Students are encouraged to examine the tiniest details to become better medical and nursing professionals. Photo by Richard Usatine, M.D.
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By Sheila Hotchkin

Medical and nursing students at the UT Health Science Center San Antonio are improving their observational skills through a three-week collaborative workshop with the McNay Art Museum.

Designed by the McNay, Art Rounds was developed in 2010 as a partnership with the university’s Center for Medical Humanities & Ethics (CMHE). A study of the program showed measurable improvement in participants’ visual observation and communication skills, which can lead to improved patient care.

Students who just completed the 2011 workshop went to the McNay one evening per week. Divided into interprofessional groups of 10, students toured the museum’s collection and spent time discussing what they saw. Most importantly, they learned to support their observations with evidence from the artwork.

Developing observational skills
“Much like in medicine, the issues we find in artwork may be more complex than they first seem,” said Rose Glennon, senior museum educator. “When a student says they think the subject of a painting feels a certain way, we ask them to tell us what they see that makes them think that. Different people see and notice different things.” This encourages a dialogue about all of the different possibilities.

Developing this comfort with ambiguity is one goal of the program. In a medical setting, this translates into doctors and nurses who will consider multiple possibilities when making diagnoses and devising treatment plans.

Similar programs at Harvard, Yale and Cornell medical schools have met with great success. Photo by Richard Usatine, M.D.

Some medical professionals also feel that improved visual observation skills can decrease reliance on expensive tests and other procedures that could be unnecessary, in some cases.

“Medicine has become increasingly reliant on test results and technology so that patients become nothing more than a set of lab values on a computer screen,” said Craig Klugman, assistant director and professor of medical humanities in the CMHE. “We need to train physicians to actually see the patient as a whole, rather than reducing the patient to a particular organ, tissue or lab result.

“Physicians who work in rural areas or in undeveloped countries do not have the benefit of expensive MRI machines and yet they can do a good job of evaluating their patients,” Klugman added. “These machines are not a replacement for our eyes; they are simply an extension of them.”

Listening and speaking
Communication is another key objective of the program. Group discussions encouraged students to listen closely and respond to one another.

“One very subtle but effective technique we use in the program is to paraphrase and repeat back what someone said,” Glennon explained. This can help an individual clarify a statement, encourages others to comment and demonstrates that the listener is paying close attention. These skills will become crucial when these future doctors and nurses are interacting with patients and colleagues.

“With better communication the system functions more smoothly, patients feel more valued and efficiency is created,” Klugman said.

Improving patient care
Communication and interpersonal skills are critical to providing the best patient care. A study at the Mayo Clinic showed that in addition to clinical expertise, patients look for health care providers with qualities such as confidence, empathy, forthrightness and thoroughness. A patient is more likely to trust a doctor who possesses these qualities and, according to studies, is more likely to follow medical advice and practice self-care.

In the case of nurses, a study conducted by the University of Pennsylvania Center for Health Outcomes and Policy Research showed that nurses are the single most important component in patient satisfaction. Experts agree that attentive nursing leads to lower rates of hospital readmission, hospital-acquired infections and bedsores.

Program outcomes
The 2010 Art Rounds program was carefully observed and recorded to measure its outcome. Researchers found that program participants spent more time looking at their subjects and became more confident in their observations each week. These students also increased the number of words used to describe what they saw, and showed improved tolerance for ambiguity. Finally, students in Art Rounds showed a markedly higher interest in communicating with their colleagues.

Art Rounds is scheduled to become a full-credit course in the 2011-2012 academic year. Similar programs have been offered with great success at Harvard, Yale and Cornell medical schools.

More information about the Art Rounds program can be found at http://www.texashumanities.org/art_rounds.cfm