A Picture's Worth a Thousand Words: Enhancing Qualitative Data Collection with Rich Pictures
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| Title: | A Picture's Worth a Thousand Words: Enhancing Qualitative Data Collection with Rich Pictures |
|---|---|
| Language: | English |
| Authors: | Andrea M. Barker (ORCID |
| Source: | Anatomical Sciences Education. 2026 19(1):130-143. |
| Availability: | Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us |
| Peer Reviewed: | Y |
| Page Count: | 14 |
| Publication Date: | 2026 |
| Document Type: | Journal Articles Reports - Descriptive |
| Descriptors: | Qualitative Research, Research Methodology, Data Collection, Visual Aids, Anatomy, Allied Health Occupations Education, Freehand Drawing, Science Education, Reflection |
| DOI: | 10.1002/ase.70033 |
| ISSN: | 1935-9772 1935-9780 |
| Abstract: | The use of qualitative research methods is growing among scholars interested in exploring and understanding the distinct context of anatomy education. While verbal and text-based methods like interviews and focus groups are frequently used for data collection, anatomy education scholars may benefit from including visual methods such as photovoice or diagramming in their data collection toolbox. Often used in conjunction with oral, language-based qualitative methods, visual methods aid researchers in exploring phenomena which may be difficult for participants to express. "Rich pictures" are a type of visual method which has gained popularity in the health professions education literature. Generated through asking participants to draw a detailed representation of a particular situation, rich pictures can afford researchers deeper insight into participants' perspectives and experiences while exploring complex phenomena within the context of teaching and learning. This article provides a four-part description of rich pictures to support the application of this visual method within qualitative anatomical sciences education research by: (1) describing the background and offering an overview of this method, (2) explaining how to use rich pictures as an "elicitation tool" during interviews to stimulate participants' reflections and responses, (3) offering two analysis strategies for interpreting the visual content created through rich pictures (i.e., "visual grammar" for systematically analyzing the features of a participant's drawing, and "gallery walks" for engaging research teams in collaborative analysis of the collection of all study participants' drawings), and (4) providing reflections on the use of rich pictures in anatomic science education's qualitative studies. |
| Abstractor: | As Provided |
| Entry Date: | 2026 |
| Accession Number: | EJ1493209 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwEhVrVrgFEXdEYbqB7PbZUfAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDI0-NMf_YaItGsWVXwIBEICBmvjyONdVhNsJcDBzauI5T0ecLJ-etPDJ069hts934kApD7l-HYg2xRSj6Fc5FUtCRZ9AfYhARpoNXh_DAxPsq8IlGh6lRBTB06H22vmwC1MjPKgmELF01fuy756VyETwY_cz92PTzvkOUoMeLf0lBxeB2i0shwwHAJh_wCpx77_FrPh-Jo7P8GY92-1VDQechs5ng-p0qX7GF5U= Text: Availability: 1 Value: <anid>AN0190573074;[8z8k]01jan.26;2026Jan01.04:53;v2.2.500</anid> <title id="AN0190573074-1">A picture's worth a thousand words: Enhancing qualitative data collection with rich pictures </title> <p>The use of qualitative research methods is growing among scholars interested in exploring and understanding the distinct context of anatomy education. While verbal and text‐based methods like interviews and focus groups are frequently used for data collection, anatomy education scholars may benefit from including visual methods such as photovoice or diagramming in their data collection toolbox. Often used in conjunction with oral, language‐based qualitative methods, visual methods aid researchers in exploring phenomena which may be difficult for participants to express. Rich pictures are a type of visual method which has gained popularity in the health professions education literature. Generated through asking participants to draw a detailed representation of a particular situation, rich pictures can afford researchers deeper insight into participants' perspectives and experiences while exploring complex phenomena within the context of teaching and learning. This article provides a four‐part description of rich pictures to support the application of this visual method within qualitative anatomical sciences education research by: (<reflink idref="bib1" id="ref1">1</reflink>) describing the background and offering an overview of this method, (<reflink idref="bib2" id="ref2">2</reflink>) explaining how to use rich pictures as an elicitation tool during interviews to stimulate participants' reflections and responses, (<reflink idref="bib3" id="ref3">3</reflink>) offering two analysis strategies for interpreting the visual content created through rich pictures (i.e., visual grammar for systematically analyzing the features of a participant's drawing, and gallery walks for engaging research teams in collaborative analysis of the collection of all study participants' drawings), and (<reflink idref="bib4" id="ref4">4</reflink>) providing reflections on the use of rich pictures in anatomic science education's qualitative studies.</p> <p>Keywords: drawings; health professions education; medical education; qualitative methodology; rich pictures; visual methods</p> <hd id="AN0190573074-2">INTRODUCTION</hd> <p>The use of qualitative research methods is growing among scholars interested in understanding the unique context of anatomy education and researching important issues not easily investigated via quantitative methods.[[<reflink idref="bib1" id="ref5">1</reflink>], [<reflink idref="bib3" id="ref6">3</reflink>], [<reflink idref="bib5" id="ref7">5</reflink>]] For example, qualitative research has helped anatomy educators explore the variety of knowledge, skills, and attitudes acquired during anatomy education that are <emph>not</emph> related to a course's human donor dissection learning objectives (e.g., teamwork or communication skills)[<reflink idref="bib6" id="ref8">6</reflink>]; the effectiveness and cost efficiency of anatomy education carried out in low‐resource countries[<reflink idref="bib7" id="ref9">7</reflink>]; and the impact anatomy instruction on learners' uncertainty tolerance.[<reflink idref="bib8" id="ref10">8</reflink>] Exploring the experiences and perspectives of those who work, teach, and learn in anatomy's distinct educational environment often involves qualitative data collection techniques like interviews, focus groups, or reflective writing prompts.[[<reflink idref="bib9" id="ref11">9</reflink>]] Yet, given the visual and tactile nature of the anatomical sciences and the importance of visual–spatial abilities in anatomy assessment,[<reflink idref="bib11" id="ref12">11</reflink>] anatomy education scholars likely also need qualitative research methods that go beyond the textual. Fortunately, there is a considerable toolbox of visual methods in qualitative research from which these scholars can draw.</p> <p>Visual methods in qualitative research are used to help researchers explore complex phenomena and understand how people experience and give meaning to this complexity. Within anatomy education, examples of such complexity could include exploring students' emotional reactions to learning through dissection of human donors, or how religious and cultural considerations shape anatomical curriculum development and delivery. We know that, when exploring such complex phenomena, research participants can find it difficult to articulate their experience.[[<reflink idref="bib12" id="ref13">12</reflink>]] As the tried‐and‐true expression reminds us: Words can fail us. Savvy qualitative researchers often turn to visual methods to circumvent this failure because visual methods offer participants another medium for expression through which to convey their experiences. There are many visual methods available to the anatomy education researcher, including drawings, photos, videos, selfies, maps, and diagrams.[[<reflink idref="bib14" id="ref14">14</reflink>]] The visual data generated through these methods can be used to explore a social or cultural context; to investigate how participants and researchers understand their world; and to elicit specific experiences, narratives, or emotions.[<reflink idref="bib14" id="ref15">14</reflink>] Whatever the use of visual methods, they have tremendous benefits, including drawing out tacit or hard‐to‐express knowledge, experiences, or emotions, building rapport with participants, and even challenging the existing engrained narratives about a concept by viewing it through a new perspective.[<reflink idref="bib14" id="ref16">14</reflink>] Indeed, visual methods are particularly useful methods for understanding the shifting world of anatomy education.</p> <p>One type of visual method—rich pictures—is gaining attention in the health professions education literature. While rich pictures are a visual method that utilize hand‐drawn illustrations created by participants, they differ from other drawing methods such as comics (i.e., participant generated graphic narratives combining drawing and text bubbles to tell stories) or mind maps (i.e., drawings that organize participants' understanding of concepts).