2013 Fall Webinar Series:
What Does Art have to do
with Patient Safety? Led by: Alexa Miller
The Global Alliance is grateful to the National Endowment of the Arts for its support of this webinar series, which strives to provide affordable resources to individuals and organizations wishing to establish or advance arts and health programming.
What does art have to do
with patient safety?
Alexa Miller
November 6, 2013
Objectives
Webinar participants will be able to:
– Describe challenges of clinical uncertainty;
– Describe a Visual Thinking Strategies experience
– Identify current findings on VTS impact and their
significance.
Diagnostic Error • $765 billion wasted healthcare spending1
• Leading type of malpractice claim2
• Most commonly due to faulty data-gathering or data-
synthesis (rarely faulty knowledge) 3
• Prevalent overconfidence
• Cognitive root causes under-addressed in medical
education4
1. Smith, M, Saunders, R, Stuckhardt, L, McGinnis, J, Eds; Committee on the Learning Health Care System in
America; Best Care at Lower Cost, Institute of Medicine, 2009
2. Tehrani, A et al., 25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from
the National Practitioner Data Bank, BMJ Qual Saf doi:10.1136/bmjqs-2012-001550
3. Graber, M, Franklin, N, and Gordon, R. 2005. “Diagnostic Error in Internal Medicine.” Archives of Internal
Medicine 165 (13) (July 11): 1493–1499. doi:10.1001/archinte.165.13.1493.
4. Trowbridge, R. 2008. Twelve Tips for Teaching Avoidance of Diagnostic Errors, Medical Teacher Jun; 30(5); 496-
500.
Visual Thinking Strategies
Purpose:
Help beginner viewers enjoy / access art
1. Method
For facilitating art discussion
2. Curriculum (K-6)
For access to art / cognition
3. PD Model (K-6)
To transform teaching practice
Abigail Housen, PhD., and Philip Yenawine
Co-Authors
“Exposure to art over time is the only way to
develop aesthetic understanding, and without
this time and exposure, aesthetic development
does not occur.”
Abigail Housen, Ph.D.
“Give people the opportunity to talk about things
that matter to them.”
Philip Yenawine
Art-Viewing and Medicine • Klugman, C, Peel, J, Beckmann-Mendez, D. Art Rounds: Teaching Interprofessional Students Visual
Thinking Strategies at One School. Academic Medicine 2011; 86(10): 1266-1271
• Naghshineh S, Hafler JP, Miller AR, Blanco MA, Lipsitz SR, Dubroff RP, Khoshbin S, Katz JT. Formal art observation training improves medical students’ visual diagnostic skills. Journal of General Internal Medicine 2008; 23(7): 991-7.
• Dolev JC, Friedlaender LK, Braverman IM. Use of fine art to enhance visual diagnostic skills. Journal of the American Medical Association 2001; 286(9): 1020-1.
• Bardes CL, Gillers D, Herman AE. Learning to look: developing clinical observational skills at an art museum. Medical Education 2001; 35(12):1157-61.
• Shapiro J, Rucker L, Beck J. Training the clinical eye and mind: using the arts to develop medical students’ observational and pattern recognition skills. Medical Education 2006; 40(3):263-8.
• Schaff, Pamela B, Suzanne Isken, and Robert M Tager. 2011. “From Contemporary Art to Core
Clinical Skills: Observation, Interpretation, and Meaning-Making in a Complex Environment.” Academic
Medicine 86 (10) (October): 1272–1276. doi:10.1097/ACM.0b013e31822c161d.
• Boisaubin EV, Winkler MG. Seeing patients and life contexts: the visual arts in medical education. American Journal of the Medical Sciences 2000; 319(5):292-6.
• Gaufberg, EG and Williams, MR. Reflection in a Museum Setting: The Personal Responses Tour. Journal of Graduate Medical Education: Dec 2011; 3(4): 546-549
• Ter Horst, R and Kruiper-Doesbergh, Visual Thinking Strategies, applied as a therapy in patients with chronic non-congenital brain disorder, Tijdschrift voor Neuropsychologie, Jaargang 7 n. 3
VTS Impact: Key Studies K-12 Students: critical thinking and language skills (ELL)
• Adams, A, Luke, J, Thinking Through Art – Isabella Stewart Gardner Museum School Partnership Program, Institute for Learning Innovation, 2007
• Housen, Abigail, Aesthetic Thought, Critical Thinking and Transfer, Arts and Learning Journal, Vol. 18, No. 1, May 2002.
• Aesthetic Development and Creative and Critical Thinking Skills Study, San Antonio, Texas: 2000 to 2002, Principal Researcher: Abigail Housen, Senior Research Associate: Karin DeSantis
Medical Students: observation, communication, ambiguity
• Klugman, C, Peel, J, Beckmann-Mendez, D. Art Rounds: Teaching Interprofessional Students Visual Thinking Strategies at One School. Academic Medicine 2011; 86(10): 1266-1271
• Naghshineh S, Hafler JP, Miller AR, Blanco MA, Lipsitz SR, Dubroff RP, Khoshbin S, Katz JT. Formal art observation training improves medical students’ visual diagnostic skills. Journal of General Internal Medicine 2008; 23(7): 991-7.
• Reilly JM, Ring J, Duke L. Visual thinking strategies: a new role for art in medical
education. Family Medicine 2005; 37(4):250-2
Chain of uncertainty
in clinical encounter
1. Biological variability
2. Bias
3. Errors in interpretation
4. Uncertainty
surrounding decision
5. Motives
6. Opinions
7. Values
7
6 5 4 3 2
1
Eddy, DM. Variations in physician practice:
the role of uncertainty. Health Affairs 1984; 3:74-89
“Uncertainty presents a challenge
because students are prepared to expect
the opposite.”
Ghosh, A K. 2004. “Understanding Medical Uncertainty: a Primer for
Physicians.” The Journal of the Association of Physicians of India 52
(September): 739–742.
4 Key Challenges
1. Expectations around uncertainty
2. Feelings toward uncertainty
3. Skills in uncertainty
4. Pedagogical models to address uncertainty
Art
• Takes us beyond what we know
• A low-risk experience of uncertainty
• A safe experience of the unknown
• Practice
“Continuous Search”
Caregiving
Art
Health
