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Engaging with art to improve clinical skills

med students looking at paintingThe scene: A group of medical students huddled around the iconic Robert Frank photograph Car Accident - U.S. 66, Between Winslow and Flagstaff, Arizona in the Cantor Center for the Visual Arts. They're being led through an observation exercise by Sarah Naftalis, a doctoral student in art and art history at Stanford, as part of an innovative new medical school course supported by the Bioethics and Medical Humanities Scholarly Concentration.

Naftalis asks students what they see as she gestures to the photograph, which appears to have as its focal point four people standing out in a field, looking at something under a blanket on the ground. Several students note the people, the odd lumpiness of the blanket and the reduced horizon. Second year medical student Sam Cartmell says, “Well there may be more than four people,” and points to an odd contour at the shoulder of the lone female in the photograph. Cartmell’s observation sparks a lively debate, as his fellow students take turns looking closely at the work, seeking to discern what Cartmell has seen.

The concept behind this class is so important. If medical students can grasp these observation skills, it will really serve them well in their residencies and beyond.

That moment, explains Naftalis, illustrates the “productive ambiguities of art,” as well as the benefit of engaged close looking without “rushing to assign meaning to what we see.”

The practice of engaged close looking as a means to improve observational skills is a key goal of the course, which includes gallery sessions facilitated by doctoral students from the Department of Art and Art History at Stanford paired with a clinical correlate hour where School of Medicine faculty members applied the lessons of the art gallery portion to the clinical setting. Physicians from family medicine, orthopedics, dermatology, pathology and anesthesiology led discussions on a range of topics including narrative, body in motion, skin and tone, and death.

“The thematic organization was meant to inspire conversation across disciplines, by putting two takes on a similar theme in proximity to each other for two hours,” explains art history doctoral student Yinshi Lerman-Tan, who helped develop the course. “Bringing medicine into the space of the museum was a great aspect of the course - simply allowing different bodies of knowledge to exist under one roof. The medical students would sometimes use clinical vocabulary or concepts to describe works in the gallery, making for an interesting range of language in our discussions.”

Cartmell said one important take away for him from the course, which is called “The Art of Observation: Enhancing Clinical Skills Through Visual Analysis," was learning to observe without jumping to interpretation. “I was surprised at how strong the impulse was to interpret the work, before I had actually observed the entire piece,” he says. The exercises the instructors led us through, describing what we saw objectively without commentary, really forced me to slow down and really see what was in front of me, without jumping to conclusions or interpretation."

During the session on death, pathologist Darren Salmi, MD, demonstrated how jumping to conclusions can have dire consequences in the medical profession. Salmi emphasized that for a patient “no history is better than the wrong history” and could lead to missing things that are “hiding in plain sight.” In one case Salmi demonstrated, a patient with a history of heart disease was almost misdiagnosed because the focus of the clinical gaze was on the area of the abnormally enlarged heart, which drew attention away from a small cancerous mass in the lung.

“The concept behind this class is so important,” Salmi said. “If medical students can grasp these observation skills, it will really serve them well in their residencies and beyond.”

In addition to Lerman-Tan, the course was developed by medical student Genna Braverman; Issa Lampe, curator of education at the Cantor Arts Center; and course directors Audrey Shafer, MD, an anesthesiologist and writer, and Sam Rodriguez, MD, a pediatric anesthesiologist and painter.

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

Previously: Stanford Medicine Music Network brings together healers, musicians and music lovers, "Deconstructed Pain:" Medicine meets fine arts and On death and dying: A discussion of "giving news that no family members want to hear"

Photo, of medical student Sam Cartmell, by Audrey Shafer

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