[<reflink idref="bib14" id="ref17">14</reflink>] As defined by Cristancho and Helmich, "a rich picture is a pictorial representation of a particular (educational) situation, including what happened, who was involved, how people felt, how people acted, how people behaved, and what external pressures they acted upon".[<reflink idref="bib16" id="ref18">16</reflink>] When used alongside textual qualitative methods already being employed in anatomy education like interviews,[<reflink idref="bib3" id="ref19">3</reflink>] focus groups,[<reflink idref="bib1" id="ref20">1</reflink>] and oral and written reflections,[<reflink idref="bib2" id="ref21">2</reflink>] participant generated rich pictures can offer researchers unique insight into participants' perspectives. Moreover, they can facilitate discussion thereby enhancing understanding of the phenomenon the anatomy educator is investigating.</p> <p>To help anatomy educators develop a facility with rich pictures, we offer a four‐part description of this visual method. First, we present a brief background about rich pictures, including how they have been used in health professions education research. Second, we describe how rich pictures can be used in qualitative data collection as an <emph>elicitation tool</emph> to stimulate participants' reflection and responses during semi‐structured interviews. Next, we offer two ways of analyzing the rich pictures created by participants as part of the qualitative dataset: <emph>visual grammar</emph> and <emph>gallery walks</emph>. Visual grammar is an approach for analyzing visual content and, as such, can be used as a means for systematically analyzing the features of participants' rich pictures. A gallery walk is a process for engaging a team of researchers to collaboratively examine and analyze the collection of rich pictures from all participants within the study. Finally, we offer reflections for how anatomy educators and researchers might incorporate rich pictures into their qualitative studies.</p> <hd id="AN0190573074-3">BACKGROUND</hd> <p></p> <hd id="AN0190573074-4">What are rich pictures? Why should anatomy educators use them?</hd> <p>A rich picture is a participant‐created drawing that represents a specific situation or phenomenon. The picture is drawn by a research participant in response to a prompt asked by the researcher; the picture is most often drawn by hand on paper (though can be created digitally using a tablet or computer) and may range from a basic stick figure drawing to a detailed diagram. Participants need not be skilled artists; the artistic quality of the picture is <emph>not</emph> a factor impacting the quality of the data generated. Instead, the picture is used to stimulate the participant's reflection and to offer ways for enhancing communication during verbal (e.g., interview) and text‐based (e.g., reflective writing) qualitative data collection. The picture itself may be used as part of the dataset that is analyzed to answer a research question, or it may serve simply as a prompt for supporting data collection via verbal or text‐based means. Regardless of how the picture will (or will not) be analyzed, the artistic merits of the picture are irrelevant. It is the elements in the picture itself—and the feelings, experiences, details, processes, etc. expressed therein—that are the relevant data.</p> <p>As will be discussed further in the elicitation section below, a participant creates a rich picture in response to a broad, open‐ended question (e.g., Can you draw a challenging situation you faced as an anatomy educator?). Therefore, the pictures generated can include a multitude of visual elements including, for example, the participants themselves (e.g., their role in the situation and how they were feeling), other people present (e.g., what they were doing and how they were behaving), related environmental factors (e.g., elements and configuration of the physical setting, cultural norms, institutional pressures), and the process of the situation (e.g., relationships and interactions of all the elements and the resulting outcomes). These drawings will ultimately include elements and interactions deemed important according to the perspective of the participant creating them. Rich pictures thus provide the participant and the researcher opportunities for exploring many different aspects of a situation (e.g., personal, interpersonal, physical, procedural, and political) and to identify ways in which these aspects inter‐relate.</p> <p>Beyond the breadth of considerations that rich pictures bring to a study's dataset, they also have benefits that relate to both the researcher and the participant. For researchers, a rich picture creates opportunities for navigating a data collection conversation because the drawing can be used to prompt additional questions and seek clarification. This supports a co‐construction process between the researcher and the participant, allowing for greater insights to be developed through the exploration of considerations and reflections that researchers might not have even recognized as gaps in their understanding of the phenomenon being studied. For participants, rich pictures can help them communicate experiences and emotions that may otherwise be hard to articulate. Creating a drawing about a specific topic or situation allows the participant to externally represent internal feelings and personally complex situations; then, the participant can speak <emph>to the picture</emph> to share their experience. This space—that is, between the picture and the participant's internalized feelings and experiences—can help participants share insights that might otherwise be too personal to reveal.[<reflink idref="bib17" id="ref22">17</reflink>] By reflecting on the various details of the situation and portraying them in a drawing, participants begin to organize their thoughts, which can facilitate more cohesive answers to interview questions. Additionally, through the reexamination of their drawing, participants may notice elements (e.g., emotions, interactions, and learning outcomes) from their experience they had not considered before.</p> <hd id="AN0190573074-5">How have rich pictures been used in health professions education research?</hd> <p>Rich pictures were introduced to health professions education research by one of the authors (Cristancho) who has a background in systems engineering, a field where rich pictures are extensively used as a problem‐solving tool.[[<reflink idref="bib16" id="ref23">16</reflink>], [<reflink idref="bib18" id="ref24">18</reflink>]] Born from a systems‐thinking orientation,[<reflink idref="bib20" id="ref25">20</reflink>] rich pictures have been used in systems engineering to help individuals create a multifaceted understanding of, and potential solutions to, a problem via drawing and diagramming.[[<reflink idref="bib16" id="ref26">16</reflink>], [<reflink idref="bib21" id="ref27">21</reflink>]] Cristancho imported the rich pictures method to health professions education to help educators—including anatomy educators—explore and understand the experiences of those who teach and learn in medicine's complex learning environments.</p> <p>Today, rich pictures have been incorporated into several qualitative studies in health professions education. For example, to better understand the experience of learners, researchers have used rich pictures to explore how "pimping" (i.e., repeatedly asking medical learners questions, in public, with an expectation of on‐the‐spot answers) affects medical residents in a pathology training program[<reflink idref="bib22" id="ref28">22</reflink>] and how relationships between medical students and faculty influence students' participation.[<reflink idref="bib23" id="ref29">23</reflink>] Rich pictures have been used to explore educators' perspectives as well, including their perception of how governance influences the process of implementing curriculum change[<reflink idref="bib24" id="ref30">24</reflink>] and how medical teachers make sense of formal and informal student feedback leading to performance change.[<reflink idref="bib25" id="ref31">25</reflink>] Finally, rich pictures can help illuminate multiple participants' perspectives of the same situation, as demonstrated by LaDonna et al.'s exploration into how clinical teams navigate complex situations together by asking team members to independently draw about the same shared team experience.[<reflink idref="bib26" id="ref32">26</reflink>] As these examples illustrate, qualitative research exploring complex educational situations and phenomena can benefit from integrating rich pictures to complement other qualitative methods. Although rich pictures have yet to be used and cited in anatomical sciences education publications, we anticipate many opportunities where rich pictures could be employed similar to the provided examples from the broader health professions education literature.</p> <hd id="AN0190573074-6">RICH PICTURES AS AN ELICITATION TOOL FOR DATA COLLECTION</hd> <p></p> <hd id="AN0190573074-7">How can I use rich pictures in my study?</hd> <p>Rich pictures are most frequently used as part of a semi‐structured interview as an elicitation tool (i.e., as a companion technique that uses visual stimuli [e.g., drawing] to help participants share insights and/or experiences).