Rochesterâs Art of Observation program helps medical students and clinicians cultivate essential clinical skills.
After a day of seeing and treating patients, eight faculty-physicians from the °”ÍűłÔčÏ met at the Universityâs (MAG). They sat on folding stools before a painting of a woman and three children gathered around a table, on which the woman appeared to be cutting something. Pink sticky notes concealed the paintingâs label with its title, artist, and other context.
âWhat do you see?â said , an assistant professor at the , a family physician in the UR Medicine Primary Care network, and the groupâs facilitator.
Rodrigues had just asked the first question of the , the lynchpin of the Art of Observation partnership between the Universityâs medical school, the , and the museum.
Designed to enhance observational skills for healthcare professionals, the sustained viewing and structured dialogue help participants unpack their assumptions, consider different perspectives, and avoid jumping to conclusionsâamong other cognitive biasesâbased on titles, dates, or locations. (That information is only revealed with the fourth question, when the sticky notes come off.)
BLENDING ART AND MEDICINE By observing our Memorial Art Gallery masterpieces, students and clinicians discover new angles to understanding patients and providing better care.
âI see a mom cutting food for her children,â one member of the group said. âWhy doesnât she use a cutting board on that nice wooden table?â
âSheâs the maid,â another suggested.
âBut the kids look like her,â someone countered.
âThe roomâs a bit barren and skimpy.â
âI donât know if itâs skimpy, or just blurry. It actually looks lush, maybe lit by a fire.â
ââSkimpyâ is definitely subjective,â said Rodrigues. âWhat else do you see?â
After a minute of silence, one responded: âThe kids seem healthy.â
âThe kids are hungry. Look how their hair is disheveled and theyâre staring at the food sheâs cutting. Theyâre starving.â
âOr did they just wake up from naps? Kids are always hungry.â
Each observation revealed a unique focus, perspective, and lived experienceâwhich is exactly what doctors and nurses often bring to the exam room.
The fine art of patient care
The Five Question Protocol of the Art of Observation
What do you see?
Does this remind you of anything?
Whatâs the story? What is your evidence?
What information would confirm your hypotheses?
What did you observe about yourself?
âEverything about the 5QP is designed to build clinical skills,â says , a senior associate at the Memorial Art Gallery and with the . âThis protocol evolved in response to a concern that physicians were jumping to conclusions. The Art of Observation program was designed to slow the viewer down, to actually focus on how they know what they know.â
Daiss cofounded Art and Observation at the University of Rochester in 2002 with , now a professor emeritus, after they both read about a program at Yale University that focused on enhancing medical studentsâ observational skills through the study of detailed Victorian narrative pictures. Each educator brought unique interdisciplinary training to the partnership, with Daiss having experience in both art history and hospital-based pastoral care, and Clark having trained as a medical doctor before completing a doctorate in the humanities.
From the outset, Daiss and Clark have targeted the development of sound clinical practices beyond mere observational skills. These include listening, asking questions, acknowledging biases, and describing visual information, with the objective being to avoid errors in the often-complex process of clinical diagnosis.
âWhile we canât be bias-free,â Daiss says, âwe can be bias-aware.â
Studentsâ first taste of the program is the second day of medical school or early in the Program. During sessions at the Memorial Art Gallery, they break into small groups, study a selection of narrative paintings, and review the 5QP with a trained facilitator who has knowledge of both art history and healthcare.
âOne of our objectives for this program is learning to separate out observation from inference and assumption,â says Instructor of Clinical Nursing Kristina Santory â06, â14W (MS). âIn a field that is so focused on physical assessments, lab values, and what to do next, this act of careful looking helps nursing students to pause and think: Are we seeing the whole picture?â
Santory often hears students ask, ââWeâre looking at the same painting; how can we see such different things?â Thatâs the most surprising, but also most enriching, part of the activity.â
Taking time to see the bigger picture
Far from a âone and doneâ experience, Art of Observation lays the groundwork for other opportunities to engage with visual arts throughout medical school, from visits to anatomy labs to a course called Drawing to See: Drawing as a Tool to Build Observational Skills, taught by Daiss in partnership with the museumâs art courses.
Piper Schneider â27M (MD) says her experience with Art of Observation primed her to invoke the 5QP as she studied the live model in Drawing to See. Having students sit in a circle around the model, she adds, gave each one a distinct perspective that reinforced the lessons learned in the program. âThe act of actually creating the work took me back to that thought process: Am I drawing something that I only think should be there, or that I can actually verify?â she says.
As Schneider prepares for clinical rotations as a medical student, she plans to âcheck inâ with herself using queries that arose during Art of Observation. âAm I going down the right path? Am I filling in gaps with my own biased thoughts and feelings or am I truly listening to what the patient is sharing with me? The close study of art, and drawing technique, give me tools for how to approach patient conversation and diagnostic thinking.â
Rodrigues, Daissâ former student and colleague, was likewise inspired by Art of Observation to develop the session for Rochester faculty-physicians, called Cura te ipsum (Latin for âheal thyself,â and a play on the word curate).
âI think the 5QP perfectly parallels my experience within the doctor-patient relationship,â she says. âHaving the time to appreciate details and draw parallels to what weâve seen before gives me more space to pause and not rush to conclusions. Practicing that with art helps me be more mindful in practicing that with patients.â
For the fourth question of the 5QPââWhat information would confirm your hypotheses?ââRodrigues peeled off the sticky note to reveal the title, artist, and year: Bread and Butter, painted by Dutch artist Albert Neuhuys at the turn of the twentieth century. She added that George Eastman, one of Rochesterâs most notable philanthropists, kept this painting on prominent display in his East Avenue mansion.
âHe and his mother were very close,â said Rodrigues, referring to Eastman. âThat might help us think about why he chose this for his home.â This prompted a flurry of comments.
âSo it is a mother and children!â
âThey look just like her.â
âHow else,â Rodrigues asked the group, âdoes this context support or resolve uncertainties in your conjectures?â
âI feel better for this little family that they have access to butter!â
âAnd I feel better that she isnât cutting into that table.â
âUnless itâs from IKEA,â someone added, eliciting laughter from the others.
This stage of the 5QP provides the critical background and research that, coupled with careful observation, leads to diagnostic accuracy. Likewise, the invitation to suggest multiple interpretations parallels the medical practice of differential diagnosis.
The final question (âWhat did you observe about yourself?â) encourages participants to reflect on their experience with the 5QP and what they learned about themselves individually as well as members of a group.
For William DiPasquale â24M (MD), a resident in anesthesiology at the Medical Center, this has become an ongoingâand extremely valuableâprocess in learning how to take care of patients, especially those nearing the end of life.
âMy first semester of medical school was challenging. We were studying intensely and working daily in the anatomy lab. I struggled to come to terms with the human reality of death and dying, and wasnât sure how to process those emotions,â he explains. âI reached out to Susie [Daiss], and she invited me to re-engage in the Art of Observation process.â
Dipasquale adds, âThe Memorial Art Gallery became a space where I could go, find inspiration, have moments of reflection, and process things I was learning and doing in class. Sharing these reflections helped me find a personal sense of peace, to harness my emotions in a positive way. Now Iâm much more comfortable engaging with patients who are actively dying, largely thanks to this long-term reflective process. Itâs already shaping my career.â
