This qualitative analysis of student course evaluations demonstrates that The Art of Observation elective positively impacted medical students in three overall ways:  It enhanced their observational skills, particularly in the development of a focused, deliberate process for analysis, as well as a nuanced and deep understanding of artwork and visual cues.  It contributed to developing positive physician socialization skills like teamwork, communication of complex thoughts, development of a humanistic view, and a tolerance of ambiguity.  It improved students’ overall wellness, which thereby contributes to preventing burnout.
The enhancement of observation skills from studying artwork has been described extensively in previous literature [1, 2, 4, 5, 10,11,12,13,14,15,16,17,18]. These studies have found that clinical diagnoses involve observation, description and interpretation of visual information, which are skills that can be garnered and enhanced by examining works of art . One study described that through art, “one is forced to assess the information, to question the artist, […] the subject, […] and the viewer’s response, in order to gain understanding” , which improves both processing and communication skills. Another study found that observing arts allowed students to see beyond what was expected and help in development of complex pattern recognition . Further studies concluded that the collaborative, critical thinking process that ensues from looking at art is parallel – and vital – to effective clinical practice . In our study, we also found that students felt studying artwork helped them use a focused and deliberate process of observation to create a deep and nuanced understanding. Importantly, we noticed that the most poignant comments emphasized the ability to synthesize a narrative from the distinct and seemingly unrelated details in either a work of art or a clinical vignette, thus pointing to the possibility that the development of observation skills is not an independent outcome, but rather a component of physician socialization.
Physician socialization has been traditionally regarded in terms of teaching competencies that can be measured objectively . Recently, educators have thought about physician socialization in terms of the process through which “humanistic competencies”  are achieved. The arts, inherently metaphorical and subjective, act as a medium through which educators can discuss ambiguous and complex topics and encourage medical students to integrate the combination of physical characteristics, emotions, and history that shape human perception. These unique properties allow art to enhance the personal growth of medical students and facilitate the development of a humanistic and empathetic professional identity [2, 20]. Arts-based sessions allow students to be aware of their feelings of uneasiness, nervousness, discomfort or anxiety  and hence, develop a tolerance for ambiguity. Literature supports that questioning assumptions is a key concept introduced in arts-based groups [2, 11, 14], and this allows for individuals to imagine experiences beyond their own, as well as recognize that uncertainty is an inherent part of medicine . Furthermore, discussing these feelings in the context of art helps develop communication skills needed to articulate thoughts and craft a public narrative with others . In our study, students reported enhanced self-awareness, increased tolerance of ambiguity, and development of a humanistic view of medicine, which supports this novel way of thinking about physician socialization.
Students also found that the small group discussions helped build teamwork and communication skills. Many students described the importance of teamwork in clinical practice. Although teamwork has become a major focus in healthcare and is a core competency in medical education, there is limited literature on the use of arts and humanities to teach teamwork and communication skills . We found that small group discussions during The Art of Observation sessions allowed students to practice communicating their interpretations and allowed students to become aware of the perspectives of their peers. The process of learning and growth of students is enhanced when learners engage and process their thoughts in the context of a group . We believe that the group discussion of fine works of art enhances self-reflection, a key component of physician socialization.
It is well-accepted that the arts can promote general well-being of physicians . They are an outlet for personal enjoyment and creativity, especially in the midst of a rigorous medical education curriculum. Studies have found that extracurricular activities in the arts help promote student well-being , which was corroborated in narrative course evaluations. Art courses allow for students to reflect on their role as a physician and the challenges they face as they assume this role , and we believe this self-reflection is key to preventing physician burnout. Observing or practicing art forces one to slow down and take a step back from the hectic, and often stressful, life of practicing medicine.
The Art of Observation elective was designed to meet several objectives. The first was to teach students relevant clinical skills, including the ability to observe, interpret, and communicate visual information. The second was to encourage self-reflection and promote a humanistic understanding of medicine. The final objective was to provide opportunities for students to work in teams and gain exposure to diverse perspectives. The goal of this study was to understand how students translated the activities that they completed in the course to their medical practice. The student evaluations and qualitative analysis have allowed us to discover how our course has impacted students across the years.
In validation of the themes discovered through our analysis, comments submitted were thoroughly analyzed until thematic saturation was achieved to draw conclusions regarding the impact of this elective on student’s development as physicians-in-training. However, limitations still exist. Because the Art of Observation is an optional elective rather than required curriculum, participants form a self-selected group with a demonstrated interest in medical humanities. A small number of evaluations were incomplete, and some students who participated in the course did not submit an evaluation. Students’ comments represent impressions of how they changed throughout the course, but written assessments were performed upon course completion. Therefore, the reflections and opinions expressed in the evaluations received may not be representative of all students who enrolled in the course, and the data may not capture all the changes that occur through the process of the elective. Many students are also in their preclinical years of training and may not be able to make as many connections to clinical practice as students actively engaged in patient care.