[<reflink idref="bib15" id="ref33">15</reflink>] In other words, an anatomy educator might design an interview study and start the conversation with a rich picture activity to help enrich participants' responses during the interview. The rich pictures are, then, means for eliciting rich conversations for data collection<emph>—</emph>that is, for prompting the exploration of topics illustrated in the drawing.</p> <hd id="AN0190573074-8">What is the process for using rich pictures in my study?</hd> <p>To use rich pictures as an elicitation tool, researchers can follow a 4‐step process: (<reflink idref="bib1" id="ref34">1</reflink>) setup, (<reflink idref="bib2" id="ref35">2</reflink>) training, (<reflink idref="bib3" id="ref36">3</reflink>) engagement, and (<reflink idref="bib4" id="ref37">4</reflink>) conversation.[<reflink idref="bib12" id="ref38">12</reflink>] These four steps are usually completed during a single data collection session with the researcher and participant, although the setup and training can be completed in advance of the interview. There are other resources available to help scholars learn how to develop and conduct a semi‐structured interview (see <emph>InterViews: Learning the Craft of Qualitative Research Interviewing</emph> [Kvale &amp; Brinkmann, 2015][<reflink idref="bib27" id="ref39">27</reflink>] as an example); we will focus on how rich pictures can be integrated into that process. To illustrate this integration, we offer a data excerpt from one of our own studies.[<reflink idref="bib28" id="ref40">28</reflink>] The study's aim was to explore how surgeons perceive the process of preparing for a challenging surgical procedure. We illustrate how the research team followed the 4‐step process (see Box 1), and include the rich picture created by a participant (see Figure 1) and a short verbatim excerpt of the participant's description of their drawing (see Box 1).</p> <hd id="AN0190573074-9">1 BOX Application of rich pictures as a data elicitation tool: 4‐step process with prompt exa...</hd> <p>Study aim: To explore how surgeons perceive the process of preparing for challenging surgical procedures.</p> <p>Step 1: Setup</p> <p>Prompt example: <emph>Within this study, we are interested in exploring how surgeons plan and prepare for surgeries that they anticipate being very challenging and complex. We want to hear about any aspects of preparation that you think about before engaging in the actual surgery. With that in mind, I want you to think about a time when you knew you had a challenging surgery ahead of you. Try to recall what made it particularly complex and what details you remember going into the planning and preparation for that memorable case</emph>.</p> <p>Step 2: Training</p> <p>Prompt example: <emph>Now that you have thought some about your challenging case, I am going to ask you to draw about your experience. Do not worry about your artistic skill—we will just be using this drawing to help with our conversation today. Feel free to include any details or elements that you would like—though if helpful, to get started you can think about the "who, what, where" and even elements like emotions that were a part of this case as you were preparing for it. You are also welcome to use any combination of colors, symbols, or labels in your drawing</emph>.</p> <p>Step 3: Engagement</p> <p>Prompt example: <emph>When you are ready to start drawing, I will give you about 30 min to work on it. Just let me know when you feel that you are finished and ready to share it with me</emph>.</p> <p>The picture shown in Figure 1 is the rich picture drawn by a surgeon and represents their preparation for repairing a large thoracoabdominal aortic aneurysm—a rare and difficult operation with a high mortality rate and risk of permanent paraplegia. The surgeon chose to include different steps involved when planning the surgery (noted by the phrases "step 1" and "step 2") and highlighted particularly important elements by drawing small keys next to them. The researcher then used this drawing to elicit the interview discussion with the participant during step 4—Conversation.</p> <p>Step 4: Conversation</p> <p>Prompt example: <emph>Can you describe what you have drawn in your picture please?</emph></p> <p>Note: Remaining questions will be guided by the semi‐structured interview protocol and the elements of the participant's drawing.</p> <p>Selection of participant's response within this example study:</p> <p>I thought of what was the best picture to relay what the whole case is about and I put these pieces of a puzzle and then I figure the case is actually putting the pieces now together but the more I thought of it, it is a little different than that. It is actually like putting a ship together in a bottle, you know you take all the pieces and you put them together in a bottle but it's actually harder than that because it's putting a ship together in a bottle but you can't see the bottle...When you draw this you start sequentially I find but then you almost change to circumferentially, like everything meeting in the middle, at least around the conduct of the operation.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01jan26/ase70033-fig-0001.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase70033-fig-0001.jpg" title="1 Example of a rich picture created by a participant during a study exploring how surgeons perceive the process of preparing for challenging surgical procedures." /> </p> <p></p> <hd id="AN0190573074-11">Step 1: Setup</hd> <p>During setup, the researcher's aim is to have the participant actively think about their personal experiences as related to the phenomenon under study. This reflection should happen before the participant begins drawing. Similar to preparing a participant to be interviewed for a qualitative study, the researcher will provide information about the purpose or rationale for the study. Following this background information, the researcher will ask the participant to recall a memorable situation related to the research topic. This could be a situation that was particularly impactful for the participant, elicited certain emotions, or one with a specified outcome. Guidance offered to participants will, of course, need to align with the study's research question(s).</p> <hd id="AN0190573074-12">Step 2: Training</hd> <p>After the participant has recalled a memorable situation, the researcher needs to prepare them to draw their experience. The researcher should explain to the participant that their drawing can include details about the situation—for example, who, what, where, and how it occurred—including the perceived emotions of the situation. It is important that the researcher not influence the content of participants' drawings; instead, the instructions are to offer the participant some guidance to help them start drawing. The researcher should also explain that the quality or artistic merits of their drawing are not important or relevant to the study.</p> <p>In our experience, this training step is important because participants often express hesitancy or uncertainty when faced with a blank page and asked to draw. But once participants start drawing, they often become engrossed in the process, asking no follow‐up questions and expressing no further concerns. If helpful, a drawing from a previously published study unrelated to the current research topic can be shown as an example (e.g., our Figure 1 could be used as an example of what a rich picture might look like).</p> <hd id="AN0190573074-13">Step 3: Engagement</hd> <p>Once trained, the researcher should give the participant supplies for creating their drawing. These typically include blank white paper (typically 8.5 × 11 inches) and drawing implements (e.g., colored pens, pencils, and markers). Researchers often give the same materials to each participant (note, they can be mailed to a participant who is doing the data collection activity virtually); however, participants may be asked to gather specified supplies in advance if the study has minimal funding. Then the researcher should ask the participant to draw about their recalled situation and any details they deem important. This uninterrupted drawing activity typically lasts 20–30 min during which time the researcher may stay or leave the room or turn off their camera if virtual.[<reflink idref="bib12" id="ref41">12</reflink>] Upon completion, the drawing is placed in such a way that both the participant and researcher can view it simultaneously. For interviews conducted over a virtual platform, the participant can hold the drawing in view of the camera and the researcher can use the "screenshot" feature to capture the picture.</p> <hd id="AN0190573074-14">Step 4: Conversation</hd> <p>Once the researcher and the participant can both see the drawing, the participant should be invited to describe their drawing and elaborate on the elements they chose to include (e.g., <emph>Can you tell me what you drew? What does [element] represent?</emph>). The researcher can use the participant's descriptions in conjunction with their drawing to probe for further explanation or understanding, with the researcher's questions also being guided by the semi‐structured interview protocol that was developed during study design. Questions may be asked to expand on the story of the situation using elements of the drawing as initial prompts (e.g., <emph>Can you tell me more about this [element] and the role it played in this experience?