“Learning to Perceive: Visual Thinking Strategies in Medical Education”

Prairie Doc Perspective Week of March 16th, 2025
“Learning to Perceive: Visual Thinking Strategies in Medical Education”
By Donna Merkt, director of the South Dakota Art Museum at South Dakota State University
Effective medical diagnosis depends not just on looking, but on truly perceiving. Recognizing this, many medical training programs have adopted Visual Thinking Strategies (VTS) discussions about art to enhance students’ skills in nuanced observation, inference, and communication.  In 2004, Harvard Medical School pioneered use of VTS within medical education to refine the diagnostic and interpersonal skills of future healthcare professionals. Now, VTS is embraced in over 30 medical schools. 
Through inquiry-based, participant-centered VTS discussions about art, medical students learn to slow down, look carefully, analyze details, and refine their diagnostic reasoning. During the exercise, participants focus on an artwork while discussing their observations.  The facilitator begins with: “What’s going on here?” Seeks evidence by asking: “What do you see that makes you say that?” Then, spurs the participants with: “What more can we find?” The facilitator remains neutral, paraphrases comments, and points to the artwork to guide discussion. Without authoritative guidance, participants explore multiple interpretations freely. The conversation often lasts 20 minutes per artwork. (Conversely, most museum visitors spend 30 seconds or less with a piece.)  
A 2020 study at the University of Miami Miller School of Medicine, along with others, found that students who participated in VTS showed significantly improved observational abilities compared to peers who had not engaged with the program. By examining and discussing artwork through VTS, participants sharpen their ability to notice small but significant details and interpret ambiguous visual information, a process that mirrors patient assessments, where attentiveness and contextual understanding are key. For example, learning to analyze visual cues that might indicate emotions may enhance healthcare professionals’ abilities to interpret patients’ nonverbal cues, leading to more compassionate and attentive interactions.
VTS discussions engage participants in collaborative analysis, fostering both clear articulation of observations and active listening to others’ perspectives. A systematic review of studies regarding VTS in medical education, published in BMC Medical Education (2023), found that engaging in VTS improved medical students’ observation skills and enhanced their abilities to express their findings concisely and confidently. Further, VTS participants also support their interpretations with evidence—a critical skill in patient care, where diagnoses must be explained with clarity and justification. The structured discussion format of VTS also encourages strong communication, as well as cooperative analytical skills, which are essential for collaborative work within healthcare teams.
Attuning to a patient’s needs requires careful observation, but diagnosing complex cases also demands the ability to navigate uncertainty. Patients may present with overlapping or unclear symptoms, and medical professionals must carefully weigh multiple possibilities. VTS trains students to tolerate ambiguity by prompting them to analyze complex images without immediate resolution. Further, the process fosters active listening to alternative interpretations offered by others, often leading participants to refine their own thoughts. This practice fosters adaptability, allowing future medical professionals to confidently refine their assessments rather than defaulting to initial impressions.
By engaging with works of art in VTS discussions, medical students and practitioners develop sharper attention to detail, improved communications, and increased empathy.  Ideally, this reflective approach extends into clinical practice, allowing healthcare providers to take a more holistic view of their patients, ask insightful questions, thoroughly evaluate symptoms before reaching a diagnosis, and communicate thoughtfully with patients and families.
If you would like to learn more about Visual Thinking Strategies and potential partnerships, contact your local art museum. 
Select Sources: 
Agarwal, G.G., McNulty, M., Santiago, K.M. et al. Impact of Visual Thinking Strategies (VTS) on the Analysis of Clinical Images: A Pre-Post Study of VTS in First-Year Medical Students. J Med Humanit 41, 561–572 (2020). https://doi.org/10.1007/s10912-020-09652-4
Cerqueira, A.R., Alves, A.S., Monteiro-Soares, M. et al. Visual Thinking Strategies in medical education: a systematic review. BMC Med Educ 23, 536 (2023). https://doi.org/10.1186/s12909-023-04470-3 
Rezaei S, Childress A, Kaul B, Rosales KM, Newell A, Rose S. Using Visual Arts Education and Reflective Practice to Increase Empathy and Perspective Taking in Medical Students. MedEdPORTAL. 2023;19:11346. https://doi.org/10.15766/mep_2374-8265.11346
Donna Merkt is a certified VTS facilitator and has practiced VTS for more than 15 years, during which she’s led VTS conversations with thousands of students and adults, and trained numerous educators and medical professionals to use the method.  She currently serves as director of the South Dakota Art Museum at South Dakota State University. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.