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Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education

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Abstract

Personal, creative writing as a process for reflection on patient care and socialization into medicine (“reflective writing”) has important potential uses in educating medical students and residents. Based on the authors’ experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient’s voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one’s writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others’ writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being – are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality.

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Notes

  1. Association of American Medical Colleges. “Contemporary Issues in Medicine, Medical Informatics, and Population Health: Report II of the Medical School Objectives Project,” 130–141.

  2. Swick, “Toward a Normative Definition of Medical Professionalism,” 612–616.

  3. Poirier, Ahrens and Brauner, “Songs of Innocence and Experience: Students’ Poems about Their Medical Education,” 473–478.

  4. Charon, “The Patient-Physician Relationship: Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust,” 1897–1898.

  5. Henderson, “Medical Student Elegies: The Poetics of Caring,” 128–129.

  6. DasGupta and Charon, “Personal Illness Narratives: Using Reflective Writing to Teach Empathy,” 351–356.

  7. Pellegrino, “To Look Feelingly: The Affinities of Medicine and Literature,” 19–23.

  8. Branch et al., “Becoming a Doctor: Critical-Incident Reports from Third-Year Medical Students,” 1130–1132.

  9. Henderson, 120–121.

  10. Reifler, “Poor Yorick: Reflections on Gross Anatomy,” 327–332

  11. Spatz and Welch, “Literature and Medicine as a Writing Course,” 141–150.

  12. Goldberg, Wild Mind: Living the Writer’s Life, 31–33.

  13. Lu, “Why It Was Hard For Me to Learn Compassion As a Third Year Medical Student,” 457–458.

  14. Kaiser, “Fixing Identity by Denying Uniqueness: An Analysis of Professional Identity in Medicine,” 95–105.

  15. Stein, “Ways of Knowing in Medicine: Seeing and Beyond,” 29–36.

  16. Campo, The Healing Art: A Doctor’s Black Bag of Poetry, 25.

  17. Smith and Stein, “A Topographical Model of Clinical Decision Making and Interviewing,” 361–363.

  18. Epstein, “Mindful Practice,” 833–839.

  19. Frank. The Wounded Storyteller: Body, Illness, and Ethics.

  20. Frankford et al. “Transforming Practice Organizations to Foster Lifelong Learning and Commitment to Medical Professionalism,” 708–717.

  21. Shapiro and Talbot. “Applying the Concept of the Reflective Practitioner to Understanding and Teaching Family Medicine,” 450–456.

  22. Novack et al., “Calibrating the Physician: Physician Personal Awareness and Effective Patient Care,” 502–509.

  23. Branch et al., “Small-Group Teaching Emphasizing Reflection Can Positively Influence Medical Students’ Values,” 1171–1172.

  24. Fins et al., “Reflective Practice and Palliative Care Education: A Clerkship Responds to the Informal and Hidden Curricula,” 307–312.

  25. Baernstein et al., “Promoting Reflection on Professionalism: A Comparison Trial of Educational Interventions for Medical Students,” 742–747.

  26. Swenson and Rothstein, “Navigating the Wards: Teaching Medical Students to Use Their Moral Compasses,” 591–594.

  27. King and Stanford, “Patient Stories, Doctor Stories, and True Stories: A Cautionary Reading,” 185–199.

  28. Berman, Diaries to an English Professor: Pain and Growth in the Classroom, 1–2, 29, 31–33.

  29. Markel, “Medicine and the Arts,” 48.

  30. Hatem and Ferrara, “Becoming a Doctor: Fostering Humane Caregivers through Creative Writing,” 13–22.

  31. Coulehan and Williams, “Vanquishing Virtue: The Impact of Medical Education,” 598–605.

  32. Anderson, “Forty Acres of Cotton Waiting to be Picked: Medical Students, Storytelling, and the Rhetoric of Healing,” 280–297.

  33. Good and DelVecchio-Good, “‘Fiction’ and ‘Historicity’ in Doctors’ Stories: Social and Narrative Dimensions of Learning Medicine,” 50–69.

  34. Charon, “Narrative & Medicine,” 862.

  35. Charon, “Patient-Physician Relationship,” 1897–1899.

  36. Charon, “Narrative & Medicine,” 862–863.

  37. Garro and Mattingly, “Narrative Turns,” 264–266.

  38. Mattingly, “Emergent Narratives,” 183–188.

  39. Gianakos D. “Empathy Revisited,” 135–136.

  40. Markakis et al. “The Path to Professionalism: Cultivating Humanistic Values and Attitudes in Residency Training,” 141–150.