</emph>). Other questions might focus on how the drawing was created—such as colors chosen or position and size of the elements—to elucidate any underlying meaning (e.g., <emph>Did you select this color for a particular reason?</emph>). The conversation is audio‐recorded and later transcribed so that the verbal data may be analyzed.</p> <hd id="AN0190573074-15">ANALYSIS OF RICH PICTURES DATA</hd> <p>Since rich pictures are most frequently used as an elicitation tool to enhance interview conversations between the participant and the researcher, the drawing generated by the participant is often <emph>not</emph> incorporated into the study's formal dataset. It is framed strictly as a tool for supporting the conversation; thus, the conversation is the data and the rich picture is not.</p> <p>However, education researchers are increasingly incorporating the rich picture drawings into datasets since the visual elements in the pictures carry important meaning and information worthy of inclusion in analysis.[<reflink idref="bib13" id="ref42">13</reflink>] To be sure, the drawings <emph>can</emph> be incorporated as meaningful data. The challenge is knowing <emph>how to analyze</emph> these drawings. We offer two different approaches for carrying out the analysis of rich picture drawings: one focuses on interpreting each individual picture (i.e., visual grammar); the other focuses on interpreting the group of pictures created by participants in a study as a collection (i.e., gallery walk).</p> <hd id="AN0190573074-16">Analyzing each rich picture using the visual grammar approach</hd> <p>One approach for analyzing rich pictures is to examine each drawing individually, focusing on the visual representations in each picture.[[<reflink idref="bib29" id="ref43">29</reflink>], [<reflink idref="bib31" id="ref44">31</reflink>]] This type of visual analysis, generated by scholars in the field of Visual Rhetoric, works from the premise that creators of visual content draw on compositional structures that, in the culture of the creator, carry conventional meanings. Therefore, the theories of Visual Rhetoric suggest that visual images and non‐linguistic visual structures can—like words—carry meaning since they are products of the creator's interpretations.[<reflink idref="bib31" id="ref45">31</reflink>] In other words, Visual Rhetoric posits that images can make statements and that we can interpret the meaning embedded in those statements.[[<reflink idref="bib29" id="ref46">29</reflink>], [<reflink idref="bib31" id="ref47">31</reflink>]] To help scholars analyze the meaning conveyed in images, Kress and van Leeuwen harnessed the social semiotics perspective to create a theory of visual grammar and a structured framework that defines specific visual structures and relates them to meanings associated with those structures.[<reflink idref="bib30" id="ref48">30</reflink>] This framework can be used as a tool for guiding the analysis of individual rich pictures. Kress and van Leeuwen's visual grammar relies on social conventions from Western cultures (e.g., cultures where text is read from left to right); therefore, this analysis approach cannot be transferred to the analysis of pictures made outside of that culture. This is a limitation of Kress and van Leeuwen's visual grammar: It is only usefully applied to pictures created in contemporary Western cultures.</p> <p>We highlight five different tools from visual grammar that we suggest are particularly useful for analyzing and understanding a rich picture: Two that examine the overall organization of the full drawing and three that focus on how different elements of the drawing relate to each other (Table 1).</p> <p>1 TABLE Visual grammar tools to analyze the content of rich pictures.</p> <p> <ephtml> &lt;table&gt;&lt;thead valign="bottom"&gt;&lt;tr&gt;&lt;th align="left"&gt;Tool&lt;/th&gt;&lt;th align="left"&gt;Definition&lt;/th&gt;&lt;th align="left"&gt;Example&lt;xref ref-type="fn" rid="tfn1" /&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody valign="top"&gt;&lt;tr&gt;&lt;td align="left"&gt;Analyzing the overall organization of the rich picture&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Exhaustive&lt;/td&gt;&lt;td align="left"&gt;The picture is interpreted as illustrating all the relevant parts (i.e., visual elements) of a particular whole (or situation), deemed important to include by the participantDoes not mean that the picture itself is exhaustive of all details&lt;/td&gt;&lt;td align="left"&gt;Figure&amp;#160;2. The whole being depicted is the vertebral column, made up of various labeled sections (e.g., cervical spine) that are important to note at this time&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Temporal&lt;/td&gt;&lt;td align="left"&gt;Visual elements are organized linearly across timeCan be oriented horizontally or vertically&lt;/td&gt;&lt;td align="left"&gt;Figure&amp;#160;3. Depiction of human evolution with changing figures from ape&amp;#8208;like to human across time&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Analyzing relationships between elements in the rich picture&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Given&amp;#8212;New&lt;/td&gt;&lt;td align="left"&gt;Elements organized horizontally:&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Left side is given : elements are already accepted, previously recognized, part of history, or culturally accepted as known&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Right side is new : elements are previously unknown, novel or contested; require attention&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;Division between given and new can be anywhere along the horizontal axis&lt;/td&gt;&lt;td align="left"&gt;Figure&amp;#160;3. Given space (left) represents the oldest parts of human history and the new (right) represents the most recent parts, the present&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Ideal&amp;#8212;Real&lt;/td&gt;&lt;td align="left"&gt;Elements organized vertically:&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Top is ideal : understood as generalized goal of a situation, or an abstracted model&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Bottom is real : specific information, details, or practical information&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;Division between ideal and real can be anywhere along the vertical axis; often intuitive; can represent a sense of contrast or opposition&lt;/td&gt;&lt;td align="left"&gt;Figure&amp;#160;4. Ideal space (top) is the general information of the picture: the layout of the digestive system. Real space (bottom) is the specific information about the system&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Salience&lt;/td&gt;&lt;td align="left"&gt;Degree to which an element is visually separated from other elements&amp;#8212;the visual weightCan be illustrated by color contrast, directionality, empty spacesElements with higher salience get more visual attention from viewer&lt;/td&gt;&lt;td align="left"&gt;Figure&amp;#160;3. Elements are illustrated with similar salience&amp;#8212;same color and equally spacedFigure&amp;#160;4. Elements are illustrated with different salience&amp;#8212;human figure and digestive system are larger, in color, and deserve more attention than the labels&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>1 a For additional examples of how to apply these tools, please see Box 2 and the example rich picture in Figure 1.</p> <hd id="AN0190573074-17">Analyzing the overall organization of the drawing</hd> <p>In a rich picture drawing, there are many different visual elements (i.e., parts) that come together as a picture (i.e., as a whole) to convey a meaning. While there are many ways of organizing the relationship between the parts and the whole, two are frequently used in participants' rich pictures: <emph>exhaustive</emph> and <emph>temporal</emph>.</p> <p>In an exhaustive organization, the picture depicts a situation made up of a number of different parts.[<reflink idref="bib30" id="ref49">30</reflink>] While it is labeled as <emph>exhaustive</emph>, the picture is <emph>not</emph> expected to be a truly exhaustive (i.e., comprehensive) representation of <emph>all</emph> relevant details. Instead, the picture is presented <emph>as though</emph> it is exhaustive. For example, when teaching learners about the human vertebral column, anatomy instructors may rely on the picture of a human outline wherein different aspects of the spine are illustrated and labeled (see Figure 2). Here, the whole being depicted is <emph>the vertebral column</emph> and the parts are <emph>the anatomical features and sections of the vertebral column of interest at this moment</emph> (e.g., cervical spine, vertebral body). While there are other features of the vertebral column not represented, this picture conveys the message that these are the features and sections (i.e., parts) of the vertebral column (i.e., the whole) that are worthy of note at this time.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01jan26/ase70033-fig-0002.