Artists teach students the power of observing

Instead of taking notes, medical students and residents at the University of Nebraska Medical Center in February created continuous line drawings and loose sketches of a model slumped in his chair, enveloped in sadness.

The class is a new twist that educators at UNMC in Omaha created to teach students how to observe and diagnose patients. It is an elective featuring a painter and a poet. Scottish artist Mark Gilbert, the painter behind "Saving Faces: Art and Medicine," a series of portraits of patients who have had head and neck surgery, teaches students drawing and how an artist focuses on the demeanor and manner of the subject. U.S. Poet Laureate and Pulitzer Prize winner Ted Kooser, a cancer survivor, shares with students how he observes and conveys subjects using sight, sound, smell, taste and touch.

A few other medical schools have incorporated art museum trips into their curricula to encourage students to look and think differently about their patients, but UNMC may be the first to bring artists into the classroom to share their creative process.

Katie Lazure, a third-year student, said drawing a live model -- a simulated patient asked to portray certain moods -- triggered her "aha moment." She realized that she often saw what she expected to see instead of what was there.

"When you look from the paper, back and forth, you can get a better feel," Lazure said. "His facial expression is actually this. I'd never spent a significant amount of time observing like this before."

Andrew Coughlin, another third-year medical student, said Kooser's poetry session gave him fresh insight into observation. One assignment was to describe a green pepper for someone who had never seen one before.

"You have to use your other senses, not just sight," Coughlin said. "What's the texture? The smell? When you look at it that way, it does help your observational skills."

Coughlin experienced this firsthand during his emergency medicine rotation. "One of the doctors said, 'Come in here. When you talk to the patient, smell the room a little bit,' " Coughlin said. Coughlin discovered an acetone-type smell. The patient had diabetic ketoacidosis.

These reactions are exactly what William Lydiatt, MD, a UNMC head and neck cancer surgeon, hoped to see when he helped organize the elective.

"With experience, you tend to take in a situation more quickly and get at certain things that are not otherwise related by a patient," Dr. Lydiatt said. "Depression is probably the best example. A man who has had a cancer will say everything is fine, but you see him make a quick look over at his wife, and it's a don't-say-anything type of look. Then you realize, in fact, there are a lot of issues going on."

In response, the seasoned physician will ask the patient another question. "These are things we've learned because we've seen them before," Dr. Lydiatt said. "For students who don't have that experience, our hope was that we could somehow give them some instruction in how to become better observers."

Virginia Aita, PhD, associate professor in UNMC's College of Public Health, said the class is about becoming more sensitive to the patient's humanity. "That's the hardest to teach."

The observation class is part of a larger effort at UNMC exploring the intersection of art and medicine, which includes a new series of portraits under way by Gilbert focused on patients and caregivers, including physicians. "These portraits are so beautiful, introspective and sensitive," Dr. Aita said. "You get a sense of the gravity of the experience of being ill and of giving care."

Through the pilot class and portrait series, Dr. Aita said, the school hopes to give health care professionals saturated in science an avenue to reflect on the humanity of all involved in the healing process.