Formal art observation training improves medical students' visual diagnostic skills


Sheila Naghshineh, Janet P Hafler, Alexa R Miller, Maria A Blanco, Stuart R Lipsitz, Rachel P Dubroff, Shahram Khoshbin, and Joel T Katz. 2008. “Formal art observation training improves medical students' visual diagnostic skills.” J Gen Intern Med, 23, 7, Pp. 991-7. Copy at


BACKGROUND: Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation. OBJECTIVE: To improve students' visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care. DESIGN: Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis. PARTICIPANTS: Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training. INTERVENTION: Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session. MEASUREMENTS: The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation. RESULTS: Following the course, class participants increased their total mean number of observations compared to controls (5.41 +/- 0.63 vs. 0.36 +/- 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A 'dose-response' was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03). CONCLUSIONS: This interdisciplinary course improved participants' capacity to make accurate observations of art and physical findings.