The Significance of Art in Medicine:

Visual Analysis, Critical Thinking, and Its Transferability

Brandon Neal JonesOklahoma State University

Three Questions:

• “What's going on in this picture?” • “What do you see that makes you say that?” • “What more can we find?” (Housen, 2001, p.

100)

Background.

Studies have shown that physical diagnostic skills by clinicians have been in decline in recent years (Goldstein & Simel, 2005; Mangione & Nieman, 1997; Naghshineh et al., 2008).

Critical thinking (which will be defined later), in the context of medical diagnosis, is being superseded by “expensive laboratory tests and radiological studies” for the medical practitioner (Naghshineh et al., 2008, p. 991).

So what?

Could the implementation of an aesthetic (art-based) toolset provide a critical, and transferable thought process regarding medical illness, thus reducing the reliance on expensive testing, while increasing accuracy in determining the correct diagnosis for the patient? (RQ)

What benefit does this have for a medical education/the medical community?

Is there a quantifiable effect to be found?

Definitions.

Critical thinking: “[...] reflective thinking focused on the evaluation of various alternatives” (Lampert, 2006a, p. 215; 2006b).

Transfer/Transferability: “[...] the capacity to go beyond the information given, calling attention to the fact that [it] extends thinking beyond where such thinking was first learned” and could be “[...] a predictable attribute of critical thinking” (Housen, 2001, p. 101).

Æsthetic(s): “[...] combines many faculties, merges the cognitive and the judgmental with the affective and subjective into what has been called thoughtful sensations or thoughtful feelings” (Housen, 1983, p. 2). This term should not be confused with art critique (Heid, 2005). This is a descriptive analysis of art, not a critical analysis of art.

Definitions, cont.

Visual Thinking Strategies (VTS): a curriculum series developed by Housen, and based upon the theory of æsthetic development (n.d.).

Æsthetic Development Interview (ADI): “An open-ended monologue documenting a student’s thoughts and reasoning skills as s/he responds to a work of art. ADI’s are non-directed monologues, delivered one-on-one to a researcher” (Housen, 2001, p. 104).

Clinical Imagery Interview (CII): Founded upon the ADI component of the VTS, this interview consists of the same open-ended monologue, but is based upon medical imagery, rather than art.

Housen’s Theory of Æstethic Development and Its Transferability.

This theory was first proposed in 1983 in Housen’s dissertation Eye of the Beholder: Measuring Æsthetic Development.

Housen founded a five-stage continuum of æsthetic understanding based on years of research using the ADI.

Benefit?

Although the obvious implications for this research are to the arts, and to medical students and practitioners, this research may be especially useful for those intending to enter into specialties such as Rheumatology, where complex illnesses, such as autoimmune diseases, usually have no definitive testing for diagnosis (Khamashta & Ramos-Casals, 2011; Muzna & Abdul, 2012).

Why Quant.?

Research on this subject must have the ability to be translated for those who do not come from arts backgrounds. Art administrators and educators can anecdotally speak of the benefits of art, but anecdotes do not provide the necessary weight to convince the empirically based sciences (Housen, 2001, p. 99).

Hypotheses.

Students who take the treatment course will have a higher stage progression on the ADI than the control group.

Students who come from arts or humanities backgrounds, whether in the treatment or control group, will exhibit a higher stage progression on the ADI than those who do not.

Research Design.

Quasi-experimental.

Pre-test/Post-test with Control.

Population, Sample, and Sampling Method.

Population consists of first-year, post-baccalaureate medical students accepted into the Oklahoma State University Doctor of Osteopathic Medicine program. The estimated admitted class size per year is one hundred fifteen students (Oklahoma State University Center for Health Sciences, n.d.).

Representative sample for this study will include a variety of age, gender, and ethnicity to best represent the population of medical students as they develop into doctors at Oklahoma State University. The representative sample will include at least sixty students from all pre-graduate backgrounds, but will probably consist mostly of science-based or pre-med bachelors degree programs. Sixty students would provide the best sample size due to the limited size of the population. This sample will provide approximately thirty students for each of the groups – treatment and control. No exclusion criterion is required.

Simple Randomization will be implemented.

Data Collection.

After IRB approval and participant consent, data collection will include a self-report questionnaire administered through the SONA-COE system. Before the participant’s first semester, both the treatment and control groups will participate in a one-hour ADI/CII interview to pre-test for stage level according to the Æstethic Development Theory. After the æsthetic-based treatment course has been taught in the fall semester, all participants will be asked to return for the post-test to establish stage level at close of data collection.

Instruments.

Self-Report Questionnaire

Æsthetic Development Interview

Clinical Imagery Interview

Validity and Reliability.

Validity – will be established by using independent coders for the interview data. It will be further instituted by blinding the raw data between treatment and control groups.

Reliability - The alpha coefficient (α) is not specifically reported with the instruments and coding-manual, but inter-rater reliability has been shown stable (Housen, 1983, pp. 96-99; 2001, p. 106).

Data Analysis.

The self-report questionnaire will provide nominal data.

First, the ADI will be coded by trained, independent coders for æsthetic stage development using the Æsthetic Development Coding Manual (Housen, 1983, 2001).

Second, the ADI will be coded according to critical thinking, which is outlined by Housen’s 2001 study as “supported observations” and supported “speculations [...] based on evidence” (Housen, 2001, p. 106).

The CII will be coded solely for critical thinking.

The data that is reported will be analyzed using a T-Test.

Summary.

Could the implementation of an aesthetic (art-based) toolset provide a critical, and transferable thought process regarding medical illness, thus reducing the reliance on expensive testing, while increasing accuracy in determining the correct diagnosis for the patient? (RQ)