An art‐based visual literacy training course to enhance clinical skills in dermatology trainees

Prevalence of visual art education in medical school curricula: a national survey of US medical schools

Background: The Association of American Medical Colleges (AAMC) has recommended integrating medically-relevant arts and humanities curricula into medical student education in order promote physician skills development. An analysis of the state of existing visual arts-based medical school pedagogies was conducted to inform future implementation strategies.Methodology: An electronic survey was distributed to representatives of US medical schools to describe the prevalence and characteristics of visual arts-based medical school curricula. Official courses, informal events, cross-registration opportunities, and established art museum partnerships were assessed.Results: Survey response rates were 65% for US allopathic medical schools and 56% for osteopathic medical schools. A majority (79%) of responding institutions incorporate or support medical student art experiences in some format. Thirty-one percent (n = 36) of schools offer stand-alone humanities courses using visual arts. These were primarily allopathic programs (n = 35; 37% of allopathic programs) and only one responding osteopathic program (n = 1; 5% of osteopathic programs). Schools without dedicated courses are less likely to report other curricular and extracurricular visual arts engagement. Most visual art medical courses are offered at medical schools located in the Northeastern United States.Conclusions: Many but not all medical schools are incorporating the visual arts into their medical education curriculum. Opportunities to promote increased uptake, more effective implementation, and collaboration strategies for the AAMC recommendations are proposed.

Visual Thinking Strategies in medical education: a systematic review

BACKGROUND

Arts-based pedagogical tools have been increasingly incorporated into medical education. Visual Thinking Strategies (VTS) is a research-based, constructivist teaching methodology that aims to improve visual literacy, critical thinking, and communication skills through the process of investigating works of art. Harvard Medical School pioneered the application of VTS within medical education in 2004. While there are several studies investigating the use of VTS, there is a need to systematically assess the different programs that exist for medical education and their efficacy in improving relevant clinical skills. This systematic review aims to critically analyse the available evidence of the effectiveness of VTS in medical education to guide future research and provide a framework to adapt medical curricula.

METHODS

A systematic search of PubMed, PsycINFO, and Cochrane CENTRAL databases (through November 2022) was conducted to identify studies of VTS-based interventions in undergraduate and postgraduate medical education. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. The extracted data was then narratively synthesized.

RESULTS

Of 5759 unique citations, 10 studies met the inclusion criteria. After reference review, one additional study was included. Therefore, 11 studies were included in our review. Of these, eight reported VTS-based interventions for undergraduate medical students and three reported interventions in residency training, specifically in dermatology and ophthalmology. The main goal of most studies was to increase observational or visual diagnostic skills. Three of the studies in undergraduate medical education and two in postgraduate achieved a statistically significant improvement in observational skills in post-course evaluations. Some studies reported increased tolerance for ambiguity and empathy.

CONCLUSIONS

Although the studies varied considerably in study design, learning objectives, and outcomes, findings consistently indicate that the VTS approach can serve as a vehicle to develop crucial clinical competencies, encouraging more in-depth visual analysis that could be applied when observing a patient. Despite some limitations of the included studies (lack of control groups, self-selection bias, or non-standard outcome measures), the results of this review provide support for greater inclusion of VTS training in the medical curriculum.

From moulage to metrics: Bibliometric survey of visual arts in dermatopathology and dermatology

BACKGROUND

Both dermatopathology and dermatology are highly visual medical specialties. We performed a bibliometric literature survey of the visual arts in reference to either discipline to better understand how medical literature approaches art within the context of the two specialties.

MATERIALS AND METHODS

We performed a bibliometric analysis of publications found via multiple medical search engines and selected keywords meant to capture art-related publications in dermatopathology and dermatology. Keywords (art, portrait, painting, dermatology, dermatopathology) and keyword combinations were entered into the search engines PubMed, Google Scholar, Science Direct, Pubs Hub, and Scopus. Topics of articles, years of publication, countries of origin, and contributing journals were compiled and analyzed.

RESULTS

Eighty publications were retrieved between January 1903 and August 2021. The highest number of articles were found in both PubMed and Google Scholar (n = 55), and the top publication year was 2020 (n = 11). Geographically, the United States of America (n = 38) had the greatest number of articles. The dermatology and art keyword combination yielded the most journal articles (n = 36), and the maximum number of publications were retrieved from JAMA Dermatology (n = 14) followed by the American Journal of Dermatopathology (n = 10).

CONCLUSION

Our survey showed an increasing number of publications related to the visual arts and dermatopathology/dermatology during the examined period, and a transition from observational case studies (often relating to art history) to articles examining the incorporation of the visual arts into medical training programs or professional societies.

Using Visual Arts Education in Dermatology to Benefit Resident Wellness and Clinical Communication

INTRODUCTION

Art education interventions improve observation skills among dermatology residents, but there is limited data regarding their benefits to wellness and clinical communication.

METHODS

Residents in the Stanford dermatology residency program participated in an arts-based education session, repeated in the fall of 2018 and 2019, that included a rotation of observational exercises adapted from the Artful Thinking program through Harvard Project Zero. The 2018 session featured exercises on identification and understanding of visual observation, while the 2019 session featured exercises on perspectives and objectivity of visual observation. Participants completed preintervention, postintervention, and 3-month follow-up surveys in fall 2018 and a postintervention survey in fall 2019.

RESULTS

Twenty-one residents participated in the 2018 education session and produced an adequate response rate (62%-90%) across surveys. At 3 months, five of 13 residents (39%) reported new use of art for mindfulness and stress reduction, 12 of 13 (92%) could recall an example of use of observation to improve patient communication, and four of 13 (31%) confirmed and described adjustments to their handoff technique. In 2019, 13 out of 18 participants (72%) completed the postintervention survey. Responses reinforced themes from the prior iteration but focused on perspective, objectivity, context, and uncertainty in observations. Respondents also identified additional arenas of communication to benefit from these observational techniques.

DISCUSSION

Dermatology residents increased use of art for personal wellness and adjusted clinical communication strategies after a single arts-based education session. Annual repetition with novel exercises maintained engagement and yielded additional participant insights.

A short course in visual literacy can improve residents' observation and descriptive skills in cytopathology

Visual literacy is an essential skill in Anatomical Pathology. However, there appears to be a dearth of literature that engages explicitly with how to teach or learn visual skills with respect to Anatomical Pathology residents. Using a variety of modalities, with a focus on practical arts-based methodologies, three-two hour workshops were designed to explore the complexity of precise observation and structured description. This intervention was based on the hypothesis that cytopathology and analyzing an artwork share a language and set of formal processes. Evaluation of the workshops was both quantitative and qualitative. The former assessed pre- and post-workshop descriptions of cytology images and artworks while the latter was in the form of a focus group. An actual improvement in both cytopathology and artwork description was demonstrated while the focus group discussion revealed the majority of residents considered the workshops as having a positive impact on the observation and description skills required in Anatomical Pathology. Some felt the purpose and approach of these workshops was not made explicit enough. Thematic analysis of the focus group showed robust discussion regarding who should conduct these workshops and when they should be conducted in resident training. Unanticipated benefits of the workshops such as personal creativity and pleasure formed a significant theme that requires serious consideration. Introducing visual literacy workshops into residency training appears to be valuable and improved observation and description skills in cytopathology. The focus group discussion will be used to improve on this first set of workshops.