.267313.2, Department of Population and Data Sciences, , University of Texas Southwestern Medical Center, ; 5939 Harry Hines Blvd, Dallas, TX 75390-8570 USA

Author information

Heather Woodworth Goff http://orcid.org/0000-0002-8496-3132

Article

Publisher ID: 1671

DOI: 10.1186/s12909-019-1671-2

PMC ID: 6595600

PubMed ID: 31242945

SO-VID: d42c1cf2-739e-4ebf-8c69-4dae51f8407a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 23 October 2018

Date accepted : 13 June 2019

Funding

Funded by: University of Texas Southwestern Medical Center Department of Dermatology

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ScienceOpen disciplines: Education

Keywords: qualitative research,curriculum,burnout

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ScienceOpen disciplines: Education

Keywords: qualitative research, curriculum, burnout

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The art of observation: a qualitative analysis of medical students’ experiences

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Abstract

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Most cited references 19

Formal art observation training improves medical students' visual diagnostic skills.

Training the clinical eye and mind: using the arts to develop medical students' observational and pattern recognition skills.

Medical humanities and their discontents: definitions, critiques, and implications.

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