Effect evaluation of integrating art education into medical aesthetics postgraduate training: a single-arm pre-post study

Abstract

Background

Medical aesthetics, as an interdisciplinary field integrating medicine and aesthetics, requires practitioners to possess both technical proficiency and refined aesthetic judgment. However, current training mainly emphasizes technical skills, neglecting systematic aesthetic development. This study evaluated the effectiveness of integrating art education into postgraduate medical aesthetics training on students’ aesthetic perception.

Methods

A single-arm pre-post study was conducted with 27 medical aesthetics postgraduate students, representing the complete eligible population from the First Affiliated Hospital of University of South China during the study period. Following Kern’s 6-step curriculum development approach, we designed a 5-week art education program incorporating painting appreciation and analysis (4 weeks), dance appreciation and analysis (4 weeks), and practical art exercises with clinical case analysis (1 week). Students’ aesthetic perception abilities were objectively assessed using the Visual Aesthetic Sensitivity Test-Revised (VAST-R) and facial attractiveness image selection tasks before and after the intervention. Course quality was evaluated using a simplified Course Experience Questionnaire (CEQ).

Results

Students showed significant improvement in aesthetic perception performance. VAST-R mean scores increased significantly from 17.89 ± 2.87 pre-intervention to 20.93 ± 2.15 post-intervention (paired t-test: t(26) = 4.563, p < 0.001, Cohen’s d = 0.878), representing a 17.0% improvement. Accuracy in facial aesthetic judgment improved: students correctly identifying the most attractive male face increased from 16 (59.3%) to 26 (96.3%), while those correctly identifying the most attractive female face increased from 18 (66.7%) to 25 (92.6%) (male: p = 0.002; female: p = 0.016). Course evaluation yielded a mean satisfaction score of 3.56 ± 0.89 (5-point scale), with highest ratings for overall course quality (3.67 ± 0.88) and lowest for clinical application of aesthetic abilities (3.37 ± 0.93).

Conclusions

This exploratory single-arm study demonstrates significant improvements in aesthetic assessment performance following a 5-week art education intervention among medical aesthetics postgraduate students. The observed improvements in both abstract aesthetic sensitivity and facial aesthetic judgment tasks suggest potential benefits of integrating art education into medical aesthetics training curricula. Future research should explore the integration of art education into clinical practice through extended interventions and objective clinical evaluation components.

Introduction

With the escalating global pursuit of beauty and rapid advancement of medical technology, medical aesthetics has emerged as one of the fastest-growing specialized fields in contemporary medicine [1, 2]. As an interdisciplinary domain integrating medicine and aesthetics, medical aesthetics fundamentally aims to preserve, refine, and enhance human physical beauty through medical interventions [3, 4]. However, unlike traditional medical specialties, success in medical aesthetics depends not only on technical excellence but also requires practitioners to possess acute aesthetic perception and precise aesthetic judgment capabilities.

The central importance of aesthetic competency in medical aesthetics has been widely recognized. Clinical research demonstrates that medical disputes and patient dissatisfaction primarily stem not from technical errors, but from aesthetic concept discrepancies and communication barriers between patients and practitioners [5, 6]. Patient expectations for aesthetic treatments are often highly individualized and subjective, with physicians’ aesthetic judgment directly influencing postoperative outcome evaluations and patient satisfaction [7, 8]. The advent of social media has further amplified this challenge, as diversified aesthetic standards create increasingly complex aesthetic decision-making environments for medical aesthetics practitioners [9, 10]. Therefore, cultivating medical aesthetics professionals with profound aesthetic competency has become an urgent industry need.

Nevertheless, current medical aesthetics education systems exhibit significant structural deficiencies. Existing postgraduate training models overemphasize basic medical knowledge and operational skill transmission while inadequately addressing aesthetic theory and practical capability development [11, 12]. This “technique-heavy, aesthetics-light” educational orientation creates theory-practice disconnection, leaving graduates ill-equipped with systematic judgment frameworks and problem-solving abilities when confronting complex aesthetic challenges. Surveys indicate that over 90% of medical aesthetics practitioners consider aesthetic competency courses essential in professional education, yet domestic educational resource allocation remains markedly insufficient [13–15].