  41. Lu, 457.

  42. Prislin et al, “Assessing the Acquisition of Core Clinical Skills Through the Use of Serial Standardized Patient Assessments,” 480–483.

  43. Wipf et al, “Turning Interns into Senior Residents: Preparing Residents for Their Teaching and Leadership Roles,” 591.

  44. Testerman et al, “The Natural History of Cynicism in Physicians,” 843–845.

  45. Rucker and Shapiro, “Becoming a Physician: Students’ Creative Projects in a Third-Year IM Clerkship,” 391–397.

  46. Squier, “Teaching Humanities in the Undergraduate Medical Curriculum. In Narrative Based Medicine: Dialogue and Discourse in Clinical Practice, 128–139.

  47. King and Stanford, “Patient Stories, Doctor Stories, and True Stories: A Cautionary Reading,” 185–199.

  48. Hardwig, “Autobiography, Biography, and Narrative Ethics,” 50–64.

  49. Garro and Mattingly, 266–7.

  50. Mattingly, 187.

  51. Shafer and Fish. “A Call for Narrative: The Patient’s Story and Anesthesia Training,” 124–42.

  52. Charon. “Reading, Writing… ,” 286–87.

  53. Warnock. “Language and Literature as Equipment for Living: Revision as a Life Skill,” 34–57.

  54. Shearer and Toedt, “Family Physicians’ Observations of Their Practice, Well Being and Health Care in the United States,” 751–756.

  55. Park and Adler, “Coping Style as a Predictor of Health and Well-Being Across the First Year of Medical School,” 627–631.

  56. Riley, “Understanding the Stresses and Strains of Being a Doctor,” 350–353.

  57. Weisberg and Duffin, “Evoking the Moral Imagination: Using Stories to Teach Ethics and Professionalism to Nursing, Medical and Law Students,” 247–263.

  58. Coulehan. “Tenderness and Steadiness: Emotions in Medical Practice,” Literature and Medicine 14 (1995): 222–236.

  59. Esterling et al, “Empirical Foundations for Writing in Prevention and Psychotherapy: Mental and Physical Outcomes,”92–94.

  60. Pennebaker, “Telling Stories: The Health Benefits of Narrative,” 1243.

  61. Smyth et al, ``Effects of Writing about Stressful Experiences on Symptom Reduction in Patients with Asthma or Rheumatoid Arthritis,'' 1304–1309.

  62. Pennebaker, 1245.

  63. Epstein, “Uninvited Guests in the Doctor-Patient Relationship” Psychiatry Grand Rounds.

  64. Payne, “A Strange Unaccountable Something: Historicizing Sexual Abuse Essays,” 115–157.

  65. Gordon. “Stress During Internship: A Prospective Study of Mood States,” 228–231.

  66. Christakis and Feudtner, “Temporary Matters. The Ethical Consequences of Transient Social Relationships in Medical Training,” 739–743.

  67. Matarosso, “No Appealing Solution: Evaluating the Outcomes of Arts and Health Initiatives,” In Medical Humanities, 36–49.

  68. Shapiro et al, “Point-of-View Writing: A Method for Increasing Medical Students’ Empathy, Identification and Expression of Emotion, and Insight,” in press.

  69. Downie, “Medical Humanities: Means, Ends, and Evaluation,” 204–222.

  70. Hunter et al, “The Study of Literature in Medical Education,” 787–794.

References

  • C. M. Anderson, “Forty Acres of Cotton Waiting to be Picked: Medical Students, Storytelling, and the Rhetoric of Healing.” Literature and Medicine, 17 (1998): 280–297.

    Google Scholar 

  • Association of American Medical Colleges, “Contemporary Issues in Medicine, Medical Informatics, and Population Health: Report II of the Medical School Objectives Project.” Academic Medicine, 74 (1999): 130–141.

  • A. Baernstein, and K. Fryer-Edwards, “Promoting Reflection on Professionalism: A Comparison Trial of Educational Interventions for Medical Students.” Academic Medicine, 78 (2003): 742–747.

    Article  PubMed  Google Scholar 

  • J. Berman, Diaries to an English Professor: Pain and Growth in the Classroom (Amherst, MA: University of Massachusetts Press, 1994), 1–41.

  • W. Branch, R. J. Pels, R. S. Lawrence, and R. Arky, “Becoming a Doctor: Critical-Incident Reports from Third-Year Medical Students.” New England Journal of Medicine, 329 (1993): 1130–1132.

    Article  CAS  PubMed  Google Scholar 

  • W. T. Branch, L. Pololi, R. M. Frankel, J. L. Coulehan, and P. C. Williams, “Small-Group Teaching Emphasizing Reflection Can Positively Influence Medical Students’ Values.” Academic Medicine, 76 (2001): 1171–1172.

