Art helps nursing, medical students strengthen observation skills

The study, "One Thousand Words: Evaluating an Interdisciplinary Art Education Program," finds that students in the medical professions can effectively be taught visual observation skills through the use of art.

"Observation is key to diagnosis, and art can teach students to slow down and really look," said Craig Klugman, a bioethicist and medical anthropologist at DePaul University who is a co-author of the study. "Art is a powerful tool for teaching, and this program helped nurses and doctors become more adept at observation and encouraged them to move away from making assumptions."

Klugman, chair of the Department of Health Sciences at DePaul, and co-author Diana Beckmann-Mendez, assistant professor of nursing at the University of the Incarnate Word, taught and evaluated Art Rounds -- a semester-long course that brought together seven nursing students and 12 medical students at the University of Texas Health Science Center at San Antonio. The course, taught in 2012, offered an interprofessional learning opportunity for future clinicians who do not often get the chance to take classes together. The students met at the McNay Art Museum for four sessions and for four sessions in a classroom.

To hone in on observation skills, Klugman and Beckmann-Mendez taught students to use Visual Thinking Strategies (VTS), a technique originally developed to help kindergarteners look at art. They asked students, "What do you see? What do you see that makes you think that? What more do you see?"

Each week, students used these strategies to look at artwork. They were assigned "art patients," works of art that they visited for 30-minute stretches and assessed using VTS. Students also researched the artwork and artists and described them to each other, practicing listening skills. During one session, students were presented with live models wearing simulated skin conditions, including a rash and a removed tattoo. Students used VTS to examine these human subjects and diagnose them.

To measure their progress, Klugman and Beckmann-Mendez administered a pretest and post-test asking students to describe images of patients and art. The researchers counted words in the student responses, coding them to measure changes in themes such as emotion, evidence, medical language and storytelling.

The change in several areas was significant, the researchers found. After taking the course, students discussed emotion less and made more medical observations. "We didn't teach students art terms, and as a result they drew from terminology they had already learned. Their language changed and tended to become more clinical," said Klugman. Overall, students used more words to describe art and patients and increased their total number of observations.

After the course, students also told fewer personal narratives and stories and instead worked to interpret the images using only the evidence before them. In physical examinations, it's important for clinicians to remove this type of bias, explained Klugman.

"A clinician might notice one thing about a patient, such as dirty hands or torn clothes, and jump to conclusions without looking more closely. We found that art can teach students to see both the big picture and small details that can be easily overlooked," he said.

The gains that students made in observation were not matched, however, by an increase in students' empathy in their responses.

"Teaching methods and context matter," said Klugman. "By focusing on pure observation skills, students learned to observe and not interpret. As educators, we must be mindful of how we use art and what we want students to get from the experience."

Art can be a versatile tool in the classroom, according to Klugman. At DePaul, He teaches a medical humanities course for undergraduates, and his class visits the DePaul Art Museum for one session to give students a taste of the Visual Thinking Strategies technique. He also includes novels, movies and a variety of storytelling and human experience in the arts, working to deepen students' connection with patients and themselves.

"When people go into health care, they tend not to stay in one place," said Klugman. "Art museums give students an anchor in the community, a place to come back to. In addition to building their observation skills, medical arts programs can give students a lifelong relationship with the humanities."