Sensory

What the eye can’t see: closer observation with touch and drawing in anatomy education

Guest post, by Leonard Shapiro B.Soc.Sc., B.A. Fine Art (Hons.), Department of Human Biology, University of Cape Town, South Africa. (www.lateralleap.co.za, Twitter: @leonard_shapiro, Instagram: @leonard_shapiro)

In the post, Leonard Shapiro describes how he came to develop an observation method based on touch and drawing.

Fig. 1: Anatomy observation exercise using touch and drawing in action. A class of 20 UCT medical students observing and drawing a humerus on single sheet of paper in a group exercise. Filmed by Leonard Shapiro and edited by Layla Mahomed.

The expression that something is ‘under our nose’ refers to the way we often fail to see things that are close to us.

I have found that even with an object in plain sight and in close proximity, there is a lot more in front of us than meets our eye. By observing an object using our sense of touch, we are able to add much more about the three-dimensional (3D) form and detail of the object that would otherwise be entirely unavailable to sight-only observation.

Figs 2– 3: Feeling the hammer to understand its 3D form, and then drawing what is felt. Drawing by UCT medical student, Rivoningo Baloyi. Image credits: Leonard Shapiro.

As neuroscience informs us, the afferent nerves of our hand (the nerves going from our hands to our brain) take up a large part of the sensory cortex of our brain (Figs. 4 and 5, below). It makes sense therefore, to include our sense of touch if we want to observe physical objects in more detail and better understand their 3D form and structure.

Fig. 4 (left): The Homunculus ‘pink person’, illustrated by Chris Macivor. Fig. 5 (right): The ‘brain image’, illustrated by Spencer Sutton. These show the relatively large amount of nerves from the hand represented in the sensory cortex of the brain. A cortical homunculus is a distorted representation of the human body, representing areas and proportions of the human brain dedicated to processing sensory functions for different parts of the body.

Six key finger movements

We naturally apply a number of movements with our hands and fingers when we touch an object, to gather information about its shape, texture and weight. In fact, we unconsciously use our hands and fingers to explore objects daily in order to gain a direct, ‘in-touch’ understanding of their characteristics. We do this though what Professors Roberta Klatzky and Susan Lederman identified as six key finger-movements, or Exploratory Procedures (EPs), with which we gather information about objects that we come into contact with (Klatzky and Lederman, 1987).

Fig 6: Six manual exploratory procedures (EPs). (Klatzky and Lederman, 1987).

The observation method that I designed importantly includes the sense of touch, via the active application of the EPs to explore an object. When touch and sight is coupled with drawing, a far more comprehensive set of data about an object is obtained, especially about its 3D form. I named this the Haptico-visual observation and drawing (HVOD) method. This has proved to be a valuable observation method for medical students, especially as a complement to their study of human anatomy – better observers make for better surgeons, better radiation oncology planners, better orthopaedic surgeons and better general practitioners, to name a few.

I evolved this method as a result of 13 years of teaching observational drawing to artists and first-time drawers. I would ask my students to use their hands to feel the object they were observing and drawing. This made a dramatic impact on their drawing quality; they observed the object far more accurately and translated this accuracy into their drawings.

This drawing style results in drawings that do not look like photographic, hyper-realistic representations of the object; rather, the drawings are made up of gestural lines that track and describe its 3D form, observed using both touch and sight. This style of drawing is referred to as ‘gestural drawing’. Exploring an object using touch involves gestures and using drawing to describe what has been touched involves similar gestures.

Fig. 7: Observing the base of the skull using touch. Drawing by UCT medical student, Nevin George.   

Why include touch AND drawing in the observation process?

Drawing the 3D form of the object can inform us of the accuracy with which we have understood the object. Drawings are our recordings of what we observe, and inform us as to how well we have observed that object. By looking back-and-forth between the object we are observing and through our drawing of it, we begin to notice which areas of the object we have observed well and which areas we still need to observe more closely. By returning our gaze and touch to those areas of the object, we observe it further and get to understand it as it really is, and not as we imagine it to be.