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase70033-fig-0002.jpg" title="2 The human vertebral column.[32]" /> </p> <p></p> <p>A second organizational approach is <emph>temporal</emph>, where the parts are ordered linearly (either horizontally or vertically) across time.[<reflink idref="bib30" id="ref50">30</reflink>] The whole picture is understood to be a timeline, and the parts are the series of chronologically unfolding stages on that timeline. Take, for example, the iconic picture of human evolution often called The March of Progress or The Road to Homo Sapiens (see Figure 3). This picture consists of a series of figures, where the first figure on the far left is ape‐like and crouched over using both hands and feet to move forward. Each figure that appears to the right after the first is a little less crouched over and a little less ape‐like, ending with the walking figure. We interpret this picture to be a timeline of human evolution (note that no labels or captions are needed to convey this meaning).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01jan26/ase70033-fig-0003.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase70033-fig-0003.jpg" title="3 The march of progress.[33]" /> </p> <p></p> <hd id="AN0190573074-20">Analyzing the relationships between elements in the drawing</hd> <p>Once we understand the organizational pattern that shapes the rich picture as a whole, we can examine how different elements of the picture are placed on the page and in relation to each other. This is called the analysis of <emph>compositional structures</emph>. While there are many types of compositional structures discerned by Kress and Van Leeuwen, three are particularly useful when analyzing rich pictures: (<reflink idref="bib1" id="ref51">1</reflink>) Given—New, (<reflink idref="bib2" id="ref52">2</reflink>) Ideal— Real, and (<reflink idref="bib3" id="ref53">3</reflink>) Salience.</p> <hd id="AN0190573074-21">Given—New</hd> <p>When analyzing how elements in a picture relate to one another, the elements carry different meanings depending on where they are physically located on the page. The left side of the page is the space of <emph>given</emph> information, signaling that the visual elements presented there are already accepted, previously recognized, part of history, and culturally accepted as <emph>known</emph>.[<reflink idref="bib30" id="ref54">30</reflink>] In contrast, the right side of the page is the side of <emph>new</emph> information, of elements that are previously unknown to the viewer, thus requiring attention.[<reflink idref="bib30" id="ref55">30</reflink>] In other words, the visual elements on the left side of the picture (given) are culturally understood to be commonsense or self‐evident; elements on the right side (new) are culturally understood to be novel or contested. This is illustrated in The March of Progress timeline (Figure 3). In the given space are the oldest parts of the human evolution timeline: the history. In the new space are the most recent parts of the timeline: the present. By presenting the timeline horizontally across the given and new spaces, the viewer intuitively understands where the timeline begins and ends, where <emph>then</emph> and <emph>now</emph> is located. It is important to know that the line dividing the given and the new need not be the center of the page; that division can land anywhere along the horizontal axis.</p> <hd id="AN0190573074-22">Ideal—Real</hd> <p>The visual elements that are located at the top and bottom of the rich picture also carry different meanings. At the top of the picture is the space of the <emph>ideal</emph>, and at the bottom is the space of the <emph>real</emph>. Between these two spaces, there is a sense of contrast.[<reflink idref="bib30" id="ref56">30</reflink>] The visual elements located at the top—in the space of the ideal—are understood as the generalized goal or the abstracted model. In contrast, the visual elements located at the bottom—the space of the real—are understood as presenting specific information, details, and practical information.[<reflink idref="bib30" id="ref57">30</reflink>] This is illustrated in Figure 4, a depiction of the human digestive system. Depicted in the space of the ideal is the layout of the digestive system in the human body. In the space of the real are the labels for the figure, giving more specific information about the system. The line dividing the ideal and real is not always located at the center of the picture; the dividing line can be anywhere in the picture and is often intuitively understood by the viewer.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01jan26/ase70033-fig-0004.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase70033-fig-0004.jpg" title="4 The human digestive system.[34]" /> </p> <p></p> <hd id="AN0190573074-24">Salience</hd> <p>Salience refers to "the degree to which an element is visually separated from other elements".[<reflink idref="bib30" id="ref58">30</reflink>] Different parts of the picture have different levels of salience—that is, different levels to which an element is visually emphasized or deemphasized. These different degrees of salience are achieved through features such as color contrasts, the use of directionality, and empty spaces between elements. These varying degrees of salience convey a hierarchy of importance among the elements of the picture—elements with higher saliency (those that are visually emphasized) deserve more of the viewer's attention. Differences in saliency are illustrated in Figures 3 and 4. In Figure 3, each figure in The March of Progress has similar saliency—they are of similar color, facing the same direction, and equally spaced across the page. The elements are depicted as being equally important. In contrast, in Figure 4, the illustrated human figure and its digestive system have greater salience than the labels, and so the figure is more important than the labels.</p> <hd id="AN0190573074-25">Using visual grammar to analyze a rich picture</hd> <p>These Visual Grammar tools can help researchers analyze the rich pictures created by their participants. Researchers can select the visual grammar tools that they consider to be most useful depending on the content and structure of the participant's drawing. When initially approaching the analysis of a rich picture, researchers may begin by examining the overall drawing for any organizational structure (e.g., Does the drawing appear to be organized temporally left to right or top to bottom? Does the drawing attempt to include all elements of a particular phenomenon, such as representing all the different people involved in the drawn situation or all the emotions the participant expressed experiencing?). Following an analysis of the overall organization, researchers can then examine the various elements within the drawing (e.g., How do the elements relate to each other and where are they drawn on the page? Is there any horizontal or vertical relation of elements that could represent underlying meaning? Are certain elements standing out by size, location, or color in comparison to others and potentially why?). These are just some initial questions that may guide researchers as they begin to analyze rich pictures. We present an example application of this analytical process in Box 2, applying visual grammar to the rich picture shown in Figure 1.</p> <hd id="AN0190573074-26">2 BOX Applying visual grammar to a rich picture.</hd> <p>First, we decided on the organizational structure of the picture—a decision informed by the drawing itself and the participant interview. We determined that the picture used a <emph>temporal</emph> organization because the parts of the drawing are arranged into a timeline consisting of two steps (step 1 is labeled on the left of the picture, and step 2 is labeled at the center). The process of the surgical procedure is rather simple, consisting of only two steps. But the rest of the drawing elements indicate that there are many complex considerations that shape each step in this timeline—that is, each step of the <emph>experience</emph> of the procedure.</p> <p>Next, we can analyze the parts of the drawing. In the <emph>given</emph> space (left side), the participant drew the patient and explained that "the patient to the left here has got this ticking time bomb of this [pointing to top of aorta on left of page] large thoracoabdominal aneurysm which is up in the chest, this [pointing to the bottom of the aorta] is in the belly." This is the starting point of the participant's story of the case, the known information that is accepted and unquestioned. The patient has an aneurysm that requires surgery (step 1 of the timeline); this is not contested. In contrast, what is contested (<emph>new</emph>), is how to best go about carrying out the surgery (step 2 of the timeline). This is visually conveyed since step 2 of the surgery is located in the <emph>new</emph> space which, in this drawing, begins to the right of the <emph>given</emph> space and to the left of the center of the page. Step 2 is also given higher <emph>salience</emph> by being at the center of the drawing, emphasized by several arrows pointing toward the center where the participant illustrated the organ to be operated on. <emph>Salience</emph> is also used to highlight that a successful surgery is a team effort. Many individuals (represented with stick drawings) are focusing their efforts (illustrated with arrows) toward contributing to a successful surgical outcome. Each person (e.g., nurses, the anesthetist) is key to the success of the surgery and so has a key and green puzzle piece drawn beside them because, as the participant explained, "the case is actually putting the pieces now together." Each member of the care team has a key piece of the puzzle; a successful surgery is one where all the pieces come together. Since most of the drawing is in black, the use of green creates visual weight for the puzzle pieces, drawing the viewer's attention to those elements, and thereby emphasizing the importance of each team member bringing their skills (i.e., their puzzle piece) to the operating table.