Doctors and business leaders share similar roles as diagnosticians, communicators, and team leaders. Hailey Group’s approach to developing talent is partly rooted in a discussion method called Visual Thinking Strategies (VTS), which has been applied—and studied—for more than a decade within healthcare to improve observation, collaboration, precision of language, and comfort with ambiguity, key attributes of effective doctors and leaders.

The following entries, which summarize research on the impact of VTS interventions within medical education, are quotes from a chapter written by Alexa Miller, Philip Yenawine, and Dabney Hailey in the 2015 book, Visualizing Learning: Essentials of Teaching and Integrating Visual and Media Literacy.


“A 2008 study at Harvard Medical School analyzed a 10-week intervention with first- and second-year medical students that mixed VTS with clinical didactics and drawing (Naghshineh et al. 2008). Results in post-test writing samples included significant increases in frequencies of observations—students made 38 % more observations on both medical and art imagery than control group students—and in frequencies of use of evidence to back up interpretations. Importantly, students who attended eight or more sessions increased observation and language skills significantly more than students who attended seven or less. This ‘dose effect’ speaks to the developmental nature of acquiring visual literacy skills.

….The Harvard study included qualitative analysis of student writing samples documenting ‘increased sophistication’ in the words students chose to describe both clinical and art imagery (i.e., the increased or new use of words such as ‘shading’ or ‘contour’). These language changes reflect that students’ abilities to observe, infer, and express meaning from visual material (either clinical or artistic) became more robust and precise.”


“…students’ descriptions of visual material became more comprehensive, as demonstrated in [a study at the Robert Wood Johnson Medical School (Jasani and Saks 2013)], where analysis of writing samples documented increases in use of speculative language, visual analogies, and in the scope of interpretations.”


“A study conducted at the University of Texas Health Science Center in San Antonio (Klugman et al. 2011) looked at the results of three 90-minute VTS-based sessions with medical and nursing students; researchers examined student responses to both art and clinical imagery with both qualitative and quantitative tools in order to assess learning. Across the three studies—Harvard, RWJF, and Texas—students looked longer and had more to say following VTS interventions, indicating their enhanced performance of three crucial aspects of clinical observation: the ability to describe concretely what is perceived, the ability to separate fact from inference, and the understanding that observation takes time (Boudreau et al. 2008).”

In addition to looking at skill development, studies on VTS from the healthcare professions have also focused on the methodology’s effect on attitudes and beliefs about learning. Klugman et al. (2011) documented increases in positive views towards the essential role of communication within health care, and the importance of discussions about what is seen and found as being necessary for effective diagnosis; they also showed an increase in participants’ tolerance of ambiguity—a cognitive variable significant to aspects of medicine including worldview, test ordering, defensive practice, and discomfort in scenarios of death and grief (Geller 2013).”


“A separate qualitative study on nursing students’ experiences with VTS at Indiana University revealed two standout themes: ‘feeling safe in learning’ and ‘thinking and seeing differently’ (Moorman 2013). Students particularly valued that during VTS discussions, they were able to express differences of opinions without feelings of criticism or judgment. They also positively emphasized the experience of having their own judgments change based on observations made by others. ‘Ok, I can see how you got to this’ is how one student describes this experience, which connects with ‘mutual respect,’ a subtheme of the Indiana study.”


A qualitative study from the social work field, conducted at the University of North Carolina, Chapel Hill, examined an intervention in which VTS was used in diversity training for teachers (Chapman et al. 2013). The researchers looked at both ‘schema change’ and how images function in catalyzing dialogue. Their findings noted changes in participants’ descriptions of ‘shifts in awareness, perspective-taking, attitude change, and more complex thinking about Latino/Latina immigrants’ (the subject of most of the images used in this case). Many of these attitudinal findings reflect participants’ reconciliation of their own visual experiences with the experiences of others, suggesting the persuasive influence of social interactions as part of the visual literacy learning process, and its potential to alter schemas about the construction of knowledge.”


Boudreau, J. D., Cassell, E. J., & Fuks, A. (2008). Preparing medical students to become skilled at clinical observation. Medical Teacher, 30, 857–862.

Chapman, M., Hall, W., Colby, R., & Sisler L. A. G. (2013). How images work: An analysis of a visual intervention used to facilitate a difficult conversation and promote understanding. Qualitative Social Work, 13(4), 456–476. doi:10.1177/1473325013496597.

Croskerry, P. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine, 78(8), 775–780.

Geller, G. (2013). Tolerance for ambiguity: An ethics-based criterion for medical school selection. Academic Medicine, 88(5), 1–4.

Hailey, Dabney, Miller, Alexa, & Yenawine, Philip. Understanding visual literacy: The visual thinking strategies approach. In D. M. Baylen, & A. D’Alba (eds.), Visualizing learning: essentials of teaching and integrating visual and media literacy. New York: Springer. 2105.

Jasani, S., & Saks, N. (2013). Utilizing visual art to enhance the clinical observation skills of medical students. Medical Teacher, 35, e1327–e1331. doi: 770131.

Klugman, C., Peel, J., & Beckmann-Mendez, D. (2011). Art rounds: Teaching interprofessional students visual thinking strategies at one school. Academic Medicine, 86(10), 1266–1271.

Moorman, M. (2013). The meaning of visual thinking strategies for nursing students. Dissertation, University of Nevada Las Vegas.

Naghshineh, S., Hafler, J., Miller, A., Blanco, M. A., Lipsitz, S., 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.