When learning new skills, some struggle to learn the basics while others pick it up (seemingly) effortlessly. A friend and mentor recently sent me this article:
Why Are Some People Better At Drawing Than Others?
The article states that people who draw well are able to properly “see” their subject and have an innate ability to recognize proportions, light/shadows, etc. In contrast to those who struggle with drawing, who may not properly take in these subtle features. It is no surprise that skilled artists develop an “eye” for detail. Parallels can be drawn for skilled surgeons as well. The medical student may recognize obvious anatomical features. As they progress through their training, they learn to recognize normal versus abnormal characteristics. Further on, they recognize “planes” which broadly describe the natural spaces that occur between tissues. An operation can go well if you get into the right “plane” and the first step is recognizing it.
Fortunately, there is hope for us all!. Practice is the key to improving one’s skill, whether in art or surgery. In addition to the repetitive act of practicing, the important step is also reflecting on the last art piece or the last surgical case and thinking, continuously, how one can improve. In learning either discipline, people have a misconception that practice involves repeatedly “going through the motions”. In other words, “If I just do 100 cases of x, I will be an expert!” That is simply not true or even feasible as a trainee in this day and age. The phrase that comes to mind is, “Insanity is doing the same thing over and over again and expecting different results.” Reflection is integral to practice and without it, one cannot hope to improve. There is often this pressure to do more cases, hurry up!!! It takes every bit of my effort to slow down. Be mindful. And reflect.
The paradigm of surgical training is what educators like to call “graduated responsibility”. As we progress through our training, we incrementally ramp up what we are permitted to do in the operating room. I don’t know when this happened but somewhere in the past few months, I’ve felt a “switch”. For lack of better word, it is when one goes from being a surgical trainee with an attending staff always being in the room to being the surgeon. It is during a case when you realize that the most experienced surgeon in the room is you. It is when you stop yourself mid-sentence, as “the resident/fellow working for doctor so-and-so” to “the surgeon”. Families arrive at the surgical waiting area asking for you (who me?).
Of course, I am fortunate that this has occurred during fellowship and not during my first day of independent practice. I am grateful that more experienced help is only a phone call away. Mind you, this has come after years of surgical training. While most young surgeons are confident in their skills by this point, it is normal to feel some apprehension. For me, it has made me acutely aware of all the tiny details that I used to take for granted. It has made me a little obsessive-compulsive, too but one can hardly be faulted for that. My sketching and note-taking has also become a bit more refined as well. It covers not so much the basics but little nuggets of wisdom from my mentors that I would hate to forget as I move into practice. Seemingly minor points that allows the surgery to look effortless (which would otherwise be a struggle)! The other day, I noticed that the content of my drawings have changed and probably around the time that this so-called “switch” happened.
Last year, I was in the operating room several days per week and was much busier clinically. Aside from rough OR sketches, the only time I had to draw was on weekends and during my frequent periods of insomnia. I had difficulty sleeping and would just draw to get my mind off the constant thoughts about work. It was a form of meditation, of intense concentration that would not allow for any other thoughts. Although I loved it, life was about work and I would fit in drawing and running, with time for little else. I hardly saw my family last year and that was not sustainable.
The second (research) year of fellowship has been much less structured. Aside from the few days where I am scheduled in the clinic or operating room, the rest has been up to me with regards to research projects. I see my family every day, commute from the suburbs, run less and sleep more. All in all, I probably am still a happier person for it. I rarely have those nights where I am up several hours drawing. I have to say that I am much less inspired, although some would say manic. I do find it hard to enter that meditative state again when I draw during daylight hours. I don’t know what it is about night time and creativity, but there is something that is very special about those hours of the night.
Typically, surgeons review imaging (Xray, ultrasounds, CAT scans, MRI scans, etc.) preoperatively to help plan for surgery. At the AMI conference, physicians and illustrators discussed how art and technology can help with preoperative planning. During one presentation, a plastic surgeon showed 3D reconstructions of skull imaging to help plan a facial transplantation. During surgery for craniosynostosis (premature fusion of the suture lines of the skull), another presenter showed how 3D printing could be applied. Here, the goal of that surgery is to recreate a normal shape of the skull in children with craniosynostosis. 3D printouts of the skull with pre-planned markings for the bone grafts were sterilized and used to mark out the grafts intraop. All grafts were designated with a letter, eg Graft A. These grafts were then placed into a second template that showed where they would sit. Very cool.
As I write this, I am sitting on a weathered wooden bench in a park, at the center of the huge medical campus that is the Cleveland Clinic. I’ve had an amazing time here at the Association of Medical Illustrators Annual Meeting, learning new ideas and getting inspired by the works of art in the Salon and thought-provoking lectures, seminars and discussions.
Initially, I had my doubts about how much I would get from this conference as a physician. I met up with the only other non-illustrator that I know here for a brief research meeting. It just so happens that he is married to a medical illustrator and they attend one another’s conferences. Yet, the scope of the conference has been so broad that is has been very accessible to someone like myself. I identify as someone who is a physician primarily, enjoys art as a hobby and often thinks about the intersection of the two disciplines. In addition, there have been talks that have tapped into the deep recesses of my memory, such as 1st year anatomy, differential calculus and quantum physics! Just the mention of these topics and I was like, “oh yeah, I used to know this”. I love how medical illustrators are link between the worlds of art and science, and how much potential there is for their unique skill sets + problem-solving abilities.
Here are my favorite talks thus far:
In the few times that I have been asked to illustrate surgical techniques for publications and presentations, photorealism has been my goal. This involves sketching in a light H graphite pencil, tracing it out with an HB and shading in the darker shadows with an 3B pencil or even willow charcoal. Then I would blend with a blending stump or Q-tip and take out highlights with a fine pencil eraser. My technique was self-taught, as I had never taken an art class up until recently. Resources included Brian Duey’s website and the book he recommends entitled, “Drawing Realistic Textures in Pencil”. Both are amazing self-taught artists that can get you started in the world of photorealism.
Whenever I would try to make a drawing as realistic as possible with the above technique, I found it very time-consuming. I don’t know how many times that I blend a tone, it would fade too much and I have to add more tone to it. Or how many times that I just have to start over. The other issue that I have is that it does not scan well. I use a multipurpose HP scanner/printer and either the scan loses the fine detail of my tones or it picks up too much and the background white paper shows us as gray. The same happens when I take a photo with my DSLR camera. With my rudimentary photoshop skills, I find it difficult to strike a good balance of a keeping a clean background with sharp details and tones within the drawing. Here is an example rough sketch (although not photorealistic here, you can see how the background looks terrible):
While I am not a professional medical illustrator, I am occasionally approached by colleagues for drawings. Sometimes, they are looking for illustrations to be done on a tight timeline (i.e. <1 week) on a tight budget (i.e. free). Other times, they need rough sketches for medical illustrators to work from, whom ultimately produce finished pieces for publication. Here’s my drawing for a paper that was recently presented at a national meeting.
Title: Seromuscular bladder augmentation
Media: Graphite, Photoshop