Training the Eye of the Beholder

By Robert Press

Sometimes, the intersections of art and science are subtle. They’re represented by the physician whose musical background helps him develop a new listening device, or the artist whose anatomical drawings aid medical research centuries beyond his death. Sometimes, however, those intersections are far more direct—such as with the work of Jaclyn Gurwin, MD’15, Gil Binenbaum, MD’02, MSCE’09, GME’06, and their colleagues, who have drawn connections between ophthalmological observational skills and the training one would receive in art observation, description, and interpretation.

The idea was simple: Take some number of medical students and bring them to the museum instead of the anatomy lab, give them courses in art observation taught by professional art educators, and see how well they respond when presented with clinical images yet again, especially compared with those students who haven’t taken the same art observation courses.

If you’re unfamiliar or uncomfortable with how art and science can mingle to produce something clinically beneficial, it’s a study premise that might seem far-fetched—but it didn’t seem that way to Gurwin, an ophthalmology resident at Penn, in part because she’d already seen the benefits of art education on a medical career firsthand.

“Having studied fine arts myself and having witnessed its impact on my medical training, I knew art observation training would be a beneficial practice in medical school,” she said. “Observing and describing are skills that are taught very well in fine arts training, and so it seemed promising to utilize their teachings and apply it to medicine.”

Gurwin and Binenbaum’s findings, published in the journal Ophthalmology in September: The medical students who’ve dabbled in art just do better.

It’s a glimpse at how non-clinical training can and does make for a better-prepared medical professional. Not only does art observation training improve med students’ abilities to recognize visual cues, it also improves their ability to describe those cues.

Observation for Ophthalmologists

The ability to effectively observe and report is particularly crucial for ophthalmologists, whether they’re in training or they’ve been around for a while, as just being able to know what you’re looking at and tell others about it is a huge part of the diagnostic process. According to Gurwin, this typically breaks down to the metrics of quantity, size, shape, depth, color, and distribution.

“For example, in a patient with mild nonproliferative diabetic retinopathy, we may describe the retina as having three (quantity) small (size), round (shape), intra-retinal (depth) red (color) spots in the inferotemporal periphery (distribution),” she said. “This type of description is especially useful for trainees who are not yet trained in diagnosis, because it allows them to simply describe what they are seeing and communicate findings to others in the field.” 

Ophthalmologists take a systematic approach to analyzing the eye by moving from front to back, structure to structure. According to Gurwin, the structured approach helps make the subtleties of disease easier to pick up—so a clue to the diagnosis inside the eye will not be missed.

“We are able to visualize subtle corneal changes, changes in retinal vessel caliber, the depth of retinal hemorrhages, or changes in the optic nerve, all of which are findings that are pivotal to developing a differential diagnosis,” she said.

Observation in the Arts

“The tools used for observation in ophthalmology are the same for art,” said Gurwin, who studied fine arts as an undergraduate at Penn. “We note color, shapes, lines, distribution, contrast, and movement. These are all descriptive categories, which allow people to describe and digest artwork prior to making further conclusions about it.”

The group of students who took the training described in Gurwin and Binenbaum’s study received six custom, 1.5-hour art observation sessions at the Philadelphia Museum of Art under the tutelage of the museum’s professional art educators. An “Artful Thinking” approach was employed, and the students were pushed to focus on introspection and observation prior to interpretation.

Across the six sessions, students were taught about the principles of art, the vocabulary of artistic descriptions, and the fundamental processes of observation, description, comparison, and interpretation.

Figures in a Landscape, by Sidney Goodman, courtesy Philadelphia Museum of Art

Expanding the Scope of Observation

The study results—with their measured analysis of the students’ improved observational abilities—are one thing, but anecdotal responses to the course have also been promising, as Gurwin and Binenbaum found through post-study questionnaires and discussion. Students who received the training indicated they’re already applying their course-learned skills in clinically meaningful ways.

Students also told Gurwin and Binenbaum of improvements in their ability to see others’ points of view. That suggests that the impact of their art training—which placed them in a listen-first environment where multiple viewpoints were encouraged to deal with complex, sometimes subjective topics—is preparing them for everything from the bedside to the collaborative diagnostic environment.

“I think my biggest takeaway was appreciating teamwork and the perspectives of other people,” said Christy Hong, a fourth-year medical student in the MD/MBA program at Penn who participated in the art training as a first-year student. “It enlarged my definition of what makes a good scope of observation. My observation alone isn’t enough. Medicine is a team sport. I always seek the opinions of my colleagues on the floor, if possible, to get a fuller sense of what’s going on and be able to triage it more appropriately.”

To Gurwin, the results—anecdotal and otherwise—are encouraging. They show that art observation training may very well have a place in overall medical training, and could translate into physicians being better prepared straight out of medical school.

And so she plans on pushing the concept further, mapping ever more of those intersections between art and medicine. In future studies, she aims to better measure changes in emotional competency, look in on the long-term effects of art training on medical practice, and extend the training to residents, fellows, and attendings. As a result of the study, The Perelman School of Medicine began to offer the Philadelphia Museum of Art course as an elective to first-year medical students.

“I believe art observation training could have a profound impact on the physician experience,” Gurwin said.

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