</p> <p>Finally, the participant also used the spaces of <emph>ideal—real</emph> to convey important information about the complexity of the case. In the <emph>real</emph> space (bottom), the participant drew all the details of the surgery itself, emphasizing that these are the practical considerations and specific details that need to be taken into consideration to carry out the surgery. But, in the <emph>ideal</emph> space (top), the participant drew the patient's brain and spinal cord, explaining that "the over‐arching devil or concern in all of this is the spinal cord, so this is the brain and the spinal cord and that is the thing that is the elephant in the room or the devil overlooking all of this operation." In the space of the general essence of the picture, the participant chose to draw, in red, what they described as "the thing we don't want to see." It is the problem that could arise given the risk of paraplegia during repair that the surgical team hopes will not factor into the surgery. By placing it in the space of the ideal and by using a salient color, the participant conveys that the brain and spinal cord are important and problematic, visually hovering over the surgery and threatening its success.</p> <p>These are just some of the ways that visual grammar can help us analyze the messages conveyed by the participant to the viewer through rich pictures. There are many other elements within Figure 1 that could be analyzed for insight.</p> <p>As this example illustrates, the tools of visual grammar can help the researcher analyze each rich picture drawn by a study participant. Over the course of a research study, the researcher can conduct this analysis for each drawing and then look for patterns across the full collection of rich pictures drawn by all study participants. However, the tools of visual grammar focus on conducting an analysis of each individual drawing. Another approach—that is, gallery walks—can help the researcher look across the full collection of drawings.</p> <hd id="AN0190573074-27">Analyzing the collection of rich pictures using a gallery walk</hd> <p>One approach for analyzing a study's collection of rich pictures is through the process of a gallery walk. Drawing on principles from education, assessment for learning research, and museum curation, the process of a gallery walk invites researchers to interact and reflect on the presented materials.[[<reflink idref="bib35" id="ref59">35</reflink>]] If the study is being carried out by a team of researchers, the gallery walk also facilitates team discussion about presented materials among team members.[<reflink idref="bib35" id="ref60">35</reflink>] Gallery walks have been applied primarily in educational settings as strategies for continuous professional development for teachers[[<reflink idref="bib35" id="ref61">35</reflink>], [<reflink idref="bib37" id="ref62">37</reflink>]] and as a learning technique for undergraduate students.[<reflink idref="bib36" id="ref63">36</reflink>] However, gallery walks can equally be applied to support research purposes. The use of gallery walks in research has been concentrated in the context of health professions education, primarily through the experience and guidance of one of the authors (Cristancho). Gallery walks have been used to enhance research into a number of health professions education research topics including: exploring medical trainees' emotions in complex clinical situations[<reflink idref="bib38" id="ref64">38</reflink>]; how the clinical environment influences medical learner motivation,[<reflink idref="bib39" id="ref65">39</reflink>] and the moral dilemmas these learners face early in their clinical training[<reflink idref="bib40" id="ref66">40</reflink>]; how junior doctors experience interprofessional collaboration as they transition to clinical practice[<reflink idref="bib41" id="ref67">41</reflink>]; and how experienced physicians define problems in complex situations.[<reflink idref="bib42" id="ref68">42</reflink>] Within each of these, the gallery walk process resulted in additional insights and interpretations which helped researchers construct a better understanding of the phenomena being studied. Here, we document the process we have followed when using gallery walks for data analysis. We note that, to date, gallery walks have been conducted in person; however, such analysis could be carried out virtually (i.e., sharing the visual images with research team members for review in advance of a group meeting for discussion) in geographically dispersed teams.</p> <p>When used to support research, it is important to keep in mind the four general stages for using gallery walks:</p> <p></p> <ulist> <item> Setup: Researchers display visual materials (i.e., rich pictures) on the walls of a room, enabling the researcher(s) to easily view, inspect, and consider each picture individually and as a collection. If some researchers are unfamiliar with the interview transcripts associated with the pictures, a short summary (e.g., one or two paragraphs) might accompany each picture.</item> <p></p> <item> Rotation: Researchers physically move around the room, individually spending time appreciating each separate picture and the collection of pictures as a whole.</item> <p></p> <item> Engagement: Researchers engage with the materials by making personal analytic memos about their observations of the visual features of individual pictures and of the collection of pictures as a whole.</item> <p></p> <item> Reflection: Researchers reflect on the insights generated by examining the gallery of pictures. If the research involves a team of collaborators, this is when the team would discuss and wrestle with their observations and insights.</item> </ulist> <p>As this outline suggests, stages 1 and 2 guide the construction of the gallery and the viewing of the materials. Stages 3 and 4 guide how the analysis is conducted. To support the analytical work of stages 3 and 4, we suggest following a sequential progression of three interpretive processes: <emph>reacquainting</emph>, <emph>integrating</emph>, and <emph>focusing</emph>.</p> <hd id="AN0190573074-28">Reacquainting</hd> <p>The aim of reacquainting is for the researcher(s) to become familiar with each rich picture's story. If the researcher conducted the interviews in which the rich pictures were generated, simply moving around the room may be a sufficient reacquainting activity. However, if the study is carried out with a team of collaborators, there may be members of the research team who are less familiar with each interview transcript and associated rich picture. In such situations, the study's lead researcher may need to share details of a participant's story that accompanies each drawing with the team. While a summary posted beside each drawing can support reacquainting work, it is important that each research collaborator be familiar with the nuances of each participant's descriptions of their rich picture. During reacquainting, collaborators should be encouraged to ask clarification questions and to inquire about specific elements of each drawing. The researchers should also be encouraged to consider metaphors, motifs, or specific visual elements that recur across the gallery of drawings. They should make analytical notes of these observations. The lead researcher should also share with the team the purpose of the research study to ensure that all collaborators are appropriately oriented toward answering the study's research question. Finally, during this reacquainting work, the researchers should remember that the quality of the art is not being judged; instead, they are considering the collection of data as a whole and making observations about how the pictures speak to the study's research aim and question(s).