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Students Telling Stories

Gaining insights and empathy through reflective writing.

Reflective writing is honest writing that puts you in touch with a part of you that doesn’t get revealed in conversation,” says Paul Gross, M.D., an assistant professor of family and social medicine at Einstein, an attending physician in family medicine at Montefiore and a driving force behind reflective writing at Einstein. “It stimulates you to think about important questions, such as ‘How are we treating our patients and each other?’ and ‘How do we make sure we’re doing what we set out to do when we entered the field of medicine?’”

Writing can serve to inoculate against burnout, cynicism, impatience and arrogance, and help students have compassion for their patients and themselves.”

Starting with orientation, medical students do reflective writing throughout their Einstein careers. It’s part of the first- and second-year Introduction to Clinical Medicine course and the third-year Patients, Doctors and Communities (PDC) course, and is offered as an elective to fourth-year students.

In addition to leading an orientation workshop in reflective writing, Dr. Gross is a PDC small-group leader at Einstein and also the editor of Pulse: Voices from the Heart of Medicine
(pulsevoices.org), an online literary journal that publishes writing by healthcare professionals, students and patients. He also teaches reflective writing to family and social medicine residents at Montefiore. Depending upon the setting, writing topics may be suggested by a curriculum or by Dr. Gross, but students often choose to write about events that particularly moved them. Dr. Gross encourages them to read their stories aloud to one another; their responses are overwhelmingly supportive.

“Reflective writing is not about writing well or creating perfect sentences,” he says. “The aim is to get students in touch with their truest feelings and make sense of their experiences by putting them on paper.”

The third year may be the most crucial time for reflective writing. “Evidence indicates that as students go through medical school, they become more impatient and less empathetic, and have higher rates of depression,” notes Dr. Gross. “Those problems seem to peak during the third year, when students embark on their clerkships and are exposed to people who are sick and dying. Writing can serve to inoculate against burnout, cynicism, impatience and arrogance, and help students have compassion for their patients and themselves.”
Third-year student Paul Wojack was skeptical at first about the possible benefits. “My perspective changed when I began working with patients daily and often found myself in emotionally charged situations,” he says. “Writing about those experiences and sharing experiences is cathartic—I get to release emotions and realize I’m not alone, because I know from my classmates’ writing that we’re all having difficult patient encounters.”

Over the past decade, reflective writing has become increasingly common in medical education. Studies indicate that it’s more than just a warm and fuzzy addition. A systematic review of reflection as a learning tool published in the Journal of Graduate Medical Education found that reflective writing “has a positive impact on empathy, increases comfort with learning in complex situations and enhances engagement in the learning process.”

Sarah Stumbar, M.D., M.P.H., a family physician and 2015 graduate of Montefiore’s residency program in social medicine, studied reflective writing with Dr. Gross and continues to write. “Often, it will take me a few months during which I am thinking about a certain patient interaction,” says Dr. Stumbar, now an assistant professor of family medicine in the department of humanities, health and society at the Herbert Wertheim College of Medicine at Florida International University in Miami. “Writing helps me figure out how my patients’ stories are woven into my own story—of medicine, of humanity, of growing up.”

Reflective Writing Essays by Third-Year Med Students

My first patient was a vibrant man in his forties who loves his job, his wife, and his family. He also has a nonresectable brain tumor, probably a glioblastoma. My attending asked me to join the conversation where we would tell the patient the test results, and I’ll never forget his face when we told him what we now knew. But what really broke my heart was when he cried as he mourned the loss of time to do all that he had planned to do.”

One night during my surgery rotation, the team was called to the emergency room to examine a patient with an infected, necrotic toe. It was clear that his diabetes was uncontrolled; his left leg and two of his right toes had already been amputated. But the patient’s perception was very different. He said his case was minor and that his A1C level was tightly controlled. When we asked about his amputations, he said they were the result of malpractice. In response to questions about his necrotic toe he insisted the bone poking through the decaying flesh was just his toenail. I couldn’t understand this mindset. If he believed his toe wasn’t a problem, why did he come to the ER? What could I do to help him realize that he needed to control his diabetes? How could I show him that we were only trying to help? I felt powerless to help someone who clearly needed help, both surgically and psychologically.”

6:15 A.M. on my last shift on the labor and delivery floor. I’d been at the hospital two weeks, scrubbed into eight C-sections, but still hadn’t delivered a baby. My shift ended in an hour, and I was certain another night would pass without a delivery. But then the fetal monitoring screen showed one mother-to-be contracting strongly and often so we readied her room for delivery. I’d met her the night before—32 years old with a history of substance abuse and 10 to 20 documented suicide attempts. By 7:15 A.M. we’d delivered a healthy baby girl. That moment was beautiful. Two days later, the mother tried to leave the hospital without the baby and was stopped by security. I imagine it was just another sad moment in her life, and I wish her the best trying to overcome her demons.”

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