    Article  PubMed  Google Scholar 

  • R. Campo, The Healing Art: A Doctor’s Black Bag of Poetry (New York: W.W. Norton, 2003), 7–40.

  • R. Charon, “Reading, Writing, and Doctoring: Literature and Medicine.” American Journal of Medical Science, 319 (2000): 285–291.

    Article  CAS  Google Scholar 

  • R. Charon, “The Patient-Physician Relationship: Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust.” Journal of the American Medical Association, 286 (2001):1897–1902.

    Article  CAS  PubMed  Google Scholar 

  • R. Charon, “Narrative and Medicine.” New England Journal of Medicine, 350 (2004): 862–864.

    Article  CAS  PubMed  Google Scholar 

  • D. A. Christakis, and C. Feudtner, “Temporary Matters. The Ethical Consequences of Transient Social Relationships in Medical Training.” Journal of the American Medical Association, 278 (1997), 739–743.

    Article  CAS  PubMed  Google Scholar 

  • J. L. Coulehan, “Tenderness and Steadiness: Emotions in Medical Practice.” Literature and Medicine, 14 (1995): 222–236.

    CAS  PubMed  Google Scholar 

  • J. L. Coulehan, and P. C. Williams, “Vanquishing Virtue: The Impact of Medical Education.” Academic Medicine, 76 (2001): 598–605.

    CAS  PubMed  Google Scholar 

  • S. DasGupta, and R. Charon, “Personal Illness Narratives: Using Reflective Writing to Teach Empathy.” Academic Medicine, 79 (2004): 351–356.

    Article  PubMed  Google Scholar 

  • R. Downie, “Medical Humanities: Means, Ends, and Evaluation.” In Medical Humanities, eds. Evans, M and IG Finlay (London: BMJ Books, 2001), 204–222.

  • R. M. Epstein, “Mindful Practice.” Journal of the American Medical Association, 282 (1999): 833–839.

  • R. M. Epstein, “Uninvited Guests in the Doctor-Patient Relationship.” Psychiatry Grand Rounds, University of Washington, Feb 1, 2001.

  • B. A. Esterling, L. L’Abate, E. J. Murray, and J. W. Pennebaker, “Empirical Foundations for Writing in Prevention and Psychotherapy: Mental and Physical Outcomes.” Clinical Psychology Review, 19 (1999): 79–96.

    Article  CAS  PubMed  Google Scholar 

  • J. J. Fins, B. J. Gentilesco, A. Carver, P. Lister, C. A. Acres, R. Payne, and C. Storey-Johnson, “Reflective Practice and Palliative Care Education: A Clerkship Responds to the Informal and Hidden Curricula.” Academic Medicine, 87 (2003): 307–312.

    Article  Google Scholar 

  • A. W. Frank, The Wounded Storyteller: Body, Illness, and Ethics (Chicago: University of Chicago Press, 1995).

    Google Scholar 

  • D. M. Frankford, M. A. Patterson and T. R. Konrad, “Transforming Practice Organizations to Foster Lifelong Learning and Commitment to Medical Professionalism.” Academic Medicine, 75 (2000): 708–717.

    Article  CAS  PubMed  Google Scholar 

  • L. C. Garro, and C. Mattingly, “Narrative Turns.” In Narrative and the Cultural Construction of Illness and Healing, eds. C Mattingly and LC Garro (Berkeley: University of California Press, 2000), 259–269.

  • D. Gianakos, “Empathy Revisited.” Archives of Internal Medicine, 156 (1996):135–136.

    Article  CAS  PubMed  Google Scholar 

  • N. Goldberg, Wild Mind: Living the Writer’s Life (New York: Bantam Books, 1990), 1–42.

    Google Scholar 

  • B. J. Good, and M. J. DelVecchio-Good, “‘Fiction’ and ‘Historicity’ in Doctors’ Stories: Social and Narrative Dimensions of Learning Medicine.” In Narrative and the Cultural Construction of Illness and Healing, eds. C Mattingly and LC Garro (Berkeley, CA: University of California Press, 2000), 50–69.

  • G. H. Gordon, F. A. Hubbell, F. A. Wyle, and R. A. Charter, “Stress During Internship: A Prospective Study of Mood States.” Journal of General Internal Medicine, 1 (1986): 228–231.

    CAS  PubMed  Google Scholar 

  • J. Hardwig, “Autobiography, Biography, and Narrative Ethics.” In Stories and Their Limits: Narrative Approaches to Bioethics, ed. HL Nelson (New York: Routledge, 1997), 50–64.