</p> <hd id="AN0190573074-29">Integrating</hd> <p>Once the researcher(s) has familiarized themselves with the study's full set of rich pictures and the stories behind them (from the interview data), the analysis turns to generating a synthesis of the reflections offered and the insights generated during the reacquainting process. This work is labeled <emph>integration</emph> because the analytical work of this process involves integrating together the whole set of rich pictures to generate new insights, and integrating together the multiple and varied perspectives of the full research team. If the researcher is working as part of a collaborative team, integration involves discussing each collaborator's analytical notes, looking for commonalities and differences between perspectives, and exploring a breadth of interpretations that can help explain how the rich pictures answer the study's research question. This step is not unlike asking a team of researchers engaging in thematic analysis to collaboratively generate codes that represent significant data items in a transcript. The integrating work of a gallery walk requires the researchers to look for aspects of individual drawings that, together, embody a shared meaning or insight. Successfully engaging in integrating work often results in developing many different insights that touch on a range of different aspects of the phenomenon being investigated.</p> <p>If the researcher is working alone (i.e., without a team of collaborators), integration can be more difficult because the lone researcher will need to consider alternative perspectives and interpretations. Generating an array of varied insights is possible, but it demands that the individual researcher actively contemplate viewpoints that compete with their own interpretations.</p> <hd id="AN0190573074-30">Focusing</hd> <p>The final analysis process involves creating a set of analytic interpretations that coherently address the study's research question, complete with references to specific visual data elements from the drawings that substantiate that interpretation. Since the integrating process often generates a multitude of insights, the focusing process involves recognizing which insights are directly relevant to the study's research question. Perhaps some insights are tangential and can be set aside. Perhaps some insights should be clustered together to offer greater explanatory power. Perhaps an insight has multiple aspects embedded within it that need to be teased apart further. The focusing work of the gallery walk, then, is akin to generating themes from codes in the thematic analysis tradition.[<reflink idref="bib43" id="ref69">43</reflink>] The research team must bring together all the insights generated during integration to determine the answer to their research question. In other words, they need to reflect on and work with their insights to craft an answer to their research question that is based on the gallery of rich pictures data.</p> <hd id="AN0190573074-31">CONSIDERATIONS FOR USING RICH PICTURES IN QUALITATIVE STUDIES</hd> <p>In summary, this article describes the use of rich pictures as a visual method within qualitative inquiry to aid anatomy education researchers interested in exploring complex phenomena and to aid participants in expressing their experiences of that complexity. We have described how rich pictures can be used to enhance the collection of verbal or text‐based qualitative data as an <emph>elicitation tool</emph>. Furthermore, we described two analytical approaches to incorporate the visual data created in participants' rich pictures: <emph>visual grammar</emph> and the <emph>gallery walk</emph>.</p> <p>When considering using rich pictures as part of the design of a qualitative study, several questions need to be explored. As with any research project, methodological design choices are informed by the research question(s) and guidelines belonging to the methodology of choice. Although rich pictures can be used as part of a variety of methodologies, researchers must consider whether including rich pictures as an elicitation tool is needed to reach the desired level of depth in data collection. Also, asking participants to draw rich pictures requires time—time that then cannot be spent on oral conversation. This can mean that participants may be asked to give more of their time to data collection than if only oral conversation was used. There is also a risk that participants draw images that are "off topic" or somehow tangential to the study's focus. Just as with oral data collection, the participant will need to be redirected, and more time may need to be spent drawing. Furthermore, when the research question(s) warrant analysis of the visual data in the rich pictures, an important consideration is about timing: When will the analysis of the pictures occur within the research process? Would it be more helpful for the research team to analyze the interview transcripts first and then use those findings to inform the rich picture data analysis? Or should the researcher(s) conduct the analysis of both textual and visual data simultaneously? Will one form of data—textual versus visual—hold more weight than the other in shaping the research findings? Or are they equally important? These are all design choices to be discussed and decided upon by the research team. We suggest that there are not right or wrong answers to these questions; instead, each answer has implications that the researcher(s) need to consider and report.</p> <p>Before embarking on a study which includes rich pictures, we also encourage spending time considering the attitudes of study participants and of the audience to whom the research will ultimately be targeted. Not all participants nor all audiences will be receptive to the use of visual data in research. In addition to participants' attitude, researchers should also consider other potential ethical concerns to minimize harm to participants. While some participants may find drawing about their experiences therapeutic or empowering, others may provoke unexpected emotional reactions while engaging with rich pictures research.[<reflink idref="bib12" id="ref70">12</reflink>] Researchers should be prepared to offer additional emotional support following interviews when needed. Finally, how to disseminate and share the results of this research should be considered, particularly in relation to the public sharing of participants' drawings in published manuscripts. Like in all research, maintaining participant confidentiality is essential. Participants must give consent for their drawings to be published. Further deliberation about ethical considerations and dissemination concerns for participants' rich pictures may be useful to consider (see Chapter 13 from <emph>Researching Medical Education</emph>[<reflink idref="bib12" id="ref71">12</reflink>] and Cristancho and Helmich 2019[<reflink idref="bib16" id="ref72">16</reflink>] for more information).</p> <p>Regardless of the specific methodological design, conducting qualitative research utilizing rich pictures will require added work to execute. We encourage those interested in rich pictures to collaborate with a team of researchers. Using this method, especially when incorporating the analysis of visual data, will result in considerably more data to be collected and interpreted; this can easily become overwhelming for a single researcher. In addition, since rich pictures are especially well suited for research questions exploring complex and dynamic phenomena where multiple and sometimes divergent perspectives are included, constructing and assembling these differing perspectives will benefit from a team of researchers.</p> <hd id="AN0190573074-32">CONCLUSION</hd> <p>The visual method of rich pictures can be a useful tool in the anatomy educator's research toolbox. This elicitation tool can help participants offer nuanced and detailed reflections on topics that are uniquely relevant to anatomy education. Imagine how rich pictures might offer learners the opportunity to illustrate the personal, social, and political tensions they navigate when they struggle with the ethics of donor dissections. Imagine how rich pictures might offer anatomy educators the opportunity to diagram the physical, social, and political considerations they navigate when working with struggling learners. These are just two examples of how rich pictures could help anatomy educators understand their learning context in new and important ways. This visual method can also help anatomy educators explore the unique perspectives of a diversity of participants, promote creativity, generate new research questions, and bring considerations to light that may have been hidden because they were too difficult to put into words.</p> <hd id="AN0190573074-33">Author Contributions</hd> <p> <bold>Andrea M. Barker:</bold> conceptualization; writing – original draft; writing – review &amp; editing; project administration. <bold>Sayra M. Cristancho:</bold> conceptualization; writing – original draft; writing – review &amp; editing; resources. <bold>Renée E. Stalmeijer:</bold> conceptualization; writing – original draft; writing – review &amp; editing. <bold>Abigail W. Konopasky:</bold> conceptualization; writing – original draft; writing – review &amp; editing. <bold>Lara Varpio:</bold> conceptualization; writing – original draft; writing – review &amp; editing.</p> <hd id="AN0190573074-34">ACKNOWLEDGMENTS</hd> <p>None.</p> <hd id="AN0190573074-35">FUNDING INFORMATION</hd> <p>None.</p> <hd id="AN0190573074-36">DISCLAIMER</hd> <p>The opinions and assertions expressed herein are solely those of the authors and do not necessarily reflect the official policy or position of the United States Department of Veterans Affairs, Uniformed Services University of the Health Sciences, the United States Department of Defense, or the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.</p> <hd id="AN0190573074-37">ETHICS STATEMENT</hd> <p>Not applicable.