Reflecting on Experience: Developing a Creative Writing Practice in Medical School - PowerPoint Presentation

1. Reflecting on Experience: Developing a Creative Writing Practice in Medical SchoolNolan Pearson, BA/BM, MMUniversity of Michigan Medical SchoolNolan PearsonUniversity of Michigan Medical Schoolnrpearso@med.umich.eduContactRotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214–2236. doi:10.1001/jama.2016.17324Rilke, Rainer Maria. “Turning Point.” The Selected Poetry of Rainer Maria Rilke (New York: Vintage International, 1989), Trans. Stephen Mitchell, 132-135. McAdams, Dan. “Identity and the Life Story”. Autobiographical Memory and the Construction of a Narrative Self: Developmental and Cultural Perspectives. Ed. Robyn Fivush and Catherine A. Haden. (Mahwah: Lawrence Erlbaum Associates, 2003), p. 187-202. Mary Jo Kreitzer & Maryanna Klatt (2017) Educational innovations to foster resilience in the health professions, Medical Teacher, 39:2, 153-159, doi:10.1080/0142159X.2016.1248917ReferencesIn light of the recent focus on physician burnout and high rates of depression and anxiety among medical students, there are necessary efforts to find means of bolstering resilience.1 As medical trainees, it is important to find outlets for expressing and reflecting upon our joys and sorrows and to explore activities that foster empathy. In this project, a broadly-focused creative writing practice was developed that culminated in the production of both fiction and non-fiction works. Habits for incorporating these new skills were ingrained with the larger goal of building a sustainable and lifelong reflective writing practice during a medical career. AbstractA poem was accepted for publication by Pulse – voices from the heart of medicine. A short story remains in progress. A collection of clinical reflections was written for future personal reference. A medical journalism piece on meditation and mindfulness curricula in medical school was submitted for publication. A regular writing practice was established. Sample haikus (unpublished): Sample patient reflections (with modified identifiers): 1) Mr. Wang is eighty-nine years old, and he is angry. Unrelentingly angry. The clinic room is warm and crowded with him in a wheelchair, his middle-aged daughter, a Cantonese interpreter, Dr. Huff and me. Mr. Wang immigrated to San Francisco in the 1950s, and though he had no more than an eighth-grade education in China and never picked up fluent English, he had supported his family well with decades of work in the textile industry. Today he has no English, and little Cantonese either. However, he maintains a steady patter of loud syllables, rising to a full-blown yell at times as he points accusatorily at whomever is speaking. When Dr. Huff attempts a physical exam, he violently swats her arm away. He is not the only one who is angry today. His daughter Pam has read “DNAR” on an external chart, and she assures us that this is absolutely not their wish. We confirm that our documentation aligns with his goals of care, and that we will make special annotation that the outside note is incorrect. Making eye contact with Mr. Wang, he glares at me and shows his canine teeth. He jabs in the air in my direction and hollers. His eyes are furious, and I wonder what he sees and what he means to say. Mr. Wang has late-onset Alzheimer’s Disease.IntroductionFiction: Within the Humanities Pathway of Excellence, a month-long creative writing elective that focused on reflecting on dementia and memory loss was built with the help of advisors in the Neurology and Psychiatry Departments. The goal at outset was to produce a short story for dissemination. Two months of clinical cognitive neurology electives at Michigan Medicine and UCSF were completed, while keeping a weekly-updated reflection journal.Background reading included a creative writing manual, a syllabus of short stories and short story anthologies, and essays on themes of coping with dementia: personal narratives, caregiver responses, family dynamics, and provider experiences. During the elective month, the draft of an original short story was written.In response to an interview with a community member living with dementia at the Turner Senior Resource Center’s Silver Club, a long-form poem was written and shared in a public reading.Several additional poems (long form and haiku) were written based on my medical student experiences and prior experiences working as caregiver to a patient with Alzheimer Disease. Nonfiction: A 10-day silent meditation retreat served as inspiration for an investigative piece on the evidence for the risks and benefits of insight-based meditation on psychological well-being and the inclusion of mindfulness and meditation in wellness curricula.A collection of clinical reflections on dementia patients seen in clinic throughout this experience was written and shared with advisors for feedback.ApproachComing to medical school with a professional music background, I have an ingrained and practical respect for the work and commitment that underlies artistic achievement. Because of that, I tried to approach a project of developing basic creative writing skills from square one as a medical student with modest expectations. Despite that outlook, in the process of trying to lay the foundations of a new artistic outlet in synchrony