The art of
observation-is it a natural impulse or an exact science?
According to professionals at the
University of Texas Health Science Center at Houston (UT-Houston), the
techniques of observation are honed skills of a trained eye that can be taught,
tracked and evaluated.
A Lost Art
Practitioners, applying the abstract to make concrete
diagnoses, practiced this indefinable and important art of medicine for
centuries. Relying almost solely on a keen eye and thorough, direct, one-on-one
communication and evaluation, the doctor would study and assess the patient's
speech, manner and condition. It has been a valuable aspect to patient care and
diagnosis, and unfortunately, there is a growing concern that the legacy and
use of the skill is not being completely carried over into today's medical
practice. Today's pressures, complexities involving patient care and advanced
technologies encourage a physician to rely heavily on equipment and tools to
make a diagnosis, and to make it quickly.
Technological advances have provided insights and
opportunities to quickly and more comprehensively evaluate an individual's
health and detect illness. However, the resulting unintended consequence of
these advances appears to be a diminishing regard for fundamental practices and
skills that still provide critical signs of a person's health and well being.
One of the challenges of the modern medical school is ensuring the two
methodologies continue to co-exist.
A Class of Discovery
At the University of Texas Health
Science Center at Houston, today's medical students are learning to observe
patients with the trained eyes of an art critic viewing
masterpieces.
"The
Art of Observation" is one of only a few programs in the United States that
helps physicians-in-training master skills in observation and description. The
program utilizes portrait art and medical photographs to emphasize basic,
physical-diagnostic skills. Through this elective course for first- and
second-year medical students at UT-Houston, future physicians visit the
galleries of The Museum of Fine Arts, Houston (MFAH) to discover how to better
observe their patients' manner and behavior.
During this series of three, two-hour evening
sessions, students first practice observing various pieces of art and then
apply those observation skills to actual patient
photographs.
Glenn
McDonald, M.D., assistant professor of renal diseases and hypertension at the
University of Texas Health Science Center at Houston, created the course in
Houston after reading about a similar initiative in New York. Dr. McDonald
developed the course last year out of a concern that medical students and
residents might be relying too much on technology to make their diagnoses. As a
result, the medical school embarked upon a mission to find ways to teach this
skill through more engaging and innovative approaches. Dr. McDonald believed
this approach would help teach the indescribable but undeniable art of medicine
out of the opera of the clinical arena, by opting for an environment that was
rich with visual stimulation and devoid of technological distractions.
In the first
hour, the students are placed in small groups. Senior museum docents then
assign the student groups to various classic portraits and give them time to
take in all the details. Later, all the groups gather together in one of the
museum's teaching auditoriums to view the various portraits. The students lead
a discussion, and the docents, who already know the full story behind each
painting, confirm whether their observations match. Looking at art becomes an
effective way to isolate and exercise the continuing development of a skill and
talent.
During the
second part of the course, Dr. McDonald presents students with medical
photographs and asks them to interpret the visual clues in each patient's face
and body. This is sometimes more challenging than observing the paintings,
because the photos are of actual patients. Often, the ravages of illness make
it difficult to distinguish age, gender and even race, but after further study,
the students begin to recognize subtle details. What they begin to "observe"
are the visible manifestations of severe disease.
Bringing science to art "The Art of
Observation" is not just a nice evening in a museum; it truly addresses issues
that are fundamental to the teaching and practice of medicine. It is one thing
to look at pictures and make points, it's quite another to set up objective
modules to evaluate observatory skill levels. Working with Lincoln Gray, Ph.D.,
an otolaryngology professor at UT-Houston, and George Ramirez, student and
family programs manager at the MFAH, Dr. McDonald is beginning to take the
class to the next level. Gray's research involves evaluating perceptual
learning, specifically the effects of experience on
perceptions.
Gray
has extensive experience objectively evaluating perception. Part of this
evaluation will be how experienced physicians observe as differentiated from
how new physicians observe. In the end, it is the goal of the team is to
detect, differentiate, discover and quantify how people learn to see what's
crucial when a patient walks in the door. Many experienced physicians are
exceptionally good at this. How do these physicians acquire these skills? Is it
natural ability or a talent, which can be learned?
So why start with medical
students?
There are many reasons. First, they are there to learn, and
they're just at the beginning. By getting them involved early, they have the
advantage of many years of practice and the ability to develop good form from
the onset of their medical education. They are given a sense of the importance
of developing the skill along with an early appreciation of the role
observation can play in a diagnosis. Over the years as the skill sharpens,
relying on it becomes as natural as walking and talking - it's done with a high
degree of competence without even thinking about it.
Secondly, because of the emphasis on
clinical care, students are relegated to lesser positions in practical
settings. Clinically, they don't have the experience, and they can't make any
decisions. They are learning by watching, not doing. In critically important,
life-and-death environments, they aren't able to be hands on; yet, they know
that in the future, they will need to be able to perform in a similar
fashion.
The
theory still holds that people learn more when they can enjoy the experience.
Dr. McDonald's initial goal was to test this theory. His vision was to get
students away from the clinical setting, where they felt removed and
ineffective, and into a unique, change of venue where they could relax and
fine-tune another area of learning.
There is no question of the interest and demand. The
elective class is always filled in 30 minutes or less, and those who are not
quick enough to enroll are relegated to the wait list. Currently, individuals
from other schools and museums in Fort Worth, Toronto and San Diego are in
discussions with UT-Houston and the MFAH, wanting to set up similar
programs.
A
Portrait of Potential
For the future, there is great potential for this course's
practical expansion. The curriculum would translate well for potential
continuing medical education (CME) classes, allowing practicing physicians to
focus on these important skills in a different environment as
well.
"The Art of
Observation" is an astute way to educate physicians and promote this
excellence. It is essential that we emphasize the fundamental skill of
observation before it becomes extinct. These skills are essential in all
professions, but especially in medicine. For, no matter how far we have come
and no matter how helpful technology has become, it alone does not serve as a
replacement for that time honored principle of being able to see what's right
before our eyes.
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