Text Box 3.

Themes That Emerged from the Qualitative Analysis of Visual Skills Examinations and Examples of Students’ Observations

CATEGORIES FOR ART IMAGERY	CORRESPONDING CATEGORIES FOR PATIENT PHTOGRAPHS
Observations	Visual findings
This is a color painting…at the right side, at the foot of the bed is a miniaturized young male figure who is leaning over the edge of the bed, with his [left] hand on his cheek and [right] hand on the bed, with…red circular object in his hand	The sclera is almost completely red-uniformly across the eye with no visible blood vessels. There is a small ring of white sclera around the brown iris that is more visible on the left
At the foot of the bed is a blue can that gives off white twists of smoke that are hardly distinguishable from the white floor of the room	An actively weeping, bright red bloody circular ulcer on the [right] index finger that appears 3 mm in diameter…beside it is another 2-mm lesion that has healed and appears to be scabbed since there is a deep brown hue to the ulcerated area
Interpretations supported by evidence	Clinical diagnosis or interpretations supported by evidence
A religious home (judging from cross, painting of Virgin Mary on bureau, votive candle and the ceremony with which this woman brings palm branches to the ailing woman)	It seems like this rash causes open lesions on the skin. There are evidences of the lesion process…red spots, blisters, open-bleeding blisters, and scabs
The lady appears young because her hair is dark black without any gray—as is the young male’s-but the elderly woman brooding over her has dark black hair with shades of gray mixed
Speculative thinking to generate multiple interpretations	Speculative thinking to develop a differential diagnosis
On the back of the door is a poster for nonsmoking campaign. The skeleton icon in the poster is of the same white bony patterning as the patient. Or, perhaps it not a poster for no smoking—it is ambiguously a poster or a window in the door. It could be the grim reaper looking through the window coming to collect the patient	A man’s right hand pathology…maybe contact dermatitis. Alternatively it may be a superficial burn, self-induced excoriations, or a viral eruption
Awareness of the absence of observations	Pertinent negatives or awareness of the absence of visual findings
The back wall is blank, not decorated…The purposeless movements of the women, the agitated, angular poses, the blankness of the room and the mesh on the window suggest a madhouse/psychiatric ward	There is no scleral icterus…no cuts or obvious scars
	The patient’s eyes do not appear properly aligned, as there is a slight esotropia of the L eye, which is medially displaced as evidenced by her [left] iris being more towards the midline, whereas her [right] eye appears normal since it is centrally aligned with no evidence of strabismus or esotropia
Use of fine arts concepts	Use of fine arts concepts
There are color motifs that run through the painting. Red—mother’s dress, medication, candle, flowers, object in the child’s hand and slippers; all these objects signify hope and recovery	The man’s eyes are asymmetrical. His right eyelid droops (ptosis) over his pupil
There is a lot of imbalance in the picture-awkward motions, odd figures, disproportionate bodies…and a range of moods from anger to…timid and calm