with a new career path, I often struggled with feelings of inadequacy and incompetency as a writer. Necessary adjustments included resetting goals and exploring various writing styles to find a best fit. Though the outcomes of my project are humble, the steps I have taken embolden me to continue with this effort in residency and beyond. I would encourage other medical students to bolster their confidence and resilience, to more deeply understand their patients’ experiences, and perhaps to increase their empathy, by exploring a new creative modality. With realistic expectations and supportive advisors, embracing the role of being a “fish out of water” is congruent with the larger experience of being a medical student, and this is perhaps a uniquely appropriate time to find and develop new talents.Reflection Work of the eyes is done, now go and do heart-work on all the images imprisoned within you; for you overpowered them: but even now you don’t know them.2Philosopher and education reformer John Dewey is often attributed (though perhaps erroneously) with the aphorism that we learn not by experience but by reflecting on that experience. As medical trainees, we are exposed to a steady stream of emotionally charged experiences with scant time to process and learn from them. We can perhaps look for guidance to a long tradition of physician-writers -- Anton Chekhov, William Carlos Williams, Abraham Verghese, Oliver Sacks, Perri Klass -- that utilized fiction and non-fiction as means of making sense of this profession and the human condition. Social psychologist Dan McAdams advocates a “life-story theory of identity” in which the conscious and selective appropriation of our life experiences is imaginatively manipulated and construed by the individual in order to make sense of his or her life, and that building upon this natural process with intentionality may be linked to improved mental health.3 By extension, there is mutually therapeutic value in examining the narratives of our patients to construct meaning in a focused manner.Curricular innovators in medical education have suggested that incorporating creative writing may help preempt burnout.4 As part of a longitudinal and flexibly organized creative writing project, planned experiences, patient interviews, and clinical encountersResultsObstacles and ModificationsThe initial project was to produce a short story acceptable for dissemination, but it became clear that this was an overly ambitious first step as novice writer, and that my writing style was perhaps better suited for nonfiction. Modifications to my project included regular discussion with my advisor with goal-setting adjustments toward smaller, realizable steps: short poems, journal responses, and selecting an alternate current issues topic to research and on which to write a nonfiction medical student perspective.hushed blanketof rusty foliagein the trauma bay-aphasia-Grandma chuckles:“what’s-his-name.”2) Despite a slight stoop and shuffle in her gait, Marcia is vital and laughs easily. At fifty-seven, there is ample gray in the thick and unruly hair that sometimes falls into her face. She tremulously sweeps it aside. Her expression is open, but as our chat goes along, her eyes become agitated as she searches for words and for focus. She and John, her husband, are the type of couple who look more and more alike the longer they have been together: twenty years. They are overweight but fit, dressed in shorts, colorful oversized t-shirts, and sturdy hiking sandals. Though she has great trouble finishing her sentences, her words occasionally flow effortlessly while they reminisce about favorite travel experiences: Turkey, Vietnam, Iceland, Mexico. Last winter before she became ill, she and Mike made it to the UK for the first time. That will have been their last major trip. During our naming test, she simply does not know what a “hammock” is. Those are trees, but the thing in the middle? “I don’t know!” John is incredulous: what a funny story they have about a hammock. The first time they went camping, Marcia set theirs up and plopped down for a rest, but was immediately ejected out onto the ground and had the breath knocked out of her. She laughs at his retelling of the story, but still has no concept of the object itself. The neurological exam takes a lot out of her too, and the mood in the room darkens. Everything is difficult, and Marcia becomes tearful as her frustration builds. She startles to Dr. Geschwind’s touch. She cannot follow complex instructions. She cannot demonstrate how she might saw a piece of wood. Her convivial personality resurfaces when asked to pretend she is throwing a ball. Glimpses of an erstwhile class-clown peek through her confusion: she rolls her eyes and lobs an imaginary softball with an aggressively awkward motion. She laughs. Never would it have been any less awkward, she has never been anything close to an athlete! John finishes the majority of her thoughts during this research visit. “We have had one brain as long as we’ve been together,” he says. “I’m just carrying more of the weight now”. Marcia has sporadic Creutzfeldt-Jakob disease.were followed up with reflective writing in multiple formats. I aimed to develop creative writing skills and habits as a medical student that I might carry forward in my future practice as physician.