Learning to Look: A Picture of Health UB Department of Family Medicine UB Anderson Gallery Ginny Lohr, MFA, MA, BSN, RN Richard Pretorius, MD, MPH Denise McGuigan, MSEd Niv Mor, MFA, MS-3 Karen Devlin STFM 34th Annual Predoctoral Education Conference Portland, Oregon January 25, 2008

Background In the 1990’s the University at Buffalo (UB) had an educational experience using visual arts as a tool to teach medical diagnostic skills to 3 rd year medical students at an art gallery. The learning experience was developed and led by the late Dr. Richard Sarkin until In 2005, the experience was resurrected, revised and expanded into the first year Clinical Practice of Medicine (CPM) course.

3 Learning Unit Lecture given instructing diagnostic assessment using artwork. Homework assignment completed at the art gallery; students utilized their ability to assess figurative art for assessment purposes. Clinical skills exam involved student interpretation of two paintings for medical assessment.

4 Philosophy Art intersects with health in four domains: 1) diagnostic evaluation 2) therapeutic intervention 3) self-renewal 4) communication of health concepts

5 Development of New Elective received funding from Johnson & Johnson and the Society for the Arts in Healthcare to further expand the CPM art and medicine experience and to develop an elective. Educational initiative between UB Department of Family Medicine, UB Anderson Art Gallery, Erie County Medical Center, and Aspire of Western New York, Inc. Purpose - to enhance medical students’ perceptual skills using visual art as a teaching tool.

6 Learning to Look: The Artist’s Remedy to the Physician’s Perspective Mission: To address the multi-faceted approaches available in the community to educate medical students, exposing them to a variety of participatory experiences in community arts organizations and alternative health care settings.

7 Course Objectives: 1)Medical students’ perceptual acuity skills will be enhanced through expanded clinical learning experiences. 2)Through increased understanding of how the world of art informs the world of science and medicine, students will measure their increased perception of patients and sharpen their observational skills. Learning to Look: The Artist’s Remedy to the Physician’s Perspective

8 Piloted in spring 2007 Eight weeks 11 medical students 1 dental student Course credit Learning to Look: The Artist’s Remedy to the Physician’s Perspective

9 Journaling and self-reflection Lectures and guest presenters Art activity with nude figure drawing model Two standardized patient encounters  Pre-test  Post-test Elective Components

10 Clinical art experience at ECMC Expressive visual arts program for adolescent and adult inpatients in the hospital psychiatric unit. Studio art session at Aspire On-site at Aspire’s school, The Center for Learning, with the after-school program students. Elective Components continued

11 METHOD Pre- and Post-OSCE OSCE (Objective Standardized Clinical Evaluation) done on first and last day of course; both sessions recorded on video Same SP (standardized patient) used in both sessions SP was evaluator of students 12 questions with Likert scale on pre- and post OSCE evaluation

12 RESULTS Pre- and Post-OSCE Reliability Analysis Cronbach’s Alpha = Excellent level of reliability Overall Scores Paired Sample T-test No sig diff (alpha = 0.336) Item Analysis Wilcoxon Signed-Rank Test Questions 5 & 6 with sig diff (p < 0.05)

13 RESULTS Skill Development Skills Developed as Self-Identified by Students on Post-Course Evaluation: At a level of 4.7/5 (on Likert scale): empathy sensitivity to the patient’s mood seeing the person establishing rapport with the patient

14 RESULTS Skill Development At a level of 4.5/5: awareness of and responding to non-verbal cues understanding human nature seeing patient’s perspective comfort describing feelings and attending to the patient At a level of 4.3/5: looking at a patient’s appearance to reach diagnostic conclusions

15 RESULTS Future Impact Open ended question—how course will affect the student’s medical practice Responses clustered in three thematic areas: 1)learning the value of careful observation 2)moving beyond the disease model to think about patients as persons in a holistic and integrated way 3)relating to patients with compassion and humanism

16 Helped to develop perceptual acuity skills of medical students. Improved student’s interpretation of the human body. Helped to expose the student to the “social” issue of nudity and provide them an opportunity to find their and the patient’s own level of comfort. Conclusions

17 Presentation at the Society for the Arts in Healthcare 19 th annual conference. Continue elective and make available to students with art backgrounds and in other health professions. Further study and analysis of pre- and post-interview videos and recently acquired transcriptions of student OSCE standardized patient interviews. Future Plans