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Background Arts-based pedagogical tools have been increasingly incorporated into medical education. Visual Thinking Strategies (VTS) is a research-based, constructivist teaching methodology that aims to improve visual literacy, critical thinking, and communication skills through the process of investigating works of art. Harvard Medical School pioneered the application of VTS within medical education in 2004. While there are several studies investigating the use of VTS, there is a need to systematically assess the different programs that exist for medical education and their efficacy in improving relevant clinical skills. This systematic review aims to critically analyse the available evidence of the effectiveness of VTS in medical education to guide future research and provide a framework to adapt medical curricula. Methods A systematic search of PubMed, PsycINFO, and Cochrane CENTRAL databases (through November 2022) was conducted to identify studies of VTS-based interventions in undergraduate and postgraduate medical education. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. The extracted data was then narratively synthesized. Results Of 5759 unique citations, 10 studies met the inclusion criteria. After reference review, one additional study was included. Therefore, 11 studies were included in our review. Of these, eight reported VTS-based interventions for undergraduate medical students and three reported interventions in residency training, specifically in dermatology and ophthalmology. The main goal of most studies was to increase observational or visual diagnostic skills. Three of the studies in undergraduate medical education and two in postgraduate achieved a statistically significant improvement in observational skills in post-course evaluations. Some studies reported increased tolerance for ambiguity and empathy. Conclusions Although the studies varied considerably in study design, learning objectives, and outcomes, findings consistently indicate that the VTS approach can serve as a vehicle to develop crucial clinical competencies, encouraging more in-depth visual analysis that could be applied when observing a patient. Despite some limitations of the included studies (lack of control groups, self-selection bias, or non-standard outcome measures), the results of this review provide support for greater inclusion of VTS training in the medical curriculum.

The humanities have been increasingly incorporated into medical school curricula in order to promote clinical skills and professional formation. To understand its current use, we reviewed the literature on visual arts training in medical education, including relevant qualitative and quantitative data. Common themes that emerged from this review included a focus on preclinical students; instruction promoting observation, diagnostic skills, empathy, team building, communication skills, resilience, and cultural sensitivity. Successful partnerships have involved local art museums, with sessions led primarily by art educators employing validated pedagogy such as Visual Thinking Strategies or Artful Thinking. There is evidence that structured visual arts curricula can facilitate the development of clinical observational skills, although these studies are limited in that they have been single-institution reports, short term, involved small numbers of students and often lacked controls. There is a paucity of rigorous published data demonstrating that medial student art education training promotes empathy, team building, communication skills, wellness and resilience, or cultural sensitivity. Given these concerns, recommendations are offered for fostering more robust, evidence-based approaches for using visual arts instruction in the training of medical students.

The paper exemplifies the use of Visual Thinking Strategies method in the biomedical area as implemented in the degree course in Medicine and Surgery at the University of Florence through the analysis of the Pre-Raphaelite painting Maria Virgo by May Louise Greville Cooksey. The team includes an art historian, a medical historian, two palaeopathologists, a rheumatologist, an endocrinologist and two anatomist, who have adopted their disciplines’ diagnostic methodologies. The nodose hands of the Virgin Mary in the painting remind the art historian of Botticelli’s and Filippino Lippi’s Madonne, models for the Pre-Raphaelites, whereas the rheumatologist conjectures that she suffers from knuckle pads.

