The Art of Observation: How Medical Students' Art History Interest Enhances Clinical Skills

Observation is a fundamental skill in medicine, serving as the cornerstone for accurate diagnosis, effective prognostication, and appropriate treatment. This skill, however, is often learned implicitly rather than explicitly taught in medical school curricula. The ability to observe effectively goes beyond a mere glance; it demands meticulous attention to detail and the deft integration of visual information. Integrating visual arts, such as paintings and film, into medical school can build visual literacy and improve observation skills, teamwork, listening skills, and reflective and analytical thinking.

The Importance of Visual Literacy in Medicine

Clinical observation, derived from the Latin word "observare" (to watch over, note, heed, look to, attend to, guard, regard, comply with), requires more than a casual glance. It necessitates the integration of visual information to generate meaning. "Visual literacy" is a kind of aesthetic reasoning informed by careful observation. It can inform clinicians about things the patient is not directly telling them that might be relevant to a diagnosis or to good communication.

For example, patients who are unable to communicate their symptoms due to their clinical state (e.g., coma, intoxication, or hepatic encephalopathy) may display swollen features or erythema. Some patients withhold information from their clinicians due to embarrassment, fear, and the desire to avoid confrontation, which might be evident from the presence of perspiration, pallor, or body language.

Notably, there is no accepted system to teach visual literacy to physicians-in-training. Humans are not machines, yet it is easy for medical students, especially those in their preclinical years, to view the body as simply a collection of parts. As students begin to work with simulated patients (actors) and real patients, they discover other elements that are critical to whole-person care-namely, emotional, psychological, and spiritual aspects.

Integrating Visual Arts into Medical Education

Medical schools are increasingly incorporating the arts and humanities into their curricula, often emphasizing their benefits in enhancing students’ clinical skills. The potential for these curricula to foster flourishing is equally, if not more, crucial. Art museum-based medical education offers an innovative way to nurture students’ core dimensions of flourishing.

One of the methods with the greatest evidence is Visual Thinking Strategies (VTS), which provides a structured framework for facilitating open-ended discussions prompted by a work of art, ensuring methodological consistency while allowing room for creativity. Whether conducted in the classroom, online, or in a museum, VTS and other museum-based pedagogical methods encourage students to use works of art to explore the big questions-what it means to be human, to be a physician, and to lead a good life (for themselves and their patients).

The Bond University Model

In 2014, the medical humanities program at Bond University School of Medicine in Queensland, Australia, was formally overhauled. The history of medicine lecture and compulsory reflective film-making assignment were replaced with the following four elements:

A 50-minute, noncompulsory Medical Humanities Workshop.
A compulsory mixed media art creation and reflective essay assignment.
Medical Humanities Week.
The Art is Good Medicine community art exhibit.

The Medical Humanities Workshop uses visual thinking strategies to teach visual literacy. The remainder of the session comprises observational activity, with the class divided into three groups. All three groups perform their observations simultaneously (but separately). With all groups present together the teacher then interacts with each group using visual thinking strategies to draw attention to visual cues and their significance. During this experience, all groups listen to and interact with each other about their observations and interpretations. While wearing headphones/earbuds, Group #1 watches a brief film clip on a laptop or tablet device. Group #2 studies an award-winning poem written by a medical student during her oncology rotation.

The compulsory art assignment gives students seven weeks to create a work of mixed media on any topic related to health care. The students also write a 500-1,000 word reflective essay that describes the media, interprets the artwork, and discusses their reasons for creating the artwork.

During a five-day period each March, the foyer of the medical school is converted into an art gallery displaying mixed media art creations from the compulsory assignment. Each year, approximately 20-25 students (from a class of approximately 100) volunteer to display their art during Medical Humanities Week. Students and teachers from across the university visit the foyer to view the art. Medical Humanities Week culminates with an evening gala for the local community, giving medical students the opportunity to interact with teachers and fellow students as well as parents and guests attending the free event. The art is judged by two professionals from the community and an AUD $100 prize awarded. Teachers also judge the art during the week using an online survey; the winner of the Teachers Choice Award receives an AUD $50 shopping mall gift card.

Compared to the prior curriculum, this revamped curriculum allows students to explore their “creative side” without the pressure of a requirement for technical or artistic skill. The art gallery component promotes direct interactions with peers, teachers, and the community (their future patients).

