Becoming a doctor: fostering humane caregivers through creative writing

Abstract

We qualitatively examined themes covered in a creative writing elective designed to enhance pre-clinical medical students’ writing, observation, and reflection skills relative to experiences in their medical education. Qualitative analysis of writings’ themes was carried out via iterative consensus building process and validated through member checks and literature review. Fourteen students completed the elective, seven for each year it was given. Students submitted 86 written pieces. Qualitative analysis demonstrated the presence of nine themes: students’ role confusion, developing a professional identity, medicine as a calling, physician privilege and power, humanizing the teacher, the limits of medicine, death and dying, anticipating future challenges, and identification with the patient. Students evaluated this creative writing course favorably, indicating value in writing and reflection. Themes covered are of concern to second-year medical students as well as other trainees and practicing physicians. Writing may aid in the professional development of physicians.

Introduction

Reflection is a critical part of professional training [1]. It is intimately connected with self-awareness, and together they help physicians and physicians in training to examine beliefs and values, deal with strong emotions, and resolve interpersonal conflict [2], [3], [4]. Schon distinguishes between reflection in action, fine tuning an act in the middle of performing it as a function of thinking about what you are doing, and reflection on action, thinking about an act or event at a time separate from that event [1]. Often, the most vexing problems require reflection on action. While training which incorporates reflection and self-awareness takes place in some medical schools and residency programs [5], [6], [7], [8], [9], [10], this is not a uniform part of curricula. One outcome of reflection can be enhanced self-awareness, which is felt by many to be critical to a physician’s work [3].

One method to encourage reflection is through the writing and sharing of narratives or critical incidents [11], [12], [13]. Narrative probes the depths of medical experience [14], allows for greater understanding of our patients [15], our work, and ourselves [16]. In addition, writing narratives has demonstrated positive health and behavioral effects in such varied groups as prisoners, distressed crime victims, first time mothers, men who have been laid off from their jobs, arthritis and chronic pain sufferers, and medical students [17].

If patient care is enhanced by eliciting and understanding the patient’s perspective [16], [18], we postulated that setting aside time to reflect on students’ early patient encounters from multiple perspectives (the patient’s, the student’s, and the doctor’s) would make students’ future patient care more humane. In a parallel fashion, by having faculty set aside time to listen to the students’ perspectives, we hoped to make their educational experience more humane, thus creating a program that strives to live up to the ideals it advocates. This contrasts with the concept of the “hidden curriculum” in which researchers have identified a discordance between principles that are taught and principles that are practiced [19].

In order to enhance students’ opportunities for reflection, we established an elective for second-year medical students entitled “Creative Writing for Medical Students.” It gave students the chance to write about and discuss significant experiences related to their medical education as they were going through these experiences. We report the elective’s outcomes based on the first 2 years of students’ writing. Our aim in analyzing the students’ writing was to understand the challenges and unique issues faced by second-year medical students in the process of their professional development as prospective physicians.