Observational Skills - Use of Fine Art to Enhance Visual Diagnostic Skills

Description

Figure 4 is an example of one of the paintings used at the Yale Center for British Art. The main points of discussion during the YCBA intervention for The Death of Chatterton can be seen below. Legend: The Death of Chatterton, by Henry Wallis (1856).

Figure 4: Discussion points for The Death of Chatterton, by Henry Wallis (1856)

• Is the figure sleeping, dead or unconscious? His abnormal posture makes it unlikely that he is sleeping. His cyanotic skin rules out unconsciousness and points towards death.
• Where in the house is this scene located? Since the view of the city through the window is from above, it could be either an attic or a basement if the house were on a hilltop. Even though the darkness in the room would be expected in a basement, the slanting roof seen in the window's construction reveals the location as an attic.
• What is the time of day? Both the smoke still rising from the candle that has burned out after being lit all night, and the yellowish/pink sky indicate it is dawn (not dusk). The angle of the light shining on him provides another clue.
• How old is the figure? His smooth skin and physique suggest an adolescent man (Chatterton was 17 years old).
• What does his fisted left hand and arm position indicate? Perhaps he was clutching his chest and experiencing chest pain related to his death.
• What was his cause of death? The empty vial fallen to the floor may indicate that his death was not accidental. The crumbled paper in his right hand and the torn manuscript on the floor may provide his motivation (Chatterton used arsenic to poison himself after he was discovered to have plagerized his poetry).

Figure 5: Example of one of the photographs used in the pre-test and post-test: Herpes Zoster.

Figure 5: Grading Key
The ten visual features used as grading criteria for this photograph include:

• Back of the arm
• Lesions extend to the shoulder
• Hair seen on arm and in the axilla
• Gender/Age
• Lesions found in clusters
• Description of individual lesions
• Varying sizes of the clusters
• Varying sizes of lesions within clusters
• Dermatomal/linear distribution
• Other Observation (e.g. five major clusters of lesions, low muscle mass of triceps, lesions are in differing stages of development)*

*Students were given credit for "other observation" when a keen observation was made not previously considered by the graders.

Examples of some of the paintings used at the Yale Center for British Arts

The Death of Chatterton, by Henry Wallis (1856).

George, 3rd Earl of Cowper & the Gore Family, by Johann Zoffany (1775).

The Bard, by John Martin (1817).

Years 98-99	../images used for pre- and post-testing
Set A	Herpes Zoster involving posterior arm and scapular region.	Blue Nevus (OTA)
Set B	Melantoic freckle	Vitiligo

Years 99-00	../images used for pre- and post-testing
Set A	Male acromegalic face.	Herpes Zoster involving posterior arm and scapular region.	Female with McCune-Albright syndrome whose back shows scoliosis and cafe-au-lait spots.	Close-up of neck from previous image.
Set B	Female figure with primary biliary cirrhosis shown from the waist up.	Male with obese adbomen covered with wart-like lesions in a wave pattern.	Elderly female with purpura in sun-exposed areas on the arms and chest.