можно рисовать напрямую, но нарисованное исчезает после обновления вида карты. Сам пробовал рисовать (точки, линии, полигоны). вот пример из справочника:
Private Sub UIToolControl1_MouseDown(ByVal button As Long, ByVal shift As Long, ByVal x As Long, ByVal y As Long)
Dim pMxDoc As IMxDocument
Dim pActiveView As IActiveView
Dim pScreenDisplay As IScreenDisplay
Dim pRubberPolygon As IRubberBand
Dim pFillSymbol As ISimpleFillSymbol
Dim pRgbColor As IRgbColor
Dim pPolygon As IPolygon
Set pMxDoc = Application.Document
Set pActiveView = pMxDoc.FocusMap
Set pScreenDisplay = pActiveView.ScreenDisplay
Set pRubberPolygon = New RubberPolygon
Set pFillSymbol = New SimpleFillSymbol
Set pRgbColor = New RgbColor
pRgbColor.Red = 255
pFillSymbol.Color = pRgbColor
Set pPolygon = pRubberPolygon.TrackNew(pScreenDisplay, pFillSymbol)
With pScreenDisplay
.StartDrawing pScreenDisplay.hdc, esriNoScreenCache
.SetSymbol pFillSymbol
.DrawPolygon pPolygon
.FinishDrawing
End With
End Sub