A ground-breaking partnership between the Bechtler Museum of Modern Art and Carolinas HealthCare System is aiming to improve diagnostic skills by exposing medical students and practitioners to art.
Nine pieces in the Bechtler’s collection will be used this fall in a program to sharpen observational ability. In The Art of Living: Improving Medical Diagnostic Skills, students will examine modern artworks and discuss what they see. Then instructors will reveal hidden meanings, teaching them to exercise deeper analytical skills.
“Modern art is great for this because of the ambiguity, which is so profound in modern art,” says Bechtler president John Boyer. “It forces the viewer to dig deeper for meaning.”
Charlotte’s program is modeled after one at Harvard Medical School. Since 2004, about 175 clinicians have taken the course that combines art museum experiences with clinical learning. In a 2005 study, students in the course scored 37 percent better than others in a visual test designed to evaluate their accuracy of observations and use of evidence to back up their interpretations.
Alexa Miller, co-creator of the Harvard program and a consultant on the Charlotte project, says there are unexpected benefits in helping professionals develop observational skills.
“It is only through putting these skills into practice that people learn what it means and feels like to really look. Looking requires time, both thoughts and feelings, and suspending biases and judgments.
“Looking also teaches how the differences of other people are an asset to understanding, and how there can be more than one right answer in any given situation. It is only when we really look that we see.”
Charlotte project unique
What sets the Charlotte project apart is its focus on using art to illustrate the most common diagnostic errors physicians make.
A recent survey of clinicians found that 47 percent report encountering diagnostic mistakes – missed symptoms or a faulty diagnosis – at least monthly. Common causes of these errors include deciding too early in the diagnostic phase what ails the patient without considering other possibilities. Studying modern art can illustrate the faulty process because as you study the work, more details emerge.
“One detail could change an entire diagnosis,” says Christopher Lawing, Bechtler vice president for programming and research. “We look at a work, then pick out a hidden detail that you can only see if you study it.”
Doctors want to get to the right answer quickly, Lawing says, but there’s a danger in deciding too quickly and not considering alternatives.
Here’s an example: A woman arrives at the emergency room with a burning pain in her abdomen. She says it feels like the peptic ulcer she was treated for the previous year and admits she had quit taking her medicine for it.
Making the assumption that the ulcer is flaring up again is the obvious answer. But a physician open to other possibilities might order a scan just to be sure – and thus discover the symptoms also pointed to a potentially fatal aortic aneurysm requiring immediate surgery.
“That’s ‘premature closure.’ There can be multiple right answers,” says Lawing.
To illustrate that point, students will view the 1957 work by Max Ernst, “Project Pour un Monument a W.C. Fields.” Painted in vibrant colors, the first impression people tend to draw is that it’s an abstract of a woman holding a parasol.
But there’s also a faint facial image beneath a top hat. On further examination, one can make out the head of comic actor W.C. Fields. Ernst loved Fields’ 1940 movie “My Little Chickadee” with Mae West and based his painting on a cinema poster for it.
Considering other answers
By having a dozen students discuss as a group what they see in the work helps them realize that others’ perceptions could be valid. Carolinas HealthCare favors a team approach in diagnosing patients, and the group art exercises are intended to underscore the value of that process.
Students from UNC Chapel Hill medical school getting experience at Carolinas HealthCare and clinicians from Carolinas Medical Center will participate. About two dozen third- and fourth-year med students are spending two years at Carolinas HealthCare as part of their training and others rotate through for experience in their specialties.
“We’re excited about what we can learn from visual thinking and applying it to meta-cognitive errors,” said Lisa Howely, CMC assistant vice president of medical education.
Over three years, the Bechtler hopes to work with a dozen students at a time with six two-hour classes every other week. It is seeking grants to cover the projected $260,000 cost of the program, which ultimately will serve about 100 students. Long-term, the objective is to create a template for museums and medical centers that can be used anywhere.
“My personal objective,” says Boyer, the museum’s president, “is that when you sit down with your young physician, you’ll say, ‘I hope you took this course at the Bechtler.’ ”
