Experience of observation skill workshop intervention for ophthalmologists in fellowship training

Observation skill workshop: The genesis

The Education Academy recognized some essential foundation skills for good clinical practice, with observation skill as one of these. The seven-hour physical workshop was conducted on the first of July 2022 for post-graduate fellows at the institute. Learnings acquired from virtual workshops held one year earlier helped us improve the structure and quality of the present physical workshop. The data captured through this workshop were reviewed retrospectively. This study complied with the tenets of the Declaration of Helsinki. The Study involved study participants’ perceptions, and study approval was obtained from the Institutional Review Board (IRB) of the Institute Ethics Committee (IEC) Hyderabad Eye Research Foundation. Ethics Reference Number: LEC-BHR -01-23-151 was approved on 22^nd March 2023.

The details are given below.

Post-graduate fellows (Batch 2022, N=34) were invited via e-mail to participate in the foundation skill workshops. The e-mail communication included clear guidelines for the fellows to bring their own laptop/tablet device to fill the pre- and post-workshop assessment. The actual workshop started with an introductory speech by the facilitator/moderator explaining the structure and content of the workshop and the program schedule. The introduction included information regarding the research component of the workshop and invited participants to participate in the workshop and the pre-post assessment.

The pre-workshop assessment comprised two non-clinical images to spot the difference and five clinical images from various subspecialties of ophthalmology, such as medical retina, uveitis, cornea, oculoplasty, and strabismus. The pre-workshop assessment of trainees was conducted using Quizizz, an online gamified student engagement platform. Each image was projected for five minutes, and participants’ responses were obtained. The total duration was 35 minutes, and the responses were stored in the Quizizz application and later retrieved. Clinical images were graded by two expert ophthalmologists who were blinded to the intended use.

After the pre-workshop assessment, the facilitator/moderator made a presentation on observation as a preeminent foundational skill, dwelling on its importance in daily practice in the clinical setting and in academic research. Such interventions have been made in the past in ophthalmology and various fields of medicine. The entire workshop was interactive, piquing audience interest by showcasing images and then inviting all trainees to comment on and add points to the description of the image if they considered that information was inaccurate or insufficient. After attending the workshop, participants were asked to form four groups and take a tour of the campus where various photographs and paintings were displayed that riveted their attention. The trainees were encouraged to describe their observation points by looking at random sketches/paintings, or photographs. The facilitator/moderator further guided the groups while making collective observations. In the last segment of this workshop, the participants were assessed on the Quizizz platform for their observation skills, using a new set of two non-clinical images and five clinical images.

At the end of the workshop, the participants’ reflections were collected after committing to confidentiality and anonymity. The pre- and post-observation grades of participants were then compared.

Statistical analysis

Analyses were performed using SPSS Version 21.0 (IBM SPSS Statistics Inc., Armonk, NY, USA) software.⁶ Normality was checked using the Shapiro–Wilk test. Continuous data are presented as median or interquartile range. Categorical data are presented as proportions. Comparative analyses were performed using the Wilcoxon signed-rank test, and a probability value < 0.05 was considered statistically significant.

Interplay of Art and Science

Integrating art and medicine, as demonstrated in the collaboration between a medical school and an art museum, promises to enhance the observation, description, and interpretation skills of medical students.⁸ Ongoing unlearning and relearning leads to clarity in our perceptions, conquering setbacks, leading to newer ways of doing something, and eventually, distinctive new knowledge. Authors adhering to traditional scholasticism have endeavored to preserve this art, challenging its decline by reinvigorating observation skills through unique methods, much like an art form.⁹

Research highlights that clinical methods excel in pattern recognition, whereas art-based approaches uniquely foster emotional recognition, empathy, narrative understanding, and a multifaceted perspective, which extends to healthcare.¹⁰ Concepts like the spider web narrative and the Golden Minute underscore the importance of trainees honing their observation skills and attending to subtle patient details.¹¹ Moreover, integrating visual art training into medical education, primarily focusing on preclinical students, addresses various skills, such as observation, empathy, and teamwork, using established methods, such as visual thinking strategies or artistic thinking.¹² Further, a study in ophthalmology demonstrates that formal art observation training significantly improves observation skills in medical students, with potential applications in specialized medical fields.¹³

Conclusion – Wanted: A purposeful leap of faith

Just as an owl can easily see what is at the back of its head by flexing its neck three-quarters on both sides, the observant nature of a Master of Cognition (known in India as an Ashtavadhani) permits a speedy and appropriate response to difficult questions from multiple directions with great nonchalance. However, how can one observe which is invisible, inaudible, imperceptible, unknowable, or beyond the horizon, reach, or ken? Historically, humankind has willed the individual and collective consciousness to access power beyond what is known (hailing discovery, invention, innovation, wait and watch, intuition, extra-sensory perception, serendipity, and so on). Again, the purposeful leap of faith that helped outer space practitioners of our cosmos land a rover nearest to the unknown south side of the moon may well be the prescription for us to bring into the known great and small mysteries closer home waiting to be noticed, studied, and unraveled by the observant eye.

Observation skills are important for medical professionals to initiate self-efficacy in the care setting, benefiting their patients and themselves in achieving self-dependence and self-care. At the meso level, these help to resolve health issues for the community using multimodal preventive and promotive care. At the macro level, clinicians provide curative, rehabilitative, or palliative care, collated and systematized based on long, hard, sensitive, and personal observation. At the micro level, the good doctor’s sensitivity in the doctor-patient interaction helps them to be aware of their own biases which prevent the doctor from providing care that would make the patient self-dependent.¹⁴

Being observant is essential for success in many areas of life including education, work, and relationships. The importance of observation skills is speedily sizing up, facilitating process improvement, identifying a concern early (before it becomes a problem), and resolving knotty problems. At the tertiary level, a guided approach to enhance one’s observation skill and arrive at a logical interpretation can help doctors make more accurate clinical diagnoses. However, as clinical knowledge cannot in isolation serve patients, medical professionals must also readily impart new learning about the theory and practice of observation skills, actively letting go of inherent biases. By sharing their clinical prowess with their peers, superiors, and trainees in other specialties of medicine, they can become better collaborators and enhance their professionalism. Similarly, through observant empathy of functional vulnerability, such as vision loss in patients (their significant others), medical professionals can practice providing better care to the human being in every patient, collaborating without exception.