Art education, as a vital pathway for cultivating aesthetic perception, holds unique value in medical aesthetics talent development [16, 17]. The diverse forms of art—painting, dance, music—can stimulate individual aesthetic consciousness through different sensory experiences, enhancing sensitivity to and judgment of beauty [18, 19]. Particularly, painting and dance offer complementary aesthetic training: painting presents static visual compositions demonstrating proportion, balance, and color relationships, while dance provides dynamic bodily expression embodying rhythm, coordination, and emotional content [18, 20–22]. Their integration can comprehensively enhance learners’ aesthetic perception capabilities [23, 24]. In medical education, art education has been proven to improve students’ observational skills, humanistic literacy, and clinical communication abilities, though its systematic application in aesthetic capability cultivation requires further exploration [16, 17, 25–27].

Despite theoretical recognition of art education’s importance in medical aesthetics talent development, systematic empirical research remains lacking regarding how to construct scientifically effective art education curricula and the actual impact of such educational interventions on students’ aesthetic perception capabilities. Existing aesthetic ability assessment tools primarily focus on abstract art appreciation, while evaluation methods for human aesthetic judgment in medical aesthetics clinical practice remain insufficient. Additionally, organic integration mechanisms between art education and medical aesthetics professional education have yet to be established, and quantitative evaluation systems for educational effectiveness require improvement.

Therefore, this study employed Kern’s 6-step curriculum design methodology to construct an art education curriculum system centered on painting and dance for medical aesthetics postgraduates. Using the Visual Aesthetic Sensitivity Test-Revised (VAST-R) and facial attractiveness image selection tasks to objectively assess educational intervention effects, we aimed to validate the effectiveness of systematic art education in enhancing medical aesthetics postgraduate students’ aesthetic perception capabilities, providing empirical evidence and theoretical guidance for medical aesthetics professional education reform.

Methods

Study design and participants

This single-arm pre-post study was conducted among medical aesthetics postgraduate students at the First Affiliated Hospital of University of South China between 2023 and 2024. This was designed as a pilot study to evaluate the feasibility and preliminary effectiveness of art education in medical aesthetics training.

A total of 27 students voluntarily enrolled in the course and completed all assessments, representing all available medical aesthetics postgraduate students in the program during the study period. No a priori power calculation was performed as we aimed to include the entire population of eligible students rather than selecting a calculated sample size. All enrolled students participated voluntarily and completed the full study protocol with no dropouts or missing data (Fig. 1).

Fig. 1.

Participant flow diagram. Flow of medical aesthetics postgraduate students through enrollment, intervention, and follow-up phases of the art education intervention study. All eligible participants (n = 27) completed the entire study protocol with no dropouts or missing data, resulting in a 100% retention rate

Inclusion criteria included: (1) enrolled medical aesthetics postgraduate students, (2) voluntary participation with informed consent, and (3) completion of all pre- and post-course evaluations. Exclusion criteria included: (1) prior exposure to similar art education courses, (2) incomplete participation in the intervention program, and (3) missing assessment data.

Curriculum development

We developed an integrated art education curriculum using Kern’s 6-step approach to curriculum design, which has been successfully implemented across multiple medical specialties [28]:

Step 1: problem identification and general needs assessment

The medical aesthetics department possesses unique characteristics distinguishing it from other medical specialties. Given that aesthetic demands serve as fundamental motivations for aesthetic treatments, physicians’ aesthetic literacy critically determines surgical outcomes and patient satisfaction [11, 13]. However, aesthetic education within Chinese medical aesthetics programs remains rudimentary, lacking comprehensive art course offerings and systematic artistic training frameworks [14, 15].

Step 2: targeted needs assessment

Internal surveys revealed that approximately 93% of aesthetic medical practitioners (N = 79) consider aesthetic literacy course introduction necessary. The current curriculum traditionally emphasized professional knowledge and clinical skills while insufficiently focusing on aesthetic theory, creating difficulty for students to integrate medical techniques with aesthetic design.

Step 3: goals and learning objectives

1. Students should understand and master fundamental art principles (proportion, balance, harmony), enhancing sensitivity to and appreciation of beauty.

2. Through integrating art education with professional fields, students should develop higher levels of artistic aesthetic ability and clinical translation competence.

Step 4: educational strategies

The curriculum integrated painting and dance elements into the existing medical aesthetics postgraduate education system, structured as a 5-week program with weekly sessions dedicated to both painting and dance, each lasting approximately four hours.

Step 5: implementation

The program comprised two phases (see Fig. 2):

Fig. 2.

Weekly learning objectives for the aesthetic design course. This figure presented the five-week structure of a course focused on aesthetic design, integrating art and ballet to teach key visual principles. All artworks and dance performances are credited to their respective artists and choreographers

Weeks 1–4

Instructors presented visual art and dance works, elucidating pertinent aesthetic principles. Painting sessions emphasized appreciation and analysis of classical realistic oil paintings, focusing on proportion structure line color and shading for static aesthetic training [20, 21] Dance sessions analyzed classical ballet performances, examining facial expression coordination and muscle movement for dynamic aesthetic experiences [22].

Week 5

Students engaged in basic figure-drawing exercises and dance movement practices under instructor guidance, while simultaneously analyzing real clinical cases within the Medical Aesthetics Department, including cosmetic treatment plan design and postoperative outcome evaluation.

Step 6: evaluation

Comprehensive assessments were conducted before and after the course using validated instruments to measure aesthetic improvement.

Outcome measures

Primary Outcomes

VAST-R

The VAST-R test comprises 25 pairs of black-and-white abstract images, each pair including an original design and a modified version with diminished aesthetic quality [29]. The stimuli encompass a range of visual features, varying in form complexity, curvature, spatial arrangement, and artistic texture, from simple geometric figures to expressive brushstroke forms. Participants are asked to select the better-designed image from each pair within 30 min. Each correct selection scores one point, and the total score reflects visual aesthetic sensitivity. VAST-R is a copyrighted instrument; only derived data and summary results are presented here, and the original test content is not included due to copyright restrictions.

Facial attractiveness image selection

This task utilized the validated facial stimulus set from Amaya et al. [30]. The stimulus set consisted of 40 standardized frontal-view photographs of Caucasian individuals for each gender (male and female), originally sourced from DeBruine and Jones datasets, plus composite images derived from each cohort (Fig. 3). All subjects in the original dataset consented to publication of their photographs, and the study was conducted in accordance with Declaration of Helsinki as revised in 2013.

Fig. 3.

Facial attractiveness image selection task: presentation of real and composite male and female faces used for participant assessment. The task included two panels, (a) and (b): panel (a) presented female faces, and panel (b) displayed male faces. In each panel, 40 real facial images were arranged in a grid, with one composite image shown on the left

The composite images were generated using Webmorph.org, a specialized web-based software for averaging and transforming faces [30]. Standardized facial landmark points were manually placed on various aspects of each face (e.g., mid-upper lip, medial point of eyebrow) to delineate facial features. Each face had the same number of standardized points to ensure accurate averaging of corresponding facial landmarks across all faces. Monochrome photographs were used to eliminate potential biases from hair, skin, and eye color variations. This methodology has been validated through large-scale crowdsourced evaluation, where composite faces consistently received higher attractiveness ratings than individual faces [30].

Attractiveness Criteria and Objective Standards: The composite face represents the “more attractive” option based on established evolutionary psychology principles, specifically the theory of koinophilia (preference for average features) [30]. Amaya et al. demonstrated through large-scale crowdsourced evaluation (n = 870–876 raters) that composite faces consistently receive significantly higher attractiveness ratings than individual constituent faces across all demographic groups (all p < 0.0001) [30].

