Fine arts curriculum improves observational skills of dermatology trainees: a pilot study
DEAR EDITOR, Developing observational skills is an essential part of medical training, yet there may be little formal teaching in the curriculum. Visual exercises have long been a means of improving observational skills among medical practitioners and students. Visual Thinking Strategies (VTS) is a method of fine arts observation based on research by psychologist Abigail Housen and museum educator Philip Yenawine. Trained facilitators build a group understanding of a work of art based on three sequential, open ended questions: 'What's going on in this picture? 'What do you see that makes you say that? and 'What more can we find? VTS has been used effectively for groups ranging from schoolchildren to corporations, and also in medical education. These methods have not been applied to dermatology house officer training. Accordingly, we performed an interventional study examining the implementation of an art based observational training programme for dermatology house officers utilizing the VTS method. This was a prospective open label intervention study with preand post course tests to assess the impact of the course on observational skills in dermatology house officers. In autumn 2014, dermatology house officers in the Harvard Combined Dermatology Training Program participated in a mandatory VTS based course. Twenty seven of 28 house officers were available for the course, and all gave informed consent for study participation. The four session course (introductory 3 h and three subsequent 1 5 h sessions) was led at the Museum of Fine Arts, Boston, over a 2 month period by two professional arts educators and two dermatology faculty members, all with formal VTS training. VTS was used in every session along with complementary themes including descriptive language (colour, light and texture) exploring assumptions and approaching ambiguity. A number of expanded VTS techniques were also used, for example VTS with medical images, 'back to back drawing' and using house officers as VTS facilitators. Brief homework was based on the session's theme, such as 'How did you use VTS this week in your clinical practice? For the preand post tests house officers provided handwritten responses to 'What's happening in this image? Please be as descriptive as possible' Preand post tests included three clinical images and two art images (8 and 5 min each, respectively) of similar content and complexity. To control for possible learning and image differences, house officers were divided in two equal groups by year; one group received pretest A and post test B, the other received pretest B and post test A. Responses were typed and blinded as to prevs. post test, and the numbers of unique accurate observations per image were scored and averaged by consultant dermatologists. A survey assessing participants' satisfaction with the course was distributed following course completion. The data from the preand post tests were analysed to generate means and SDs of the number of observations. Twosided t tests were conducted to determine whether the change in the number of observations from preto post test significantly differed from zero. Similarly, t tests were used to evaluate the change in the number of observations by subgroup including sex, postgraduate level and the number of sessions attended. Our results showed that 96% (27 of 28) of eligible dermatology house officers participated in the study, with 85% of participants attending three or more sessions. The overall number of observations made by house officers on image tests significantly increased after completing the course (28 7 11 2 vs. 33 1 10 2, P 0 038) There was also a trend towards greater improvement in images completed earlier in the test as opposed to at the end (Table 1) Comparisons of image test results by demographic characteristics and number of sessions attended were performed (Table 2) Among men, significant improvement was found in medical image test scores only (25 3 7 8 vs. 29 2 7 2, Table 1 Image test results of dermatology residents before and after a Visual Thinking Strategies course (n 25)
The British journal of dermatology