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VTS in Medical Education

Why Medical Schools Use VTS

Clinicians make sense of complex visual information every day—radiology images, pathology slides, physical findings, emotional cues. But while these cues are critical to diagnosis and care, the skills to interpret them are often assumed, not taught.

VTS is an enjoyable, structured, research-backed method to slow down, look closely, and interpret visual data—with peers. By engaging in well facilitated discussions of art, learners practice the same habits required in clinical work.

Evidence shows VTS improves:

    • Observation accuracy — noticing more, with greater precision

    • Diagnostic reasoning — grounding interpretations in evidence

    • Communication — making thinking visible to teams

    • Collaboration — learning across perspectives

    • Tolerance of uncertainty — delaying closure effectively

    • Empathy and reflection — recognizing bias, reading social cues

VTS is used in medical training at Harvard Medical School, Johns Hopkins Medicine, Brigham and Women’s Hospital, and by educators at the University of Pennsylvania. It is not about art appreciation—it is about improving clinical practice.

Selected Studies

Visual Thinking Strategies (VTS) is increasingly recognized as a powerful tool in medical education. Approximately two dozen peer-reviewed studies have been published in high-impact journals on the value of implementing Visual Thinking Strategies (VTS) in medical education curriculums (Agarwal, Boudreau, Cerqueira, Chisolm, Chisolm, Frontiera, Gaufberg, Kagan, Kelly-Hedrick, Klugman, Kloek, Naghshineh, Poirier, Ryznar, Van Leeuwen). A landmark NIH-funded study by Naghshineh et al. (2008) found that VTS’s structured art observation significantly improved medical students’ visual diagnostic accuracy. More recently, two 2023 systematic reviews (Boudreau & Liben, Academic Medicine; Cerqueira et al., BMC Medical Education) confirmed that VTS enhances clinical observation, communication, and diagnostic reasoning. 

