“You will have changed profoundly”: a letter writing exercise for 4th Year medical students
Keywords:
Medical Education, Narrative Medicine, Identity Transformation, Medical Humanities, Reflective WritingAbstract
Introduction: Reflective writing, an exercise where students respond to a prompt in writing and then read their writing aloud in class, is a core component of Narrative Medicine. Student writings often reveal truths about their own experiences moving through medical education, including the identity transformation they experience. Method: The purpose of this study was to ask fourth-year medical students (N=15) enrolled in Narrative Medicine elective courses at two large U.S. Midwestern medical schools to reflect on their medical school experience. The students were asked to write a letter in response to the following prompt: “if you could tell your 1st day of medical school self anything, what would it be?” Results: Through thematic analysis, the authors identified three major themes in these letters, including student reflections of medical school as a journey, identity transformation and identity management within medical school, and the value of important relationships and the role they play in the medical student experience. Discussion: We conclude the paper with a discussion on what we can learn from these student letters, calling for more attention to the vulnerability of students as they progress through medical school and more research on the kinds of transformation students experience. Medical students can be vulnerable, and the system that has been created for them to develop into empathetic, skilled physicians often contributes to that vulnerability. Therefore, institutions should not only allow students to reflect and give voice to their experience, but also encourage a reimagining of certain aspects of medical education.
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Cohen MJ, Kay A, Youakim JM, Balaicuis JM. Identity transformation in medical students. Am J Psychoanal. 2009;69(1):43-52. doi:10.1057/ajp.2008.38.
Benbassat J. Undesirable features of the medical learning environment: a narrative review of the literature. Adv Health Sci Educ Theory Pract. 2013;18(3):527-36. doi:10.1007/s10459-012-9389-5.
Goldie J. The formation of professional identity in medical students: considerations for educators. Med Teach. 2012;34(9):e641-e648. doi:10.3109/0142159X.2012.687476.
Sharpless J, Baldwin N, Cook R, Kofman A, Morley-Fletcher A, Slotkin R, Wald HS. The becoming: students' reflections on the process of professional identity formation in medical education. Acad Med. 2015;90(6):713-7. doi:10.1097/ACM.0000000000000729.
Broadhead RS. Individuation in facework: theoretical implications from a study of facework in medical school admissions. Symb Interact. 1980;3(2):51-68.
Charon R. Narrative Medicine: Honoring the Stories of Illness. New York, NY: Oxford University Press; 2006.
DasGupta S. Narrative humility. Lancet. 2008;371(9617):980-1. doi:10.1016/s0140-6736(08)60440-7.
Cunningham H, Taylor D, Desai UA, Quiah SC, Kaplan B, Fei L, Catallozzi M, Richards B, Balmer DF, Charon R.. Looking back to move forward: first-year medical students' meta-reflections on their narrative portfolio writings. Acad Med. 2018;93(6):888-94. doi:10.1097/ACM.0000000000002102.
Wear D, Zarconi J, Garden R, Jones T. Reflection in/and writing: pedagogy and practice in medical education. Acad Med. 2012;87(5):603-9.
Song P, Stewart R. Reflective writing in medical education. Med Teach. 2012;34(11):955-6. doi: 10.3109/0142159X.2012.716552.
Cunningham H, Taylor DS, Desai UA, Ender KL, Glickstein J, Krishnan US, Richards BF, Charon R, Balmer DF. Reading the self: medical students’ experience of reflecting on their writing over time. Acad Med. 2021;96(8):1168-74. doi: 10.1097/ACM.0000000000003814.
Hermann N. Creativity: What, Why, and Where? In: The Principles and Practice of Narrative Medicine. Charon R, DasGupta S, Hermann N, Irvine C, Marcus ER, Colón ER, Spencer D, Spiegel M (eds). New York, NY: Oxford University Press; 2017: 211-232.
Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract. 2009;14(4):595-621. doi:10.1007/s10459-007-9090-2.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.
Cooper H, Camic M, Long DL, Panter AT, Rindskopf D, Sher KJ. Thematic analysis. The Handbook of Research Methods in Psychology. Washington, DC: American Psychological Association; 2012: 57-71.
Butler-Kisber L. Qualitative inquiry: Thematic, narrative and arts-informed perspectives. Thousand Oaks, CA: Sage; 2010.
Cherry K, Smith DH. Sometimes I cry: the experience of loneliness for men with AIDS. Health Commun. 1993;5:181-208.
Fisher WR. Narration as a human communication paradigm: the case of public moral argument. Commun Monogr. 1984;51:1-20.
Campbell BH, Treat R, Johnson B, Derse AR. Creating reflective space for reflective and "unreflective" medical students: exploring seminal moments in a large-group writing session. Acad Med. 2020;95(6):882-7. doi:10.1097/ACM.0000000000003241.
Wald HS, Anthony D, Hutchinson TA, Liben S, Smilovitch M, Donato AA. Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice. Acad Med. 2015;90(6):753-60.
Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613-22. doi:10.4065/80.12.1613.
Stewart SM, Betson C, Lam TH, Marshall IB, Lee PW, Wong CM. Predicting stress in first year medical students: a longitudinal study. Med Educ. 1997;31(3):163-8. doi:10.1111/j.1365-2923.1997.tb02560.x.
Stewart SM, Lam TH, Betson CL, Wong CM, Wong AM. A prospective analysis of stress and academic performance in the first two years of medical school. Med Educ. 1999;33(4):243-50. doi:10.1046/j.1365-2923.1999.00294.x.
Tyssen R, Vaglum P, Grønvold NT, Ekeberg O. Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study. Med Educ. 2001;35(2):110-20. doi:10.1046/j.1365-2923.2001.00770.x.
Park Cl, Adler NE. Coping style as a predictor of health and well-being across the first year of medical school. Health Psychol. 2003;22:627-31.
Branch W, Pels RJ, Lawrence RS, Arky R. Becoming a doctor. Critical-incident reports from third-year medical students. N Engl J Med. 1993;329(15):1130-32.
Pololi L, Frankel RM. Small-group teaching emphasizing reflection can positively influence medical students' values. Acad Med. 2001;76(12):1172-3.
Misra-Hebert AD, Isaacson JH, Kohn M, Hull AL, Hojat M, Papp KK, Calabrese L. Improving empathy of physicians through guided reflective writing. Int J Med Educ. 2012;3:71–7.
Chen PJ, Huang CD, Yeh SJ. Impact of a narrative medicine programme on healthcare providers' empathy scores over time. BMC Med Educ. 2017;17(1):108. doi:10.1186/s12909-017-0952-x.
Woloschuk W, Harasym PH, Temple W. Attitude change during medical school: a cohort study. Med Educ. 2004;38(5):522-34.
Milota MM, van Thiel GJMW, van Delden JJM. Narrative medicine as a medical education tool: A systematic review. Med Teach. 2019;41(7):802-10.
Wald HS, McFarland J, Markovina I. Medical humanities in medical education and practice. Med Teach. 2019;41(5):492-6.
Dyrbye LN, Thomas MR, Eacker A, Harper W, Massie FS Jr, Power DV, Huschka M, Novotny PJ, Sloan JA, Shanafelt TD. Race, ethnicity, and medical student well-being in the United States. Arch Intern Med. 2007;167(19):2103–2109.
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