Interpreting art may help medical students improve diagnostic skills

A program uses art to help medical students understand cultural competence, recognize racial bias and potentially sharpen their diagnostic skills, the program’s coordinator told Healio Primary Care.

Medication errors cause at least one death daily in the United States, according to WHO. The Institute of Medicine estimates that at least 44,000 Americans die yearly from medical errors. Both agencies advocate for programs that reduce those numbers.

Stephen Russell, MD, associate professor of internal medicine and pediatrics at the University of Alabama at Birmingham School of Medicine, collaborated with UAB’s Abroms-Engel Institute for Visual Arts and the Birmingham Civil Rights Institute to develop the program, “Prescribing Art: How Observation Enhances Medicine.”

The “first-of-its-kind course” was attended by almost 30 medical students from the class of 2021 and two faculty members from Stanford University.

“We showed students the John Singer Sargent painting ‘Lady Helen,’ which depicts a woman wearing a fine dress and nice jewelry,” Russell said. “We then ask students to tell us what they thought her life might be like. The students thought she might be of high society; however, Lady Helen was a nurse who served during World War One.”

He said the students’ inadvertent, personal and systematic biases in interpreting “Lady Helen” can occur during physician-patient encounters.

“Our program teaches the importance of asking questions to correctly diagnose and treat disorders and not jump to medical conclusions based on how a person presents themselves,” Russell said. “By using art as a medium to examine bias, the students learned something new about themselves and each other.”

The UAB program is based on a similar one at Yale School of Medicine, he said.

According to a JAMA report, the Yale program asked 90 medical students to describe what they saw in a series of photographs of patients with medical disorders. Students were then randomly assigned to either a lecture on history taking and physical exams; a lecture that also utilized abdominal X-rays; or to study a painting for 10 minutes and then describe it to other students. After the intervention, they were again asked to describe what they saw in the series of photographs of patients with medical disorders.

Researchers found no significant differences in scores among the three groups before their respective intervention. However, students who studied the painting had significantly better post-intervention scores than those who attended the history taking and physical exam lecture (P = .001 each year).

“The need to learn does not end with the end of medical school,” Russell said. “The objectives of self-reflection for biases in medicine; for a better understanding of the power of observation in medicine; and a better appreciation, or a tolerance of ambiguity or tolerance of uncertainty in the medical profession is an absolutely worthy goal.”

References:

• Dolev JC, et al. JAMA. 2001;doi:10.1001/jama.286.9.1019.
• National Academies of Sciences, Engineering and Medicine. To Err Is Human: Building a Safer Health System https://www.nap.edu/download/9728. Accessed July 11, 2020.
• WHO. WHO launches global effort to halve medication-related errors in 5 years. https://www.who.int/news-room/detail/29-03-2017-who-launches-global-effort-to-halve-medication-related-errors-in-5-years. Accessed July 11, 2020.