  • D. Hatem, and E. Ferrara, “Becoming a Doctor: Fostering Humane Caregivers Through Creative Writing.” Patient Education and Counseling, 45 (2001): 13–22.

    Article  CAS  PubMed  Google Scholar 

  • S. W. Henderson, “Medical Student Elegies: The Poetics of Caring.” Journal of Medical Humanities, 23 (2002): 119–132.

    Article  Google Scholar 

  • Accreditation Council for Graduate Medical Education http://www.acgme.org/outcome/comp/compMin.asp (accessed 12/1/05)

  • K. M. Hunter, R. Charon, and J. L. Coulehan, “The Study of Literature in Medical Education.” Academic Medicine, 70 (1995): 787–794.

    Article  CAS  PubMed  Google Scholar 

  • R. Kaiser, “Fixing Identity by Denying Uniqueness: An Analysis of Professional Identity in Medicine.” Journal of Medical Humanities, 23 (2002): 95–105.

    Article  Google Scholar 

  • N. M. P. King, and A. F. Stanford, “Patient Stories, Doctor Stories, and True Stories: A Cautionary Reading.” Literature and Medicine, 2 (1992): 185–199.

    Google Scholar 

  • M. C. Lu, “Why It Was Hard For Me to Learn Compassion As a Third Year Medical Student.” Cambridge Quarterly of Healthcare Ethics, 4 (1995): 454–458.

    Article  CAS  PubMed  Google Scholar 

  • K. M. Markakis, H. B. Beckman, A. L. Suchman, and R. M. Frankel, “The Path to Professionalism: Cultivating Humanistic Values and Attitudes in Residency Training.” Academic Medicine, 75 (2000): 141–150.

    Article  CAS  PubMed  Google Scholar 

  • H. Markel, “Medicine and The Arts.” Academic Medicine, 76 (2001): 48

    Article  CAS  PubMed  Google Scholar 

  • F. Matarosso, “No Appealing Solution: Evaluating the Outcomes of Arts and Health Initiatives.” In Medical Humanities, eds. M. Evans and I. G. Finlay (London: BMJ Books, 2001), 36–49.

  • C. Mattingly “Emergent Narratives.” In Narrative and the Cultural Construction of Illness and Healing, eds. C. Mattingly and L. C. Garro (Berkeley: University of California Press, 2000), 181–211.

  • D. H. Novack, A. L. Suchman, W. Clark, R. M. Epstein, E. Najberg, and C. Kaplan, “Calibrating the Physician: Physician Personal Awareness and Effective Patient Care.” Journal of the American Medical Association, 278 (1997): 502–509

    Article  CAS  PubMed  Google Scholar 

  • C. L. Park, and N. E. Adler, “Coping Style as a Predictor of Health and Well-Being Across the First Year of Medical School.” Health Psychologist, 22 (2003): 627–631.

    Article  Google Scholar 

  • M. Payne, “A Strange Unaccountable Something: Historicizing Sexual Abuse Essays.” In Writing and Healing: Toward an Informed Practice, eds. C. M. Anderson and M. M. MacCurdy (Urbana, Ill: National Council of Teachers of English, 2000), 115–157.

  • E. Pellegrino, “To Look Feelingly: The Affinities of Medicine and Literature.” Literature and Medicine, 1 (1992): 19–23.

    Google Scholar 

  • J. W. Pennebaker, “Telling Stories: The Health Benefits of Narrative.” Journal of Clinical Psychology, 55 (1999): 1243–1254.

    Article  CAS  PubMed  Google Scholar 

  • S. Poirier, W. R. Ahrens, and D. J. Brauner, “Songs of Innocence and Experience: Students’ Poems About Their Medical Education.” Academic Medicine, 73 (1998): 473–478.

    Article  CAS  PubMed  Google Scholar 

  • M. D. Prislin, M. Giglio, E. M. Lewis, S. Ahearn and S. Radecki, “Assessing the Acquisition of Core Clinical Skills Through the Use of Serial Standardized Patient Assessments.” Academic Medicine, 75 (2000): 480–483.

    Article  CAS  PubMed  Google Scholar 

  • D. R. Reifler, “Poor Yorick: Reflections on Gross Anatomy.” In Teaching Literature and Medicine, eds. A. H. Hawkins and M. C. McEntyre (New York: The Modern Language Association, 2000), 327–332.

  • G. J. Riley, “Understanding the Stresses and Strains of Being a Doctor.” Medical Journal of Australia, 181 (2004): 350–353.

