Medical Exhibits - Demonstrative Evidence Expert Blog - MediVisuals

By: Robert Shepherd MS, Certified Medical Illustrator, Vice President and Director of Eastern Region Operations, MediVisuals Incorporated

As like most moveable joints, the tibiotalar joint consists of smooth articular bone covered by thick, shock-absorbing articular cartilage.

During trauma, the joint surfaces can be driven together resulting in injuries to the cartilage and microfractures of the articular surface (even without obvious intrarticular fracture).

The bone and cartilage then undergo changes that result in the progressive breakdown of the joint. As the process advances, the joint becomes painful. In most cases, the only treatment options are joint replacement or fusion.

The acromioclavicular (AC) joint also frequently falls victim to traumatic arthritis. As the AC joint enlarges (hypertrophy) it impinges on the rotator cuff, which is referred to as subacromial impingement. This can cause irritation or tearing of the rotator cuff and is most often treated by AC joint resection and subacromial decompression.

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Just as all treating physicians and/or medical experts are not the same, all medical illustrators are not the same. Attorneys typically go to great lengths to ensure that testifying experts for their cases are adequately credentialed, but many give little thought to applying the same due diligence when selecting a medical illustrator. This can be a big mistake because unlike many “professionals”, there is no basic training, licensing, or certification process that is required for an individual to call themselves a “medical illustrator”. Many less skilled and/or less qualified “medical illustrators” market to attorneys – perhaps because attorneys are less able to detect errors in their work. For these reasons, it is the responsibility of the attorney and/or medical expert to their clients to ensure they enlist the services of a medical illustrator who is qualified to provide those services.

Working with a qualified medical illustrator who has experience in the medical-legal area can be a pleasant, enjoyable experience for the testifying expert as these medical illustrators are able to read and comprehend medical records, review imaging studies, and discuss complicated anatomical and medical terms on a very similar level as the expert. On the other hand, working with an un- or minimally qualified and/or inexperienced medical illustrator can be a frustrating and time consuming task that may require multiple revisions of drafts, ineffective demonstrative aids, or even embarrassment during a hearing because of the discovery of some error or inconsistency during testimony.

It can be difficult to determine the qualifications of a medical illustrator based upon looking at their artwork alone. A copy of a résumé or curriculum vitae should be requested. One of the most basic requirements that the résumé should show would include graduation from one of the below medical illustration graduate programs. There are several medical illustration programs in colleges and various institutes in North America and across the globe; however, only five are currently accredited by the American Medical Association, and Commission on Accreditation of Allied Health Education Programs. Those programs include:

• Medical College of Georgia - Master of Science in Medical Illustration

• University of Illinois at Chicago - Master of Science in Biomedical Visualization

• Johns Hopkins University - Master of Arts in Medical and Biological Illustration

• University of Texas, Southwestern – Master of Arts in Biomedical Communications

• University of Toronto - Master of Science in Biomedical Communications

Other criteria that should be evident in a résumé or CV that would help demonstrate at least minimal qualifications are 1) Certification as a medical illustrator as issued by The Board of Certification of Medical Illustrators and 2) Professional Membership in the Association of Medical Illustrators. Both of these require that the individual possess at least minimal medical illustration training and skill levels. Also, just as there are different subspecialties in medicine which require specific and advanced skills and knowledge, specialization in “medical-legal” illustration requires additional knowledge and experience in addition to those required for general medical illustration. For that reason, it is also wise to select a qualified medical illustrator who is not only familiar with illustration and medicine, but also has a significant amount of experience in creating illustrations for litigation purposes.

A very effective way of increasing the effectiveness of expert testimony is by enhancing focus, understanding, and recall by teaming the testifying expert with a qualified medical illustrator, experienced in preparing legal graphics (illustrations, animations, models, etc.). By working together, the medical knowledge and oral skills of the expert can be supported by expertly created medical graphics that greatly clarify complicated anatomical, physiological, and medical subtleties. Together they result in much more effective communication with the decision makers than if verbal testimony or the graphics were used alone (one mode of communication used alone without being supported by the other). In addition, during a period of hours or days of listening to arguments that are typically only verbal, decision makers grasp the opportunity to focus on visuals in the form of illustrations, photographs, models, and/or animations. In fact, information is generally better processed if jury members and other triers of fact can have information presented in a multimodal fashion (i.e. combinations of simultaneous auditory, visual, and tactile stimuli).

The effectiveness of visuals is supported throughout our society by such common phrases as “A picture is worth a thousand words”, and “Seeing is believing.” In addition, numerous manuscripts refer to studies substantiating that recall is greatly increased when the verbal message is supported by visual images. Typically these studies have shown that after varying periods of time information that was delivered by a combination of voice supported by visuals was recalled at a significantly higher percentage than the same message delivered by voice alone.

References

DeBoth, C. J., & Dominowski, R. L. Individual differences in learning: Visual versus
auditory presentation. Journal of Educational Psychology, 1978; Aug 70 (4): 498-503

McCall, J., & Rae, G. Relative efficiency of visual, auditory and combined modes of
presentation in learning of paired-associates. Perceptual and Motor Skills, 1974; June (38) : 955-958.

Multimodal Learning Through Media: What the Research Says. Cisco Web site. http://www.cisco.com/web/strategy/docs/education/Multimodal-Learning-Through-Media.pdf. Accessed August 19, 2008.