</p> <ref id="AN0190573074-38"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Lai HL, Perng SJ, Huang CY. Nursing students' perceptions of a silent mentor program in an anatomy course. Anat Sci Educ. 2019 ; 12 (6): 627 – 635.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Shiozawa T, Glauben M, Banzhaf M, Griewatz J, Hirt B, Zipfel S, et al. An insight into professional identity formation: qualitative analyses of two reflection interventions during the dissection course. Anat Sci Educ. 2020 ; 13 (3): 320 – 332.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref3" type="bt">3</bibl> <bibtext> Byram JN, Nuland V, Sonya E, Harrell KM, Mussell JC, Cornwall J. 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Konopasky and Lara Varpio</p> <p>Reported by Author; Author; Author; Author; Author</p> <p></p> <p>Andrea M. Barker is adjunct assistant professor, Division of Physician Assistant Education and Sciences, University of Utah School of Medicine, Director, Center of Excellence in Musculoskeletal Care and Education, and Co‐Director, Advanced Fellowship in Health Professions Education Evaluation and Research, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah.</p> <p>Sayra M. Cristancho is an associate professor, Department of Surgery and Department of Anatomy and Cell Biology, Centre for Education Research &amp; Innovation (CERI), Schulich School of Medicine &amp; Dentistry.</p> <p>Renée E. Stalmeijer is an associate professor, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.</p> <p>Abigail W. Konopasky is an associate professor and Director of Medical Education Research and Scholarship, Department of Medical Education, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.</p> <p>Lara Varpio is a professor in the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and Co‐Director of Research in Medical Education at the Children's Hospital of Philadelphia.</p> </aug> <nolink nlid="nl1" bibid="bib11" firstref="ref12"></nolink> <nolink nlid="nl2" bibid="bib12" firstref="ref13"></nolink> <nolink nlid="nl3" bibid="bib14" firstref="ref14"></nolink> <nolink nlid="nl4" bibid="bib16" firstref="ref18"></nolink> <nolink nlid="nl5" bibid="bib17" firstref="ref22"></nolink> <nolink nlid="nl6" bibid="bib18" firstref="ref24"></nolink> <nolink nlid="nl7" bibid="bib20" firstref="ref25"></nolink> <nolink nlid="nl8" bibid="bib21" firstref="ref27"></nolink> <nolink nlid="nl9" bibid="bib22" firstref="ref28"></nolink> <nolink nlid="nl10" bibid="bib23" firstref="ref29"></nolink> <nolink nlid="nl11" bibid="bib24" firstref="ref30"></nolink> <nolink nlid="nl12" bibid="bib25" firstref="ref31"></nolink> <nolink nlid="nl13" bibid="bib26" firstref="ref32"></nolink> <nolink nlid="nl14" bibid="bib15" firstref="ref33"></nolink> <nolink nlid="nl15" bibid="bib27" firstref="ref39"></nolink> <nolink nlid="nl16" bibid="bib28" firstref="ref40"></nolink> <nolink nlid="nl17" bibid="bib13" firstref="ref42"></nolink> <nolink nlid="nl18" bibid="bib29" firstref="ref43"></nolink> <nolink nlid="nl19" bibid="bib31" firstref="ref44"></nolink> <nolink nlid="nl20" bibid="bib30" firstref="ref48"></nolink> <nolink nlid="nl21" bibid="bib35" firstref="ref59"></nolink> <nolink nlid="nl22" bibid="bib37" firstref="ref62"></nolink> <nolink nlid="nl23" bibid="bib36" firstref="ref63"></nolink> <nolink nlid="nl24" bibid="bib38" firstref="ref64"></nolink> <nolink nlid="nl25" bibid="bib39" firstref="ref65"></nolink> <nolink nlid="nl26" bibid="bib40" firstref="ref66"></nolink> <nolink nlid="nl27" bibid="bib41" firstref="ref67"></nolink> <nolink nlid="nl28" bibid="bib42" firstref="ref68"></nolink> <nolink nlid="nl29" bibid="bib43" firstref="ref69"></nolink> |
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| Items | – Name: Title Label: Title Group: Ti Data: A Picture's Worth a Thousand Words: Enhancing Qualitative Data Collection with Rich Pictures – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Andrea+M%2E+Barker%22">Andrea M. Barker</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-3619-9368">0000-0003-3619-9368</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sayra+M%2E+Cristancho%22">Sayra M. Cristancho</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-8738-2130">0000-0002-8738-2130</externalLink>)<br /><searchLink fieldCode="AR" term="%22Renée+E%2E+Stalmeijer%22">Renée E. Stalmeijer</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8690-5326">0000-0001-8690-5326</externalLink>)<br /><searchLink fieldCode="AR" term="%22Abigail+W%2E+Konopasky%22">Abigail W. Konopasky</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-3033-5552">0000-0002-3033-5552</externalLink>)<br /><searchLink fieldCode="AR" term="%22Lara+Varpio%22">Lara Varpio</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1412-4341">0000-0002-1412-4341</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Anatomical+Sciences+Education%22"><i>Anatomical Sciences Education</i></searchLink>. 2026 19(1):130-143. – Name: Avail Label: Availability Group: Avail Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 14 – Name: DatePubCY Label: Publication Date Group: Date Data: 2026 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Descriptive – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Qualitative+Research%22">Qualitative Research</searchLink><br /><searchLink fieldCode="DE" term="%22Research+Methodology%22">Research Methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Data+Collection%22">Data Collection</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+Aids%22">Visual Aids</searchLink><br /><searchLink fieldCode="DE" term="%22Anatomy%22">Anatomy</searchLink><br /><searchLink fieldCode="DE" term="%22Allied+Health+Occupations+Education%22">Allied Health Occupations Education</searchLink><br /><searchLink fieldCode="DE" term="%22Freehand+Drawing%22">Freehand Drawing</searchLink><br /><searchLink fieldCode="DE" term="%22Science+Education%22">Science Education</searchLink><br /><searchLink fieldCode="DE" term="%22Reflection%22">Reflection</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1002/ase.70033 – Name: ISSN Label: ISSN Group: ISSN Data: 1935-9772<br />1935-9780 – Name: Abstract Label: Abstract Group: Ab Data: The use of qualitative research methods is growing among scholars interested in exploring and understanding the distinct context of anatomy education. While verbal and text-based methods like interviews and focus groups are frequently used for data collection, anatomy education scholars may benefit from including visual methods such as photovoice or diagramming in their data collection toolbox. Often used in conjunction with oral, language-based qualitative methods, visual methods aid researchers in exploring phenomena which may be difficult for participants to express. "Rich pictures" are a type of visual method which has gained popularity in the health professions education literature. Generated through asking participants to draw a detailed representation of a particular situation, rich pictures can afford researchers deeper insight into participants' perspectives and experiences while exploring complex phenomena within the context of teaching and learning. This article provides a four-part description of rich pictures to support the application of this visual method within qualitative anatomical sciences education research by: (1) describing the background and offering an overview of this method, (2) explaining how to use rich pictures as an "elicitation tool" during interviews to stimulate participants' reflections and responses, (3) offering two analysis strategies for interpreting the visual content created through rich pictures (i.e., "visual grammar" for systematically analyzing the features of a participant's drawing, and "gallery walks" for engaging research teams in collaborative analysis of the collection of all study participants' drawings), and (4) providing reflections on the use of rich pictures in anatomic science education's qualitative studies. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2026 – Name: AN Label: Accession Number Group: ID Data: EJ1493209 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1002/ase.70033 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 14 StartPage: 130 Subjects: – SubjectFull: Qualitative Research Type: general – SubjectFull: Research Methodology Type: general – SubjectFull: Data Collection Type: general – SubjectFull: Visual Aids Type: general – SubjectFull: Anatomy Type: general – SubjectFull: Allied Health Occupations Education Type: general – SubjectFull: Freehand Drawing Type: general – SubjectFull: Science Education Type: general – SubjectFull: Reflection Type: general Titles: – TitleFull: A Picture's Worth a Thousand Words: Enhancing Qualitative Data Collection with Rich Pictures Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Andrea M. Barker – PersonEntity: Name: NameFull: Sayra M. Cristancho – PersonEntity: Name: NameFull: Renée E. Stalmeijer – PersonEntity: Name: NameFull: Abigail W. Konopasky – PersonEntity: Name: NameFull: Lara Varpio IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 1935-9772 – Type: issn-electronic Value: 1935-9780 Numbering: – Type: volume Value: 19 – Type: issue Value: 1 Titles: – TitleFull: Anatomical Sciences Education Type: main |
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