This methodology provides objective attractiveness criteria through:

• (i)Mathematical averaging of facial features, eliminating subjective selection bias.
• (ii)Empirical validation via diverse population ratings showing universal preference for average composites.
• (iii)Statistical significance testing confirming robust preference patterns independent of individual variation.
• (iv)Theoretical grounding in evolutionary psychology demonstrating cross-cultural consistency in averageness preferences.

The “correct” choice (composite face) is thus determined by convergent evidence from mathematical processes, empirical validation, and evolutionary theory rather than subjective aesthetic judgments, providing a standardized and reproducible assessment framework [30].

Participants viewed all 41 images (40 individual faces + 1 composite) for each gender cohort and were asked to identify the most attractive face. Images were presented in random order to prevent order bias. Participants were given up 30 min to complete the selection task. The number of participants correctly identifying the composite image as the most attractive was recorded for both pre- and post-course assessments.

Validation and cross-cultural considerations

While the facial stimulus set utilized Caucasian faces, extensive cross-cultural research has demonstrated substantial agreement in facial attractiveness judgments across diverse populations [31, 32]. Meta-analytic evidence indicates that fundamental aspects of facial beauty, particularly averageness and symmetry, show remarkable cross-cultural consistency [33–35]. The composite faces used in this study represent mathematically averaged features that enhance universal attractiveness cues (facial symmetry, proportionality, and averageness) rather than culture-specific beauty ideals. This approach aligns with established principles that facial averageness represents a biologically-based standard of beauty that transcends cultural boundaries [31].

Secondary outcomes

Course Experience Questionnaire (CEQ)

Participants completed five simplified CEQ items evaluating course quality on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).

1. Instructors clearly conveyed professional concepts and practical techniques.

2. Course enabled mastery of fundamental painting and dance concepts, enhancing aesthetic knowledge.

3. Course improved aesthetic sensitivity.

4. Course will help apply aesthetic principles more effectively in future practice.

5. Overall satisfaction with course quality.

Statistical analysis

Data analysis was conducted using IBM SPSS version 21.0. Descriptive statistics are presented as means and standard deviations for continuous variables, and frequencies and percentages for categorical variables.

Pre- and post-intervention VAST-R scores were compared using paired samples t-tests, as this method is appropriate for analyzing continuous data from the same participants measured at two time points, with effect sizes calculated using Cohen’s d (Small = 0.2, Medium = 0.5, Large = 0.8).

McNemar’s tests were employed for analyzing paired categorical data (facial attractiveness selections), as this non-parametric test is specifically designed for comparing proportions in paired binary outcomes, with effect sizes reported as Cohen’s g.

Course evaluation data were analyzed using one-sample t-tests to determine whether mean scores significantly differed from the neutral point (3.0) on the 5-point Likert scale, as this method tests whether sample means differ from a hypothesized population mean.

Statistical significance was set at p < 0.05 for all analyses. All tests were two-tailed, and exact p-values are reported where applicable.

Ethical considerations

This research study was approved by the First Affiliated Hospital of University of South China Health Sciences Research Ethics Board (Ethics approval number: 2023110210001, approval date: February 10, 2023).

The ethics committee granted exemption from formal informed consent procedures, as this educational intervention study posed minimal risk to participants and involved routine educational assessment activities. All participants were informed about the study objectives and procedures, and participation was voluntary. The committee determined that the research was conducted in accordance with ethical guidelines and posed no additional risks beyond normal educational activities.

This study adhered to the Declaration of Helsinki for ethical principles for medical research involving human subjects.

Results

Participant characteristics

Twenty-seven students participated in this study, with a median age of 25.6 years (Interquartile Range: 23–28), including 13 females (48.1%), spanning postgraduate years 1–3. No participants had prior exposure to related courses, and all underwent identical educational and assessment protocols.

