travel through the attached device, the clinician’seye is removed from the ophthalmoscope’s viewinghole. This reduces the field of view of the patient’sfundus. In order to eliminate this problem, thedesign has since been incorporated within the exist-ing housing of a conventional direct ophthalmo-scope. In due course, a randomised trial willevaluate the impact of this new teaching ophthalmo-scope on the teaching and assessment of medicalstudents in fundoscopy.

REFERENCE

1 Gupta RR, Lam W-C. Medical students’ self-confidencein performing direct ophthalmoscopy in clinicaltraining. Can J Ophthalmol 2006;41 (2):169–74.

Correspondence: Christopher Schulz, Department of Anatomy,Brighton and Sussex Medical School, University of Sussex,Brighton BN1 9PX, UK. Tel: 00 44 1273 877810;E-mail: chrisschulz@doctors.org.uk

doi: 10.1111/medu.12434

Clinical sketches: teaching medical illustration tomedical students

Kevin T Liou, Paul George, Jay M Baruch &Franc�ois I Luks

What problem was addressed? Many physiciansdraw. We are not all artists, but we often use picturesinstead of thousands of words, whether to explainmedical concepts to students or procedures topatients. Cultural, language and educational barriersmay hinder verbal communication, and the use ofsimplified diagrams can enhance patients’ under-standing of their medical condition.1 Of course, notall sketches are created equal. But just as medicalstudents can be taught how to communicate betterwith patients and colleagues, so too can they developthe rudiments of sketching as an acquired ratherthan an innate talent.What was tried? Rather than teaching detailedartistic illustration to a few ‘talented’ individuals, wesought to inculcate basic graphic rules to a largegroup of medical students. Twenty-three first-yearmedical students with different artistic backgroundsparticipated in our medical illustration workshop aspart of an arts and humanities-based curriculum. Weemphasised three aspects of illustration as a tool: (i)organising one’s thoughts and clarifying anatomicrelationships; (ii) using the optimal complexity level

of a sketch to illustrate a problem most clearly, and(iii) choosing the most representative aspects orsteps of a procedure. The workshop combined a pre-sentation on the historical role of medical illustra-tion, discussions on why it remains relevant today,and hands-on exercises on the principles of basicdrawing, perspective, lighting, shadows, shading andtexture.In one exercise, we asked students to simplify

head and neck plates from an anatomy atlas in orderto make them easily understandable by a patient. Inanother, students worked in pairs: one studentillustrated adult and foetal blood circulation withthe aid of diagrams and the other provided feed-back. Finally, we showed a video of a laparoscopicadrenalectomy and asked students to illustrate theoperation, limiting themselves to only three figures.With this added constraint, students had to decidewhether to include or leave out certain steps. Theability to select which details are relevant to the lar-ger picture – to offer an accurate synthesis – is alsoessential in non-visual aspects of clinical practice,such as in formulating diagnoses and delivering oralpresentations.What lessons were learned? A total of 85% ofstudents rated the workshop ‘valuable’ or ‘very valu-able’. Although the intent was not to complementanatomy classes, it may have been more useful, inretrospect, to match the technical aspects with thestudents’ anatomic knowledge. In future workshops,we plan to coordinate the drawing exercises withanatomy instructors and to select topics that havealready been covered. Interestingly, some studentscommented that our illustration exercises high-lighted gaps in their anatomy knowledge base,revealing connections between anatomical structuresthey had not noticed before.Many questions remain. Is basic illustration a skill

for all, or a tool for the artistic few? When – and forhow long – should it be taught? How can it be use-ful to all, regardless of specialty interests? Does itreally make us better communicators? And how dowe measure this?

REFERENCE

1 Stone CA. Can a picture really paint a thousandwords? Aesth Plast Surg 2000;24:185–91.

Correspondence: Franc�ois I Luks, Department of Paediatric Surgery,Alpert Medical School, Brown University, 2 Dudley Street, Suite190, Providence, Rhode Island 02905, NJ, USA. Tel: 00 1 401 2280556; E-mail: Francois_Luks@brown.edu

doi: 10.1111/medu.12450

ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548 525

really good stuff