Journal of Medical Humanities

, Volume 27, Issue 4, pp 231–244 | Cite as

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

Original Paper

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.

Keywords

Writing Creative writing Professionalism Medical education Reflective practice 

References

  1. 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
  2. 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.Google Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. J. Berman, Diaries to an English Professor: Pain and Growth in the Classroom (Amherst, MA: University of Massachusetts Press, 1994), 1–41.Google Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. R. Campo, The Healing Art: A Doctor’s Black Bag of Poetry (New York: W.W. Norton, 2003), 7–40.Google Scholar
  8. R. Charon, “Reading, Writing, and Doctoring: Literature and Medicine.” American Journal of Medical Science, 319 (2000): 285–291.CrossRefGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. R. Charon, “Narrative and Medicine.” New England Journal of Medicine, 350 (2004): 862–864.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. J. L. Coulehan, “Tenderness and Steadiness: Emotions in Medical Practice.” Literature and Medicine, 14 (1995): 222–236.PubMedGoogle Scholar
  13. J. L. Coulehan, and P. C. Williams, “Vanquishing Virtue: The Impact of Medical Education.” Academic Medicine, 76 (2001): 598–605.PubMedGoogle Scholar
  14. S. DasGupta, and R. Charon, “Personal Illness Narratives: Using Reflective Writing to Teach Empathy.” Academic Medicine, 79 (2004): 351–356.CrossRefPubMedGoogle Scholar
  15. R. Downie, “Medical Humanities: Means, Ends, and Evaluation.” In Medical Humanities, eds. Evans, M and IG Finlay (London: BMJ Books, 2001), 204–222.Google Scholar
  16. R. M. Epstein, “Mindful Practice.” Journal of the American Medical Association, 282 (1999): 833–839.Google Scholar
  17. R. M. Epstein, “Uninvited Guests in the Doctor-Patient Relationship.” Psychiatry Grand Rounds, University of Washington, Feb 1, 2001.Google Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. A. W. Frank, The Wounded Storyteller: Body, Illness, and Ethics (Chicago: University of Chicago Press, 1995).Google Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.Google Scholar
  23. D. Gianakos, “Empathy Revisited.” Archives of Internal Medicine, 156 (1996):135–136.CrossRefPubMedGoogle Scholar
  24. N. Goldberg, Wild Mind: Living the Writer’s Life (New York: Bantam Books, 1990), 1–42.Google Scholar
  25. 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.Google Scholar
  26. 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.PubMedGoogle Scholar
  27. 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.Google Scholar
  28. D. Hatem, and E. Ferrara, “Becoming a Doctor: Fostering Humane Caregivers Through Creative Writing.” Patient Education and Counseling, 45 (2001): 13–22.CrossRefPubMedGoogle Scholar
  29. S. W. Henderson, “Medical Student Elegies: The Poetics of Caring.” Journal of Medical Humanities, 23 (2002): 119–132.CrossRefGoogle Scholar
  30. Accreditation Council for Graduate Medical Education http://www.acgme.org/outcome/comp/compMin.asp (accessed 12/1/05)Google Scholar
  31. K. M. Hunter, R. Charon, and J. L. Coulehan, “The Study of Literature in Medical Education.” Academic Medicine, 70 (1995): 787–794.CrossRefPubMedGoogle Scholar
  32. R. Kaiser, “Fixing Identity by Denying Uniqueness: An Analysis of Professional Identity in Medicine.” Journal of Medical Humanities, 23 (2002): 95–105.CrossRefGoogle Scholar
  33. 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
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. H. Markel, “Medicine and The Arts.” Academic Medicine, 76 (2001): 48CrossRefPubMedGoogle Scholar
  37. 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.Google Scholar
  38. 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.Google Scholar
  39. 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): 502–509CrossRefPubMedGoogle Scholar
  40. 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.CrossRefGoogle Scholar
  41. 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.Google Scholar
  42. E. Pellegrino, “To Look Feelingly: The Affinities of Medicine and Literature.” Literature and Medicine, 1 (1992): 19–23.Google Scholar
  43. J. W. Pennebaker, “Telling Stories: The Health Benefits of Narrative.” Journal of Clinical Psychology, 55 (1999): 1243–1254.CrossRefPubMedGoogle Scholar
  44. 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.CrossRefPubMedGoogle Scholar
  45. 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.CrossRefPubMedGoogle Scholar
  46. 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.Google Scholar
  47. G. J. Riley, “Understanding the Stresses and Strains of Being a Doctor.” Medical Journal of Australia, 181 (2004): 350–353.PubMedGoogle Scholar
  48. L. Rucker, and J. Shapiro, “Becoming a Physician: Students’ Creative Projects in a Third-Year IM Clerkship.” Academic Medicine, 78 (2003): 391–397.CrossRefPubMedGoogle Scholar
  49. A. Shafer, and M. P. Fish, “A Call for Narrative: The Patient’s Story and Anesthesia Training.” Literature and Medicine, 13 (1994):124–142.PubMedGoogle Scholar
  50. J. Shapiro, and Y. Talbot, “Applying the Concept of the Reflective Practitioner to Understanding and Teaching Family Medicine.” Family Medicine, 23 (1991): 450–456.PubMedGoogle Scholar
  51. 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
  52. 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.PubMedGoogle Scholar
  53. R. Smith, and H. F. Stein, “A Topographical Model of Clinical Decision Making and Interviewing,”Family Medicine, 19(1987): 361–363.Google Scholar
  54. 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.CrossRefPubMedGoogle Scholar
  55. 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.Google Scholar
  56. 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.Google Scholar
  57. H. F. Stein “Ways of Knowing in Medicine: Seeing and Beyond.” Families, Systems, & Health, 21 (2003): 29–36.CrossRefGoogle Scholar
  58. 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
  59. H. M. Swick, “Toward a Normative Definition of Medical Professionalism.” Academic Medicine, 75 (2000): 612–616.CrossRefPubMedGoogle Scholar
  60. 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
  61. 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.Google Scholar
  62. 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.CrossRefPubMedGoogle Scholar
  63. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Johanna Shapiro
    • 1
  • Deborah Kasman
    • 2
  • Audrey Shafer
    • 3
  1. 1.Department of Family MedicineUniversity of California Irvine Medical CenterIrvineUSA
  2. 2.Georgetown University School of MedicineWashingtonUSA
  3. 3.Veterans Affairs Palo Alto Health Care System, Stanford University School of MedicineStanfordUSA

Personalised recommendations