Table 1 Study characteristics – Visual Thinking Strategies in Medical Education
From: Visual Thinking Strategies in medical education: a systematic review
Study | Study design | Number of participants | Participants | No. of sessions, duration | Goal | Format | Measurement | Results | Control group | MERSQI score |
|---|---|---|---|---|---|---|---|---|---|---|
Naghshineh et al., 2008 [22] | Prospective, partially randomized study design with pre- vs. post-course evaluations | 58 Intervention (n = 24) Control (n = 34) | 1st-2nd year Medical and Dental students | 9 weekly, 2.5-h sessions | Improve Visual Diagnostic Skills | Elective pre-clinical course: “Training the Eye: Improving the Art of Physical Diagnosis” at the Boston Museum of Fine Arts (MFA), facilitated by art educators trained in VTS, followed by a lecture linking visual arts concepts with physical diagnosis | Comparison of post-course vs. pre-course mean frequency of accurate observations | Increased observation skills. Increased use of fine arts concepts linked to physical findings in descriptions of clinical images. Improvement in participants who attended 8 or more sessions compared to 7 or fewer | Yes | 12.5 |
Klugman et al., 2011[23] | Quasi-experimental | 32 (18 medical students) | 1st-3rd year Medical Students and Nursing Students | 3 weekly, 90-min sessions | Improve physical observation skills, increase tolerance for ambiguity, and increase interest in learning communication skills | Sessions at an art museum led by museum educators trained in VTS as a part of an enhancement program | Comparison of pre and posttest evaluations | Increased total time spent looking at art and patient images. Increased number of words used to describe and number of observations made. Increased tolerance for ambiguity and positive views toward healthcare professional communication skills. No significant differences between medical and nursing students | No | 11 |
Jasani & Saks, 2013 [24] | Quasi-experimental | 110 | 3rd-year Medical Students | 1 session, 3 h | Improve observation skills in clinical diagnosis | Classroom discussion about fine art images, facilitated by a 4th-year medical student with interest in the visual arts. Part of a required course | Comparison of pre and posttest evaluations of patients’ photographs descriptions | The mean number of observations between pre- and posttests was not significantly different. Decreased use of subjective terminology. Increased scope of interpretations, use of speculative thinking, and visual analogies on descriptions. Increased mindfulness and clinical observation skills on student feedback | No | 10 |
Huang et al., 2016 [25] | Quasi-experimental | 27 | PGY- 2–5 Dermatology residents | 4 sessions, 7,5 h total, over a 2-month period | Improve observation skills | Mandatory course at the Museum of Fine Arts Boston, led by 2 professional arts educators and 2 dermatology faculty, all with formal VTS training | Comparison of pre- and posttest descriptions of clinical and art images | The overall number of observations made by residents on image tests significantly increased | No | 11 |
Bentwich & Gilbey, 2017 [31] | Quasi-experimental | 67 | 1st-year Medical Students | 1 session, 90 min | Increase tolerance of ambiguity and increase empathy | Classroom combined lecture and interactive discussion about art images, led by a physician with an interest in art. Performed within a mandatory course | Subjective participant feedback (post-intervention survey) | Increased acceptance of multiple meanings (tolerance of ambiguity) and improved visual observation skills. Impact on the ability to feel the suffering of others and on teamwork. High correlation between increased acceptance of multiple meanings and increased empathy | No | 7.5 |
Allison et al., 2017 [30] | Qualitative | 8 | 1st and 2nd-year Medical Students | 1 session, 20 min | Improve medical students’ understanding of the social determinants of health | Analysis of a street art mural in Nepal depicting the lives of ordinary Nepalis, facilitated by 3 faculty members.This session was a part of a pre-clerkship elective for medical students from Canada | Transcripts from sessions | Consolidation of complex community health concepts. Deeper understanding of the social determinants of health in Nepal | No | N/A (qualitative study) |
Ho Tiu et al., 2019 [32] | Quasi-experimental | 10 | PGY-1/PGY-2 dermatology trainees | 7 sessions | Improve clinical skills | Visual literacy training course taking part in art galleries and facilitated by an art historian | Participant satisfaction surveys and pre- and post-course assessments | Improved clinical observational skills. Expanded vocabulary and descriptive ability for clinical material. Increased clinical confidence and professional development across managing ambiguity, communication, respect, and reflective practice. Most pronounced impact on first-year trainees and on females | No | 11 |
Visscher et al., 2019 [29] | Qualitative | 50 | 3rd-year Medical Students | 1 session, 45 min | Improve medical students’ understanding of the radiology profession | Artworks depicting radiology encounters with patients, presented as digital images, were analysed, moderated by a VTS facilitator. This session was a part of a one-week radiology elective | Subjective participant feedback (post-session questionnaire) and transcribed audio recordings of sessions | Better understanding of the radiologists’ clinical roles. Reduced negative stereotypes of the radiology profession and of radiologists | No | N/A (qualitative study) |
Agarwal et al., 2020 [26] | Quasi-experimental | 101 Intervention n = 41 Control n = 60 | 1st-year Medical Students | Two 3-h sessions, over two weeks | Improve observation skills | Workshop at a university art museum, facilitated by museum educators. Participation was voluntary | Comparison of pre- and post-tests descriptions | Increased number of clinical and general patient observations and no statistically significant difference in the number of diagnostic comments or “self-deprecating remarks” Increased number of words used to describe clinical images Increased total time spent analysing and describing clinical images | Yes | 11.5 |
Cole et al., 2020a [27] | Single-arm trial | 4 | PGY-1/ PGY-2 ophthalmology residents | 3, 60-min sessions | Increase observation skills and increase ability to apply these skills in clinical settings. Increase tolerance of ambiguity | Classroom observation and discussion of art images, facilitated by an art historian | Subjective participant feedback | Improved clinical and observational skills. Improved detection of visual elements, attention to descriptive detail, awareness of assumptions, and acceptance of multiple possible meanings | No | Unclear |
Srivastava et al., 2022 [28] | Qualitative | 29 students | Medical students | 10 weekly,2.5 h sessions | Improve observation skills | A virtual “Training the Eye: improving the art of physical diagnosis” elective course. One session in person followed by 9 remote sessions through Zoom, using high-resolution images of artwork selected from museums around the world. Facilitated by a VTS trained art educator, Teaching Assistants, and the students themselves, who learned VTS facilitation during the course | Subjective participant feedback (post-course questionnaire) | Appreciation for deep looking and for the mindfulness aspects of the humanities curriculum. Better understanding of visual biases. 75% of students agreed or strongly agreed that the course objectives were able to be met virtually | No | N/A (qualitative study) |