The assessment data of VAST-R

Analysis of VAST-R scores indicated significant improvement in visual aesthetic sensitivity among all 27 participants. Mean scores increased significantly from 17.89 ± 2.87 pre-intervention to 20.93 ± 2.15 post-intervention (paired t-test: t(26) = 4.563, p < 0.001). The mean improvement was 3.04 points (95% CI [1.67, 4.41]), with a large effect size (Cohen’s d = 0.878), corresponding to a 17.0% increase in aesthetic perception performance (Fig. 4).

Fig. 4.

Comparison of VAST-R scores pre- and post-intervention. The figure illustrates a dot plot comparing participants’ paired VAST-R scores before (pre-course, red) and after (post-course, blue) the intervention. Each dot denotes an individual participant’s score, with horizontal bars showing the mean and standard deviation for each group. Data are shown as mean ± SD. Statistical significance was determined using paired t-test (p < 0.001)

Facial attractiveness image selection

For male facial selection, the proportion of participants choosing the more attractive face increased from 59.3% (16/27) pre-intervention to 96.3% (26/27) post-intervention (McNemar χ² = 8.10, exact p = 0.002, Cohen’s g = 3.162). Similarly, for female facial selection, accuracy improved from 66.7% (18/27) to 92.6% (25/27) (McNemar χ² = 5.14, exact p = 0.016, Cohen’s g = 2.646). Both improvements represent large effect sizes according to Cohen’s conventions (Fig. 5). The observed improvement in composite face identification suggests enhanced performance in aesthetic discrimination following art education, possibly reflecting greater visual-spatial awareness relevant to aesthetic medicine practice (Table 1).

Fig. 5.

Changes in correct identification of most attractive faces pre- and post-intervention. The bar graph depicts the number of students who correctly identified the most attractive male (red bars) and female (orange bars) face images before (pre-intervention) and after (post-intervention) the course. Data are presented as counts of correct identifications (Male: 16/26 students; Female: 18/25 students). Statistical significance was determined using McNemar’s test (Male: p = 0.002; Female: p = 0.016)

Table 1.

Pre-post intervention comparison of outcome measures

Measure	Pre- intervention	Post- intervention	Test statistic	p-value	95% CI	Effect size
VAST-R Score (M ± SD)	17.89 ± 2.87	20.93 ± 2.15	t(26) = 4.563	< 0.001	[1.67, 4.41]	d = 0.878
Male face selection (%)	59.3% (16/27)	96.3% (26/27)	χ² = 8.10	0.002*	-	g = 3.162
Female face selection (%)	66.7% (18/27)	92.6% (25/27)	χ² = 5.14	0.016*	-	g = 2.646

Effect sizes are reported as Cohen’s d for continuous outcomes and Cohen’s g for categorical outcomes

CI Confidence Interval

*p-values for face selection accuracy are from McNemar’s exact test

Course quality assessment

Course evaluations using a 5-point Likert scale indicated overall positive feedback (Table 2). All questionnaire items scored significantly above the neutral point of 3.0 (all p < 0.05), with an overall average score of 3.56 ± 0.89 (t(134) = 7.311, p < 0.001, Cohen’s d = 0.629), suggesting generally favorable student perceptions of the art-integrated curriculum.

Table 2.

Course experience questionnaire results

Questionnaire Items	Mean ± SD	95% CI	Test statistic*	p-value	Effect size (Cohen’s d)
Clear conveyance of professional concepts	3.59 ± 0.93	[3.22, 3.96]	t(26) = 3.309	0.003	0.637 (Medium)
Mastery of aesthetic concepts and principles	3.63 ± 0.97	[3.25, 4.01]	t(26) = 3.384	0.002	0.651 (Medium)
Improved aesthetic sensitivity	3.56 ± 0.75	[3.26, 3.85]	t(26) = 3.844	< 0.001	0.740 (Medium)
Application in future aesthetic medicine	3.37 ± 0.93	[3.00, 3.74]	t(26) = 2.078	0.048	0.400 (Small)
Overall satisfaction with course quality	3.67 ± 0.88	[3.32, 4.01]	t(26) = 3.950	< 0.001	0.760 (Medium)
Average	3.56 ± 0.89	[3.41, 3.71]	t(134) = 7.311	< 0.001	0.629 (Medium)

