Judging from her expression and
apparel in the John Singer Sargent painting, the second-year student
figured Sears wanted to speak her mind but was stifled by the
times in which she lived.
If Sears lived in the 21st Century
rather than the late-1800s, Roshek reasoned, she would be a strong-headed
leader, possibly even a congresswoman. He deduced all of this
just by looking at her portrait.
That was the point of Roshek’s
assignment during a unique medical course that emphasizes skills
in observation that will, in turn, give students a keen eye toward
patient care.
“Art of Observation,”
a novel educational initiative between the Medical School and
the Museum of Fine Arts, Houston, is one of only a few programs
in the United States that uses art to help physicians-in-training
master skills in observation and description.
Glenn McDonald, M.D., assistant
professor of renal diseases and hypertension, said he developed
the course last year in part because he felt medical students
and residents may be relying too much on technology to make their
diagnoses.
“In an age of managed care
and advanced technology, one of the temptations is to not take
the time to carefully observe your patients,” Dr. McDonald
said. “You have a lot of patients to see, and it may be
faster to say, ‘Abdominal pain in Exam 3. We’re going
to order a CT.’
“It may be an easier route,
but you may not recognize a number of features, which are critical
to making a diagnosis. We want to emphasize the fundamental skill
of observation before it becomes extinct,” Dr. McDonald
said. “Students need to realize that no matter how helpful
technology has become, it is no match a good set of eyes and a
brain.”
“Art of Observation,”
an elective offered to first- and second-year medical students,
consists of three, two-hour sessions at the museum. Currently,
it is offered twice a year, but because of its popularity, the
Medical School and the museum are hoping to expand the program
to accommodate more students. New sponsorship from Teachers Insurance
and Annuity Association College Retirement Equities Fund (TIAA-CREF),
one the largest private pension systems in the nation, will help
accomplish this expansion.
“This is a very creative way
to introduce students to the art of observation in clinical medicine
– a skill which has probably been under-emphasized in recent
years,” said Patricia Butler, M.D., associate dean for educational
programs.
The class utilizes portrait art
and medical photographs to emphasis basic physical diagnostic
skills.
First, senior museum docents
assign students to various classic portraits and give them time
to take in all the details. Afterward, the students lead a discussion,
and the docents let them know if their observations match the
story behind each painting.
“In textbooks, you are
looking at symptoms,” said Ryan Barrientos, a first-year
medical student who took the art observation course in the fall.
“You aren’t considering their emotions, so it’s
easy to forget that a patient is more than his symptoms. He may
be sad. He may be depressed.
“Looking at these paintings
is good practice for developing the skills we will need when we
start seeing patients,” Barrientos said. “Observation
needs to be the first step before you even start asking questions.”
During the second part of the course, Dr. McDonald presents students
with medical photographs and asks them to interpret the visual
cues in each patient’s face and body.
This is sometimes more challenging
than observing the paintings, because some of the patients are
so sick, it is difficult to distinguish their age, sex, and race.
“These are real diseases with
real implications that require critical observation,” Dr.
McDonald tells the students. “The patients are depending
on you. This is serious stuff.”
A quick study can reveal a patient’s
anguish, loneliness, or sheer determination. It also can draw
attention to tell-tale signs of severe disease, such as renal
failure or Addison’s disease.
Autumn Jackson, a second-year student,
said that assignment was an eye-opener. She and a small group
of other students observed a picture of a patient they determined
to be a 12-year-old boy. The patient was a woman in her 20s.
“You have to really look at
the patient and decipher what’s going on, and even then,
your first reaction may be completely wrong,” Jackson said.
“These are real people, and they have a story to tell. You
have to observe. You have to listen.”
Dean L. Maximilian Buja, M.D., said
the museum offers an excellent learning environment. He added
that the course is well suited for the school’s Master Teacher
Program, which seeks to enhance education in the foundations of
medicine and the skills of clinical practice.
Carrie Robinson-Cannon, the museum’s
docent program manager, said post-tests reveal that students gain
a heightened awareness and are better able to observe, describe,
and interpret medical photographs than they were at the beginning
of the course.
“We are taking a different
approach to sharpening a skill that is essential in all professions,
but especially medicine,” Robinson-Cannon said. “The
response from the students has been phenomenal, and we are proud
to foster a partnership that is allowing us to open their eyes
and minds.”
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