Selected Citations

  • Agarwal, G. G., McNulty, M., Santiago, K. M., Torrents, H., & Caban-Martinez, A. J. (2020). Impact of Visual Thinking Strategies (VTS) on the analysis of clinical images: A pre-post study of VTS in first-year medical students. Journal of Medical Humanities, 41(4), 561–572. https://link.springer.com/article/10.1007/s10912-020-09652-4 — Summary: VTS training significantly improved medical students’ descriptive language, analysis time, and quality of clinical observations—key diagnostic skills.
  • Bentwich, M. E., & Gilbey, P. (2017). More than visual literacy: Art and the enhancement of tolerance for ambiguity and empathy. BMC Medical Education, 17, 200. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-1028-7 — Summary: A controlled study of Israeli medical students found that VTS-style art discussions significantly improved students’ tolerance for ambiguity and empathy.
  • Boudreau, J. D., Cassell, E. J., & Fuks, A. (2008). Preparing medical students to become skilled at clinical observation. Medical Teacher, 30(9–10), 857–862. https://doi.org/10.1080/01421590802331446
  • Cerqueira, A. R., Alves, A. S., Monteiro-Soares, M., et al. (2023). Visual Thinking Strategies in medical education: A systematic review. BMC Medical Education, 23, 536. https://doi.org/10.1186/s12909-023-04470-3 — Summary: Synthesizes evidence on VTS in medical education, concluding that VTS improves observation, diagnostic reasoning, and communication skills.
  • Chisolm, M. S. (2021). How visual arts-based education can promote clinical excellence. Academic Medicine, 96(8), 1100–1104. doi:10.1097/ACM.0000000000004175
    https://journals.lww.com/academicmedicine/fulltext/2021/08000/how_visual_arts_based_education_can_promote.32.aspx — Summary: Methods like VTS enhance observation, reasoning, communication, empathy, and professionalism.
  • Chisolm, M. S., Duke, L., & Stephens, M. B. (2023). Visual Thinking Strategies in medical education: Staying open to possibilities. Academic Medicine, 98(3), 295. https://doi.org/10.1097/ACM.0000000000005112
  • Frontiera, M. S., et al. (2024). “Visual thinking strategies” improves radiographic observational and interpretative skills in veterinary medical students. Frontiers in Veterinary Science, 11, 1480301. doi:10.3389/fvets.2024.1480301
    https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2024.1480301/full — Summary: VTS sessions improved abilities to observe and interpret radiographic images.
  • Gaufberg, E., DiGiovanni Evans, B., Rutberg, P., & Chisolm, M. S. (2023). What’s art got to do with it?—Transfer of learning in museum-based health professions education. International Review of Psychiatry, 35(7–8), 672–681. https://doi.org/10.1080/09540261.2023.2288299
  • Huang, J. T., Reynolds, S. D., DiGiovanni, E. B., Zimmermann, C., Joyce, C. J., Katz, J. T., et al. (2016). Fine arts curriculum improves observational skills of dermatology trainees: a pilot study. British Journal of Dermatology, 175(4), 815–817.
  • Jasani, S. K., & Saks, N. S. (2013). Utilizing visual art to enhance the clinical observation skills of medical students. Medical Teacher, 35(7), e1327–e1331. DOI:10.3109/0142159X.2013.770131
    https://pubmed.ncbi.nlm.nih.gov/23641917/ — Summary: Controlled study where students in facilitated VTS discussions showed measurable gains in descriptive richness and accuracy.
  • Kagan, H. J., Yenawine, P., Duke, L., Stephens, M. B., & Chisolm, M. S. (2023). Visual Thinking Strategies and the peril of ‘see one, do one, teach one’. International Review of Psychiatry, 35(7–8), 663–667. https://doi.org/10.1080/09540261.2023.2276377
  • Kelly-Hedrick, M., Chugh, N., Zahra, F. S., Stephens, M., & Chisolm, M. S. (2022). Art museum-based teaching: Visual Thinking Strategies. Academic Medicine, 97(8), 1249. https://doi.org/10.1097/ACM.0000000000004600
  • Klugman, C. M., Peel, J., & Beckmann-Mendez, D. (2011). Art rounds: Teaching interprofessional students visual thinking strategies at one school. Academic Medicine, 86(10), 1266–1271. https://doi.org/10.1097/acm.0b013e31822c1427
  • Kloek, T. G., & van der Vleuten, C. P. M. (2024). Twelve tips for facilitating Visual Thinking Strategies with medical learners. Advances in Medical Education and Practice, 15, 1155–1161. https://pure.johnshopkins.edu/en/publications/twelve-tips-for-facilitating-visual-thinking-strategies-with-medi
  • Mehta, A., & Agius, S. (2023). The use of art observation interventions to improve medical students’ diagnostic skills: A scoping review. Perspectives on Medical Education, 12(1), 169–178. https://pmejournal.org/articles/10.5334/pme.20 — Summary: Maps 15 studies of formal art-observation training (incl. VTS); calls for stronger designs.
  • Mukunda, N., Moghbeli, N., Rizzo, A., Niepold, S., Bassett, B., & DeLisser, H. M. (2019). Visual art instruction in medical education: a narrative review. Medical Education Online, 24(1), Article 1558657. https://www.tandfonline.com/doi/full/10.1080/10872981.2018.1558657 — Summary: Reviews visual-arts training in medical curricula; finds improved observation skills; notes small, single-site studies.
  • Naghshineh, S., Hafler, J. P., Miller, A. R., Blanco, M. A., Lipsitz, S. R., Dubroff, R. P., Khoshbin, S., & Katz, J. T. (2008). Formal art observation training improves medical students’ visual diagnostic skills. Journal of General Internal Medicine, 23(7), 991–997. doi:10.1007/s11606-008-0667-0
    https://link.springer.com/article/10.1007/s11606-008-0667-0 — Summary: Structured VTS-style art observation improved accuracy and detail when describing clinical images.
  • Pitman, B. (2022). Art museum and medical school partnerships: Program descriptions. The Edith O’Donnell Institute of Art History, University of Texas at Dallas.
  • Poirier, T. I., Newman, K., & Ronald, K. (2020). An exploratory study using Visual Thinking Strategies to improve undergraduate students’ observational skills. American Journal of Pharmaceutical Education, 84(4), 7600. doi:10.5688/ajpe7600
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223938/
  • Ryznar, E., Kelly-Hedrick, M., Yenawine, P., & Chisolm, M. S. (2023). Relevance of Visual Thinking Strategies for psychiatry training. Academic Psychiatry, 47(1), 78–81. https://doi.org/10.1007/s40596-022-01590-8
  • Van Leeuwen, T. M., Singer, N., & Matthen, M. (2023). Thinking eyes: Visual Thinking Strategies and the social brain. Frontiers in Psychology, 14, Article 1222608. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1222608/full