The Association of Medical Illustrators Annual Meeting (AMI) 2016 is now in full swing!
It is a sunny day in Hotlanta with a high of 95. Hence, the flames on the conference bag (left). The conference hotel is appropriately shaped like a thoracic cage (right).
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
Discussed the question “Why Draw?”
Discussed the notion that “I can’t draw!”
- 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.
Sketchbooks come in every imaginable size, binding and paper to suit any purpose. Coupled with my stationery obsession, I have more sketchbooks than I will ever need or use. One limitation to the sketchbooks, in all their variety, is the lack of customization. You are essentially stuck with whatever order your drawings are in and whatever paper is in that sketchbook.
I came across the Arc Customizable Notebook system from Staples a few months ago. It has been amazing for my Bullet Journal. It contains 8 rings, a durable poly or leather cover and pages that can be moved around. Like a binder in its flexibility but feels like a notebook. I’ve recently thought of applying it to a surgical sketchbook for use as I transition into practice.
Here’s what one will need:
- Small Arc Notebook (6-3/8″ x 8-3/4″)
- Poly cover – $7.99 USD
- Leather cover – $16.99
- Tab dividers – $4.99
- Arc System Desktop Punch – $42.99 (whoa!)
- Lined paper for written notes
- Sketchbook paper of choice
- For me, it’ll be mostly white paper and a few pages of toned paper
- 8.5″ x 11″ 45-lb white paper for dry media (cut in half)
My sketchbook will contain sketches for common surgeries, divided into 5 main sections. I have been dragging my feet on this due to the desktop punch. Not only is it pricey, it is also heavy as sin. And I’ll be transporting it across the country for the big move after fellowship.
This book will serve as my own personal surgical atlas and flexible enough to make changes as my techniques evolve.
I’ll post again once I actually do this!
Last week, I left class and shared a short walk with the Director of Bioethics at my home institution. Our lively conversation started with bioethics, then went to grant writing, then arts-based research methods and finally, to the intersection of art and medicine. She remembered hearing Laura Ferguson, the artist in residence at NYU School of Medicine, speak at a recent American Society for Bioethics and Humanities conference. It was an odd thing to hear an artist speak about her experience with scoliosis and teaching an art and anatomy at a bioethics conference:
Drawing the Human Heart
For those who want to hear about her experience teaching medical students art and anatomy, I would recommend starting at 24:00 min.
I’ll end this with some beautiful quotes from Laura Ferguson.
On seeing in art:
“The key to good drawing is openness. You have to learn to look without preconceptions. To let go of what you think and learn to really see.”
For those who are learning (and never cease to learn):
“You may not have always the tools or the techniques to get what you see onto the paper, to allow others to see through your eyes. But that is the goal. To bring others into the experience.”
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.
At the Association of Medical Illustrators (AMI) Annual Meeting in 2015, I was simply blown away by the talent within the medical illustration community. Not only do medical illustrators create beautiful works of art, they also have a unique hybrid of skills – both in the worlds of art and science. It was that skill set that can be useful for problem-solving and we saw many examples of how medical illustrators helped to develop novel solutions to challenges in medicine. At this conference, I had wonderful side conversations at the coffee breaks, over beers and over dinner with other attendees. We shared an immediate bond over our (geeky) love of art and medicine. Our conversations were surprisingly genuine and in-depth, and not the idle chit-chat that I sometimes encounter at conferences.
I thought it would be a long shot when I submitted an abstract to the AMI Annual Meeting 2016 in Atlanta, GA. The abstract was based on the idea of drawing as a tool for surgical trainees and I was going to delve into some of my own experiences. Nevertheless, I received this email the other day:
Great…Now I have five months to worry about this!
The last Turner exhibit that I attended was over ten years ago at the local art gallery and featured Turner, Whistler and Monet. It was so long ago that I can’t remember whom I attended the exhibit with. But I do remember Turner’s oil paintings and his distinct use of light and color. Of the three artists, his paintings clearly stood out.
On Saturday, I went to a new Turner exhibit and became re-acquainted with his work after many years. J. M. W. Turner (1775-1851) was a British landscape painter who had an incredible body of work spanning 60 years. Going through the gallery, he seemed to focus much of his attention on natural disasters, such as floods, fires and storms. There’s a great story of him asking to be tied to a ship’s mast during a storm in order to experience it first-hand. He painted his landscapes with broad, sweeping strokes and took a fine brush to draw in little details such as people and animals (which my daughter pointed out in delight).
Here are some of my favorites (2 of 3 were in the exhibit):
The Morning After the Deluge – Moses Writing the Book of Genesis (left)
Snow Storm: Steam-Boat Off a Harbour’s Mouth (top right)
Fishermen at Sea (bottom right)
The exhibit also inspired my little budding artist to share her own work: