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Details December
2001 It takes years to become a good doctor, and for physicians, one of the hardest skills to master is the art of creating a reasonable diagnosis from a suite of often disconnected signs and symptoms. "Diagnosis is about pattern recognition, and it involves a great deal of memorization," says Irwin Braverman, professor of dermatology at the School of Medicine. "After a certain point, however, you can't rely on patterns or memory alone. You have to find fine details." In training medical students, Braverman noticed that their ability to see required practice, and four years ago, the professor discovered an offbeat method for creating better diagnosticians. Call it the Sherlock Holmes approach.
"Holmes was a master of deductive reasoning, which requires the epitome of observational skills," says Braverman. But rather than send his students to the library (or the moors), the physician, himself an art aficionado, brought dermatology residents to the Yale Center for British Art. There, each doctor-in-training, under the tutelage of Linda Friedlaender, curator of education, was told to concentrate for ten minutes on a painting, such as the Death of Chatterton, by Henry Wallis. Then, the student was asked to describe the artwork in detail. "The idea was that the exercise might make them more visually alert," says Braverman, "and after only about two hours of practice over four weeks, their descriptions of patients improved." In 1998, the physician tried the experiment with beginning medical students and noticed similar results. The Medical School was intrigued and allowed Braverman to offer the training to more first-year students, one of whom was Jacqueline Dolev '01MD, who evaluated the art program to fulfill the thesis requirement of her degree. Dolev's research, coauthored with Friedlaender and Braverman, was published in the September 5 issue of the Journal of the American Medical Association. "The JAMA study showed that the students who had this training improved their observational skills on average by about 10 percent," says Braverman. "This sounds small, but it was statistically significant. Improvements in this area could translate into less dependence on costly tests." A prescription
of art observation is now a required part of the Medical School
curriculum, and several other universities, including Cornell, have
adopted the approach. Braverman even used a painting, instead of
a patient, in a clinical presentation at a recent meeting of the
New England Dermatology Society. "Everything in a work of art
is placed in a certain position for a reason, and if you learn to
look, you can figure out what's going on," says Braverman.
"We've shown that if you put a 'frame' around a patient, you
can improve your ability to see the meaning of all the signs and
symptoms inside the frame and come up with a better diagnosis."
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Yale
Alumni Magazine, PO Box 1905, New Haven, CT 06509-1905. USA.
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