Images in Assessment

Thought and care should be taken when using images in medical education assessment.

An example of an image used in assessment of anatomy knowledge, from Vorstenbosch et al 2013.
An example of an image used in assessment of anatomy knowledge, from Vorstenbosch et al 2013.

The use of images in assessment can increase the difficulty of some questions, and lower the difficulty and discriminating power in others, depending upon the type and complexity of images that are chosen (Vorstenbosh et al 2013). Surprisingly, the use of images in assessment has received almost no previous attention in scholarly work and as our media become increasingly digital the use of images is likely to increase. Vorstenbosh and colleagues have provided an important contribution to an area that requires much more attention.

The use of images in assessment as stimulus format (questions) is an area that can use additional attention.  Another area for further examination is  how images (drawings) are used as response format, with students providing drawings as answers. Drawings are visual representations of knowledge that includes spatial and can include descriptive information when labels are included. When is it most appropriate to request a drawing as an answer to a question?  Does a drawing provide unique benefits for assessing some types of knowledge?

Vorstenbosch did not consider the use of drawings in assessment.  Their focus was on the use of images as stimulus format in anatomy assessment.  Surprisingly, they were unable to find any previous published work in how images impact assessment, which suggests their work may become a  starting point in a new field of inquiry.   This area could use more research and Vorstenbosch et al have provided a meaningful contribution.


Vorstenbosch M., Klaassen T., Kooloos J., Bolhuis S., and Laan R. 2013. Do Images Influence Assessment in Anatomy? Exploring the Effect of Images on Item Difficulty and Item Discrimination. Anatomical Sciences Education (6) 29-41.

Please feel free to share your thoughts or comments below….



Observing Life-drawing in Medical Education

The human body is obviously of great interest to the physician; the patient’s body and mind are the focus of health care.  Visual artists also have great interest in the human body, explored most directly through life-drawing studies.

Sitting woman, drawing in black crayon, school of Rembrandt (17th century). From Wikipedia.

While there is a long history of using ‘living models” in anatomy training (Collett et al 2009), attempts to use life-drawing sessions in medical education are more recent and rare.  Although educational useful in several ways, initial reports suggest life-drawing is not appear to be helpful to students for learning anatomy (Collett et al 2009, Phillips 2000). It seems that the emotional charged nature of the naked human body involved in life-drawing and limitation to visible surface anatomy limit the utility of life-drawing for teaching of anatomy.

The use of life-drawing does appear to be helpful for providing students with a more holisitic view of the human body (Phillips 2000) or to explore ideas of cultural stereotypes related to attractiveness and beauty (Collett et al 2005). Life-drawing sessions also provide opportunities for observation drawing training and students do feel that the observation drawing does provide increased clinical skills of hand-eye coordination and an ability to observe critically (Collett et al 2005).


Although life-drawing may have limited utility for teaching anatomy topics, when students engage in observation drawing training that uses anatomical specimens (bones, pro-sections), the sessions improved or allowed discovery of unrealized drawing skills, helped them to observe structure in new ways, and to consider morphology from different perspectives (Mitchell 2001).  Responding to Phillips’ use of life-drawing, Mitchell’s letter to the editor provides a brief summary of a semester long course titled “Images of Anatomy” offered to BSc degree students at St George’s Hospital Medical School from 1999-2001 focused gross anatomy training within a clinical context.  Part of the course involved three 2-hour sessions on drawing anatomical images taught by a professional art teacher.

Providing formal observation drawing skills training to medical students that uses anatomical models and pro-sections as subject matter is what was continues to be explored at Dalhousie Medical School (MODEL Program).

Please feel free to share your thoughts below…


Collett T. J. and McLachlan 2005.  Does ‘doing art’ inform students’ learning of anatomy? Medical Education, (39) 521.

Collett T. J., Kirvell D., Nakorn A., and McLaclan J. C. 2009.  The role of living models in the teaching of surface anatomy: Some experiences from a UK Medical School.  Medical Teacher, (31) pgs. e90-e96.

Mitchell B. S. 2001.  Life Drawing Classes (Letter to the Editor). Medical Education (35) 516-517.

Phillips P. S. 2000.  Running a life drawing class for pre-clinical medical students.  Medical Education (34), pgs. 1020-1025.


Drawing, Dissection, and Time

My interest in the pedagogical benefits of observation drawing was initially inspired when I had been thinking about debate that continues to appear in educational literature about the importance of anatomy dissection in medical education (citations). It occurred to me that anatomy dissection, being a process that requires elevated attention and delicate hand dexterity to expose the fine details of delicate anatomical structures, was a process that required learners to slow down and invest time in careful observation of the subject. Anatomical dissection requires elevated attention, purposeful action and a slow and methodical process. It is possible to cut improperly and destroy a structure, so dissection requires learners to slow down and observe deeply.

