Naghshineh Sheila, Hafler Janet P, Miller Alexa R, Blanco Maria A, Lipsitz Stuart R, Dubroff Rachel P, Khoshbin Shahram, Katz Joel T
Harvard Medical School, Medicine Education Office, Brigham and Women's Hospital, Boston, MA, USA.
J Gen Intern Med. 2008 Jul;23(7):991-7. doi: 10.1007/s11606-008-0667-0.
Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation.
To improve students' visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care.
Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis.
Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training.
Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session.
The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation.
Following the course, class participants increased their total mean number of observations compared to controls (5.41 +/- 0.63 vs. 0.36 +/- 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A 'dose-response' was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03).
This interdisciplinary course improved participants' capacity to make accurate observations of art and physical findings.
尽管有证据表明医学生的体格检查技能不足,但这些技能的教学却有所减少。提高检查技能的一种方法是教授“视觉素养”,即通过仔细且无偏见的观察来推断生理和病理生理的能力。
通过对艺术作品的结构化观察、对美术概念的理解并将这些技能应用于患者护理,提高学生的视觉敏锐度。
采用前瞻性、部分随机的课程前后评估,使用混合方法进行数据分析。
24名临床前学生参与者与34名处于相似培训阶段的同学进行了比较。
“训练眼睛:提高物理诊断艺术”包括八组配对的艺术观察练习课程,以及将美术概念与物理诊断主题相结合的教学内容和一次选修的人体写生课程。
在1小时的视觉技能测试中准确观察的频率,用于评估课程前后对患者照片和艺术图像的描述。采用内容分析来确定主题类别。所有评估对研究组和课程前后评估均保持盲态。
课程结束后,与对照组相比,班级参与者的总平均观察次数增加(5.41±0.63对0.36±0.53,p<0.0001),并且对艺术和临床图像的描述更加精细。与参加七次或更少课程的参与者相比,参加八次或更多课程的参与者呈现出“剂量反应”(分别为6.31 + 0.81和2.76 + 1.2,p = 0.03)。
这门跨学科课程提高了参与者对艺术和体格检查结果进行准确观察的能力。