Medical students learn ‘art’ of observation

While most people associate medical school with cadavers and chemistry, once a semester, Yale medical students put down their books, leave the lab and head to the art gallery.

At the Yale School of Medicine, a spring tradition — a class that uses paintings to teach prospective doctors the art of observation — is winding down for the year. In its 11th year, “The Observational Skills Workshop,” a collaborative effort between the medical school and the Yale British Art Gallery, makes use of 19th-century Victorian paintings housed at the British Art Center to develop medical students’ eye for detail.

It is important for medical students to begin visually analyzing things early, said dermatology professor Irwin Braverman, who developed the class with British Art Center Curator of Education Linda Friedlaender. Typically, he said, it takes about five years after the end of residency for a doctor’s personal experiences in medicine to synergize with their medical school training — the point in their careers where their skills in visual analysis really emerge.

But his class jump-starts that process, he said, by forcing students to focus on really understanding and analyzing a painting in front of them.

“This is something you really can’t teach anyone to do by lecturing,” Braverman said. “They actually have to do it.”

A PROVEN METHOD

The idea, Braverman recalled, took root one day when he was conducting a class and felt his residents were not describing patients as well as he felt they should have been.

“I was wondering, how could I get them to see the fine details in the patients’ rashes and thinking of ways I could teach them to see the details,” Braverman said. “The idea popped into my head: If I were to show them an object that would be completely unfamiliar — they would probably describe anything that was there.”

Anticipating that paintings would be foreign objects to most residents, Braverman took them on an excursion to an art gallery and asked them to describe what they were seeing in the paintings. He said he found that after the exercise, his residents’ analysis of patients’ symptoms improved. He then saw comparable effects after putting a few medical students through the same exercise. At that point, Braverman said, he realized he might be onto something.

He was right. In a study conducted following the class’ debut, Braverman and his colleagues found that, after taking his course, first-year students detected important details nearly 10 percent better than peers who had not.

Now, 11 years after its initial class, not only is “The Observational Skills Workshop” mandatory for all first year students at the Yale School of Medicine, but over 20 other institutions have incorporated an adaptation of it into their curricula.

After viewing a painting, each student must present their objective observations of the work before drawing any conclusions.

PAINTINGS AS PATIENTS

“We pick paintings that are not abstract,” Jennifer Kowitt, an assistant curator at the British Art Center said. “They have identifiable aspects and some sort of narrative element.”

This task is easier said than done. Braverman explained that a student must say a character’s mouth is turned up or down, rather than that they are happy or sad, which is an inferred conclusion.

“You assume it’s going to be easy, but actually, you have to describe beyond the surface of what’s in the painting,” said Kevin Koo MED ’12, who is enrolled in the workshop this semester. “That’s a deeper level of observation.”

The students’ task is further complicated by the fact that the 19th-century paintings chosen for the class contain contradictory messages and tell ambiguous stories.

The result is that students tend to come up with two, or sometimes three, divergent theories that synthesize aspects of the image, Braverman said, which is a situation parallel to that of performing a differential diagnosis of a patient.

“The paintings are really a surrogate for patients,” Braverman said. “What the students learn is what a differential diagnosis is, how do you narrow it down, what do you do with the contradictions.”

But the class is not just picture frames and paint. After observing the artwork, students then have a group discussion about a more familiar topic: patients.

In a moderately sized conference room on the first floor of the British Art Center, Braverman circulates photographs of actual patients around the class. One after another, the students must point out something unique about the image. The exercise, he said, draws an immediate connection between the work done in the gallery and the students’ medical studies — pushing them to make observations they otherwise wouldn’t have.

“Being a doctor is all about seeing everything that’s in front of you — and not just seeing but really looking and watching and observing,” Koo said. “To be a better observer is to be a better doctor.”

Comments

  • x5

    This could be one of the more fun aspects of medical school.

  • yalemed

    don't fool yourself, this 'class' is a joke. as is dermatology. very underwhelming

  • Randi

    Dear Rebecca,

    Your recent article is very well written, yet I do not find your article ‘new news’. Too many in America, and beyond falsely believe that artificial sweetners in food/beverages make them more healthful, while they are not and never will be. As far as getting back to basics, that should be the most potent promotion for conquering obesity, yet the promotion on counting calories and nutrients persevere, and obesity continues to rise!

    Needless to say I am passionate about good homemade foods and would like to forward you a copy of my recent cookbook: Love More Feed Less, A Tasty Path Toward Avoiding Childhood Obesity.

    If interested please contact me (no there are no sugar subs whatsoever in the pages or recipes, but good, easy and affordable homemade foods for the family to enjoy in adjusted serving sizes).

    Good article!

    Randi/The Muffin Lady

    Randi L. Levin
    The Muffin Lady Inc,
    http://www.themuffinlady.com
    http://www.childobesitysupportivesolutions.com