For individual items, df = 26 (n = 27). For the overall mean score, df = 134 (27 participants × 5 items – 1)

Effect sizes reported as Cohen’s d

CI  Confidence Interval

*All values derived from one-sample t-tests against the neutral midpoint (3.0)

The highest rated aspect was “overall satisfaction with course quality” (3.67 ± 0.88), suggesting substantial student approval of the integrated art education approach. Students also provided high ratings for their “mastery of aesthetic concepts and principles” (3.63 ± 0.97), reflecting positive perception of knowledge acquisition in aesthetic understanding. However, the relatively lower score for “application in future aesthetic medicine” (3.37 ± 0.93) suggests that while students valued the theoretical components, they perceived room for strengthening practical connections to clinical aesthetic medicine practice.

Discussion

Study design and methodological considerations

Training in aesthetic judgment is seldom incorporated into programs for aesthetic and reconstructive surgery, where the emphasis remains predominantly on technical skills, with insufficient attention to the aesthetic dimensions of diagnosis and treatment planning. As highlighted in Facial Aesthetics: Concepts and Clinical Diagnosis, integrating aesthetic judgment into diagnosis and treatment planning is crucial for optimal clinical practice [36].

This single-arm pre-post study was designed to explore the potential effects of an art education program on aesthetic literacy among medical aesthetics postgraduate students. To ensure rigorous assessment of the curriculum’s effectiveness, we employed a multi-dimensional evaluation framework combining objective and subjective assessment tools: the VAST-R for abstract aesthetic sensitivity, a facial attractiveness selection task for concrete aesthetic judgment, and a simplified CEQ for students’ perceptions of teaching quality [29, 37–39]. This complementary design ensures that both aesthetic competence and educational quality are systematically assessed across different domains, providing robust evidence for curriculum optimization in medical aesthetics education.

The single-arm design was adopted based on practical and ethical considerations. Withholding potentially beneficial art education from a control group was deemed inappropriate in postgraduate medical training, consistent with established practices in medical education research [40]. Additionally, the cohort-based nature of postgraduate medical education limited randomization possibilities within the same academic year. While this design limits causal inferences compared to randomized controlled trials, the substantial effect sizes observed across multiple validated instruments provide meaningful evidence of educational intervention effectiveness.

Objective assessment outcomes

Standardized assessment improvements

Pre-post course assessment comparisons revealed significant improvements in both VAST-R scores and facial image selection accuracy, suggesting enhanced performance in abstract and concrete visual aesthetic tasks. The 17.0% improvement in VAST-R scores indicates that systematic art education may meaningfully contribute to abstract aesthetic sensitivity development. More importantly, the substantial improvement in facial aesthetic judgment accuracy from approximately 60% to over 90% correct identification suggests the program’s potential benefits for developing clinically relevant aesthetic assessment capabilities.

Clinical relevance of findings

This finding is particularly significant as facial aesthetic evaluation frequently occurs in clinical settings, and the composite facial images used in our assessment reflect scientifically established principles of facial attractiveness [30, 41, 42]. The improved performance in identifying optimal facial proportions and symmetry represents fundamental competencies potentially applicable to aesthetic medicine practice, including patient consultation, treatment planning, and outcome evaluation. The composite face selection task, based on scientifically validated attractiveness principles, provides an objective proxy for clinical aesthetic judgment capabilities routinely required in real-world practice. These improvements suggest potential benefits for clinical aesthetic assessment; however, it should be noted that performance on standardized laboratory tasks may not fully capture the complexities of real-world clinical decision-making, highlighting the need for further translational research.

Mechanisms of educational effectiveness and durability

The substantial improvements observed raise important questions about the durability and underlying mechanisms of enhanced aesthetic judgment. The significant effect sizes achieved within a relatively short intervention period (5 weeks) suggest potentially meaningful cognitive changes in performance rather than superficial learning effects. We hypothesize that these gains likely reflect lasting changes in visual-spatial processing networks, consistent with research demonstrating that art education produces enduring modifications in perceptual and analytical capabilities [43].