Survey Results

Feedback was solicited with a voluntary, anonymous, online 15-question survey. The survey was offered to 280 medical students who had taken the curriculum; 23.6 percent (N = 66) completed the survey. The majority of the students supported the addition of arts education to the medical school curriculum (54.6 percent) and keeping arts education in the curriculum (63.6 percent). After completing the art assignment, many students felt pride (65.2 percent), a sense of achievement (53.0 percent), and enjoyment (48.5 percent). All three student groups ranked improvement of reflective thinking as the skill most influenced by arts education. Improvement in observation skills was also ranked among the top three skills by all three cohorts. Furthermore, after engaging with the arts curriculum, 40 percent of students were actively creating art or observing art as a method of stress relief.

The positive comments show students’ general support for visual arts in the medical school curriculum.

Art Museum-Based Education and Flourishing

Art museum-based education is defined as an “approach that can occur in museums, other in-person settings, and/or online, which is informed by museum-based education adapted for health professional learners and involves exploring and/or creating visual and other forms of art, as well as individual and group reflection on these activities”.

Art museum-based education may foster emotional regulation and mindfulness among medical learners, as well as offer them an emotional reprieve from the demands of training. Many museums are designed to foster comprehensibility and comfort through clearly labeled exhibits, guided prompts, and/or educators or interactive exhibits to facilitate discussion and, ultimately, visitor well-being. Further, art museums can encourage engagement with (and tolerance of) unfamiliar material while also encouraging reflections that connect personal insights to broader cultural or historical contexts. Museums can also offer freedom from the pressures to be correct, as unlike clinical or academic environments, no expectation of reaching a predetermined “right answer” to the artwork exists.

Read also: Innovation at Albany Med

Supporting the Domains of Flourishing

Art museum-based learning activities can support medical learners’ flourishing across several domains:

Mental and Physical Health: Viewing artwork can be beneficial to reducing stress. A recent scoping review found a reduction in self-reported stress levels and cortisol levels in museum visitors, as well as a reduction in systolic blood pressure.
Happiness and Life Satisfaction: Engaging with art, including observing artwork and visiting museums, is associated with improved life satisfaction. Fostering curiosity in a low-stakes environment, like art museums, where artwork allows for multiple interpretations and uncertainty is celebrated rather than feared, may help medical students find happiness in embracing ambiguity.
Meaning and Purpose: Museum-based activities not only combat the cynicism and instrumentalism that can arise from focusing solely on publishing papers, attaining high scores on examinations, and technical mastery, but can offer students a renewed sense of meaning and purpose, as well as an opportunity to cultivate character and virtue.
Character and Virtue: These activities can help students connect with a meaningful desire to improve representation in medicine, combat injustice, and advocate for equitable care that understands the whole patient.
Close Social Relationships: Participation in activities such as viewing art in galleries and museums has also been shown to strengthen interpersonal relationships and reduce feelings of loneliness. For medical students who face high levels of burnout and emotional exhaustion, these experiences offer a valuable opportunity to build connections with both peers and faculty in a relaxed, non-clinical setting.

Examples of Art Museum-Based Initiatives

Programs like the Baltimore Museum of Art’s reflective workshops in collaboration with Johns Hopkins School of Medicine incorporate pieces like Vincent van Gogh’s Ravine, inviting students to reflect on themes of hope amidst an amorphous landscape and connect them to their personal journeys through the COVID-19 pandemic. A Johns Hopkins study on reflective practices in museum settings found that engaging with art can assist students in answering subjective, complex questions like “What does it mean to live a good life?” for both themselves and their future patients.

Yale’s Making the Invisible Visible encourages medical students to engage with artwork to examine the structures and hierarchies they will encounter in their careers. By confronting themes of bias, racism, and power through works such as Kerry James Marshall’s Untitled (2009), students are reminded of the broader responsibilities of inclusivity and ethics inherent in being a physician.

The Art of Observation Course

Yale School of Medicine’s Dr. Irwin Braverman developed The Art of Observation course in the late 1990s after discovering that medical students’ observational skills can be enhanced through visual training, a practice which involves looking at paintings and verbalizing one’s findings.

In 2019, The University of Texas Southwestern Medical Center published a study regarding their Art of Observation course, with three principal findings among participants: heightened observational skills, development of empathy and a reduction in burnout. In the field of radiology, for example, trainees who study fine arts earlier in their training are better able to find abnormalities with enhanced perceptive skills. What’s more, art-based teaching allows clinicians to explore emotional experiences in medicine to enhance their empathy and connect with patients.

The Barnes Foundation's Approach

The Barnes Foundation’s Art, Well-Being and Medicine program uses the collection to explore topics and concepts relevant to medical education, clinical practice, and overall well-being. For instance, how might close looking at a painting help hone diagnostic skills? Or can discussing a work of art with a partner as well as a larger group enhance effective communication?

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