Reflective Writing as Professional and Personal Development

Dean A. Seehusen, MD, MPH, FAAFPProgram DirectorNCC – Family Medicine Residencydean.a.seehusen.mil@health.mil

Objectives• Describe the benefits of reflective writing

for medical professionals and educators• List the 2 most important features of

reflective writing• List the 3 key tasks of the reflective writer• Name at least 5 venues for publishing

reflective writing• Generate ideas for potential reflective

writings

Agenda

• Introductions• Define reflective writing• Identify features of reflective writing• Identify key tasks of reflective writer• Discuss publishing

***Interspersed audience tasks***

Introduction

• Who is in the audience?

Introduction

• Who is in the audience?• Who am I?

Introduction

• Who is in the audience?• Who am I?• Why did I begin publishing?

Introduction

• Who is in the audience?• Who am I?• Why did I begin publishing?• Why do I continue to publish?

Reflective Writing

• A practice in which the writer describes a real or imagined scene, event, interaction, passing thought, memory, form, adding a personal reflection on the meaning of the item or incident, thought, feeling, emotion, or situation in his or her life.

“But I don’t see patients”• You will still have professional topics

that inspire passion for you and others

• Your work– Impacts you personally– Impacts patients– Impacts the scientific literature– Has the ability to stimulate reflection

Professional Benefits

• Validating professional identity• Develop critical thinking skills• Challenge assumptions• Connection with peers• Potential for publication• Develop insight into profession• Improve patient care skills

Shapiro J. Fam Med 2012;44:309-11

Personal Benefits

• Catharsis• Acknowledge emotions• Self-assessment• Self-understanding• Values clarification• Prevent cynicism and disillusionment• Offsetting burnout

Shapiro J. Fam Med 2012;44:309-11

Getting Started

An audience participation event

Who is YOUR Audience?

• Yourself– Memoir– Personal satisfaction– Therapy

• Small group of colleagues– Department– Military only– Professional society

• Publication

Who is YOUR Audience?

• Yourself– Memoir– Personal satisfaction– Therapy

• Small group of colleagues– Department– Military only– Professional society

• Publication

Audience Task #1

• List 3-5 events or episodes from your professional life that elicit significant emotion from you (could be a concept)

• They may also have some significant overlap with your personal or social life, but should connect to your professional life in some way

• You will NOT be coerced into sharing anything you do not wish to

Two Indispensible Features• A story that is:

– Heart wrenching, fascinating, tear jerking, hilarious, one-of-a-kind, mesmerizing, paradoxical, awe-inspiring

• A concept that is:– Fundamental to your profession,

frequently forgotten, controversial, heretical, dogmatic, in need of revision, outdated, timeless

Sara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die. It started with a cough and pain in her back. Then a chest X-ray showed her left lung had collapsed, and her chest was filled with fluid.

-Letting Go

Atul Gawande in The New Yorker

This is the point in Sara’s story that poses a fundamental question for everyone livingIn the era of modern medicine: What do wewant Sara and her doctors to do now? Or, to put it another way, if you were the one who had metastatic cancer – or, for that matter, a similarly advanced case of emphysema or congestive heart failure – what would you want your doctors to do?

-Letting Go

Atul Gawande in The New Yorker

Three Tasks

• Tell the story exceptionally well• Lucidly describe the concept• Convincingly relate the story to the

concept

You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s okay” or “I’m sorry” or “I love you.”

-Letting Go

Atul Gawande in The New Yorker

“Her father and her sister still thought that she might rally. But when the others had stepped out of the room, Rich knelt down weeping beside Sara and whispered in her ear. “It’s okay to let go,” he said. “You don’t have to fight anymore. I will see you soon.”

-Letting Go

Atul Gawande in The New Yorker

Audience Task #2

• Pick 1-2 of the events or episodes from the list you developed before

• If you are having a hard time picking, pick the ones that elicit the most emotion in you

• List the major emotions these elicit in you and why

Two Broad Categories

• Confirmatory– Reaffirm beliefs– Validating professional and personal

values

• Transformative– Challenge norms– Altering world view

Shapiro J. Fam Med 2012;44:309-11

Confirmatory

• These reflective writings leave you feeling re-energized and thankful

• Show the value of your work• Remind you why you do what you do• Make you proud of what you do

Transformative

• These reflective writings make you re-assess about what you believe to be true

• Special circumstances that led to you act in a way you normally would not have

• Expose an additional way of looking at a problem

• An experience that will alter the way you think or act in the future

Possible Structures

• Two course meal• Sandwich• Layer cake

The Two Course Meal

Story Concept

StoryConcept

OR

The Sandwich

Story ConceptStoryConcep

tOR

Story Concept

The Layer Cake

OR

StoryConcep

tStory

Concept

Concept

ConceptStory

ConceptStory

Story

Audience Task #3

• Narrow your list down to just one • If you are having trouble, pick one that

you think other professionals:– would relate to– could learn from– might be emotionally stirred by

• Take 5 minutes to write the story in an outline fashion or as a single paragraph

Places to Publish• Top Tier

– JAMA: “A Piece of My Mind”– Annals of Internal Medicine: “On Being a Doctor”– BMJ: “Fillers”

• Other– Family Medicine: “Narrative Essays”– Medical Encounter: “Narratives & Health”– Pulse: http://www.pulsemagazine.org– Letters to the Editor

Obligations to Others

• How does the story reflect on others?– Colleagues– Family– Patients

• Confidentiality• Consider requesting permission

Shapiro J. Fam Med 2012;44:309-11

Reflection and Education

• Excellent way for learners to process the new experiences they are having

• May actually lead to increased resiliency

• Proposed as a method for teaching empathy

• For residents, addresses ICS and PBLI• Impact on professionalism?

Wald HS, Reis SP. J Gen Intern Med. 2010;25(7):746-9.

Audience Task #4• Write a paragraph about what message you

think this event/episode/concept reveals.• Potential questions to ask yourself:

– What could other professionals learn from this? – What larger truth about your profession does it

reveal? – What does it say about human nature? – What weakness of downside of your profession

does it expose?

A Personal Example

• “Going Home” published in November 2008

• Email from medical student who had read the essay and felt the same way

• Letter to the Editor published in April 2009

University of Wisconsin MS3I would just like to take the time to thankyou for writing your essay “Going Home”…. Ican’t convey how much I appreciate youressay…I have a copy that I keep in my whitecoat on the wards as a reminder to followthe “milk prices” as it is a great proxy for howthe farmers of north central Wisconsin aredoing in such a tenuous time…

Outcomes of “Going Home”• Personal catharsis• Publication in the peer-reviewed

literature• Personal impact on a medical learner• Publication for that learner• Suggests a possible scholarly

question that is amenable to research through relatively simple methods

Bibliography• Shapiro J. Narrative Medicine and Narrative Writing. Fam Med.

2012;44:309-11.• Bolton G. Reflective Practice: Writing and Professional

Development. London: Paul Chapman Publishers; 2001.• Roy R. Teaching cultural sensitivity through literature and

reflective writing. Virtual Mentor. 2007;9(8):543-546.• Shapiro J, Kasman D, Shafer A. Words and wards: a model of

reflective writing and its uses in medical education. J Med Humanit. 2006;227:231-244.

• Wald HS, Reis SP. Beyond the margins: reflective writing and development of reflective capacity in medical education. J Gen Intern Med. 2010;25(7):746-9.

• Charon R, Hermann N. A sense of story, or why teach reflective writing? Acad Med 2012;87(1):5-7.

Questions?Comments?