    PubMed  Google Scholar 

  • L. Rucker, and J. Shapiro, “Becoming a Physician: Students’ Creative Projects in a Third-Year IM Clerkship.” Academic Medicine, 78 (2003): 391–397.

    Article  PubMed  Google Scholar 

  • A. Shafer, and M. P. Fish, “A Call for Narrative: The Patient’s Story and Anesthesia Training.” Literature and Medicine, 13 (1994):124–142.

    CAS  PubMed  Google Scholar 

  • J. Shapiro, and Y. Talbot, “Applying the Concept of the Reflective Practitioner to Understanding and Teaching Family Medicine.” Family Medicine, 23 (1991): 450–456.

    CAS  PubMed  Google Scholar 

  • J. Shapiro, L. Rucker, J. Boker, and D. Lie, “Point-of-View Writing: A Method for Increasing Medical Students’ Empathy, Identification and Expression of Emotion, and Insight.” Education for Health 19(2006): 96–105.

    Google Scholar 

  • S. Shearer and M. Toedt, “Family Physicians’ Observations of Their Practice, Well Being and Health Care in the United States.” Journal of Family Practice, 50 (2001), 751–756.

    CAS  PubMed  Google Scholar 

  • R. Smith, and H. F. Stein, “A Topographical Model of Clinical Decision Making and Interviewing,”Family Medicine, 19(1987): 361–363.

    Google Scholar 

  • J. M. Smyth, A. A. Stone, A. Hurewitz, and A. Kaell, “Effects of Writing about Stressful Experiences on Symptom Reduction in Patients with Asthma or Rheumatoid Arthritis.” Journal of the American Medical Association, 281 (1999): 1304–1309.

    Article  CAS  PubMed  Google Scholar 

  • L. S. Spatz, and K. Welch, “Literature and Medicine as a Writing Course.” In Teaching Literature and Medicine, eds. AH Hawkins and MC McEntyre (New York: The Modern Language Association, 2000), 141–150.

  • H. Squier, “Teaching Humanities in the Undergraduate Medical Curriculum. In Narrative Based Medicine: Dialogue and Discourse in Clinical Practice, eds. T. Greenhalgh and B. Hurwitz (London: BMJ Books, 1998), 128–139.

  • H. F. Stein “Ways of Knowing in Medicine: Seeing and Beyond.” Families, Systems, & Health, 21 (2003): 29–36.

    Article  Google Scholar 

  • S. L. Swenson, and J. A. Rothstein, “Navigating the Wards: Teaching Medical Students to Use Their Moral Compasses.” Academic Medicine, 7 (1994): 591–594.

    Google Scholar 

  • H. M. Swick, “Toward a Normative Definition of Medical Professionalism.” Academic Medicine, 75 (2000): 612–616.

    Article  CAS  PubMed  Google Scholar 

  • J. K. Testerman, K. R. Morton, L. K. Loo, J. S. Worthley, and H. H. Lamberton, “The Natural History of Cynicism in Physicians.” Academic Medicine, 71 (1997): 843–845.

    Google Scholar 

  • T. Warnock, “Language and Literature as Equipment for Living: Revision as a Life Skill.” In Writing and Healing: Toward an Informed Practice, eds. CM Anderson and MM MacCurdy (Urbana, Ill: National Council of Teachers of English, 2000), 34–57.

  • M. Weisberg, and J. Duffin, “Evoking the Moral Imagination: Using Stories to Teach Ethics and Professionalism to Nursing, Medical and Law Students.” Journal of Medical Humanities, 16 (1995): 247–263.

    Article  PubMed  Google Scholar 

  • J. E. Wipf, L. E. Pinsky, and W. Burke, “Turning Interns into Senior Residents: Preparing Residents for Their Teaching and Leadership Roles.” Academic Medicine, 70 (1995), 591–596.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Family Medicine, University of California Irvine Medical Center, 101 City Drive South, Rte 81, Bldg 200, Suite 512, Orange, Irvine, California, 92868, USA

    Johanna Shapiro

  2. Georgetown University School of Medicine, Washington, DC, USA

    Deborah Kasman

  3. Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Stanford, CA, USA

    Audrey Shafer

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  1. Johanna Shapiro
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  2. Deborah Kasman
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  3. Audrey Shafer
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Correspondence to Johanna Shapiro.

Additional information

This work was supported in part by HRSA Predoctoral Training in Primary Care Grant #HP 000224–02 (Elizabeth Morrison, M.D. MS.Ed., Principal Investigator); and by the UCI Department of Family Medicine.

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Shapiro, J., Kasman, D. & Shafer, A. Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education. J Med Humanit 27, 231–244 (2006). https://doi.org/10.1007/s10912-006-9020-y

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