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By the time I'm done with Painter it looks like this.
I forgot to mention, while I'm using the pencil and brush tools, I keep my thumb on the 'apple' and 'option' keys.
'apple' gives you the layer select tool with which you can click on something in the image to make its layer active.
(make sure you have 'Auto Layer select' checked in the toolbar)
'option' give you the eyedropper tool.

When I'm ready, I save it as a photoshop file.