Could the implementation of an aesthetic (art-based) toolset provide a critical, and transferable, thought process regarding medical illness, thus reducing the reliance on expensive testing, while increasing accuracy in determining the correct diagnosis for the patient? See GoPokes.org for more information.

1. The Significance of Art in
Medicine:
Visual Analysis, Critical Thinking, and Its Transferability
Brandon Neal Jones
Oklahoma State University

2. Three Questions:
• “What's going on in this picture?”
• “What do you see that makes you say that?”
• “What more can we find?” (Housen, 2001, p. 100)

10. Background.
 Studies have shown that physical diagnostic skills by
clinicians have been in decline in recent years (Goldstein
& Simel, 2005; Mangione & Nieman, 1997; Naghshineh et
al., 2008).
 Critical thinking (which will be defined later), in the context
of medical diagnosis, is being superseded by “expensive
laboratory tests and radiological studies” for the medical
practitioner (Naghshineh et al., 2008, p. 991).

11. So what?
 Could the implementation of an aesthetic (art-based)
toolset provide a critical, and transferable thought process
regarding medical illness, thus reducing the reliance on
expensive testing, while increasing accuracy in
determining the correct diagnosis for the patient? (RQ)
 What benefit does this have for a medical education/the
medical community?
 Is there a quantifiable effect to be found?

12. Definitions.
 Critical thinking: “[...] reflective thinking focused on the
evaluation of various alternatives” (Lampert, 2006a, p. 215;
2006b).
 Transfer/Transferability: “[...] the capacity to go beyond the
information given, calling attention to the fact that [it] extends
thinking beyond where such thinking was first learned” and
could be “[...] a predictable attribute of critical thinking” (Housen,
2001, p. 101).
 Æsthetic(s): “[...] combines many faculties, merges the cognitive
and the judgmental with the affective and subjective into what
has been called thoughtful sensations or thoughtful feelings”
(Housen, 1983, p. 2). This term should not be confused with art
critique (Heid, 2005). This is a descriptive analysis of art, not a
critical analysis of art.

13. Definitions, cont.
 Visual Thinking Strategies (VTS): a curriculum series developed
by Housen, and based upon the theory of æsthetic development
(n.d.).
 Æsthetic Development Interview (ADI): “An open-ended
monologue documenting a student’s thoughts and reasoning
skills as s/he responds to a work of art. ADI’s are non-directed
monologues, delivered one-on-one to a researcher” (Housen,
2001, p. 104).
 Clinical Imagery Interview (CII): Founded upon the ADI
component of the VTS, this interview consists of the same open-
ended monologue, but is based upon medical imagery, rather
than art.

14. Housen’s Theory of Æstethic
Development and Its
Transferability.
 This theory was first proposed in 1983 in Housen’s
dissertation Eye of the Beholder: Measuring Æsthetic
Development.
 Housen founded a five-stage continuum of æsthetic
understanding based on years of research using the ADI.

15. Benefit?
 Although the obvious implications for this research are to
the arts, and to medical students and practitioners, this
research may be especially useful for those intending to
enter into specialties such as Rheumatology, where
complex illnesses, such as autoimmune diseases, usually
have no definitive testing for diagnosis (Khamashta &
Ramos-Casals, 2011; Muzna & Abdul, 2012).

16. Why Quant.?
 Research on this subject must have the ability to be
translated for those who do not come from arts
backgrounds. Art administrators and educators can
anecdotally speak of the benefits of art, but anecdotes do
not provide the necessary weight to convince the
empirically based sciences (Housen, 2001, p. 99).

17. Hypotheses.
 Students who take the treatment course will have a higher
stage progression on the ADI than the control group.
 Students who come from arts or humanities backgrounds,
whether in the treatment or control group, will exhibit a
higher stage progression on the ADI than those who do
not.

18. Research Design.
Quasi-experimental.
Pre-test/Post-test with Control.

19. Population, Sample, and
Sampling Method.
 Population consists of first-year, post-baccalaureate medical students
accepted into the Oklahoma State University Doctor of Osteopathic
Medicine program. The estimated admitted class size per year is one
hundred fifteen students (Oklahoma State University Center for Health
Sciences, n.d.).
 Representative sample for this study will include a variety of age, gender,
and ethnicity to best represent the population of medical students as they
develop into doctors at Oklahoma State University. The representative
sample will include at least sixty students from all pre-graduate
backgrounds, but will probably consist mostly of science-based or pre-med
bachelors degree programs. Sixty students would provide the best sample
size due to the limited size of the population. This sample will provide
approximately thirty students for each of the groups – treatment and
control. No exclusion criterion is required.
 Simple Randomization will be implemented.

20. Data Collection.
 After IRB approval and participant consent, data collection
will include a self-report questionnaire administered
through the SONA-COE system. Before the participant’s
first semester, both the treatment and control groups will
participate in a one-hour ADI/CII interview to pre-test for
stage level according to the Æstethic Development
Theory. After the æsthetic-based treatment course has
been taught in the fall semester, all participants will be
asked to return for the post-test to establish stage level at
close of data collection.

21. Instruments.
Self-Report Questionnaire
Æsthetic Development Interview
Clinical Imagery Interview

22. Validity and Reliability.
 Validity – will be established by using independent coders
for the interview data. It will be further instituted by
blinding the raw data between treatment and control
groups.
 Reliability - The alpha coefficient (α) is not specifically
reported with the instruments and coding-manual, but
inter-rater reliability has been shown stable (Housen,
1983, pp. 96-99; 2001, p. 106).

23. Data Analysis.
 The self-report questionnaire will provide nominal data.
 First, the ADI will be coded by trained, independent coders for
æsthetic stage development using the Æsthetic Development
Coding Manual (Housen, 1983, 2001).
 Second, the ADI will be coded according to critical thinking,
which is outlined by Housen’s 2001 study as “supported
observations” and supported “speculations [...] based on
evidence” (Housen, 2001, p. 106).
 The CII will be coded solely for critical thinking.
 The data that is reported will be analyzed using a T-Test.

24. Summary.
 Could the implementation of an aesthetic (art-based)
toolset provide a critical, and transferable thought process
regarding medical illness, thus reducing the reliance on
expensive testing, while increasing accuracy in
determining the correct diagnosis for the patient? (RQ)