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Mastering the art of observation

Nursing and medical students hone their skills at the MAG

A group of medical students from the University of Rochester are doing rounds—but not at a hospital. Instead, they’re moving from painting to painting at the University of Rochester’s Memorial Art Gallery and at each stop must answer a simple question: What do you see? Slowly their observations unfurl, as each student reveals a new detail that many of the others hadn’t previously considered.

It’s all part of the Art and Observation program, a partnership between the MAG and the university’s Division of Medical Humanities and Bioethics, which reaches more than 500 health care students every year at colleges throughout Rochester.

“This is not an art history or art appreciation lesson,” says Susan Dodge-Peters Daiss, who oversees the program. “This is really a lesson in looking.”

Yale University pioneered the first Art and Observation program in 1999, and Daiss and Stephanie Brown Clark, an associate professor at the University of Rochester, brought the program here in 2002. Over a single two-and-a-half-hour session, students view three to five paintings and discuss a series of open-ended questions—a process that hones their observational skills, individually and in teams, and parallels the clinical practice of diagnosing patients.

First, they take an inventory of observed details—the setting, people, their clothing, objects in the space, and so on—without inferring anything further about the artist’s intentions.

“For physicians, one of the challenges is not to jump to conclusions, not to jump to—and this is the term that’s used—a premature closure,” says Daiss. “You’re not seeing evidence of the disease; you’re seeing a person with a disease. That’s very important, and that’s what we’re teaching—a person first.”

Other questions—such as “does this remind you of anything?”—reveal who the students are as observers—what prior experiences or biases they have, and how that colors what they notice about an artwork or patient. Many paintings used in the program depict themes or elements of race, gender, age, or socioeconomic status.

Before students reach their final interpretations, they can ask for additional information about the work. But, as Daiss explains, every question they pose must be targeted to elicit precise, useful information, just as doctors order certain tests to screen for specific conditions.

Finally, students discuss their interpretations of the scene before them.

“Whether they’re seasoned clinicians, first-year medical students, or nursing students, they all said it was really great to have different perspectives than their colleagues. They would not have seen all of the things that were discussed, come up with as many interpretations, or felt as challenged if they had done it on their own,” says Clark.

“Students often talk about having to reconsider what they thought they saw and what they thought was going on in the painting, and that does have clinical applicability,” Clark continues. “It allows students to think about the positive aspects of working in teams and also the complexities of working in teams.”

Rachel Kowal, a staff dermatopathologist at Muhlbauer Dermatopathology Laboratory, sees about a hundred cases a day and must use her observational skills to discern patterns and issue diagnoses to help her patients. Kowal, who participated in Art and Observation during medical school, says the program teaches skills critical to her daily work.

“Visual pattern recognition is the difference between making a diagnosis and not,” she says. “It’s not enough to just say, ‘This is melanoma.’ What might look like melanoma on a slide, for example, might be called something different in a child than in an adult—and that’s critical. For me, the art of observation comes in looking at the patient’s history, their age, the site of the lesion, and putting everything together.” 


Matthew Biddle is a freelance writer based in Buffalo. Tweet him at @matthew_biddle.

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