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You're a what? Medical illustrator.

Do you remember that series of pictures in your high school biology book that depicts the human anatomy? A half dozen transparent overlays, with different vital organs drawn on each one, rest sequentially upon the outline of a body, and show that beneath the skin, at least, we're all pretty much alike. These vivid images, and others like them, offer more than a look at our livers and lungs. They reveal the unique mix of skills of the professionals who produce them--medical illustrators.

"Medical illustration combines art and science to convey information," says Dave Klemm, an illustrator at Georgetown University Medical School in Washington, DC. Illustrators use a variety of media, from carbon dust to pen and ink to computers, in order to translate complex medical research into clear, vibrant, and accurate pictures. To create these pictures, they need a firm grasp on anatony, pathology, and physiology. And to reach many different audiences, from doctors and scientists to elementary school students, an "illustrator must be sensitive to how people learn," say Klimm. "So in a sense, then, an illustrator is an artist, a scientist, and an educator."

Klemm's interest in art began with his first box of crayons. In high school, the sciences, particularly biology, captured his attention. Klemm believes many illustrators share these early interests. He continued to explore both art and science after he enrolled in college. While he pursued his bachelor's degree in commercial art from South Dakota State University, he says, "I also took a number of medically-related courses, which whetted my appetite for the field of medical illustration."

For a few years after college he worked as a graphic artist. Then he entered the graduate program in medical illustration at the University of Texas Southwestern Medical Center at Dallas. That program is one of five accredited by the Association of Medical Illustrators and the Council on Allied Health Education/American Medical Association (CAHEA/AMA).

Competition for admission to the certified programs is rigorous. Programs accept only a small number of students. Klemm, for example, was one of just six students in his class.

Generally, applicants need a bachelor's degree in either art or science, a strong academic record, and an art portfolio that demonstrates the breadth and depth of their skills. Some programs favor students with a stronger background in either art or science. Others seek a balanced class. In the Johns Hopkins University program, the mix of students entering with an art of science degree is about equal. Gary Lees, director of the Department of Art as Applied to Medicine at Hopkins, believes that "those entering with a pure science background have a more difficult time. Artistic skills build upon themselves. It takes longer for a young person to gain sophistication in artistic techniques."

Medical illustration programs generally last 2 years. They combine instruction in art with classes in anatomy, physiology, and other sciences. "We do not teach art in a vacuum," says Gary Lees, "we meld the two disciplines of art and science together." Aspring illustrators attend many science classes alongside medical students. The aim of the programs, says Lees is "to train individuals to think visually and to educate others to think visually. As medical illustrators, we become educators. The art that we produce is there to teach, to convey information."

Students receive training in a variety of media, not solely in illustration. "To create effective visuals, you need a basic understanding of the production processes of printing, photography, video, and film production," says Klemm. Very few original illustrations are ends in themselves. Usually, they must be reproduced as slides, used in videotapes, or printed in textbooks. It's valuable for illustrators to understand the reproduction process so that they can see how the original is translated into another medium. They learn the limitations of some media and the advantages of others. Programs also include courses in casting and molding prostheses that may be used in reconstructive or cosmetic surgery.

"We present the student with real problems in real settings," says Lees, "just as any illustrator will encounter." Students visit operating rooms to sketch surgical techniques, draw from photographs, and work with anatomical atlases and other references. "Sometimes we'll give the student a manuscript that we've received for illustration or send them to the library to read 4 or 5 articles on a particular subject," says Lees. There may be no visual record of what they are to do. "That requires that they interpret what they read, conceptualize it, and then render it."

According to Lees, students respond differently to challenges. For example, one person may walk into an operating room and immediately sketch exactly what they see. "But that same student might have difficulty understanding the surgical technique that the surgeon is trying to impart. Another student might have difficulty sketching rapidly but have a clear idea of what the surgeon is trying to do. We all have different strengths," says Lee.

About 800 medical illustrators work around the country. An additional 30 or so enter the market each year. They work in medical schools, major medical centers, and publishing houses. Some illustrators freelance, which requires business skills in addition to their professional ones. In the last few years, other opportunities have emeged. For example, about a dozen firms around the country specialize in "demonstrative evidence," that is, illustrations used to support medical and malpractice litigation. "Generally students have no problem finding employment, providing they're willing to go where the jobs

are," says Lees.

