In the museum, seeing is promoted to see

During a master class at the museum, medical students and doctors learn to observe more closely. Plus, it’s an exercise in learning to hold off on judgment until you’ve gathered all the information—essential skills for a doctor.

Top universities such as Harvard and Yale have been using art for more than a decade to develop observation skills and social skills.1 Also in the Netherlands, art education has gained ground in recent years, and various medical faculties have set initiatives regarding which art plays a role in education . The range differs in terms of content and implementation and ranges from an optional series of masterclasses in artist studios in Nijmegen to a compulsory working group ‘The Art of Looking’ in the Boijmans Van Beuningen Museum in Rotterdam.2 In this article we describe the first experiences of art education in Amsterdam UMC, as part of the project ‘See better by looking at art’.

The Rijksmuseum in Amsterdam has developed an educational program ‘Tabula Rasa’ where participants learn to look at art objects in a structured way. This program is specifically aimed at medical students and doctors and has been developed in collaboration with VUmc and UMC Utrecht. Based on a few tasks, the participants learn to ‘see better by looking at art’. There are four learning objectives:

1. Improving observation skills by seeing in phases.

2. Withhold judgment until all information is gathered.

3. To test one’s own judgment against that of others.

4. Improving transfer skills.

Naming, description, interpretation

Two enthusiastic art educators and an experienced doctor guide medical students and young doctors in an interactive workshop that focuses on some of the art objects in the museum.

In the first task, participants are encouraged to ‘look in phases’ at an art object: one by one you have to quickly name what can be seen in a sixteenth-century painting (Figure 1). Without interpreting what is happening on the canvas, individual elements are named and described, which turns out to be more difficult than expected for some participants. The task of this three-step display method: name, describe and understand (interpret). not only trains students’ observational skills but also teaches them to defer their judgment until all information is gathered. A skill that is not only useful in the museum, but also important when a doctor sees a new patient for the first time.


Figure 1. Medical students during the Tabula Rasa working group in the Rijksmuseum

Seeing through someone else’s eyes

In a subsequent task, one of the participants is guided with their eyes closed by two colleagues to a work of art and placed with their back to the object. While a colleague describes the artwork, the participant who cannot see the object is instructed to draw the object based on the description. A third colleague observes the interaction between the two participants and sees which information ends up on the drawing paper and which is lost. Certain important contextual factors seem so obvious that they are not mentioned. This becomes clear when the artist turns around and is surprised to discover that the carefully drawn object is not a painting but a sculpture.

The importance of this exercise in structured information transfer, as it takes place daily between healthcare providers, is explained by one of the participants, a doctor: ‘Imagine that this is not about an art object, but about a patient in the ED during of a night move. How would you describe this patient?’ One of the medical students present explains: ‘This assignment is a good representation of the situation in the emergency room when you talk to your supervisor about a patient by telephone. It is so crucial that you pass on the relevant information so that your supervisor can form a true picture of the patient.’

The most arrogant shooter

When the inquisitive group of future doctors or specialists stand in front of a 17th-century civic guard painting and are asked who is the most arrogant person in the painting, at least five different figures are pointed to (Figure 2). The facilitators then ask the participants why they consider the designated person to be arrogant. “Is it the attitude, or the averted or indifferent look?” In a lively exchange of views, opinions differ widely. ‘It’s nice to see how different people make different judgments based on exactly the same visual information; that’s how it happens in real life, of course’, says one of the bachelor’s students. Becoming aware of the subjective lens through which they see the world around them is also important in the hospital. It is not only about being able to test a personal opinion against that of colleagues or other care staff, but also against the patient’s.


Figure 2. Medical students in front of a civil guard portrait look through a cardboard window at the people depicted; who is the most arrogant sagittarius?

From everyday stress and rush

This program has recently been pursued by five separate groups as part of this research into the application of art education for medical professionals. The program was received with great enthusiasm by participants at various stages of their training as doctors or specialists. Everyone was withdrawn from the hustle and bustle of everyday life in the Rijksmuseum for an afternoon. By physically moving from the hospital to the world of visual arts, the participants found themselves in a free, unprejudiced environment. An inspiring environment where prior knowledge is not required and where there is no preconceived hierarchy. The museum thus offers a creative workplace for training observation and communication skills, skills that are essential for working in a (future) medical practice.

