Drawing has been a very positive influence on my development as a surgeon. Naturally, I wanted to share that with others in our Division. The premise being that visual notes are useful for learning, communication and medical documentation.
The plan was to have two medical illustrators and a staff/mentor lead a workshop on visual note-taking for our colleagues. When those three could not do it at the last minute, I was Plan D! I cobbled something together and here’s what it looked like:
Warm up exercise
First, draw from memory and then, from a reference object
Emphasized that this session is not about drawing in the artistic sense but rather, visual note-taking.
Shared drawings/visual notes from some of my residents and my own sketchbook, which gave them an idea that it doesn’t always have to be representative or artistic. It just has to be a visual reminder for the draw-er.
Gave pointers on what to draw. I made up an acronym “STAIRS” just to be cute.
Traction (e.g. traction sutures, retractors)
Instruments and hands
Relationships (i.e. between anatomical landmarks)
You might ask what does “Symbols” mean? It is just a way of representing common objects, like one would use simple icons. Scissors could be drawn as:
Answered the question, “Why not just take photos or watch videos on YouTube?”
This is a very good question from a senior colleague. I think the difference here is that there is a very active component to drawing. As you trace out the anatomy, you experience the image very differently than merely looking at it.
Finally, we ended with drawing exercise.
I chose a YouTube video of a kidney transplantation. Not only is the anatomy clear and well-defined, it can also be the most satisfying operation to perform (I recall all the times that patients literally cried out of happiness when their new kidney made urine).
We divided the surgery into 12 parts and each of us were assigned a step to draw
Watched the video and drew our assigned step
Presented our own drawing (in sequential order)
I was so proud of everyone at the end, when we had a full panel from start to finish of this operation! It proved that they all can draw!
Overall, it was an enjoyable experience to share this with my colleagues. I don’t know if it will change the hardcore skeptics but I think it made a few consider drawing in the future. A week later, I saw one of my co-workers make a small sketch in his clinic notes for the first time and it made me smile.
To date, I’ve spoken to three groups of surgeons and trainees, as well as other individuals about the use of drawing for surgical education, documentation and generally “figuring stuff out”. The most common response is, “I can’t draw.” This is coming from surgeons who have two fully-functioning hands, trained for years to operate and have fine motor skills better than the majority of the general population. And yet, the act of drawing is what they do with the scalpel or Bovie (a.k.a. electrocautery tool) in the operating room. For me, I had an inherent fear of drawing until my early thirties. In the end, it took an influential mentor, supportive family and friends, an art class, a sketchbook and the will to try.
It was a mental hurdle, rather than a lack of ability.
Here are 10 steps for anyone to overcome their fear of drawing:
Forget about perfection.
Buy a notebook – Something that is nice enough that you’ll want to use it but not so expensive that you’ll be afraid to use it (ahem, Moleskin). I started off with a regular $2 lined notebook from Staples. I made both written + visual notes and found the lines were less intimidating than blank pages.
Get into a routine of drawing (daily if possible) – This could mean taking 5 minutes at the beginning or end of your day. The key is making it a habit.
Roughly outline the image(s) first and fill in the finer details later – Do this without erasing anything at first. You can always return to this later with a darker pencil or pen over your outline, erasing mistakes later. The key is getting it down when your memory is fresh.
Draw from reference photos or other stationary objects – Learning to draw is not just about mark-making but also honing your skills of observation. Photos and stationary objects will give you more time to observe. For instance, those who are learning to draw figures might go to a museum or gallery to learn on statues first.
Listen to music – This might help for some distraction and “loosen” you up.
Take beginner drawing class or buy a beginner drawing book – I prefer the art class, since it gave me a chance to be among other beginners and realize that I’m not totally off. They might get you to do some exercises to loosen up and be freer with your drawing, depending on the instructor. I found this to be immensely helpful.
Show your work to (supportive) family and friends – Depending on who they are, you might have to be a bit selective on this one. People are generally very encouraging and not expecting you to be Michelangelo.
Deconstruct your subject – Breaking down the object into simple geometric shapes is what many experienced artists still do and makes drawing much more accessible to novices. Then for shading, breaking tones down into 5-6 discreet tones will add realism (but not a necessity at this stage).If you can simplify it, then do so.
Accept that you will never be done – Along the same vein as “Forget about perfection”, there is always something that you could add or change. If you accept that you’ll stop at (arbitrarily) 50% or 75% or 80% of completion, then it will allow you to move on.
Do you have any other tips to share? If so, leave a comment or share them with me @SurgicalArt on Twitter. Oh yes, I’m on Twitter now. Something I never thought I would say.
Hands are very tricky to draw. I’ve started and given up on so many hand drawings. Between a photo of a hand burn and my own hand as a model, this is what I came up with. It’s still a bit off and I’m not sure why.
This week, our program hosted interviews for fellowship candidates. Residents from all over North America filed into the conference room this morning at 7am to listen to presentations meant to showcase our program. Prior to sitting down individually with each applicant, we reviewed their letters of intent and reference letters in support of their candidacy.
Over the years, I have read dozens of reference letters. Words such as “talented” or “gifted” are often used by referees. These terms are used to endorse applicants in reference letters, introduce awardees or eulogize colleagues who have passed away. To have talent or a gift is so superlative that it is not for describing the average (albeit still exceptional by many standards) person in a highly competitive field like surgery or fine arts. In a way, I read these words with a certain degree of skepticism, as I don’t believe in the idea that someone can passively exhibit a high level of skill.
Who benefits from sketching in the operating room?
It can be useful for med students scrubbing in for the first time, residents/fellows learning the procedure, all the way up to seasoned staff (see below). It is something that I will continue to do throughout my career.
Earlier in the year, I registered for an Introduction to Drawing course through the local art school. The course consisted of twelve 3-hour classes that took place on Saturday mornings and I planned to miss out on the days that I was on-call at the hospital.
The first class was intended to loosen us up. We drew enormous, larger-than-life self-portraits using bright color pastels. I felt like I was in grade school again. I think the point was to do something that, absurd as it was, got us out of the idea that art had to be perfect. We learned to embrace our mistakes, learn from them and just draw over them with another color.
Surgery has always intrigued me. When I was twelve years old, I read a poignant and (darkly) humorous memoir of a neurosurgeon entitled, “When the Air Hits Your Brain”. I realized that there was something very different about surgery, compared to all of the other careers out there. It was the concept of form and function of the human body that drew me to surgery. The idea that certain diseases were due to an anatomical abnormalities that affected the bodies function and that this could be “fixed” was very appealing. Years later, I learned of the difference that surgery could make in peoples’ lives.
After three years of undergraduate studies, four years of medical school, five years of a surgical sub-specialty residency and now, a pediatric surgical sub-specialty fellowship, I have found a new passion in drawing.