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Formal Art Observation Training Improves Medical Students’ Visual Diagnostic Skills

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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.


To improve students’ visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care.


Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis.


Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training.


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.


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.


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).


This interdisciplinary course improved participants’ capacity to make accurate observations of art and physical findings.

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Grant support was provided by The Creative Center, New York, NY. We appreciate the administrative assistance provided by Linda Grover and Robert E. Heroux. We are grateful to Judith Hill for her contribution to the assessment process. Judy Pembroke, Wai-Kit Lo, M.D., course faculty members, MFA collaborators, including Barbara Martin, and participants in the 2003–2004 TE pilot, provided important creative contributions to the course design. Assessment tools were developed with the input of Philip Yenawine, Abigail Housen, and Patricia Foley of Visual Understanding in Education. The funding organization had no role in the (1) design or conduct of the study, (2) collection, analysis, or interpretation of the data, or (3) preparation, review, or approval of the manuscript.

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Some of this material was presented at the October 2006 Medical Education Day poster session, Harvard Medical School, Boston, MA.

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Correspondence to Joel T. Katz M.D..

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Naghshineh, S., Hafler, J.P., Miller, A.R. et al. Formal Art Observation Training Improves Medical Students’ Visual Diagnostic Skills. J GEN INTERN MED 23, 991–997 (2008).

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