Eyeworld

18 January 2018 EW NEWS & OPINION Research highlight by Liz Hillman EyeWorld Staff Writer heard of institutions incorporating art observation training into clinical courses, but there were not many formal studies that looked at the effect of this, and none looked at the effect of art observation alone on medical or ophthalmological observation skills. Overall, the researchers said that this type of training could be especially beneficial in medical specialties that rely heavily on direct observation. "We would recommend art ob- servation training to medical school students, as this training has shown to improve medical and ophthal- mological observational skills," Drs. Gurwin and Binenbaum said. "This type of training is particularly ben- eficial in fields that rely on physical exam skills or image-based testing to drive diagnoses and treatment plans, such as ophthalmology, der- matology, and radiology. However, we think it is beneficial in all fields of medicine because observation is a fundamental part of medical diag- nosis and management. We have be- gun to offer the course as an elective option to Penn Med students, and there has been a lot of interest from other schools around the nation, so we anticipate other such programs appearing over the next few years." Drs. Gurwin and Binenbaum said they hope to continue research on the connection between art, medicine, and empathy. One ob- jective would be to bring this type of training to those more advanced in their medical education, such as residents and fellows, and practicing attendings. This, they said, would allow them to examine effects on clinical skills as well as the impact of physician experience. EW Reference 1. Gurwin J, et al. A randomized controlled study of art observation training to improve medical student ophthalmology skills. Oph- thalmology. 2017 Aug 3. Epub ahead of print. Editors' note: Drs. Gurwin and Binenbaum have no financial interests related to their comments. Contact information Binenbaum: Johanna.Harvey@uphs.upenn.edu Gurwin: Johanna.Harvey@uphs.upenn.edu The training also involved classes on flexible thinking and changing view- points based on new observations made when looking at artwork. All participants took an obser- vation skills pretest and post-test in which they described art images, ret- inal photographs, and clinical pho- tographs of ocular surface and/or periocular disease. The descriptions, depending on topic, were graded by either art professionals or ophthal- mologists, the latter of whom graded using a 24-point scale. The training group saw a mean change in their pre- and post-test scores of +6.2, while the control was –7.6. For clinical images, the training group had a mean change of +12.8, compared to the control group's –5.9. Those who took the art observation training courses report- ed in a post-training questionnaire that they were already applying these skills in clinical situations. The reasons for the decline in scores of the control group are unclear but could be related to the focus of medical school curriculum or a poorer effort potentially made by the students without the training, Gurwin et al. explained. The researchers also looked at the effect of art observation training on empathy. "Observation is not only important for clinical diagno- sis, but it is also a first step in being empathetic. To be able to empathize, one must be able to recognize emo- tions, which inherently requires the skill of observation," Gurwin et al. stated. While there was not a signifi- cant difference between the pre- and post-tests on emotional recognition skills, those who were in the art observation group did report in a survey that they felt the training improved their ability to empathize, though not necessarily how the re- searchers thought it would. "We hy- pothesized that observation would improve empathy because observing facial cues and body language is the first step in being empathetic," Gurwin et al. stated. "But students described another way in which the course made them more empathetic; it allowed them to better appreciate the opinions of their peers." Prior to this research, Drs. Gur- win and Binenbaum said they had "We found that this training not only improved the medical students' art observational skills but their ophthalmological and medical observational skills as well. These observational skills are vital in med- icine," Drs. Gurwin and Binenbaum wrote in an email to EyeWorld. "For example, when looking at a nevus in the retina, one must observe certain characteristics to know if it is con- cerning for melanoma. If one isn't observing carefully, a potentially life-threatening disease could easily be missed. This training teaches stu- dents how to become astute observ- ers. By the end of the program, the students who received the training were already commenting on how immediately they were using [this] new observation approach and their newly acquired skills in their clinical coursework, such as looking at CT images or disease photographs. They also reported an additional, unantic- ipated benefit: The group discussions in the art observation classes made them even more collaborative in their medical school coursework." Those who received training were taught by professional art edu- cators at the Philadelphia Museum of Art, using the "artful thinking" approach. This approach, Drs. Gur- win and Binenbaum explained, "fo- cuses on describing art in a system- atic way utilizing language such as line, color, movement, depth, etc." Study finds art training makes medical students better observers W hile first-year medical students find them- selves engrossed in a heavy course load focused mainly on the basic sciences, a new study suggests pulling from another, seemingly unrelated, field of study—art—could enhance some of their medical skills. The research published in Ophthalmology describes a controlled trial of 36 first-year medical students who were randomized into two groups: one received art observation training in six, 1.5-hour classes over 3 months. 1 The other group served as a control without this training but was granted access to the art museum. Co-investigators Jaclyn Gur- win, MD, ophthalmology resident, Scheie Eye Institute, University of Pennsylvania, Philadelphia, and Gil Binenbaum, MD, MSCE, associate professor of ophthalmology, Perel- man School of Medicine, University of Pennsylvania, and pediatric eye surgeon, division of ophthalmology, Children's Hospital of Philadelphia (CHOP), found art observation training could translate to improved clinical observation skills. How art could enhance clinical observation skills

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