Presented By: Nancy Donohoo, Boston University Chobanian & Avedisian School of Medicine
Co-Authors: Neoreet Braha, Boston University Chobanian & Avedisian School of Medicine
Kayra Cengiz, Boston University Chobanian & Avedisian School of Medicine
Cassandra Lee, Boston University Chobanian & Avedisian School of Medicine
Brandon Oddo, Boston University Chobanian & Avedisian School of Medicine
Tony Robinson, Boston University Chobanian & Avedisian School of Medicine
Emma Schmidt, Boston University College of Fine Arts
Noah Siegel, Boston University Chobanian & Avedisian School of Medicine
Jonathan Wisco, Boston University Chobanian & Avedisian School of Medicine
Crystal Zhu, Boston University Chobanian & Avedisian School of Medicine

Purpose
Previous studies have investigated the use of clinical illustrations to improve health literacy. Drawing experience varies amongst healthcare professionals and can be difficult to develop without guidance. A video tutorial was created to assist clinicians in improving the comprehensibility of their clinical illustrations.

Methods
Four physicians of Boston University Chobanian & Avedisian School of Medicine illustrated concepts related to their specialty: disc herniation (DH), Parkinson's disease (PD), sickle cell (SC), and X-ray imaging (XR); watched a video tutorial; and re-illustrated those concepts. For each concept, undergraduate student participants took a pre-quiz, saw either a pre-video (A) or post-video (B) image, and then took a post-quiz. The quiz scores were analyzed for differences in performance.

Results
We conducted paired sample t-tests for each of the eight testing conditions and found that quiz scores improved in all disciplines [DH-A: t(20) = 5.767; p <0.001; DH-B: t(20) = 4.903; p <0.001; PD-A: t(22) = 2.237, p = 0.018; SC-A: t(22) = 4.746, p <0.001; SC-B: t(21) = 1.914, p = 0.035; XR-B: t(22) = 2.113, p = 0.023]. Independent sample t-tests showed higher test score improvement for SC [t(43) = 1.707, p = 0.048] after viewing the post-tutorial image than when viewing the pre-tutorial image. The starting artistic ability of a physician is a confounding variable and may explain the lack of significant difference in post-test scores between A and B groups.

Conclusion
Clinical illustrations can enhance patient-provider communication and improve patient understanding across a variety of disciplines. Video tutorials are low-cost educational tools with the potential to improve clinical drawing skills and health literacy. Future studies should recruit participants with a wider range of health literacy to better assess the impact of image quality on understanding.