“Wash Your Eyes, See Differently”: Visual Thinking Strategies and Ageism in Medical Students—A Single-Arm Quasi-Experimental Pretest–Posttest Study

As the world's population ages, the number of people over sixty is growing faster than at any time in history. In many places, including Iran, this shift is happening with such speed that health systems are struggling to keep up. A major obstacle to caring for this growing group is not a lack of medical technology, but a set of deep-seated beliefs held by the people who will one day treat them. Many young medical students, despite their training, carry unconscious assumptions that older adults are frail, confused, or less valuable than younger people. This collection of stereotypes, prejudices, and discriminatory behaviors is known as ageism. It can lead to poorer health outcomes, missed diagnoses, and a sense of isolation for the elderly. While medical schools teach the biology of aging, they often miss the human side: how to see an older person as a whole individual rather than a collection of declining symptoms. Researchers are now asking if the arts, specifically the practice of looking closely at images, can help clear away these biases and teach future doctors to see differently.

A team of researchers at Zahedan University of Medical Sciences set out to test this idea with a group of thirty-five students who had not yet begun their internships. These students came from five different fields: medicine, nursing, physiotherapy, nutrition, and public health. The researchers wanted to see if a short, focused course based on a method called Visual Thinking Strategies could change how these students felt about older people. This method is not about art history or memorizing facts; it is a structured way of looking at pictures together. In a session, a facilitator shows an image and asks simple, open questions like, "What is happening in this picture?" and "What do you see that makes you say that?" The goal is to force the viewer to slow down, look for evidence in the image, and listen to how others interpret the same scene. By doing this, participants are encouraged to notice their own automatic thoughts and realize that their first impression might be just one of many possibilities.

The study took place over three consecutive days in the fall of 2025. The students were divided into small, mixed-discipline teams and attended three ninety-minute sessions. On the first day, they looked at ten different artworks depicting older adults in various situations—some working, some with family, some alone, and some sick. Guided by the facilitator, they discussed what they saw and what evidence in the painting supported their ideas. They were asked to listen to different viewpoints and avoid making quick judgments. On the second day, the activity shifted to poetry. The groups looked at a picture of an elderly person and worked together to write a haiku, a short three-line poem, that captured what they thought the person might be feeling or saying. On the final day, they engaged in a mask-making exercise. They were given an artistic image of an older person and asked to paint a mask that expressed their feelings about that image, then describe what they had created. Throughout the process, the focus remained on observation, evidence, and the shared experience of interpreting complex human images.

Before the first session began, the students filled out surveys to measure their current attitudes. One survey asked them to agree or disagree with statements about the elderly, such as whether they are generally happy or if they are a burden on society. Another survey measured specific instances of ageism, asking about their beliefs regarding the elderly's ability to work, their financial status, and their mental sharpness. After the three days of workshops, the students took the same surveys again. The results showed a clear shift in their thinking. The average score on the attitude survey, which measures how positive someone feels toward older people, went up significantly. At the same time, the average score on the ageism survey, which measures negative stereotypes and discriminatory views, went down significantly. The change was not just a small fluctuation; the data indicated that the students held fewer negative beliefs and more positive views after the intervention than they did before.

The researchers noted that this approach worked by creating a safe space for students to question their own assumptions. When students were forced to find visual evidence for their claims, they could not rely on vague stereotypes. When they heard a classmate from a different field of study describe the same picture in a completely different way, it challenged their idea that there was only one "correct" way to see an older person. The study suggests that these brief, art-based exercises can help future healthcare providers break down the mental walls they have built around aging. However, the authors were careful to point out the limits of their work. Because there was no control group of students who did not receive the training, they cannot say for certain that the art sessions were the only reason for the change, though the timing of the shift makes it highly likely. They also noted that the study was small and took place at a single university, so the results might look different in a larger or more diverse group. Furthermore, they did not measure whether these new attitudes lasted for months or years after the workshops ended.

Despite these limitations, the findings offer a promising path forward for medical education. The study demonstrates that a short, low-cost intervention can move the needle on deeply held biases. It suggests that the tools to combat ageism might not always be found in textbooks or lectures, but in the quiet, focused act of looking at a picture and asking, "What else do you see?" By training students to observe carefully and listen openly, medical schools may be able to produce doctors who see the person behind the age, ensuring that the growing number of older adults receives care that is not only medically sound but also deeply respectful.