The improved performance in detecting facial symmetry and proportionality involves fundamental visual-spatial competencies that could be continually reinforced through aesthetic medicine practice, though longitudinal studies are needed to assess long-term retention. Furthermore, the integration of multiple artistic modalities (painting and dance) may have strengthened cognitive pathways associated with aesthetic processing, creating a comprehensive approach to aesthetics perception that extends beyond temporary performance enhancement. These cognitive and perceptual changes underlying improved aesthetic judgment may support long-term skill retention and potentially facilitate translation of laboratory gains into clinical competence. However, longitudinal studies are needed to definitively establish the persistence of these educational benefits.

Student feedback analysis and curriculum optimization

The questionnaire results, with an average score of 3.56 ± 0.89, indicate overall positive reception of the curriculum. Students rated fundamental aesthetic knowledge acquisition highest (3.67 ± 0.88), suggesting positive approval of the course structure and content delivery. However, the lowest rating for aesthetic ability application in clinical practice (3.37 ± 0.93) indicates that practical components, including hands-on art exercises and clinical case analyses, may not fully meet students’ application needs. The feedback indicates areas for curriculum optimization while supporting the value of our interdisciplinary pedagogical approach that integrates painting and dance as core components to enhance aesthetic judgment and application skills.

Innovative pedagogical model and its significance

Unlike traditional medical aesthetics education, our interdisciplinary approach positioned painting and dance education as core elements throughout theoretical instruction and practical training. Previous studies have incorporated arts into medicine as supplementary tools for improving observational skills and understanding anatomy [25–27], but few have focused specifically on enhancing aesthetic competencies among postgraduate students. Our innovative pedagogical model cultivates refined aesthetic sensibility by balancing art and technology, enhancing capacity for nuanced aesthetic judgment and creative clinical application.

In aesthetic medical education, integrated assessment approaches that combine clinical skills evaluation with critical thinking components have demonstrated strong reliability and validity [44]. The positive student feedback regarding aesthetic knowledge acquisition, combined with the substantial effect sizes in standardized assessments, provides encouraging preliminary evidence of educational effectiveness, warranting further investigation through comprehensive longitudinal studies.

Clinical translation challenges

Laboratory-to-clinical translation gap

Laboratory-based assessment improvements do not automatically guarantee enhanced clinical performance. The translation from controlled assessment conditions to complex clinical scenarios involving patient interaction, individualized treatment considerations, and dynamic decision-making requires further investigation. Previous systematic reviews have shown that simulation-based assessments correlate positively with patient-related outcomes, with pooled correlations of 0.51 for provider behaviors and 0.24 for patient outcomes [45].

While these correlations suggest meaningful relationships between standardized assessments and clinical performance, they also underscore the gap between controlled assessments and real-world clinical practice. Importantly, research consistently demonstrates that self-reported satisfaction and confidence measures bear little relation to independent expert assessments of competency improvements, highlighting the importance of objective assessment measures like those employed in our study [46].

Future research directions

Future research should incorporate objective clinical evaluation components, such as standardized patient assessments, treatment planning exercises with real clinical cases, or peer/expert evaluation of clinical aesthetic judgments, to establish direct links between educational intervention outcomes and clinical competency. Longitudinal follow-up studies examining actual clinical performance and patient outcomes are essential for establishing clinical utility and demonstrating the translation of educational gains into sustained clinical competency improvements [47].

Limitations

Methodological limitations

Beyond the design considerations discussed above, several specific limitations warrant acknowledgment. Test-retest effects represent a significant concern, as participants completed identical assessment instruments at both time points. While the 5-week intervention period and substantial improvements suggest genuine learning, we cannot definitively separate intervention effects from practice effects without appropriate controls.

Sample size and statistical power

The small sample size (n = 27), while representing the complete available population, limits statistical precision. Post-hoc power analysis revealed approximately 95% power for the observed large effect (Cohen’s d = 0.878), but inadequate power to capture smaller effects that might still carry clinical significance.

