Dean A Seehusen MD MPH FAAFP Program Director NCC Family Medicine Residency d eanaseehusenmilhealthmil Objectives Describe the benefits of reflective writing for medical professionals and educators ID: 701393
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Reflective Writing as Professional and Personal Development
Dean A. Seehusen, MD, MPH, FAAFP
Program Director
NCC – Family Medicine
Residency
d
ean.a.seehusen.mil@health.milSlide2
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 writingsSlide3
Agenda
Introductions
Define reflective writing
Identify features of reflective writing
Identify key tasks of reflective writer
Discuss publishing
***Interspersed audience tasks***Slide4
Introduction
Who is in the audience?Slide5
Introduction
Who is in the audience?
Who am I?Slide6
Introduction
Who is in the audience?
Who am I?
Why did I begin publishing?Slide7
Introduction
Who is in the audience?
Who am I?
Why did I begin publishing?
Why do I continue to publish?Slide8
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. Slide9
“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 reflectionSlide10
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;44:309-11Slide11
Personal Benefits
Catharsis
Acknowledge emotions
Self-assessment
Self-understanding
Values clarification
Prevent cynicism and disillusionment
Offsetting burnout
Shapiro J.
Fam
Med 2012;44:309-11Slide12
Getting Started
An audience participation eventSlide13
Who is YOUR Audience?
Yourself
Memoir
Personal satisfaction
Therapy
Small group of colleagues
Department
Military only
Professional society
PublicationSlide14
Who is YOUR Audience?
Yourself
Memoir
Personal satisfaction
Therapy
Small group of colleagues
Department
Military only
Professional society
PublicationSlide15
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 toSlide16
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, timelessSlide17
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 YorkerSlide18
This is the point in Sara’s story that poses a fundamental question for everyone living
In the era of modern medicine: What do we
want 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 YorkerSlide19
Three Tasks
Tell the story exceptionally well
Lucidly describe the concept
Convincingly relate the story to the conceptSlide20
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 YorkerSlide21
“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 YorkerSlide22
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 whySlide23
Two Broad Categories
Confirmatory
Reaffirm beliefs
Validating professional and personal values
Transformative
Challenge norms
Altering world view
Shapiro J.
Fam
Med 2012;44:309-11Slide24
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 doSlide25
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 futureSlide26
Possible Structures
Two course meal
Sandwich
Layer cakeSlide27
The Two Course Meal
Story
Concept
Story
Concept
ORSlide28
The Sandwich
Story
Concept
Story
Concept
OR
Story
ConceptSlide29
The Layer Cake
OR
Story
Concept
Story
Concept
Concept
Concept
Story
Concept
Story
StorySlide30
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 paragraphSlide31
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 EditorSlide32
Obligations to Others
How does the story reflect on others?
Colleagues
Family
Patients
Confidentiality
Consider requesting permission
Shapiro J.
Fam
Med 2012;44:309-11Slide33
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. Slide34
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?Slide35
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 2009Slide36
University of Wisconsin MS3
I would just like to take the time to thank
you for writing your essay “Going Home”…. I
can’t convey how much I appreciate your
essay…I have a copy that I keep in my white
coat on the wards as a reminder to follow
the “milk prices” as it is a great proxy for how
the farmers of north central Wisconsin are
doing in such a tenuous time…Slide37Slide38
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 methodsSlide39
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. Slide40
Questions?
Comments?