Over the spring of 2003, our protocol evolved as we introduced it to both medical students and clinicians. The Art and Observation protocol was tested first in an eight-week Medical Humanities elective that alternated sessions in the museum with those in a clinical setting. In both sessions, we focused on a sequence of questions that adhered closely, if not exactly, to the VTS1 model: “What do you see?” “What’s your hypothesis about the story?” “What’s your evidence?” Part way through the museum sessions, we identified an essential gap in our process. One student encounter stands out in memory. Tentatively, speaking on behalf of the class, she voiced the collective frustration that the process raised but did not answer questions about the works of art. To align our protocol more closely with the diagnostic process, the students wanted answers about the works of art. They appreciated our open-ended, non-judgmental approach, but they were acutely aware that the clinical relevance of this protocol required more. Valuable as the open-ended protocol was in addressing the hazard of “premature closure,” there came a point to acknowledge the essential role of information and expertise. To address the “limits of just looking,” we asked the students to pose questions for information needed to rule in/rule out differing hypotheses or points of view. The value of formulating questions to elicit specific information to help interpret the works of art was easily equated with the value of ordering targeted clinical tests to answer specific diagnostic questions.
During the spring of 2003, we also introduced Art and Observation to groups of clinicians, testing its relevance to their professional experience. Their support not only echoed the students’ enthusiasm but resulted in the program’s inclusion that fall in the orientation program for the incoming first-year medical students. To accommodate all 104 members of the incoming class, we were faced with training a corps of small group facilitators that included medical students, clinicians, and museum docents. Ensuring that all facilitators would offer a consistent experience, we required all the facilitators to attend two 3-hour training sessions at the museum to learn and practice the protocol, and, particularly, to experience its potential personally. Particularly challenging for many of the trainees was their lack of background with art. This discomfort, however, served to focus their attention on the protocol itself, and to mirror the experience of those they were being trained to lead. The emphasis on the protocol rather than information about the art also proved a challenge for the museum docents who also had to focus on the protocol’s open-ended questions and sideline their art expertise. Each training session culminated in a debriefing in which the trainees brought their unanswered questions to the museum educator who served in an expert role analogous to a clinical consult by a healthcare provider with specialty expertise. This served not only to resolve unanswered questions but also reinforced the value of our interdisciplinary collaboration. Finally, all the facilitators reflected on their personal experience with the process, and its professional relevance.