Table 1.

Study characteristics – Visual Thinking Strategies in Medical Education

Study	Study design	Number of participants	Participants	No. of sessions, duration	Goal	Format	Measurement	Results	Control group	MERSQI score
Naghshineh et al., 2008 [22]	Prospective, partially randomized study design with pre- vs. post-course evaluations	58 Intervention (n = 24) Control (n = 34)	1st-2nd year Medical and Dental students	9 weekly, 2.5-h sessions	Improve Visual Diagnostic Skills	Elective pre-clinical course: “Training the Eye: Improving the Art of Physical Diagnosis” at the Boston Museum of Fine Arts (MFA), facilitated by art educators trained in VTS, followed by a lecture linking visual arts concepts with physical diagnosis	Comparison of post-course vs. pre-course mean frequency of accurate observations	Increased observation skills. Increased use of fine arts concepts linked to physical findings in descriptions of clinical images. Improvement in participants who attended 8 or more sessions compared to 7 or fewer	Yes	12.5
Klugman et al., 2011[23]	Quasi-experimental	32 (18 medical students)	1st-3rd year Medical Students and Nursing Students	3 weekly, 90-min sessions	Improve physical observation skills, increase tolerance for ambiguity, and increase interest in learning communication skills	Sessions at an art museum led by museum educators trained in VTS as a part of an enhancement program	Comparison of pre and posttest evaluations	Increased total time spent looking at art and patient images. Increased number of words used to describe and number of observations made. Increased tolerance for ambiguity and positive views toward healthcare professional communication skills. No significant differences between medical and nursing students	No	11
Jasani & Saks, 2013 [24]	Quasi-experimental	110	3rd-year Medical Students	1 session, 3 h	Improve observation skills in clinical diagnosis	Classroom discussion about fine art images, facilitated by a 4th-year medical student with interest in the visual arts. Part of a required course	Comparison of pre and posttest evaluations of patients’ photographs descriptions	The mean number of observations between pre- and posttests was not significantly different. Decreased use of subjective terminology. Increased scope of interpretations, use of speculative thinking, and visual analogies on descriptions. Increased mindfulness and clinical observation skills on student feedback	No	10
Huang et al., 2016 [25]	Quasi-experimental	27	PGY- 2–5 Dermatology residents	4 sessions, 7,5 h total, over a 2-month period	Improve observation skills	Mandatory course at the Museum of Fine Arts Boston, led by 2 professional arts educators and 2 dermatology faculty, all with formal VTS training	Comparison of pre- and posttest descriptions of clinical and art images	The overall number of observations made by residents on image tests significantly increased	No	11
Bentwich & Gilbey, 2017 [31]	Quasi-experimental	67	1st-year Medical Students	1 session, 90 min	Increase tolerance of ambiguity and increase empathy	Classroom combined lecture and interactive discussion about art images, led by a physician with an interest in art. Performed within a mandatory course	Subjective participant feedback (post-intervention survey)	Increased acceptance of multiple meanings (tolerance of ambiguity) and improved visual observation skills. Impact on the ability to feel the suffering of others and on teamwork. High correlation between increased acceptance of multiple meanings and increased empathy	No	7.5
Allison et al., 2017 [30]	Qualitative	8	1st and 2nd-year Medical Students	1 session, 20 min	Improve medical students’ understanding of the social determinants of health	Analysis of a street art mural in Nepal depicting the lives of ordinary Nepalis, facilitated by 3 faculty members.This session was a part of a pre-clerkship elective for medical students from Canada	Transcripts from sessions	Consolidation of complex community health concepts. Deeper understanding of the social determinants of health in Nepal	No	N/A (qualitative study)
Ho Tiu et al., 2019 [32]	Quasi-experimental	10	PGY-1/PGY-2 dermatology trainees	7 sessions	Improve clinical skills	Visual literacy training course taking part in art galleries and facilitated by an art historian	Participant satisfaction surveys and pre- and post-course assessments	Improved clinical observational skills. Expanded vocabulary and descriptive ability for clinical material. Increased clinical confidence and professional development across managing ambiguity, communication, respect, and reflective practice. Most pronounced impact on first-year trainees and on females	No	11
Visscher et al., 2019 [29]	Qualitative	50	3rd-year Medical Students	1 session, 45 min	Improve medical students’ understanding of the radiology profession	Artworks depicting radiology encounters with patients, presented as digital images, were analysed, moderated by a VTS facilitator. This session was a part of a one-week radiology elective	Subjective participant feedback (post-session questionnaire) and transcribed audio recordings of sessions	Better understanding of the radiologists’ clinical roles. Reduced negative stereotypes of the radiology profession and of radiologists	No	N/A (qualitative study)
Agarwal et al., 2020 [26]	Quasi-experimental	101 Intervention n = 41 Control n = 60	1st-year Medical Students	Two 3-h sessions, over two weeks	Improve observation skills	Workshop at a university art museum, facilitated by museum educators. Participation was voluntary	Comparison of pre- and post-tests descriptions	Increased number of clinical and general patient observations and no statistically significant difference in the number of diagnostic comments or “self-deprecating remarks” Increased number of words used to describe clinical images Increased total time spent analysing and describing clinical images	Yes	11.5
Cole et al., 2020a [27]	Single-arm trial	4	PGY-1/ PGY-2 ophthalmology residents	3, 60-min sessions	Increase observation skills and increase ability to apply these skills in clinical settings. Increase tolerance of ambiguity	Classroom observation and discussion of art images, facilitated by an art historian	Subjective participant feedback	Improved clinical and observational skills. Improved detection of visual elements, attention to descriptive detail, awareness of assumptions, and acceptance of multiple possible meanings	No	Unclear
Srivastava et al., 2022 [28]	Qualitative	29 students	Medical students	10 weekly,2.5 h sessions	Improve observation skills	A virtual “Training the Eye: improving the art of physical diagnosis” elective course. One session in person followed by 9 remote sessions through Zoom, using high-resolution images of artwork selected from museums around the world. Facilitated by a VTS trained art educator, Teaching Assistants, and the students themselves, who learned VTS facilitation during the course	Subjective participant feedback (post-course questionnaire)	Appreciation for deep looking and for the mindfulness aspects of the humanities curriculum. Better understanding of visual biases. 75% of students agreed or strongly agreed that the course objectives were able to be met virtually	No	N/A (qualitative study)

N/A Not applicable

^aOnly available as a conference abstract