The Middletown Press (Middletown, CT)
THE ART OF OBSERVATION
Studying paintings improves radiologists’ skills, medical school professors find
NEW HAVEN — Staring at a classic painting for 15 minutes may strain the patience even of many art lovers, but for radiologists, the exercise helps prepare them for a career in examining X-rays and discussing them with their patients.
A recently published Yale University study found that, by paying a visit to the Yale Center for British Art on the first day of their residency, the doctors improved dramatically in their ability to find abnormalities on patients’ X-rays.
“I had probably never looked at a piece of art for more than a minute or two,” said Dr. Joseph Cavallo, chief resident in diagnostic radiology at the Yale School of Medicine, who studied “The Death of Chatterton” by Henry Wallis. (He participated in the study in July 2014, when he was in his first year of residency.)
“We were forced to try and see just everything on the paintings,” he said. “The goal was not to see if I could describe what a hand looked like. It was to get you in the mindset of observing all the visual things that were presented to you. After 15 minutes you’ve pretty much described every possible detail that the artist had put into the painting,” Cavallo said.
Linda Friedlaender, senior curator of education at the British art museum, had started the Enhancing Observation program for dermatology students, who, like radiologists, rely heavily on observation in their work. Now, all first-year medical students and nursing students take part, and
the program has been extended to medical and nursing students at Quinnipiac University as well, she said.
Detail oriented
A major goal of Friedlaender’s program is to teach the trainees to separate their powers of observation from the task of interpreting their findings. Too often, a doctor will leap to a conclusion about a patient’s condition without having studied the X-ray closely enough to gather all the information possible, she said.
“The first part is the looking; then it’s objective description of the painting and then subjective conclusions and interpretations,” she said. “They are supposed to look at the painting in as much detail as possible and record what they see. … Then they can make some kind of conclusion based on the information they got from observing the painting.”
The study, published Aug. 24 in the Journal of the American College of Radiology, was led by Dr. Rob Goodman, the first author, and Dr. Michael Kelleher, now at Middlesex Hospital. Fifteen residents were shown 15 radiographs each, with a “significant abnormality” in each one, according to the study. They identified 35 of 225 abnormalities. Then they were given a training session in how to analyze a painting and asked to study a work. Afterward, the residents were able to identify 94 of the abnormalities, a 268 percent increase.
Learning to see
“We know from errors in radiology that 60 to 80 percent of errors that we make are due to us failing to see something,” Goodman said. “One of those failures is called ‘satisfaction of search.’ You’ve seen something and then you stop looking. This exercise was very useful for trainees to learn that you can’t just stop interrogating the image.”
After 15 minutes spent studying the painting, a museum educator or docent “would encourage them to see even more. They would not let you interpret anything,” Goodman said. For example, an interpretation such as “I think this petal is falling off the flower because the flower is dying” would be going beyond observation to interpreting the image, he said.
“You have to elicit all the findings before you actually put it all together and interpret it,” Goodman said. “If you interpret too early, you make a mistake.” Such an error might be missing an abnormality on the edge of an image, he said.
“Another error would be missing something that’s not present,” Cavallo said. A resident might not notice that a spleen had been removed, for example. It’s “easier to see something that’s clearly abnormal than something that’s not present and its absence is the abnormality,” he said.
Visiting the art museum on the first day of class was “a far more useful way to segue into looking at things,” Goodman said. “How do you teach perception? It’s one of those things that’s very vague. Some people are able to perceive things better than others.”
Cavallo added, “If we had done the same thing with an X-ray, it would have been much more difficult. We wouldn’t have gotten as much out of the exercise if it had been a medical image.”
“The idea of taking time to look at the beginning for 15 minutes helps to slow down the learning process and to get them to focus on as much of the painting as possible,” Friedlaender said. “Too often, medical students or residents will say afterwards, ‘As soon as I thought I knew what was going on, I stopped looking at the rest of the painting.’” This can be dangerous when it comes to diagnosing patients’ conditions.
“Being able to describe something to somebody else is paramount in a hospital setting,” Friedlaender said.
After their visit to the British art center, not only were the radiologists better able to find abnormalities in the X-rays they were shown, but they were better able to describe those findings because they used more expressive language, which they needed in order to describe their paintings.
“The vocabulary we use when we’re describing X-rays is very different,” Goodman said. “It’s something lay people wouldn’t understand.”
“Their language is much more elaborative. Their language is much more full. Their language is much more descriptive., and they start using terms they used in the galleries,” Friedlaender said.
Once the residents completed the observation portion of the program, they would describe the painting to their fellow students, encouraged by the docents to find as much detail as possible. “They are encouraging them without leading them,” she said. “A lot of them will say, ‘I didn’t see that stuff’ ... and a lot of them will say, ‘I didn’t look at the picture very carefully.’”
Friedlaender then would allow them to interpret what they had seen, while being questioned about their assumptions by other class members.
“I would say to the group, ‘This is really interesting. You’re looking at the same object and you’re coming up with three different conclusions.’ How are you going to find out which one is right?” Friedlaender said. The lesson helped the students to realize that the more carefully they examined an X-ray, the more likely they would be to come up with an accurate diagnosis, she said.
“Rob wanted them to have the experience of … describing the X-ray and what it means to them … and that empowers the patient,” she said. “It’s a difference in terms of doctor-patient relationship and that only produces better medicine and better communication.