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Fine Art Frames Diagnosis

Paintings help medical students better see patients' symptoms

WEDNESDAY, Sept. 5, 2001 (HealthDayNews) -- If you want to know how good doctors are at diagnosing illness, ask them if they ever noticed that da Vinci's Mona Lisa has no eyebrows.

First-year medical students get better at diagnosing if they analyze paintings of people and scenery, say Yale University School of Medicine researchers. Being taught how to search for detail in a painting helps students find unexpected aspects, speeding up their ability to accurately pinpoint disease in real people, the researchers say.

The findings appear in a letter in today's Journal of the American Medical Association.

The notion of using paintings to improve diagnostic skills occurred to Linda Friedlaender, the curator of education for the Yale Center for British Art in New Haven, Conn., "when one resident clearly missed the diagnostic boat while I was visiting a friend of mine who was in the hospital. She was having exploratory surgery for cancer, and the resident just stuck his head in her room just to say everything would be all right. If he had looked at her carefully -- if he took the time to observe her behavior -- it would have given away her agitation and anxiety."

Friedlaender says the experience made her go to her friend Dr. Irwin Braverman, professor of dermatology at Yale's School of Medicine. She suggested that programs she had developed to help elementary and high school students and adults become more sensitized about art could be used to "help medical students and residents sharpen their powers of observation."

Braverman says a doctor takes a good five to 10 years to gain acute clinical skills. "Most [doctors] become very analytical and develop the skill to decipher signs and symptoms. It's very akin to children who learn how to read by word recognition. After they learn that well, they realize that phonics are involved, and they develop the ability on their own to recognize and understand words. The same thing goes on with doctors."

He says, "What we are trying to teach medical students is how to be like Sherlock Holmes. We've always taught medical students to look at this particular pattern or image and say it means 'X.' And so essentially you are teaching them patterns so the next time they see that pattern on an EKG or an X-ray or any of the medical images we use, they will recognize the disease or the problem."

New doctors get in trouble because "they do not know how to analyze that unfamiliar pattern and decipher what's going on," Braverman says.

Friedlaender and Braverman developed a pilot program, asking 60 first-year medical students to view three pictures and describe them to a small group of fellow students. The paintings "weren't abstracts; they were Victorian narrative paintings," Friedlaender says. "I gave them very little guidance. I randomly assigned each student a painting. They couldn't read the label. They had to look and study the painting for 15 minutes. They then had to describe the painting."

No interpretation was allowed, Friedlaender says. "They might say there's an old man on the left of the painting, for instance. I'd intercede and say that's judgmental. What detail in the painting makes him look old? And then [I'd] ask them to follow up with details: wrinkles, gray hair, a stooped posture."

"Learning how to look at visual clues in a painting and then describe them visually to others carries over directly to help sensitize [medical students] to interpret X-rays or the symptoms on the patient themselves," Friedlaender says. "It goes to higher critical thinking skills and enhances their ability to put visual clues together."

The pilot project then became a scientific study. "We used a control group who had no museum experience and compared them to a group that did. And the group that had the museum experience scored a lot better on a follow-up test that looked at [medical] diagnostic skills," Friedlaender says.

The program works because it causes students to "think inside the frame without any distractions," Braverman says.

"The brain, in order to work, is organized to filter out unnecessary detail, and we need to overcome that in these medical situations. In every painting, every item, every detail has been placed there for a reason. The painting is the surrogate for the patient. A patient presents with signs and symptoms. A doctor is to find every one of those signs and symptoms and every one of them has to be explained."

What To Do

To see the pictures shown to the students, see the Yale University School of Medicine, Department of Dermatology. And to see images doctors use to ferret out disease, see PhotoRounds. And here's part of a give-and-take interview with the Yale researchers.

Curious to see what Leonardo da Vinci's Mona Lisa looked like? Check here.

SOURCES: Interviews with Linda Friedlaender, M.S., curator of education, Yale Center for British Art, New Haven, Conn., and Irwin Braverman, M.D., professor of dermatology, Yale University School of Medicine, New Haven, Conn.; Sept. 5, 2001, Journal of the American Medical Association
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