In the education literature that examines alternatives to gross dissection, comparisons are often made to educational programs that use pro-sections, 3D models, multimedia resources (virtual 3D models) or other eLearning resources. It occurred to me that the one thing these alternative curriculum artifacts lacked in comparison to dissection, was that the learner was not necessarily required to invest extended time and attention in the observing the content. Dissection requires time, heightened observation and focused attention, but the alternatives do not require that same level the use of attention or time.

The way in which alternative educational resources are used in education programs can vary, and this is the basis of instructional design. The use of a 3D model or pro-sections can be observed and discussed verbally, be optional supplemental material or the central focus of the educational program.  How resources are used is as important (if not more important) than what resources are used.

Observation drawing, similar to dissection, is a process that requires time, heightened observation and focused attention.  Observation drawing can be a purposeful learning process that requires learners to invest time and attention on the careful study of physical or digital 3D models and pro-sections. By incorporating observation drawing as a pedagogical method, the learner is required to invest time and attention.  Hand eye coordination and dexterity is another skill that is increased with the observation drawing, as it is with dissection. 



Observation and Creativity in Science

In the evening of Wednesday April 17th, Dr. Louis Taillefer presented the Inaugural Killam Prize Talk “On Creativity in Science” to a full room at the Rowe Building at Dalhousie University.  Dr. Taillefer presented personal reflections about creativity in science based on examples from the history of physics and recent work in his lab and with colleagues.

Dr. Taillefere discussed four aspect essential for creativity and discovery in science, including:

  1. Open Mind
  2. Imagination
  3. Observation
  4. Intuition

Two important points related to drawing and observation skills stood out during Dr. Taillefer’s presentation.  The first was that he mentioned in his work as a physicist (studying superconductors), he “drew a phase diagram many times each day” while trying to understand new phenomena or consider new experimental approaches.  The second point was that one of the major discoveries made recently in his lab came about from an observant student who noticed an almost imperceptibly subtle wiggle in a curved (exponential) line on a graph.  The first example provided evidence for the importance of sketching for knowledge construction, and the second is a great example about the importance of careful observation.

Redrawing a diagram, like this phase diagram, on a chalkboard is one way that physicists work through problems and find new solutions. Sketching is important for externalizing ideas and provides opportunities to discover new connections.

Drawing a phase diagram or a graph while thinking about a topic does not involve observation drawing, rather it is the depiction of phenomena and relationships between unseen processes.  This is an example of drawing to think.  The sketching the phase diagrams relates to the importance of sketching for the externalization of ideas that assists in the construction of new and novel relationships and ideas.  The importance of sketching for creative discovery has been studied by Verstignen et al (1998), who found that sketching as an externalization process was important for restructuring and combining knowledge to make comnnections and discoveries.

Observation skills can impact how we see data.

The second point of interest from Dr. Taillefer’s presentation involved the keen observation skills of one his students, who noticed a very slight wiggle in a line graph generated through computer analysis.  The graphed line (above) may be interpreted by some as a smooth exponential line, but a keenly observant student noticed a slight wiggle that appeared to be present.  Was the wiggle an optical illusion or perhaps an insignificant artifact or anomaly?  Greatly simplifying the physics involved, they ‘cranked up the power’ of the magnet and found that the wiggle was indeed significant, and they discovered a new phenomena (below).  Using keenly tuned observation skills and as Dr. Taillefer noted “loving your data” enough to look at it with great care an interest, is what leads to new discoveries.


There were many other interesting points made throughout Dr. Taileffer’s presentation, but the main take home message for me was his example of how his team repeatedly drew a diagram as a part of their thinking process; externalizing information as necessary for constructing new knowledge. These “thinking drawings” are different from observation drawings, but the importance of sketches for generating new knowledge is of special significance when thinking about creativity and discovery in science.





Drawing Skeletons

The third of the Dalhousie Observation Drawing sessions occurred on March 26th, from 4:30-6:00. The weekday (Tuesdays) and time seem to work well for most students. The university halls are a quieter than the morning rush, and students can attend unless assignments are due the next day.

The third session focused on skeletal subjects, including several seal bones and two mounted feline skeletons. As usual the sessions started with several short (15 second) warm up drawings, and then some longer (30 second) warm up drawings.  The idea of these warm up drawings is to encourage trying to see large shapes, angles and proportions.  Most drawings should start in this way, with light pressure lines rapidly trying to capture the large proportions and shaps.