When Klemm graduated from Texas, he took a job with the Educational Media Department at the Georgetown University Medical Center. The staff at the Education Center includes audiovisual specialists, photographers, graphic and computer artists, illustrators, and instructional designers. They served as a resource not only to the medical and scientific community at the university, but to other medical professionals in the Washington area and across the country.

Each job presents new problems to solve. In drawing a new wurgical technique for example, Klemm faces a variety of challenges. "Surgery is a process. It's dynamic," says Klemm. "I must show how tissue responds to external forces, such as scalpels, sutures, and staples. That increases the believability of the drawing."

Occasionally, Klemm observes surgery, but "even if I'm there, it's not easy to tell what's occurring. It can be pretty messy," says Klemm. So he may work from models, anatomical atlases, surgical procedure atlases, or photographs. He also has his earlier experience to rely on. In graduate school, Klemm took anomal surgery. He learned some basic surgical techniques and observed how tissue reacted to the pressure of the forceps and sutures; he could see the tissue's consistency and feel its texture. This gives him important insights into surgery.

In some cases, such as with new surgical procedures, models and atlases may not be much help. Yet the illustrator must still portray a realistic view of what occurs. Here, imagination, firmly grounded in the sciences comes into play. "You have to know exactly what's being done. You have to be an astute questioner," Klemm says. "For example, if I'm drawing a suture or a ligature around a blood vessel, I need to ask what kind of suture is it? What happens to the vessel? Does it pucker or balloon? On what side does this occur?"

Beyond portraying accurately how tissue responds, an illustrator must convey the sense of surgery as a process. Some surgeries take many hours and include many stages. Illustrators condense the process. "You could probably use a hundred drawings to show the procedure fully," says Klemm, "but time and budget won't allow it." Still, he might use thirty drawings or more to portray an operation.

For Klemm, the illustration process usually consists of three stages. After meeting with the physician or scientist whose work he will illustrate, he sketches rough drawings in pencil. "Here, I clarify for myself how I perceive the procedure and how many steps I think are needed," says Klemm. The he meets with the client to review the sketches. If it's a surgery that he's illustrating, the doctor may wish to emphasize how a certain cut is made or an instrument is used. Klemm incorporates these suggestions in the second stage if illustrations.

"In the second stage I refine what I've done," says Klemm, "and execute the drawings with more detail. I'm coming close to the final drawing." Another meeting with the client follows. Sometimes more changes will be suggested.

After the second interview with the client, Klemm proceeds to the final drawings. "The final presentation dictates the kind of media I'll use. It might be acrylic, pen and ink," says Klemm. Before it's reproduced, he consults a final time with his client.

Medical illustrators often develop a regular base of clients. "You tend to build a rapprot with certain doctors," says Klemm. "The more I deal with them the less they have to explain to me. This works out to both of our advantages."

In his way, illustrators frequently develop specialties. For example, Klemm has done many illustrations for an oral surgeon in Washington. The more knowledgeable you are in an area, says Klemm, the fewer steps you'll likely need to illustrate the procedure. "I have a feel for what he wants," says Klemm "as well as an understanding of the procedures and instrumentation. That comes with experience." His work with this surgeon has led to projects with other oral surgeons.

Klemm performs his work with painstaking care. He has to. The medical community relies heavily upon it. For a neurosurgeon, an illustration can be an elaborate map to a brain tumor; for an ophthalmologist, the drawings provide intricate insights into the workings of the eye. "You must have a passion for your work," says Klemm. "Sometimes the actual drawing or rendering can be tedious. You might have a procedure of 30 or 40 steps. You have to render each with the same degree of faithfulness."

At the end of a project Klemm has a tangible product he can hold in his hand, one which his clients are pleased to receive. "Illustrating in medicine is not simply relating an image," says Klemm. "If you were to examine a photo taken during surgery, for example, you might not be able to tell one structure from another. An illustrator can alter that image, make it more clear, more real so that other doctors and students can understand it. And the surgeon who commissioned the drawings will say, 'that's it!'"

The motto of the Association of Medical Illustrators puts the same message in different words: "Draw what can't be seen; watch what's never been done; and tell thousands about it without saying a word."

Michael Stanton is the OOQ's staff writer.
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Author:Stanton, Michael
Publication:Occupational Outlook Quarterly
Date:Dec 22, 1991
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