The arts and humanities (A&H) have been identified as essential across the continuum of medical education, and have been integrated across a variety of settings for learners in undergraduate and graduate medical education. Despite the possible benefits of A&H-based education for practicing physicians, and the increasing demand for medical education faculty to provide such content to their learners, A&H programming in continuing medical education (CME) remains limited, and less is known about the feasibility, acceptability, and potential impacts of such interventions in CME. This study describes physicians' perceptions of the value and impact of an art-based CME intervention. Four stand-alone CME sessions using pedagogy from the visual arts were conducted over Zoom. A mixed-methods approach (post-session surveys, thematic analysis of focus groups) was applied to assess perceptions of relevance and role of arts in CME, and potential mechanisms for impact. Sixty physicians (North America, Europe, and Asia) registered for at least one session. 100% of survey respondents (  = 35) supported continued integration of arts-based approaches in CME. Over 90% found it relevant to their clinical practice, their roles as educators and their well-being. Participants highlighted how unique aspects of arts-based education facilitated positive impacts on clinical skills, openness to new perspectives and renewal and joy, but noted its \"nontraditional\" aspects as potential barriers. This study suggests that, while unfamiliarity and scepticism may inhibit use of A&H in CME, physicians may view arts-based CME as a unique way to enhance clinical skills and critical thinking while supporting well-being and a growth mindset amongst established educators.

[This corrects the article DOI: 10.3389/fvets.2024.1480301.].

Professional identity formation is an important aspect of medical education that can be difficult to translate into formal curricula. The role of arts and humanities programs in fostering professional identity formation remains understudied. Analyzing learners' written reflections, we explore the relationship between an arts-based course and themes of professional identity formation. Two cohorts of learners participated in a 5-day online course featuring visual arts-based group activities. Both cohorts responded to a prompt with written reflections at the beginning and end of the course. Using a thematic analysis method, we qualitatively analyzed one set of reflections from each cohort. Themes included the nature of the good life; fulfilling, purposeful work; entering the physician role; exploration of emotional experience; and personal growth. Reflections written at the end of the course engaged significantly with art - including literature, poetry, lyrics, and film. One student disclosed a mental illness in their reflection. Our qualitative analysis of reflections written during a visual arts-based course found several themes related to professional identity formation. Such arts-based courses can also enrich learners' reflections and provide a space for learners to be vulnerable. (five short bullets conveying the main points) Arts-based courses can support learners' professional identity formation Reflection themes related to professional identity formation included entering the physician role, fulfilling clinical work, and personal growth At the end of the course, learners' reflections included significant engagement with art Reflective writing in small, arts-based learning communities can provide space for learners to be vulnerable The Role of Arts-Based Curricula in Professional Identity Formation: Results of A Qualitative Analysis of Learner's Written Reflections

Background Visual Thinking Strategies (VTS) is an evidence-based pedagogical approach that uses art analysis and structured inquiry to enhance observation, critical thinking, and teamwork, especially in medical training for clinical skills development. This study aimed to compare the short-term and delayed follow-up effects of integrating Visual Thinking Strategies and Visual Thinking Activity (VTA) tasks based on the PRISM Model with Observation Exercises (OE) on medical students’ observation skills, including the number of observations, number of words used, and time spent describing observations. Method This pre- and post-test experimental study with a control group was conducted among first-year medical students at Gonabad University of Medical Sciences during the 2023–2024 academic year. Forty-four students participated in the intervention group, receiving VTS and VTA tasks, while 45 students formed the control group, engaging in OE alone. Observation skills were assessed using standardized art images (short-term) and real-world clinical exposure (delayed follow-up) through measures of total observations, number of words used, and time spent describing observations. Descriptive statistics, analysis of one-way ANOVA/ANCOVA, and independent t-tests were employed for data analysis. Results In the short-term evaluation, the intervention group demonstrated significantly higher performance in the total number of observations ( p  = 0.001, Adjusted Partial Eta2 = 0.12), number of words used to describe art images ( p  = 0.001, Adjusted Partial Eta2 = 0.21), and time spent analyzing images ( p  < 0.001, Adjusted Partial Eta2 = 0.17) compared to the control group. However, after one month in a clinical exposure, no significant differences were found between the groups in the total number of observations ( p  = 0.62) and number of words used ( p  = 0.64). Nevertheless, the intervention group spent significantly more time describing their clinical observations ( p  = 0.04, Effect Size = 0.44). Conclusion The findings highlight the significant role of VTS in enhancing medical students’ observation skills. While both interventions were equally effective in the delayed follow-up and real-world settings regarding the total number of observations and words used, the VTS and VTA approach led to a notable increase in the time spent on observation descriptions. This conclusion warrants further investigation in future studies.