After the warm up the group did a memory drawing exercise. The seal bones were placed in the middle of the table and covered with a sheet of paper. When the sheet was lifted the participants had 30 seconds to observe the different elements, without doing any drawing. When the sheet was returned participants could then begin to draw, what they  remembered seeing.  The memory drawing is intended to demonstrate the fallability of memory.  The exercise also shows how much easier it is to draw when you observe rather than what you think you see.

Drawing skeleton specimens at the Dalhousie McCulloch Museum.
Drawing skeleton specimens at the Dalhousie McCulloch Museum.

With the warm up activities done, several longer drawings were completed on the normal newsprint paper but then the good paper (mylar) was brought out for a final (30 minute) drawing.  The use of mylar paper provided an increased ability to shade and produce very dark lines.  The mylar paper is a high-quality drawing material.  Although initially intimidated by the nice paper, the final drawings were very good.

Final drawings of the cat skeleton on mylar paper.
Final drawings of the cat skeleton on Mylar paper. Notice the seal bones on the table as well.

I am grateful for the students who have attended the sessions and participated in the Observation Drawing Sessions.  The term is starting to wind-down, assignments are coming due and exams are on the horizon. Based on these initial sessions the hosting of future sessions has good potential.


Drawing Elastics

For the past week I have been completing short daily observation drawings in a thin Moleskin folio. The intention is to draw from observation for ten-minutes per day, topics that are visually interesting and relevant for learning.  During the first week this involved drawing an online VR seal humerus (link) from multiple vantage points, as well as redrawing illustrations from academic publications.

Today, the daily observation drawing involved a small elastic band looped into a loose knot.

Ten minute elastic drawings, using Prang Charcoal Pencil (soft) in a 50 pg Moleskin folio.  The elastic knots mimic organic forms.
Ten-minute elastic drawings, using Prang Charcoal Pencil (hard) in a 50 pg Moleskin folio. The elastic knots mimic organic forms.

An elastic band makes an excellent subject for observation drawings. The shapes can change easily with a slight tug or rotation, providing multiple variations that retain and heighten the need for careful observation.  The elastics drawings  mimic organic forms; being mobile, flexible and always under slight internal tension. Also, within reason the accuracy of observation achieved can be estimated through the accuracy of depiction.

The Prang charcoal pencils are useful for focusing attention on shadows, surfaces, and providing the ability to produce the largest variation in tone (very light to very dark).

Drawing elastics will be a helpful observation drawing activity for many professions.  Elastics can mimic organic forms (biology, medicine, engineering)  and they can have complex structural and spatial relationships.

Completing observation drawing projects like this can enhance general observation skills.  It’s easy to find an elastic-band nearby.  Objectives to keep in mind.

  • Begin by lightly locating edges of form.  These can be just dots to locate edges and identify scale of objects.
  • Try to establish the edges of the drawing to fill the height or width of the page.
  • Lightly map out main shapes, observing relative sizes of elements.
  • Gradually add details across entire object, lightly at first.
  • Darker lines added as confidence in details increases through ongoing observation.
  • Continue observing and clarifying details, noting connections between elements (overlap, sizes, directionality)





Drawing Observations

The second session of the Observation Drawing for Natural Sciences was held on March 19th. A (final?) winter storm arriving tonight and only two weeks left in the term, but still several students attended and drew for ninety minutes at the end of the day. The sessions are informal and social.

A typical session, tonight started with about eight 30 second drawings, getting eyes attentive to observing carefully while loosening up the hand to move as quickly as the eyes.  Following a brief look at a few of the drawings and a chat about distance, details, mark making, and surfaces, drawing continued with several two-minute and then ten-minute drawings.

Tonight the drawings were done on 14×17 newsprint pads, using charcoal sticks and 6B pencils.  The smaller pad size worked well and avoided the need for larger and heavier drawing boards.  In the museum there are several surfaces to rest the drawing pads on, but some kind of drawing stand may be helpful in the future.





Observation Drawing at Dalhousie

The first Observation Drawing session was held in the McCulloch Museum on March 12th.  Thanks for the interest of the the several students who attended.  The museum turned out to be a very good location for this type of session – with lots of variation in subject (Audubon birds, skeletons, coral, bugs, fossils and more), scale (bugs to whale bones) and with excellent space across the room.  Lighting in the cases is very good, and supplemental lights in the next session will provide opportunity to increase contrast/shadows.