Curriculum scope limitations

The focus on painting and dance may limit comprehensive aesthetic development. Future iterations could incorporate a structured study of classical and Renaissance masterworks by artists such as Polycleitos, Piero della Francesca, Leonardo da Vinci, Michelangelo Buonarotti, and Albrecht Durer, whose works exemplify fundamental principles of proportion, symmetry, and anatomical accuracy directly applicable to medical aesthetics [48]. Complementing this historical foundation, integration of modern anthropometric and cephalometric techniques could bridge traditional artistic wisdom with contemporary clinical practice, particularly in understanding craniofacial proportions and symmetry.

Recognizing that aesthetic appreciation represents a lifelong pursuit requiring sustained engagement, this short-term program should be considered an introductory foundation rather than a complete educational endpoint. Future research could explore extended curricula incorporating diverse art forms including music, photography, and sculpture, as well as culturally matched facial stimuli to strengthen evidence across populations and assess long-term impact on clinical decision-making.

Conclusions

This single-arm pre-post study demonstrates significant improvements in aesthetic assessment performance following a 5-week art education intervention among medical aesthetics postgraduate students. The consistent improvements across multiple validated assessment tools, including a 17.0% improvement in VAST-R scores and substantial increases in facial aesthetic judgment accuracy from approximately 60% to over 90%, provide preliminary evidence that art education integration may enhance aesthetic competencies in medical aesthetics training.

The substantial effect sizes observed (Cohen’s d = 0.878 for VAST-R; Cohen’s g > 2.646 for facial selections) represent meaningful educational improvements that exceed conventional thresholds for practical significance. The multi-dimensional assessment approach, combining objective measures of both abstract and concrete aesthetic judgment, strengthens confidence in the observed improvements and suggests potential benefits across different aspects of aesthetic competency.

While the single-arm design prevents definitive causal conclusions, the magnitude and consistency of improvements across diverse aesthetic domains provide robust preliminary evidence supporting the educational value of systematic art education in medical aesthetics training. The findings suggest that integrating painting and dance appreciation into medical aesthetics curricula may represent a promising approach for developing aesthetic sensitivity among postgraduate students.

These preliminary results support the feasibility and potential effectiveness of interdisciplinary art education in medical aesthetics training and could inform the design of future controlled studies. However, definitive establishment of educational effectiveness requires rigorous evaluation through randomized controlled trials that can control for alternative explanations. Future research should prioritize controlled comparisons with standard training approaches, longitudinal assessment of skill retention, and validation of the translation from improved assessment performance to enhanced clinical practice outcomes.

Authors’ contributions

J.W. and M.L. contributed equally to this work as co-first authors. N.C. conceived the study concept, designed the curriculum framework, and supervised the overall research implementation. M.L. contributed to curriculum development, conducted data collection and analysis, and drafted the initial manuscript. J.W. participated in curriculum design, assisted with data collection, and contributed to manuscript preparation. W.W. and Q.H. assisted with data analysis, statistical evaluation, and figure preparation. X.X. contributed to curriculum implementation and participant recruitment. Y.W., as the lead corresponding author, provided overall supervision, critically reviewed and revised the manuscript, and approved the final version for submission. All authors participated in the interpretation of results, contributed to manuscript revisions, and approved the final manuscript for publication.

Funding

No funding was received for the preparation of this manuscript.

Data availability

The data supporting this study’s findings are not publicly available due to participant confidentiality but are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This research study was approved by the First Affiliated Hospital of University of South China Health Sciences Research Ethics Board (HSREB). All participants consented to participate, and participation was voluntary. Informed consent was obtained from all participants. This study adhered to the Declaration of Helsinki for ethical principles for medical research involving human subjects. Clinical trial number: not applicable.

Consent for publication

The authors confirm that they have the rights to use the facial images included in this manuscript for publication purposes. All necessary permissions and consents for publication have been obtained.

Competing interests

The authors declare no competing interests.