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Art Helps Nursing, Medical Students Strengthen Observation Skills, DePaul Study Finds

Nurses reviewing continuing education on computer

Gazing at a painting or examining a sculpture can help nursing and medical students improve their observation skills, according to a study published in the April issue of the Journal of Nursing Education. "Observation is key to diagnosis, and art can teach students to slow down and really look," Craig Klugman, PhD bioethicist and medical anthropologist at DePaul University in Chicago and co-author of the study, said in a news release. "Art is a powerful tool for teaching, and this program helped nurses and doctors become more adept at observation and encouraged them to move away from making assumptions." The study, "One Thousand Words: Evaluating an Interdisciplinary Art Education Program," finds students in the healthcare professions can effectively be taught visual observation skills through the use of art. Klugman, chairman of the Department of Health Sciences at DePaul, and co-author Diana Beckmann-Mendez, PhD, RN, FNP-BC, assistant professor of nursing at the University of the Incarnate Word in San Antonio, Texas, taught and evaluated Art Rounds, a semester-long course that brought together seven nursing students and 12 medical students at the University of Texas Health Science Center at San Antonio. The course, which was taught in 2012, offered an interprofessional learning opportunity for future clinicians who do not often get the chance to take classes together. The students met at the McNay Art Museum for four sessions and in a classroom for four sessions, according to the release. To hone in on observation skills, Klugman and Beckmann-Mendez taught students to use Visual Thinking Strategies, a technique originally developed to help kindergarteners look at art. They asked students, "What do you see? What do you see that makes you think that? What more do you see?" Each week, students used these strategies to look at artwork. Students also researched the artwork and artists and described them to each other, practicing listening skills. During one session, students were presented with live models wearing simulated skin conditions, including a rash and a removed tattoo. Students used VTS to examine these human subjects and diagnose them. To measure their progress, Klugman and Beckmann-Mendez administered a pretest and post-test asking students to describe images of patients and art. The researchers counted words in the student responses, coding them to measure changes in themes such as emotion, evidence, medical language and storytelling, according to the release. The change was significant in several areas, researchers found. After taking the course, students discussed emotions less and made more medical observations. "We didn't teach students art terms, and as a result they drew from terminology they had already learned," Krugman said in the release. "Their language changed and tended to become more clinical." Overall, students used more words to describe art and patients, and increased their total number of observations. After the course, students also told fewer personal narratives and stories and instead worked to interpret the images using only the evidence before them. During physical examinations, Klugman said, it's important for clinicians to remove this type of bias. "A clinician might notice one thing about a patient, such as dirty hands or torn clothes, and jump to conclusions without looking more closely," he said in the release. "We found that art can teach students to see both the big picture and small details that can be easily overlooked." The gains students made in observation were not matched, however, by an increase in students' empathy in their responses. "By focusing on pure observation skills, students learned to observe and not interpret," Klugman said in the release. "As educators, we must be mindful of how we use art and what we want students to get from the experience." Art can be a versatile tool in the classroom, according to Klugman. At DePaul, he teaches a medical humanities course for undergraduates, and his class visits the DePaul Art Museum for one session to give students a taste of the VTS technique. He also includes novels, movies and a variety of storytelling and human experience in the arts, working to deepen students' connection with patients and themselves. "When people go into healthcare, they tend not to stay in one place," Klugman said in the release. "Art museums give students an anchor in the community, a place to come back to. In addition to building their observation skills, medical arts programs can give students a lifelong relationship with the humanities."