McCulloch Museum Observation Drawing 2013

The bird case displays have some interesting history.

The McCulloch collection was established in the early-1800s, as educational material for the Pictou Academy (1816-1837).  While at the Academy, McCulloch instructed the teenaged, Sir William Dawson, the namesake of the Dalhousie Geology Student Society, former President of McGill University, and famous Carboniferous paleontologist and friend of Sir Charles Lylle.  Thomas McCulloch was also the first Principle of Dalhousie University (then Dalhousie College).

McCulloch’s bird collection was inspected by Audobon sometime around 1836, and Audubon apparently provided McCulloch a print as gratitude for meeting and discussion of ornithology. The McCulloch Museum was founded in 1884 when McCulloch’s brother donated the ornithology collection to Dalhousie University.

The Observation Drawing sessions will continue through March.



Thinking with a Pencil

Originally published in 1957 (Editions 1964,1981), Thinking with a Pencil by Henning Nelms provides a catalog of how the styles and technology of representation can shape the thoughts and pattens of observation. He starts by pointing out that  knowledge can affect drawing ability and confidence:

Need for Data. If you have found drawing difficult, you probably attributed this to a lack of skill. Actually, part of the trouble was almost certainly due to something quite different – lack of knowledge about the thing you were trying to draw. (Pg 1.  Ten Speed Press, Berkeley California, 1981)

The proposal that drawing skill and confidence will improve with an increase in the quality of knowledge is insightful, and the inverse also seems likely true, that knowledge will increase with drawing.  It seems that the action of completing an observation drawing, putting “pencil to paper”, will similarly increase the quality of knowledge.  Although drawing from memory is dependent upon knowledge and memory,  observation drawing provides an opportunity to visually study an object or scene in greater detail and over extended time.  Knowledge of the subject and sensitivity to the patterns of the field of study are promoted by observation drawing.

Thinking with a Pencil - Nelms 1981 CoverThe diagrams and illustrations in Nelms 1981 edition remain the originals from the 1957, maintaining the fashion and image reproduction technology methods of the late 1950’s era.  Compass protractors, copy stand devices, and late-fifties style and fashion demonstrated in the photographs display that era’s image reproduction technology and methods.

The reproduction methods and tools included in Nelms’ book were used previously by industry professionals, and provided the opportunity to improve observation and visualization skills. Yet, the tools (protractors) and methods (copy stands) in Thinking with a Pencil are not commonly used today. Among the proliferation of mobile-phones,  tablets, and laptops, our cultural landscape is even more hyper-visual than the mid-twentieth century. Our current cultural communications are dominantly visual, digital, mobile and online.

There are (rare) laptop and tablet devices that promote (permit) the use of drawing as digital input, either through peripherals or system based tablets.  However, the pencil and paper will always remain the most affordable and widely accessible technology for drawing observations or plans .  Amid this digital boom, there is perhaps no better time to ensure we keep putting pencil to paper, or stylus to screen if available.

Observation drawing provides an valuable opportunity to enhance observation skills and knowledge.  Thinking with a Pencil is filled with useful insights on the relationship between visualization and knowledge development.  Although the text has a couple of chapters that are obsolete and historical, but most of the text remains useful for those interested in improving their ability to draw, whether for observation or visualization (thinking).


Henning Nelms (1900-1986) also wrote a mystery novel (Rim of the Pit, 1944) under the pen name Hake Talbot (1).



Micro Observation Drawing

Observation drawings of three dimensional objects and spaces provide opportunities to improve spatial knowledge and perception.  Photographs and illustrations can also act as useful subjects for observation drawings, being clear to distinguish between reproduction and copying – and dominance of observation in the former.

Micro-scale Drawings

Photographs of micro-scale shapes and textures that were visualized with scanning electron microscopy can be excellent sources for observation drawing.  There is no way to view the shapes and textures at the nano-scale without use of high magnification technology.  Using high magnification images for observation drawing provides opportunities to explore the physical shapes that occur on the micro-scale.

Below is a 10 minute observation drawing (left) made from a micrograph (right) of an arm fragment of a microscopic ostracod (two-shelled crustacean), showing joints and fine vibrissae (hairs) coming from limb ends.

Micro Observation Drawing

Give it a try

Click here to view the original micrograph on Morphbank.  Or, explore Morphbank and find other micrographs or photographs you find interesting.  Choose one and create an observation drawing of the structural details.  You can zoom in/out of the Morphbank images.

Try it… and share your thoughts about if you were able to “see more” by creating the observation drawing.

Leave a comment below to share your experiences or questions.