Fig. 8: Haptic observation and drawing of humerus, by Leonard Shapiro.
Fig. 9: Medical Students observe and draw a humerus while rotating it in order to understand its 3D form. Film by Leonard Shapiro.
Fig. 10: Group drawing of humerus on single sheet of paper, by a class of 20 UCT medical students (see Fig 1 video at the beginning of this post).

Benefits in Anatomy Education

At the University of Cape Town (UCT), I run a 4-week, mark-bearing Haptico-visual observation and drawing module for third-year medical students. On this course, the students learn the HVOD method (which takes 3 days) and then go on to apply it in the study of bones, prosections, wet specimens and cadavers. The results are better spatial awareness, memorisation of anatomical parts as a visual image, improved observation and an ability to draw. I also teach and run a UCT-certificated, Continuing Professional Development HVOD course for health care professionals.

Student comments on observing using touch and drawing

“… this style of drawing, it got through to me
differently…I got more of an accurate sense
of everything that encompasses the object”.
[Participant B]


“…feeling it with your eyes open and closed and
kind of just a lot more intimately, I was able to
kind of see a lot more of it…also the abnormalities
with it”.
[Participant C]

“… the point, the point isn’t to be able to draw a
beautiful picture, the point is to have it in your
mind, to have that picture in your mind so you
can understand it and discuss it, probably in a
clinical setting, or, well that’s the thing, so I like
the idea of visualizing it in my mind and having
all the grooves, and draw it like drawing a very
flimsy sketch on a piece of paper, but more to
make sure that I’ve got the concept in my mind,
not to spend hours on a beautiful picture”.
[Participant B] (Reid, et al 2018).

International Collaborations and using electroencephalogram to understand brain activity when touch and drawing are used in observation

In 2017, by the invitation of Dr Iain Keenan, Senior Lecturer in Anatomy, I conducted a 3-day HVOD workshop at Newcastle University School of Medical Education. Dr Keenan and I share an understanding of the importance and benefits of art-based practice in anatomy education. We are close collaborators and have presented talks, abstracts and posters at a number of anatomy conferences including the International Federation of Associations of Anatomists (IFAA2019). Dr Keenan and I are collaborating in the development of a Massive Open Online Course (MOOC) which will enable medical students the world over to benefit from an online course where they can learn methods to improve their observation and study of anatomy (Shapiro and Keenan, 2019). This MOOC is a collaboration between Newcastle University and the University of Cape Town.

In addition, Dr Keenan and I are now collaborating on a study being conducted by Neuroscience PhD student Toby Branson at The University of AdelaideThe study explores different forms of anatomy learning, and includes an experiment using electroencephalogram (EEG) to measure the brain activity of people using the HVOD method in order to understand which parts of the brain are involved in this process, and why it is effective.

References

Klatzky, R. L. and Lederman, S. J. Hand Movements: A window into haptic object recognition. Cognitive Psychology, 1987. 19(3), 342-368

Reid, S., Shapiro, L. and Louw, G. How Haptics and Drawing Enhance the Learning of Anatomy. Anatomical Sciences Education, 2018. Read paper here  

Shapiro, L., Bell, K., Dhas, K., Branson, T., Louw, G., Keenan, ID. Focused multisensory anatomy observation and drawing for enhancing social learning and three-dimensional spatial understanding. Anatomical Sciences Education, 2019. Read paper here

Shapiro, L. and Keenan, ID. Collaborative optimisation of focused anatomy observation and drawing techniques for enhancing cognitive memorisation. International Federation of Associations of Anatomists (IFAA), 19th Congress Abstracts, 2019. (63:1-364). Read abstract page 63 here

Acknowledgements

Emeritus Professor Graham Louw, M.Phil. Higher Education Studies (UCT), D.V.Sc (UP), Faculty of Health Sciences, University of Cape Town, South Africa.

Professor Steve Reid, M.B.Ch.B., Ph.D., Chair of Primary Health Care in the Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

University of Cape Town (UCT) medical students for use of their drawings.

We acknowledge with gratitude the contribution of body donors to the UCT Division and Clinical Anatomy and Biological Anthropology.

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