A systematic review of visual thinking strategies in medical education

Arts and humanities are increasingly recognized as integral to medical education, fostering empathy, observation, communication, and resilience. Visual Thinking Strategies (VTS), an arts-based pedagogy rooted in museum education and developmental psychology, has been applied in medical training for more than two decades. This systematic review examined the scope, quality, and outcomes of VTS interventions across the continuum of medical education, including premedical students, medical students, residents, fellows, and faculty. Following PRISMA guidelines, we searched MEDLINE, Scopus, ERIC, and ProQuest Central through October 2024. Covidence was utilized to assist in the review process. Eligible studies were peer-reviewed original research evaluating VTS as a learning activity with medical learners using qualitative or quantitative outcome measures. Programs limited to non-medical health professions or lacking evaluation were excluded. Data extraction captured study characteristics, participant demographics, intervention design, outcomes, and methodological rigor. Quantitative studies were appraised using the Medical Education Research Study Quality Instrument (MERSQI). Of 1,866 references, 43 met criteria. Most were published between 2020 and 2024 (60%) and conducted in the United States (74%). The three largest groups of learners included medical students (33%), residents (28%), and interprofessional students (19%).The majority were single-institution, non-controlled interventional studies. Outcomes were primarily assessed at Kirkpatrick Level 1 (47%) and Level 2 (51%), with one study reaching Level 3. Quantitative assessments most frequently employed Budner’s Tolerance for Ambiguity Scale and the Communication Skills and Attitudes Scale, alongside other validated tools, while qualitative studies analyzed reflective narratives. Reported benefits included enhanced observation, communication, empathy, tolerance for ambiguity, and diagnostic reasoning. MERSQI scores ranged from 7 to 15, indicating moderate methodological quality. This review highlights a marked increase in VTS scholarship, aligned with national calls to integrate arts and humanities into medical training. While evidence supports VTS as a valuable tool for fostering key competencies, most studies remain limited in design. Future research should prioritize multi-site, longitudinal, and higher-rigor approaches to evaluate sustained effects on clinical practice and patient outcomes.