How to teach medical students to be better observers?
When we were in Middle school and in the math class we were told we will be given 60% of the marks for the method of calculation and 40 % for the correct answer.
It’s a truism in medicine that difficult diagnoses are most likely to be made by the most or least experienced doctors. The most senior have a broad set of experiences that allows them to consider many different possibilities. Because they are open to a wide variety of observations, fewer pertinent findings are filtered out. What experience-based biases allows them to look more carefully at the entire picture.
Medical schools across the country have recently joined ranks with the historic Joseph Bell in striving to teach medical students to be better observers. One of the first efforts came from Yale. Dr. Irwin Braverman, a professor of dermatology for over fifty years, had long been frustrated by the difficulty students had in describing findings of the skin. It might have been a knowledge deficit—easily remedied with books, pictures, and tests. But Braverman suspected that what his students principally
lacked was the skill of close observation. Too often they wanted to cut straight to the answer without paying attention to the details that took them there. “You teach students to memorize lots of facts,” he told me. “You say: ‘Look at this patient. Look at how he’s standing. Look at his facial features. That particular pattern represents one disease, and this pattern represents another.’ We teach those patterns so that the next time the doctor comes across it, he or she comes up with a diagnosis.” What’s missing, says Braver-man, is how to think when an oddity appears. That requires careful and detailed observation. After years of teaching he still wasn’t certain he’d found the best way to communicate that complex set of skills.
In 1998 Braverman came up with a way to teach this skill. What if he taught these young medical students how to observe in a context where they wouldn’t need any specialized knowledge and so could focus on skills that couldn’t be learned from a book, where the teaching would force students to focus on process, not content? He realized that he had a perfect classroom right in his own backyard, in Yale’s Center for British Art. The course, now part of the curriculum, requires first-year medical students to hone their powers of observation on paintings rather than patients. As I entered the cool soft light of the museum’s atrium, a dozen first-year students were standing around in small groups, waiting to enter the conference room to find out what they were doing in this unusual setting. Braverman, a round-faced man with a comb-over and an impish smile, sat at the head of a long table of lustrous dark wood like a folksy CEO of some big corporation. Their job that afternoon, he told them, was to look at the pictures they were assigned to and then just describe them. Not too hard, right? He looked around hopefully. A few students sitting near him smiled and nodded enthusiastically. The rest of the table was a harder sell. “It’s always like that,” Braverman told me as we followed the students up the stairs to the third floor, where most of the nineteenth-century enthusiastic. The rest of the students here need to be convinced. But, you watch, by the end of the afternoon, I’ll have some converts. Wait and see.” Once stationed at their assigned pictures the students reviewed the rest of the rules. They were not to read the little labels next to the paintings. They’d have ten minutes to look at the pictures and then together the class would discuss the images, one by one. Each of the pictures would have a story to tell. It was the student’s job to figure out what that story was and relate it to the rest of the group, using only concrete descriptive terms. If you think a character students were standing around in small groups, waiting to enter the conference room to find out what they were doing in this unusual setting. Braverman, a round-faced man with a comb-over and an impish smile, sat at the head of a long table of lustrous dark wood like a folksy CEO of some big corporation. Their job that afternoon, he told them, was to look at the pictures they were assigned to and then just describe them. Not too hard, right? He looked around hopefully. A few students sitting near him smiled and nodded enthusiastically. The rest of the table was a harder sell. “It’s always like that,” Braverman told me as we followed the students up the stairs to the third floor, where most of the nineteenth-century enthusiastic. The rest of the students here need to be convinced. But, you watch, by the end of the afternoon, I’ll have some converts. Wait and see.” Once stationed at their assigned pictures the students reviewed the rest of the rules. They were not to read the little labels next to the paintings. They’d have ten minutes to look at the pictures and then together the class would discuss the images, one by one. Each of the pictures would have a story to tell. It was the student’s job to figure out what that story was and relate it to the rest of the group, using only concrete descriptive terms. If you think a character students were standing around in small groups, waiting to enter the conference room to find out what they were doing in this unusual setting. Braverman, a round-faced man with a comb-over and an impish smile, sat at the head of a long table of lustrous dark wood like a folksy CEO of some big corporation. Their job that afternoon, he told them, was to look at the pictures they were assigned to and then just describe them. Not too hard, right? He looked around hopefully. A few students sitting near him smiled and nodded enthusiastically. The rest of the table was a harder sell. “It’s always like that,” Braverman told me as we followed the students up the stairs to the third floor, where most of the nineteenth-century enthusiastic. The rest of the students here need to be convinced. But, you watch, by the end of the afternoon, I’ll have some converts. Wait and see.” Once stationed at their assigned pictures the students reviewed the rest of the rules. They were not to read the little labels next to the paintings. They’d have ten minutes to look at the pictures and then together the class would discuss the images, one by one. Each of the pictures would have a story to tell. It was the student’s job to figure out what that story was and relate it to the rest of the group, using only concrete descriptive terms. If you think a character students were standing around in small groups, waiting to enter the conference room to find out what they were doing in this unusual setting. Braverman, a round-faced man with a comb-over and an impish smile, sat at the head of a long table of lustrous dark wood like a folksy CEO of some big corporation. Their job that afternoon, he told them, was to look at the pictures they were assigned to and then just describe them. Not too hard, right? He looked around hopefully. A few students sitting near him smiled and nodded enthusiastically. The rest of the table was a harder sell. “It’s always like that,” Braverman told me as we followed the students up the stairs to the third floor, where most of the nineteenth-century enthusiastic. The rest of the students here need to be convinced. But, you watch, by the end of the afternoon, I’ll have some converts. Wait and see.” Once stationed at their assigned pictures the students reviewed the rest of the rules. They were not to read the little labels next to the paintings. They’d have ten minutes to look at the pictures and then together the class would discuss the images, one by one. Each of the pictures would have a story to tell. It was the student’s job to figure out what that story was and relate it to the rest of the group, using only concrete descriptive terms."
If you think a character looks sad, he told them, figure out what you are seeing that makes you think that and describe it. If you think that the picture suggests a certain place or class, describe the details that lead you to that conclusion. A tall young man with a sweet face and a If you think a character looks sad, he told them, figure out what you are seeing that makes you think that and describe it. If you think that the picture suggests a certain place or class, describe the details that lead you to that conclusion. A tall young man with a sweet face and a prominent Adam’s apple peered at the image of a slender man whose upper torso was hanging limply over the side of a bed, his right hand touching the floor. His eyes were closed. Was he asleep? asked Braverman. “No,” he announced decisively to his fellow medical students gathered around the scene. “He could be drunk—he has a bottle in his hand—but he’s not asleep. I think he’s dead.” “How do you know that?” asked Braverman. “His coloring—it’s not right. He looks green,” he answered thoughtfully. “And there’s death all around him.” He described the sad scene. The young man lies in a small, unadorned garret narrow dirt-encrusted windows. Petals of a dying rose ornament the windowsill, their color gray in the fading light. Shreds of torn papers are strewn across the floor. “I think he’s taken his own life,” he concluded triumphantly. “Excellent,” agreed Braverman. Linda Friedlaender, curator of education, spoke briefly about the painting ( The Death of Chatterton , Henry Wallis’s rendition of the suicide of the
seventeen-year-old poet of the eighteenth century, Thomas Chatterton) and then they moved on to the next
haveHave you ever played the usual game of spark the difference pictures or cartoons?
have some fun and frustration looking at these examples
https://www.buzzfuse.net/81-1/25-photos-to-test-your-intelligence-can-you-spot-the-differences/
When we were in Middle school and in the math class we were told we will be given 60% of the marks for the method of calculation and 40 % for the correct answer.
The journeys equally important if not, more than the
destination.
Similarly in medicine sometimes it is more important to
follow the proper methodology in order to reach the diagnosis and sometimes
even if you do not reach the correct diagnosis if you follow the proper
methodology you may be able to help the patient much more than plucking a
diagnosis of the thin air.
"It’s a truism in medicine that difficult diagnoses are most likely to be made by the most or least experienced doctors. The most senior have a broad set of experiences that allows them to consider many different possibilities. Because they are open to a wide variety of observations, fewer pertinent findings are filtered out. What experience-based biases allows them to look more carefully at the entire picture.
Medical schools across the country have recently joined ranks with the historic Joseph Bell in striving to teach medical students to be better observers. One of the first efforts came from Yale. Dr. Irwin Braverman, a professor of dermatology for over fifty years, had long been frustrated by the difficulty students had in describing findings of the skin. It might have been a knowledge deficit—easily remedied with books, pictures, and tests. But Braverman suspected that what his students principally
lacked was the skill of close observation. Too often they wanted to cut straight to the answer without paying attention to the details that took them there. “You teach students to memorize lots of facts,” he told me. “You say: ‘Look at this patient. Look at how he’s standing. Look at his facial features. That particular pattern represents one disease, and this pattern represents another.’ We teach those patterns so that the next time the doctor comes across it, he or she comes up with a diagnosis.” What’s missing, says Braver-man, is how to think when an oddity appears. That requires careful and detailed observation. After years of teaching he still wasn’t certain he’d found the best way to communicate that complex set of skills.
In 1998 Braverman came up with a way to teach this skill. What if he taught these young medical students how to observe in a context where they wouldn’t need any specialized knowledge and so could focus on skills that couldn’t be learned from a book, where the teaching would force students to focus on process, not content? He realized that he had a perfect classroom right in his own backyard, in Yale’s Center for British Art. The course, now part of the curriculum, requires first-year medical students to hone their powers of observation on paintings rather than patients. As I entered the cool soft light of the museum’s atrium, a dozen first-year students were standing around in small groups, waiting to enter the conference room to find out what they were doing in this unusual setting. Braverman, a round-faced man with a comb-over and an impish smile, sat at the head of a long table of lustrous dark wood like a folksy CEO of some big corporation. Their job that afternoon, he told them, was to look at the pictures they were assigned to and then just describe them. Not too hard, right? He looked around hopefully. A few students sitting near him smiled and nodded enthusiastically. The rest of the table was a harder sell. “It’s always like that,” Braverman told me as we followed the students up the stairs to the third floor, where most of the nineteenth-century enthusiastic. The rest of the students here need to be convinced. But, you watch, by the end of the afternoon, I’ll have some converts. Wait and see.” Once stationed at their assigned pictures the students reviewed the rest of the rules. They were not to read the little labels next to the paintings. They’d have ten minutes to look at the pictures and then together the class would discuss the images, one by one. Each of the pictures would have a story to tell. It was the student’s job to figure out what that story was and relate it to the rest of the group, using only concrete descriptive terms. If you think a character students were standing around in small groups, waiting to enter the conference room to find out what they were doing in this unusual setting. Braverman, a round-faced man with a comb-over and an impish smile, sat at the head of a long table of lustrous dark wood like a folksy CEO of some big corporation. Their job that afternoon, he told them, was to look at the pictures they were assigned to and then just describe them. Not too hard, right? He looked around hopefully. A few students sitting near him smiled and nodded enthusiastically. The rest of the table was a harder sell. “It’s always like that,” Braverman told me as we followed the students up the stairs to the third floor, where most of the nineteenth-century enthusiastic. The rest of the students here need to be convinced. But, you watch, by the end of the afternoon, I’ll have some converts. Wait and see.” Once stationed at their assigned pictures the students reviewed the rest of the rules. They were not to read the little labels next to the paintings. They’d have ten minutes to look at the pictures and then together the class would discuss the images, one by one. Each of the pictures would have a story to tell. It was the student’s job to figure out what that story was and relate it to the rest of the group, using only concrete descriptive terms. If you think a character students were standing around in small groups, waiting to enter the conference room to find out what they were doing in this unusual setting. Braverman, a round-faced man with a comb-over and an impish smile, sat at the head of a long table of lustrous dark wood like a folksy CEO of some big corporation. Their job that afternoon, he told them, was to look at the pictures they were assigned to and then just describe them. Not too hard, right? He looked around hopefully. A few students sitting near him smiled and nodded enthusiastically. The rest of the table was a harder sell. “It’s always like that,” Braverman told me as we followed the students up the stairs to the third floor, where most of the nineteenth-century enthusiastic. The rest of the students here need to be convinced. But, you watch, by the end of the afternoon, I’ll have some converts. Wait and see.” Once stationed at their assigned pictures the students reviewed the rest of the rules. They were not to read the little labels next to the paintings. They’d have ten minutes to look at the pictures and then together the class would discuss the images, one by one. Each of the pictures would have a story to tell. It was the student’s job to figure out what that story was and relate it to the rest of the group, using only concrete descriptive terms. If you think a character students were standing around in small groups, waiting to enter the conference room to find out what they were doing in this unusual setting. Braverman, a round-faced man with a comb-over and an impish smile, sat at the head of a long table of lustrous dark wood like a folksy CEO of some big corporation. Their job that afternoon, he told them, was to look at the pictures they were assigned to and then just describe them. Not too hard, right? He looked around hopefully. A few students sitting near him smiled and nodded enthusiastically. The rest of the table was a harder sell. “It’s always like that,” Braverman told me as we followed the students up the stairs to the third floor, where most of the nineteenth-century enthusiastic. The rest of the students here need to be convinced. But, you watch, by the end of the afternoon, I’ll have some converts. Wait and see.” Once stationed at their assigned pictures the students reviewed the rest of the rules. They were not to read the little labels next to the paintings. They’d have ten minutes to look at the pictures and then together the class would discuss the images, one by one. Each of the pictures would have a story to tell. It was the student’s job to figure out what that story was and relate it to the rest of the group, using only concrete descriptive terms."
If you think a character looks sad, he told them, figure out what you are seeing that makes you think that and describe it. If you think that the picture suggests a certain place or class, describe the details that lead you to that conclusion. A tall young man with a sweet face and a If you think a character looks sad, he told them, figure out what you are seeing that makes you think that and describe it. If you think that the picture suggests a certain place or class, describe the details that lead you to that conclusion. A tall young man with a sweet face and a prominent Adam’s apple peered at the image of a slender man whose upper torso was hanging limply over the side of a bed, his right hand touching the floor. His eyes were closed. Was he asleep? asked Braverman. “No,” he announced decisively to his fellow medical students gathered around the scene. “He could be drunk—he has a bottle in his hand—but he’s not asleep. I think he’s dead.” “How do you know that?” asked Braverman. “His coloring—it’s not right. He looks green,” he answered thoughtfully. “And there’s death all around him.” He described the sad scene. The young man lies in a small, unadorned garret narrow dirt-encrusted windows. Petals of a dying rose ornament the windowsill, their color gray in the fading light. Shreds of torn papers are strewn across the floor. “I think he’s taken his own life,” he concluded triumphantly. “Excellent,” agreed Braverman. Linda Friedlaender, curator of education, spoke briefly about the painting ( The Death of Chatterton , Henry Wallis’s rendition of the suicide of the
have some fun and frustration looking at these examples
https://www.buzzfuse.net/81-1/25-photos-to-test-your-intelligence-can-you-spot-the-differences/
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