Purpose This study examines AI-human collaborative emotion training for medical students using an art-based intervention with visual thinking strategies (VTS) and metacognitive reflection. It aims to measure pre-post changes in emotion appraisal, empathy, and well-being, along with post-intervention reflective writings. Methods A quasi-experimental design compared medical students from an elective course in 2023 (control, n  = 35) and 2024 (intervention, n  = 33), for a total of 68 participants. The six-week intervention consisted of art-based activities three hours per week. AI-human collaborative emotion training used VTS as an interpretive framework where participants uploaded digital artwork to AI platforms, corrected AI interpretations, and compared these with peer feedback and their original intent, fostering metacognitive engagement in reflecting on the recognition and perception of both one’s own and others’ emotions. Outcome measures were emotion appraisals recorded using survey and reflective writings. Results Self-emotion appraisal significantly improved in the intervention group (pre: 5.13; post: 5.40; p  = 0.035) but not in the control group ( p  = 0.501). The significant finding remained significant after controlling for age and gender ( p  = 0.027). Others’ emotion appraisal showed no significant changes. Qualitative analysis revealed AI excelled in precise visual details and symbolism, while peers provided holistic, experience-based interpretations. Conclusions AI-assisted VTS art analysis, combined with metacognitive reflection, enhanced emotional appraisal, showing how technology and human interaction complement emotional learning, offering a balanced framework for innovation and human engagement in medical education.

Objective. To evaluate the introduction of 10 Visual Thinking Strategies (VTS) sessions into year 2 of a Bachelor of Pharmacy (BPharm) program with the aim of assisting students in developing the skills and attitudes required for inclusive practice. Methods. The evaluation used a cross-sectional study design. All members of the first two successive student cohorts to complete multiple VTS sessions completed a 38-item online reflective questionnaire exploring student perceptions of competency development, transference, and session acceptability. Students were asked for their consent to include their responses in a research study. Closed-question responses were analyzed to produce descriptive statistics. Free-text responses were categorized and quantified using an inductive approach and manifest content analysis. Results. Fifty-six percent of the students (98 of 174) allowed their responses to be included in the study. Students generally believed the sessions had supported their development of person-centred communication, cultural competence, and critical thinking skills. The minimum level of agreement that improvement in an area occurred was 74.5%. Free-text responses revealed the perception of additional skill and attitude development. Sixty percent of participants had thought about the VTS questions or used what they had learned in the VTS sessions in other settings. Eighty-six percent of students agreed that content on VTS should remain in the BPharm curriculum. Conclusion. Incorporating regular VTS sessions into the second year of a BPharm program was acceptable to students. Data suggest that inclusion of multiple VTS sessions is a valuable addition to the pharmacy curriculum, offering affective learning experiences which support development and transference of key skills and attitudes relating to the provision of inclusive person-centred care.

This systematic review examined the effects of Visual Thinking Strategies (VTS) in nursing and healthcare education. In contemporary nursing education, there is an increasing need for teaching methods that cultivate clinical reasoning, observational accuracy and reflective thinking. Visual Thinking Strategies (VTS), an interactive art-based approach, has gained attention for its potential to improve learning outcomes among healthcare professionals. A systematic review. A literature search was performed in Embase, PubMed, MEDLINE, CINAHL and PsycINFO for studies published up to 2024. Research papers documenting randomized controlled trials or quasi-experimental studies involving healthcare professionals were selected, focusing on the learning outcomes of VTS. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical checklist. A total of 1599 articles were screened for eligibility in the selection of literature. VTS was found to improve multiple educational outcomes, including clinical observation skills, critical thinking, communication, empathy and professional self-concept. VTS is an effective, practice-relevant educational strategy that can enrich nursing curricula by supporting the achievement of key learning outcomes. Integrating VTS into curricula can help train well-rounded professionals who are technically proficient and capable of delivering compassionate, patient-centered care. Registration: PROSPERO ID: CRD42024585763