After five sessions

Five sessions were organized in the Rijksmuseum. At the end of each session, there was an evaluation where the participants could share their insights and experiences with each other and with their supervisors. The different aspects and learning objectives of the program were evaluated using a short questionnaire with open questions. The questionnaires from 34 participants were analyzed. The participants were divided into four groups based on their position and clinical experience: 1. medical students, 2. medical researchers and doctors without specialist medical training (PhD/aniossen), 3. doctors undergoing specialist medical training (aiossen) and specialist doctors ( Table 1 ). All doctors in this research group worked in the surgery department in the Amsterdam region and surroundings. The open-ended responses given by the participants were assessed and scored independently by two raters (‘yes’, ‘somewhat’ or ‘no’). Table 2 shows the answers to the evaluation questions.


Table 1. Participants ‘Tabula Rasa’ Rijksmuseum


Table 2. Evaluation questions ‘Tabula Rasa’ Rijksmuseum

The results of the evaluation

In the evaluations, 71 percent (n=34) of participants indicated that the program helped them learn to delay judgment until all information about a situation has been gathered. A similar proportion (68%, n=34) believes that the tasks in the course make them more aware of the prejudices they have or could have. 82 percent (n=33) of the participants are therefore convinced that the program at the Rijksmuseum can contribute to doctors’ professional development. More than half (52%, n=33) believe that the program can contribute to better communication between doctor and patient. All participants were motivated to participate in a possible follow-up process.

Doctors more critical

Doctors were clearly more critical than (bachelor) students. They indicated that the sessions were mainly training in doctor-doctor communication and felt that a single half-day at the museum was too short to permanently improve communication skills. They emphasized the importance of a follow-up course to this program to further practice these skills. In addition to training observation skills with a view to patient contact, the training is also suitable for promoting professional interaction and collaboration.

The evaluations show that a majority of the participants believe that the program contributes positively to forming an informed judgement; an essential competence for healthcare personnel in their dealings with patients. The program in the Rijksmuseum shows how quickly people form their opinions. Interactive tasks successfully break through this often unconscious and direct judgment formation in two ways: on the one hand by learning to postpone ‘judgement’, and on the other hand by experiencing prejudices yourself and learning to deal with them. Doctors in particular should be able to make decisions together with their patients without prejudice. This requires self-awareness and a critical eye, but also feedback from others and above all: practice in a stimulating environment. Our project ‘See better by looking at art’ can contribute to this.

Objectives

The Tabula Rasa program at the Rijksmuseum was offered in five working groups of medical students, medical assistants and surgeons. Participants were enthusiastic about the creative way in which observational and communication skills were practiced in the program. The sessions at the museum offered tools for exercising professional competences, where empathy and well-considered judgment without prejudice are important. A challenge for the future is to objectify the effects of ‘looking at art’ on these skills.

Authors

Pien de Ruiter, graduate student in medicine Amsterdam UMC, Department of Surgery

Maud Reijntjes, physician-researcher surgery Amsterdam UMC, Department of Surgery

Pauline Kintz, head of the Public and Education Department at the Rijksmuseum Amsterdam

Thomas van Gulik, Emeritus Professor of Surgery Amsterdam UMC, Department of Surgery

Contact

pederuiter@amsterdamumc.nl

cc: redactie@medischcontact.nl

References

1. Mukunda N, Moghbeli N, Rizzo A, et al. Visual arts education in medical education: a narrative review. With training online. 2019; 24:1558657.

2. Reijntjes M, de Ruiter P, Linsen L, et al. The site of art observation in medical education in the Netherlands. TSG Journal of Health Sciences. 2021; 99 (75-79). https://doi.org/10.1007/s12508-021-00296-w.

3. Kintz P, Bijvoets N. Tabula Rasa. A program in the Rijksmuseum for students in medicine and nursing. Department of Publicity and Education Rijksmuseum. 15 June 2021.



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