Art Museums and Medicine: Art observation as a complementary approach for mindfulness and the practice of Medicine

Visual Arts and Medicine

At first sight, these two domains may seem completely different. However, history shows us that Medicine and Art developed from one another. For example, da Vinci and numerous scientists and physicians’ dissection drawings helped us develop a better understanding of the human body. A contemporary example that most current medical students know is Netter’s Atlas of Human Anatomy. So, how can observation of visual art make us better and more mindful doctors?

Several studies looked at the impact of visual art observation training on the performance of medical students on physical exam, primarily inspection. From 2004-2005, 58 pre-clinical students from Harvard Medical & Dental School participated in a study on this topic. 24 students were randomly selected to take part of a course called “Training the Eye: Improving the Act of Physical Diagnosis” (intervention group), while 34 students did not attend the course (control group). All 58 participants did a pre-test, consisting of a visual skills exam where they had to describe and interpret several art images and patient photographs. Then, the 24 students selected for the course attended 8 sessions of 2.5 hours each. These sessions were facilitated by physicians and by art educators. Each session was composed of a 75-minute visit at the Boston Museum of Fine Arts, where students observed 2-3 artworks. They then received a 1-hour lecture and discussion linking the visual art concepts of those art pieces with the physical diagnosis. Topics were broad, ranging from Dermatology (e.g.: jaundice, vesicles vs papules), to Neurology (e.g.: cranial palsies, gait). Through the discussions, students answered open-ended questions such as “What is going on in this picture?”, “What do you say that makes you say that?”, “What more can we find?”. Students then paraphrased other students’ comments and compared their point of views. At the end of the course, all 58 students re-took the visual skills examination. The primary outcome was the change in score between the pre- and post-test between the intervention and control groups. Students from the intervention group had a higher total mean number of observations (18.67 observations, SD 0.79), compared to the control group (13.29 observations, SD 0.63). p-value was < 0.0001. This represents a mean improvement of 5.41±0.63 observations in the intervention group, while the control group did not show any improvement (0.36±0.53 observations).1,2

Another study was conducted in 2018 at the University of Pennsylvania, Department of Ophthalmology. 36 first-year medical students were randomized to a 1:1 ratio: 18 attended a course on visual art observation (intervention group) and 18 did not (control group). The course structure was similar to Harvard’s study. However, it was focused on retinal disease images, photos of faces containing ocular surface/periocular pathologies, and artwork of course. During 6 sessions of 1.5 hours each, art educators from Philadelphia Museum of Art lead the artwork segment, while 2 ophthalmologists and 1 fourth-year medical student taught the retinal and facial photographs. All 36 participants took a pre- and post-test evaluating observational skills on artwork and photographs. For the art images, the mean change in the intervention group was +6.2 observations (SD 24.1) and the control was -7.6 (SD 14.5), p=0.047. For clinical images (including the retinal and external eye photographs), the intervention group improved to +12.8 observations (SD 12.7) while the control group was -5.9 (SD 11.5), P < 0.001. It was interesting to note that the control group actually worsened, potentially indicating that as medical students progressed in their curriculum, their observational skills were lessened.3 Numerous other studies showed the complementarity of art observation to Medicine.1-9

So how does Art observation help us become more mindful? Art observation training provides techniques to analyze one’s environment, which allows clinicians to be more aware of one’s environment. For example, if there is a hospitalized geriatric patient who is usually physically active (with a walker), but currently does not mobilize much, just by observation, one might notice that a walker is missing in the patient’s room. Just by observation, one can already identify a potential cause for the patient’s poor mobilization (i.e.: absence of a walking aid). Furthermore, art observation can make us more mindful of our own emotions in order to increase empathy, enhance communication skills, and augment our tolerance to ambiguity.1-9

Knowing that 55% of communication is non-verbal (while 38% is vocal)8, being more aware of visual cues of patients and of our environment will certainly help us in the generation of differential diagnoses, being less tempted to order unnecessary investigations, being more empathetic towards our patients, all leading us to become better doctors.

(1) Naghshineh S, Hafler JP, Miller AR, Blanco MA, Lipsitz SR, Dubroff RP, Khoshbin S, Katz JT. Formal art observation training improves medical students’ visual diagnostic skills. Journal of general internal medicine. 2008 Jul 1;23(7):991-7.
(2) Miller A, Grohe M, Khoshbin S, Katz JT. From the galleries to the clinic: applying art museum lessons to patient care. Journal of Medical Humanities. 2013 Dec 1;34(4):433-8.
(3) Gurwin J, Revere KE, Niepold S, Bassett B, Mitchell R, Davidson S, DeLisser H, Binenbaum G. A randomized controlled study of art observation training to improve medical student ophthalmology skills. Ophthalmology. 2018 Jan 1;125(1):8-14.
(4) Bardes CL, Gillers D, Herman AE. Learning to look: developing clinical observational skills at an art museum. Medical education. 2001 Dec;35(12):1157-61.
(5) Dolev JC, Friedlaender LK, Braverman IM. Use of fine art to enhance visual diagnostic skills. Jama. 2001 Sep 5;286(9):1020-1.
(6) He B, Prasad S, Higashi RT, Goff HW. The art of observation: a qualitative analysis of medical students’ experiences. BMC medical education. 2019 Dec 1;19(1):234.
(7) Mangione S, Mockler GL, Mandell BF. The art of observation and the observation of art: Zadig in the twenty-first century. Journal of General Internal Medicine. 2018 Dec 1;33(12):2244-7.
(8) Monahan L, Monahan M, Chang L. Applying art observation skills to standardized patients. Applied Nursing Research. 2019 Aug 1;48:8-12.
(9) Shapiro J, Rucker L, Beck J. Training the clinical eye and mind: using the arts to develop medical students’ observational and pattern recognition skills. Medical education. 2006 Mar;40(3):263-8.

This article was written by Melanie Leung, a fourth-year medical student at McGill University and a member of the McGill Med Mindfulness team.

© Illustration by Yukyung Kang

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: